[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1050 Introduced in Senate (IS)]
111th CONGRESS
1st Session
S. 1050
To amend title XXVII of the Public Health Service Act to establish
Federal standards for health insurance forms, quality, fair marketing,
and honesty in out-of-network coverage in the group and individual
health insurance markets, to improve transparency and accountability in
those markets, and to establish a Federal Office of Health Insurance
Oversight to monitor performance in those markets, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 14, 2009
Mr. Reid (for Mr. Rockefeller (for himself, Mr. Kohl, and Mr. Levin))
introduced the following bill; which was read twice and referred to the
Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To amend title XXVII of the Public Health Service Act to establish
Federal standards for health insurance forms, quality, fair marketing,
and honesty in out-of-network coverage in the group and individual
health insurance markets, to improve transparency and accountability in
those markets, and to establish a Federal Office of Health Insurance
Oversight to monitor performance in those markets, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Informed Consumer
Choices in Health Care 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. Findings.
Sec. 3. New minimum Federal standards for health insurance forms,
quality, fair marketing, and honesty in
out-of-network coverage.
Sec. 4. Health insurance accountability initiatives.
Sec. 5. Health insurance transparency initiatives.
Sec. 6. Office of Health Insurance Oversight.
Sec. 7. Standards and accountability and transparency initiatives for
group health plans through Departments of
Labor and the Treasury.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Effective competition in private health insurance
markets requires that consumers must have extensive and
meaningful information about what health insurance covers, what
it costs, and how it works.
(2) Based on the information currently provided by health
insurers, patients are unable to predict what their health
insurance coverage limits or out-of-pocket costs would be if
they had a serious illness. 72 million adults under age 65 had
problems paying medical bills or were paying off medical debt
in 2007, and 61 percent of those were insured at the time care
was provided.
(3) It is difficult to impossible for consumers to obtain a
copy of a health insurance policy from an insurance company
before they purchase it.
(4) Consumers often find it difficult to navigate and
evaluate their choices in today's health insurance markets and
many select a suboptimal plan as a result.
(5) The Institute of Medicine of the National Academy of
Sciences has estimated that nearly half of all American
adults--90 million people--have difficulty understanding and
using health information.
(6) The Office of Disease Prevention and Health Promotion
in the Department of Health and Human Services reports that
only 12 percent of the population using a table can calculate
an employee's share of health insurance costs for a year.
(7) A RAND Corporation study found that making it easier to
get information about insurance products and simplifying the
applications process would increase purchase rates as much as
modest subsidies would, and all these reports prove the need
for a fundamental improvement in the way insurance choices are
made available to consumers.
(8) Insurance forms provided to patients and providers are
often confusing, difficult to reconcile with medical bills, and
vary widely from insurer to insurer, thereby adding complexity
and administrative waste to the health care system.
(9) Research indicates that physicians divert substantial
resources, as much as 14 percent of their total revenue, to
ensure accurate insurance payments for their services.
Hospitals spend as much as 11 percent of their total revenue on
billing and insurance-related costs. These include time spent
determining patient insurance eligibility and benefit
structure. One study found that paperwork adds at least 30
minutes to every hour of patient care.
(10) According to the American Medical Association, there
is wide variation in how often health insurers pay nothing in
response to a physician claim and in how they explain the
reason for the denial. There is no consistency in the
application of codes used to explain the denials, making it
extremely expensive for physician practices to determine how to
respond.
(11) According to the American Medical Association, more
than half of health insurers in a recent study did not provide
physicians with the transparency necessary for an efficient
claims processing system.
(12) According to the American Medical Association, payers
vary widely on how often they use proprietary rather than
public claims edits to reduce payments (ranging from zero to as
high as nearly 72 percent). The use of undisclosed proprietary
edits inhibits the flow of transparent information to
physicians, adding additional administrative costs to reconcile
claims.
