[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2819 Introduced in Senate (IS)]







106th CONGRESS
  2d Session
                                S. 2819

 To provide for the establishment of an assistance program for health 
                          insurance consumers.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 29, 2000

Mr. Reed (for himself and Mr. Jeffords) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To provide for the establishment of an assistance program for health 
                          insurance consumers.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Care Consumer Assistance 
Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) People with health care insurance or coverage have many 
        more options with respect to coverage of, payment or payments 
        for, items, services or treatments. Also, their health plans, 
        coverages, rights, and providers are frequently being 
        reorganized, expanded, or limited.
            (2) All consumers need information and assistance to 
        understand their health insurance choices and to maximize their 
        access to needed health services. Many do not understand their 
        health care rights or how to exercise them, despite the current 
        efforts of both the public and private sectors.
            (3) Few people with health care coverage have independent 
        credible sources of information or assistance to guide their 
        decisionmaking or to help resolve problems.
            (4) It is important to maintain and strengthen a productive 
        working relationship between all consumers and their health 
        care professionals and health insurance providers.
            (5) Federally initiated health care consumer assistance and 
        information programs targeted to consumers of long-term care 
        and to medicare beneficiaries under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.) are effective, as are a 
        number of State and local consumer assistance initiatives.
            (6) The principles, policies, and practices of health care 
        providers for delivering safe, effective, and accessible health 
        care can be enriched by State-based collaborative, independent 
        education, problem resolution, and feedback programs. Health 
        care consumer assistance programs have proven their ability to 
        meet this challenge.
            (7) Health care consumers want and need reliable 
        information about their health care options that integrates 
        data and effective resolution strategies from the full range of 
        available resources. Health care consumer assistance programs 
        can provide that reliable, problem-solving information to help 
        in navigating the health care system.
            (8) Health care delivered to individuals and within 
        communities can be improved by collecting and examining 
        consumers' experiences, questions, and problems and the ways in 
        which their questions and problems are resolved. Health care 
        consumer assistance programs can educate and inform consumers 
        to be more effective, self-directed health care consumers.
            (9) Many states have created health care consumer 
        assistance programs. The Federal Government can assist the 
        States in developing and maintaining effective health care 
        consumer assistance programs.

