I 111th CONGRESS 1st Session H. R. 2668 IN THE HOUSE OF REPRESENTATIVES June 2, 2009 Mr. Murphy of Connecticut (for himself, Mr. Braley of Iowa, and Mr. Welch) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To provide for the offering of an American Trust Health Plan to provide choice in health insurance options so as to ensure quality, affordable health coverage for all Americans.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Choice in Health Options Insures Care for Everyone (CHOICE) Act of 2009. (b)

Table of contents

The table of contents of this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Establishment of American Trust Health Plan; administrative structure. Sec. 3. Finances. Sec. 4. Eligibility and enrollment. Sec. 5. Providers. Sec. 6. Benefits. Sec. 7. Premiums.

2.

Establishment of American Trust Health Plan; administrative structure

(a)

In general

There is established an American Trust Health Plan (in this Act referred to as the American Trust Health Plan or the Plan) or to provide for the offering to eligible individuals of health benefits coverage throughout the United States, including its territories. (b)

Compliance with requirements

(1)

In general

The American Trust Health Plan shall comply with all requirements that are applicable with respect to other health benefits plans to be offered through a National Health Insurance Exchange (as defined in subsection (e)), including (as specified in this Act) minimum benefit and cost-sharing requirements and premium rating requirements. (2)

Exemption from State insurance regulations

As a Federal health program, the American Trust Health Plan is not required to comply with the insurance regulations of the States to the extent health benefits plans offered through the National Health Insurance Exchange are exempt from such regulations. (3)

Satisfaction of individual mandate requirement

An individual’s enrollment with the Plan shall be treated as satisfying any requirement under Federal law for the individual to demonstrate enrollment in health insurance or benefits coverage. (c)

Plan Administration

(1)

Administrator

The American Trust Health Plan shall be administered by an Office of American Trust Health Administration (in this Act referred to as the Office) within the Department of Health and Human Services. The Office shall be headed by an Administrator (in this Act referred to as the Administrator) who shall be appointed by the President, by and with the advice and consent of the Senate. (2)

Compensation

The Administrator shall be entitled to compensation at the level II of the Executive Schedule (under section 5313 of title 5, United States Code). (3)

Limitation

The Administrator and the Office shall not participate in the administration of any regulation regarding the health insurance market or in the administration of the National Health Insurance Exchange. (4)

General authority

The Administrator shall have the same general authorities with respect to personnel and operations of the Office as the heads of other agencies and departments of the Federal Government have with respect to such agencies and departments. (d)

Advisory Board

(1)

In general

The Administrator shall be advised by an Advisory Board (in this Act referred to as the Advisory Board) composed of 7 individuals appointed by the President. The President shall nominate individuals to serve on the Advisory Board in a manner that provides for inclusion on the Board of individuals who— (A)represent the interests of patients or consumers; (B)represent the interests health care providers, at least one of whom is a physician; and (C)are experts in health care quality measurements and reporting. (2)

Duties

The Advisory Board shall advise the Administrator regarding the operation of the American Trust Health Plan and the Administrator shall consult with the Advisory Board not less often than quarterly and before making any annual changes in benefits under Plan. (3)

Terms, compensation, chair, meetings, etc

The provisions of paragraphs (2)(D), (3), (4), (5), and (6) of section 1805(c) of the Social Security Act (42 U.S.C. 1395b–6(c)) shall apply with respect to the Advisory Board and the President under this section in the same manner as such provisions apply to the Medicare Payment Advisory Commission and the Comptroller General, respectively, under section 1805 of such Act. (4)

Financing

Within the budget established for the operation of the Plan, the Administrator shall provide for payment for the costs of operation of the Advisory Board. (e)

National Health Insurance Exchange defined

In this Act, the term National Health Insurance Exchange means a mechanism established or recognized under Federal law for coordinating the offering of health benefits coverage to individuals in the United States (and includes such a mechanism that may be operated at a State or regional level) through the establishment of standards for benefits and cost-sharing and for premiums for such health benefits coverage.

3.