(13) The Federal Government currently lacks capacity to
carry out responsibility for oversight and enforcement of
current law requirements on health insurance issuers and to
provide States with technical assistance in effectively
enforcing Federal minimum standards for health insurance.
(14) In order to improve the functioning of the private
health insurance market, assure the application of existing
requirements to health insurance coverage, and reduce
administrative hassles for patients and providers, there is a
need for periodic examinations and audits of such coverage, for
greater disclosure of information regarding the terms and
conditions of such coverage, and for the establishment of a
Federal oversight office to ensure enforcement of standards.
SEC. 3. NEW MINIMUM FEDERAL STANDARDS FOR HEALTH INSURANCE FORMS,
QUALITY, FAIR MARKETING, AND HONESTY IN OUT-OF-NETWORK
COVERAGE.
(a) Group Health Insurance.--Title XXVII of the Public Health
Service Act is amended by inserting after section 2707 the following
new section:
``SEC. 2708. STANDARDS FOR HEALTH INSURANCE FORMS, QUALITY, FAIR
MARKETING, AND HONESTY IN OUT-OF-NETWORK COVERAGE.
``(a) Defining Insurance Terms; Standardizing Insurance Forms.--
``(1) In general.--The Secretary shall provide for the
development of standards for the information that health
insurance issuers are required to provide to group health plans
to promote informed choice of health insurance coverage by such
plans.
``(2) Standard definitions of insurance and medical
terms.--
``(A) In general.--The Secretary shall provide for
the development of standards for the definitions of
terms used in group health insurance coverage,
including insurance-related terms (including the
insurance-related terms described in subparagraph (B))
and medical terms (including the medical terms
described in subparagraph (C)).
``(B) Insurance-related terms.--The insurance-
related terms described in this subparagraph are
premium, deductible, co-insurance, co-payment, out-of-
pocket limit, preferred provider, non-preferred
provider, out-of-network co-payments, UCR (usual,
customary and reasonable) fees, excluded services,
grievance and appeals, and such other terms as the
Secretary determines are important to define so that
consumers may compare health insurance coverage and
understand the terms of their coverage.
``(C) Medical terms.--The medical terms described
in this subparagraph are hospitalization, hospital
outpatient care, emergency room care, physician
services, prescription drug coverage, durable medical
equipment, home health care, skilled nursing care,
rehabilitation services, hospice services, emergency
medical transportation, and such other terms as the
Secretary determines are important to define so that
consumers may compare the medical benefits offered by
insurance health insurance and understand the extent of
those medical benefits (or exceptions to those
benefits).
``(3) Standardization of insurance forms.--The Secretary
shall provide for the development of standards for the forms
used in connection with group health insurance coverage,
including for--
``(A) applications for health insurance coverage;
``(B) explanations of benefits for such coverage;
``(C) filing of complaints, grievances, and appeals
respecting such coverage; and
``(D) other common functions relating to such
coverage as the Secretary deems appropriate.
``(4) Coverage facts labels for patient claims scenarios.--
The Secretary shall develop standards for coverage facts labels
based on the patient claims scenarios described in section
2794(b)(4), which include information on estimated out-of-
pocket cost-sharing and significant exclusions or benefit
limits for such scenarios.
``(5) Personalized statement.--The Secretary shall develop
standards for an annual personalized statement that summarizes
use of health care services and payment of claims with respect
to an enrollee (and covered dependents) under group health
insurance coverage in the preceding year.
``(6) Application of standards.--No group health insurance
coverage may be offered for sale after the date that is two
years after date of the enactment of this section unless--
``(A) the benefits and other terms of coverage are
consistent with the definitional standards developed
under paragraph (2);
``(B) the application and form of coverage and
related forms are consistent with the standardized
forms developed under paragraph (3); and
``(C) there is provided coverage facts labels
described in paragraph (4) with respect to the
coverage.
``(7) Periodic review and updating.--The Secretary shall
periodically review and update, as appropriate, the standards
developed under this subsection.