SEC. 3. GRANTS.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this Act as the ``Secretary'') shall award grants to 
States to enable such States to establish and administer (including the 
administration of programs established by States prior to the enactment 
of this Act) consumer assistance programs designed to provide 
information, assistance, and referrals to consumers of health insurance 
products.
    (b) State Eligibility.--To be eligible to receive a grant under 
this section a State shall prepare and submit to the Secretary an 
application at such time, in such manner, and containing such 
information as the Secretary may require, including a State plan that 
describes--
            (1) the manner in which the State will establish, or 
        solicit proposals for, and enter into a contract with, an 
        entity eligible under subsection (d) to serve as the health 
        care consumer assistance office for the State;
            (2) the manner in which the State will ensure that the 
        health care consumer assistance office will assist health care 
        consumers in accessing needed care by educating and assisting 
        health insurance enrollees to be responsible and informed 
        consumers;
            (3) the manner in which the State will coordinate and 
        distinguish the services provided by the health care consumer 
        assistance office with the services provided by the long-term 
        care ombudsman authorized by the Older Americans Act of 1965 
        (42 U.S.C. 3001 et seq.), the State health insurance 
        information program authorized under section 4360 of the 
        Omnibus Budget Reconciliation Act of 1990 (42 U.S.C. 1395b-4), 
        the protection and advocacy program authorized under the 
        Protection and Advocacy for Mentally Ill Individuals Act of 
        1986 (42 U.S.C. 10801 et seq.), and any other programs that 
        provide information and assistance to health care consumers;
            (4) the manner in which the State will coordinate and 
        distinguish the health care consumer assistance office and its 
        services from enrollment services provided under the medicaid 
        and State children's health insurance programs under titles XIX 
        and XXI of the Social Security Act (42 U.S.C. 1396 et seq. and 
        1397aa et seq.), and medicare and medicaid health care fraud 
        and abuse activities including those authorized by Federal law 
        under title 11 of the Social Security Act (42 U.S.C. 1301 et 
        seq.);
            (5) the manner in which the State will provide services to 
        underserved and minority populations and populations residing 
        in rural areas;
            (6) the manner in which the State will establish and 
        implement procedures and protocols to ensure the 
        confidentiality of all information shared by consumers and 
        their health care providers, health plans, or insurers with the 
        office established under subsection (d)(1) and to ensure that 
        no such information is used, released or referred without the 
        express permission of the consumer, except to the extent that 
        the office collects or uses aggregate information as described 
        in section 4(c)(8);
            (7) the manner in which the State will provide for the 
        collection of non-Federal contributions for the operations of 
        the office in an amount that is not less than 30 percent of the 
        amount of Federal funds provided under this Act; and
            (8) the manner in which the State will ensure that funds 
        made available under this Act will be used to supplement, and 
        not supplant, any other Federal, State, or local funds expended 
        to provide services for programs described under this Act and 
        those described in paragraphs (3) and (4).
    (c) Amount of Grant.--
            (1) In general.--From amounts appropriated under section 4 
        for a fiscal year, the Secretary shall award a grant to a State 
        in an amount that bears the same ratio to such amounts as the 
        number of individuals within the State covered under a health 
        insurance plan (as determined by the Secretary) bears to the 
        total number of individuals covered under a health insurance 
        plan in all States (as determined by the Secretary). Any 
        amounts provided to a State under this section that are not 
        used by the State shall be remitted to the Secretary and 
        reallocated in accordance with this paragraph.
            (2) Minimum amount.--In no case shall the amount provided 
        to a State under a grant under this section for a fiscal year 
        be less than an amount equal to .5 percent of the amount 
        appropriated for such fiscal year under section 5.
    (d) Provision of Funds for Establishment of Office.--
            (1) In general.--From amounts provided under a grant under 
        this section, a State shall, directly or through a contract 
        with an independent, nonprofit entity with demonstrated 
        experience in serving the needs of health care consumers, 
        provide for the establishment and operation of a State health 
        care consumer assistance office.
            (2) Eligibility of entity.--To be eligible to enter into a 
        contract under paragraph (1), an entity shall demonstrate that 
        the entity has the technical, organizational, and professional 
        capacity to deliver the services described in section 4 
        throughout the State to all public and private health insurance 
        consumers.

SEC. 4. USE OF FUNDS.

