[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 496 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                 S. 496

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 2, 1999

  Mr. Reed (for himself and Mr. Wyden) 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. 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 enter into contracts for the 
establishment of consumer assistance programs designed to assist 
consumers of health insurance in understanding their rights, 
responsibilities and choices among health insurance products.
    (b) 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 solicit proposals 
        for, and enter into a contract with, an entity eligible under 
        section 3 to serve as the health insurance consumer office for 
        the State; and
            (2) the manner in which the State will ensure that advice 
        and assistance services for health insurance consumers are 
        coordinated through the office described in paragraph (1).
    (c) Amount of Grant.--
            (1) In general.--From amounts appropriated under section 5 
        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.

SEC. 3. ELIGIBILITY OF STATE ENTITIES.

    To be eligible to enter into a contract with a State and operate as 
the health insurance consumer office for the State under this Act, an 
entity shall--
            (1) be an independent, nonprofit entity with demonstrated 
        experience in serving the needs of health care consumers 
        (particularly low income and other consumers who are most in 
        need of consumer assistance);
            (2) prepare and submit to the State a proposal containing 
        such information as the State may require;
            (3) demonstrate that the entity has the technical, 
        organizational, and professional capacity to operate the health 
        insurance consumer office within the State;
            (4) 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; and
            (5) demonstrate that, using assistance provided by the 
        State, the entity has the capacity to provide assistance and 
        advice throughout the State to public and private health 
        insurance consumers regardless of the source of coverage.

SEC. 4. USE OF FUNDS.

    (a) By State.--A State shall use amounts received under a grant 
under this Act to enter into a contract described in section 2(a) to 
provide funds for the establishment and operation of a health insurance 
consumer office.
    (b) By Entity.--
            (1) In general.--An entity that enters into a contract with 
        a State under this Act shall use amounts received under the 
        contract to establish and operate a health insurance consumer 
        office.
            (2) Noncompliance.--If the State fails to enter into a 
        contract under subsection (a), the Secretary shall withhold 
        amounts to be provided to the State under this Act and use such 
        amounts to enter into the contract described in paragraph (1) 
for the State.
    (c) Activities of Office.--A health insurance consumer office 
established under this Act shall--
            (1) provide information to health insurance consumers 
        within the State relating to choice of health insurance 
        products and the rights and responsibilities of consumers and 
        insurers under such products;
            (2) operate toll-free telephone hotlines to respond to 
        requests for information, advice or assistance concerning 
        health insurance in a timely and efficient manner;
            (3) produce and disseminate educational materials 
        concerning health insurance consumer and patient rights;
            (4) provide assistance and representation (in nonlitigative 
        settings) to individuals who desire to appeal the denial, 
        termination, or reduction of health care services, or the 
        refusal to pay for such services, under a health insurance 
        plan;
            (5) make referrals to appropriate private and public 
        individuals or entities so that inquiries, problems, and 
        grievances with respect to health insurance can be handled 
        promptly and efficiently; and
            (6) collect data concerning inquiries, problems, and 
        grievances handled by the office and periodically disseminate a 
        compilation and analysis of such information to employers, 
        health plans, health insurers, regulatory agencies, and the 
        general public.
    (d) Availability of Services.--The office shall not discriminate in 
the provision of services 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 XVIII 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.
    (e) Subcontracts.--An office established under this section 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 met by the 
office.
    (f) Training.--
            (1) In general.--An office established under this section 
        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.--Not to exceed 7 percent of the amount 
        awarded to an entity under a contract under subsection (a) for 
        a fiscal year may be used for the provision of training under 
        this section.
    (g) Administrative Costs.--Not to exceed 1 percent of the amount of 
a block grant awarded to the State under subsection (a) for a fiscal 
year may be used for administrative expenses by the State.
    (h) Term.--A contract entered into under subsection (a) shall be 
for a term of 3 years.

SEC. 5. FUNDING.

    (a) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary in each fiscal year to carry 
out this Act.
    (b) Report of 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 this report is being prepared are sufficient to fully 
        fund this Act in such fiscal year; and
            (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.
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