Finances

(a)

Self-financing

The American Trust Health Plan shall be financially self-sustaining insofar as funds to operate the Plan, including costs of benefits, administration, and marketing, shall be derived from premiums for individuals enrolled under the Plan. The Plan is eligible to accept subsidies, including subsidies for the enrollment of such individuals, in the same manner and to the same extent as other health benefits plans offered through a National Health Insurance Exchange are eligible to accept subsidies. (b)

Contingency reserve

The Administrator shall establish and fund a contingency reserve for the Plan in a form similar to that of a contingency reserve for health benefits plans under the Federal Employees Health Benefits Program under chapter 89 of title 5, United States Code.

4.

Eligibility and enrollment

(a)

Eligibility

(1)

In general

Any individual who is made eligible to purchase coverage with a health benefits plan through the National Health Insurance Exchange is eligible to enroll with the American Health Trust Plan. (2)

Employer enrollment

To the extent provided by the National Health Insurance Exchange with respect to health benefits coverage offered through the Exchange, employers are eligible to purchase coverage for, and enroll their employees and dependents with, the Plan. (b)

Annual open enrollment period

The Administrator shall determine a yearly period of open enrollment for eligible individuals of not less than four consecutive weeks. Such a period shall be consistent with any similar annual open enrollment period established by the National Health Insurance Exchange for health benefits plans offered through the Exchange. (c)

Notices of significant changes

(1)

In general

No significant change shall be made under the Plan except with public notice and on an annual basis and consistent with rules established by the National Health Insurance Exchange for health benefits coverage offered through the Exchange. (2)

Significant change defined

In this subsection, the term significant change includes any change in benefits, copayments, deductibles, or premiums.

5.

Providers

(a)

Access to medicare provider network

(1)

In general

Except as provided in paragraph (2), any health care provider that is eligible for and accepts reimbursement for services under the Medicare program under title XVIII of the Social Security Act (in this section referred to as the Medicare) shall, as a condition of continuing to participate under such program, also participate under the American Health Trust Plan. (2)

Exception

Paragraph (1) shall not be construed as requiring a provider to accept new patients due to bona fide capacity limitations of the provider. (b)

Reimbursement levels

(1)

In general

The Administrator shall provide for payment to health care providers for covered services at rates not less, on average and in the aggregate nationally, than 105 percent of the payment rates recognized for such services (or substantially similar services) under Medicare. In the case of those services which are covered under the Plan but are not covered under Medicare, the Administrator shall seek to apply payment rates and methodologies similar to those described in the previous sentence. (2)

Adjustment

The Administrator, in determining the competitiveness of the Plan within different markets and compared to other health benefits plans offered through the National Health Insurance Exchange, may increase the payment rates for health care providers above the rate otherwise provided under paragraph (1). (3)

GPCI floors

In applying paragraph (1), the work and practice expense geographic indices applied under section 1848(e)(1) of the Social Security Act for any locality shall not be less than 1.00. (c)

Adoption of Medicare reforms

The Plan may adopt Medicare system delivery reforms that provide patients with a coordinated system of care and make changes to the provider payment structure.

6.

Benefits

(a)

In general

The Administrator shall specify the benefits to be provided under the Plan consistent with this section and in consultation with the Advisory Board. (b)

Minimum benefit level

The Plan may offer coverage with differing benefit levels so long as such benefits and levels are consistent with the benefits and levels of benefits required to be offered by health benefits plans under the National Health Insurance Exchange, and shall include the offering of at least one benefit level which closely reflects the lowest benefit level that may be offered by a health benefits plan through such Exchange.

7.

Premiums

(a)

In general

The Administrator shall specify the levels of premiums for coverage under the Plan so long as they— (1)are based upon a system of rating that is consistent with rating rules that is established for health benefits plans offered through the National Health Insurance Exchange; (2)do not take into account health status related factors for any individual enrollee; and (3)are designed to provide sufficient funds to meet the requirement of section 3(a). (b)

Rating rules

To the extent permitted for health benefits plans offered through the National Health Insurance Exchange, the premiums for the Plan shall vary based on geographic area and family size and may vary based on tobacco usage of an enrollee or other factors permitted for health benefits plans offered through the Exchange.