``(8) Evaluation of information resources.--In developing,
reviewing, and updating standards under this subsection, the
Secretary shall provide for testing and evaluation of
information resources in general and to specific audiences
including those with low literacy skills.
``(9) Consultation.--In developing, reviewing, and updating
standards under this subsection, the Secretary shall consult
with, among others, the National Association of Insurance
Commissioners, health care professionals, researchers, health
insurance issuers, group health plans, patient advocates, and
literacy experts.
``(b) Quality Assurances for Health Insurance.--
``(1) In general.--The Secretary shall provide for the
development of standards to assure the quality of benefits
under group health insurance coverage. Such standards shall
include standards relating to at least--
``(A) network adequacy and stability;
``(B) guaranteed coverage for one year of
contracted benefits;
``(C) adequacy and stability of prescription drug
networks;
``(D) utilization control systems; and
``(E) grievances and appeals.
``(2) Application of provisions.--The provisions of
paragraphs (5) through (9) of subsection (a) apply to standards
developed under this subsection in the same manner as such
provisions apply to standards developed under subsection (a).
``(c) Marketing.--
``(1) In general.--The Secretary shall provide for the
development of standards for the marketing of group health
insurance coverage. Such standards shall include standards for
at least--
``(A) marketing materials; and
``(B) sales commissions.
``(2) Nondiscrimination.--No group health insurance
coverage may be offered for sale after the date that is two
years after date of the enactment of this section unless the
issuer provides the Secretary with a written certification that
all marketing materials, seminars, and other outreach efforts
in connection with the offering of such coverage do not
discriminate on the basis of income, race, gender, ethnicity,
or other demographic factors as determined by the Secretary.
``(3) Application of provisions.--The provisions of
paragraphs (7) through (9) of subsection (a) apply to standards
developed under this subsection in the same manner as such
provisions apply to standards developed under subsection (a).
``(d) Honesty in Coverage of Out-of-Network Providers.--The
Secretary shall provide for the development of standards for the
accuracy and clarity of coverage for out-of-network providers,
including cost sharing and payments to such providers, for health
insurance issuers in group health insurance coverage that provide such
coverage.''.
(b) Application in the Individual Market.--Such title is further
amended by inserting after section 2745 the following new section:
``SEC. 2746. STANDARDS FOR HEALTH INSURANCE FORMS, QUALITY, FAIR
MARKETING, AND HONESTY IN OUT-OF-NETWORK COVERAGE.
``The provisions of section 2708 shall apply under this part to
individual health insurance coverage and enrollees in such coverage in
the same manner as such provisions apply under part A in the case of
group health insurance coverage and group health plans and participants
and beneficiaries.''.
(c) Application to the Medicare Advantage Program and the Medicare
Prescription Drug Program.--
(1) Medicare advantage program.--Section 1852 of the Social
Security Act (42 U.S.C. 1395w-22) is amended by adding at the
end the following new subsection:
``(m) Standards for Health Insurance Forms, Quality, Fair
Marketing, and Honesty in Out-of-Network Coverage.--The provisions of
section 2708(a) of the Public Health Service Act shall apply to
Medicare Advantage organizations, Medicare Advantage plans, and
enrollees in such plans in the same manner as such provisions apply
under such section to group health insurance coverage and group health
plans and participants and beneficiaries.''.
(2) Medicare prescription drug program.--Section 1860D-4 of
the Social Security Act (42 U.S.C. 1395w-104) is amended by
adding at the end the following new subsection:
``(m) Standards for Health Insurance Forms, Quality, Fair
Marketing, and Honesty in Out-of-Network Coverage.--The provisions of
section 2708(a) of the Public Health Service Act shall apply to PDP
sponsors, prescription drug plans, and enrollees in such plans in the
same manner as such provisions apply under such section to group health
insurance coverage and group health plans and participants and
beneficiaries.''.
(3) Effective date.--The amendments made by this subsection
shall apply to plan years beginning after the date that is 2
years after the date of the enactment of this Act.