    (a) By State.--
            (1) In general.--A State shall use amounts received under a 
        grant under this Act to establish and operate a health 
        insurance consumer assistance office as provided for in this 
        section and section 3(d).
            (2) Noncompliance.--If the State fails to enter into or 
        renew a contract for the operation of a State health insurance 
        consumer assistance office, the Secretary shall reallocate 
        amounts to be provided to the State under this Act.
    (b) By Entity.--An entity that enters into a contract with a State 
under section 3(d) shall use amounts received under the contract to 
establish and operate a health insurance consumer assistance office.
    (c) Activities of Office.--A health insurance consumer assistance 
office established under this Act shall--
            (1) operate a toll-free telephone hotline to respond to 
        requests for information and assistance with health care 
        problems and assist all health insurance consumers to navigate 
        the health care system;
            (2) acquire or produce and disseminate culturally and 
        language appropriate educational materials concerning health 
        insurance products available within the State, how best to 
        access health care, and the rights and responsibilities of the 
        health care consumer;
            (3) educate health care consumers about strategies that 
        such consumers can implement to promptly and efficiently 
        resolve inquiries, problems, and grievances related to health 
        insurance and access to health care;
            (4) refer health care consumers to appropriate private and 
        public entities so that inquiries, problems, and grievances 
        with respect to health insurance and access to health care can 
        be handled promptly and efficiently;
            (5) coordinate with health organizations in the State, 
        State health-insurance related agencies, and State 
        organizations responsible for administering the programs 
        described listed in paragraphs (3) and (4) of section 3(b) so 
        as to maximize the ability of consumers to resolve health care 
        questions and problems and achieve the best health care 
        outcomes;
            (6) conduct education and outreach within the State in 
        partnership with consumers, health plans, health care 
        providers, health care payers and governmental agencies with 
        health oversight responsibilities;
            (7) provide information to consumers about an internal, 
        external, or administrative grievance or appeals procedure (in 
        nonlitigative settings) to appeal the denial, termination, or 
        reduction of health care services, or the refusal to pay for 
        such services, under a health insurance plan; and
            (8) provide information to State agencies, employers, 
        health plans, insurers, and the general public concerning the 
        kinds of inquiries, problems, and grievances handled by the 
        office.
    (d) Confidentiality and Access to Information.--The health 
insurance consumer assistance office of a State shall establish and 
implement procedures and protocols to ensure the confidentiality of all 
information shared by consumers and their health care providers, health 
plans, or insurers with the office and to ensure that no such 
information is used, released, or referred to State agencies or outside 
entities without the expressed permission of the consumer, except to 
the extent that the office collects or uses aggregate information 
described in subsection (c)(8).
    (e) Availability of Services.--The health insurance consumer 
assistance office of a State shall not discriminate in the provision of 
information and referrals regardless of the source of the individual's 
health insurance coverage or prospective coverage, including 
individuals covered under employer-provided insurance, self-funded 
plans, the medicare or medicaid programs under title XVII or XIX of the 
Social Security Act (42 U.S.C. 1395 and 1396 et seq.), or under any 
other Federal or State health care program.
    (f) Designation of Responsibilities.--
            (1) Within existing state entity.--If the health insurance 
        consumer assistance office of a State is located within an 
        existing State regulatory agency or office of an elected State 
        official, the State shall ensure that--
                    (A) there is a separate delineation of the funding, 
                activities, and responsibilities of the office as 
                compared to the other funding, activities, and 
                responsibilities of the agency; and
                    (B) the office establishes and implements 
                procedures and protocols to ensure the confidentiality 
                of all information shared by consumers and their health 
                care providers, health plans, or insurers with the 
                office and to ensure that no information is transferred 
                or released to the State agency or office without the 
                expressed permission of the consumer.
            (2) Contract entity.--In the case of an entity that enters 
        into a contract with a State under section 3(d), the entity 
        shall provide assurances that the entity has no real or 
        perceived conflict of interest in providing advice and 
        assistance to consumers regarding health insurance and that the 
        entity is independent of health insurance plans, companies, 
        providers, payers, and regulators of care.
    (g) Subcontracts.--The health insurance consumer assistance office 
of a State may carry out activities and provide services through 
contracts entered into with 1 or more nonprofit entities so long as the 
office can demonstrate that all of the requirements of this Act are 
complied with by the office.
    (i) Training.--
            (1) In general.--The health insurance consumer assistance 
        office of a State shall ensure that personnel employed by the 
        office possess the skills, expertise, and information necessary 
        to provide the services described in subsection (c).
            (2) Contracts.--To meet the requirement of paragraph (1), 
        an office may enter into contracts with 1 or more nonprofit 
        entities for the training (both through technical and 
        educational assistance) of personnel and volunteers. To be 
        eligible to receive a contract under this paragraph, an entity 
        shall be independent of health insurance plans, companies, 
        providers, payers, and regulators of care.
            (3) Limitation.--An amount not to exceed 7 percent of the 
        amount awarded to an entity under a contract under section 3(d) 
        for a fiscal year may be used for the provision of training 
        under this section.
    (j) Administrative Costs.--An amount not to exceed 1 percent of the 
amount of a grant awarded to the State under this Act for a fiscal year 
may be used by the State for administrative expenses.
    (k) Term.--A contract entered into under this section shall be for 
a term of 3 years.

SEC. 5. FUNDING.

    There are authorized to be appropriated $100,000,000 to carry out 
this Act.

SEC. 6. REPORT OF THE SECRETARY.

    Not later than 1 year after the date of enactment of this Act, and 
annually thereafter, the Secretary shall prepare and submit to the 
appropriate committees of Congress a report that contains--
            (1) a determination by the Secretary of whether amounts 
        appropriated to carry out this Act for the fiscal year for 
        which the report is being prepared are sufficient to fully fund 
        this Act in such fiscal year;
            (2) with respect to a fiscal year for which the Secretary 
        determines under paragraph (1) that sufficient amounts are not 
        appropriated, the recommendations of the Secretary for fully 
        funding this Act through the use of additional funding sources; 
        and
            (3) information on States that have been awarded a grant 
        under this Act and a summary of the activities of such States 
        and the data that is produced.
                                 <all>