(d) Application to FEHBP.--The provisions of section 2708(a) of the
Public Health Service Act shall apply to the Federal Employees Health
Benefits Program under chapter 89 of title 5, United States Code, and
to contractors, health plans, and enrollees in such plans in the same
manner as such provisions apply under such section to group health
insurance coverage and group health plans and participants and
beneficiaries.
SEC. 4. HEALTH INSURANCE ACCOUNTABILITY INITIATIVES.
(a) Improved Health Insurance Accountability.--Title XXVII of the
Public Health Service Act is amended by adding at the end the following
new section:
``SEC. 2793. ACCOUNTABILITY INITIATIVES.
``(a) In General.--The Secretary, acting through the Office of
Health Insurance Oversight established under section 2795, shall
undertake activities in accordance with this section to promote
accountability of health insurance issuers in meeting Federal health
insurance requirements, regardless of whether this relates to health
insurance in the individual or group market.
``(b) Compliance Examinations and Audits.--
``(1) In general.--Without regard to whether or not there
is a determination under section 2722(a)(2) or 2761(a)(2) with
respect to a health insurance issuer, in carrying out this
section, the Secretary shall conduct independent market conduct
examinations and audits to monitor and verify the compliance of
a health insurance issuer with Federal health insurance
requirements. Such audits may include random compliance audits
and targeted audits in response to complaints or other
suspected noncompliance.
``(2) Recoupment of costs.--In connection with such
examinations and audits, the Secretary is authorized to recoup
from health insurance issuers reimbursement for the costs of
such examinations and audits of such issuers.
``(3) Relation to other authority.--The authorities under
this section are in addition to any authorities of the
Secretary, including authorities under sections 2722(b) and
2761(b).
``(c) Data Collection and Review.--
``(1) In general.--The Secretary shall collect and review
data from health insurance issuers on health insurance coverage
to monitor compliance with Federal health insurance
requirements applicable to such issuers and coverage. Upon
request by the Secretary, such issuers shall provide such data
to the Secretary on a timely basis.
``(2) Elements to review.--In carrying out this subsection,
the Secretary shall review at least the following:
``(A) Underwriting guidelines to ensure compliance
with applicable Federal health insurance requirements.
``(B) Rating practices to ensure compliance with
such requirements.
``(C) Enrollment and disenrollment data, including
information the Secretary may need to detect patterns
of discrimination against individuals based on health
status or other characteristics, to ensure compliance
with such requirements (including nondiscrimination in
group coverage, guaranteed issue, and guaranteed
renewability requirements applicable in all markets).
``(D) Post-claims underwriting and rescission
practices to ensure compliance with such requirements
relating to guaranteed renewability.
``(E) Marketing materials and agent guidelines to
ensure compliance with applicable Federal health
insurance requirements.
``(F) Data on the imposition of pre-existing
condition exclusion periods and claims subjected to
such exclusion periods.
``(G) Information on issuance of certificates of
creditable coverage.
``(H) Information on cost-sharing and payments with
respect to any out-of-network coverage.
``(I) Such other information as the Secretary may
determine to be necessary to verify compliance with
requirements of this title.
``(J) The application to issuers of penalties for
violation of such requirements, including the failure
to produce requested information.
``(3) Treatment of proprietary information.--The Secretary
may request under this subsection information that is
proprietary or that reveals a trade secret, but such
information shall not be subject to further disclosure to the
general public in a manner that reveals proprietary information
or a trade secret.
``(4) Form and manner of information.--Information under
paragraph (1) shall be provided--
``(A) in a form and manner specified by the
Secretary; and
``(B) within 30 days of the date of receipt of the
request for the information, or within such longer time
period as the Secretary deems appropriate.
``(5) Enforcement.--The Secretary shall have the same
authority in relation to enforcement of requests for data under
paragraph (1) as the Secretary has under section 2722(b).
``(6) Coordination with states.--
``(A) In general.--The Secretary shall coordinate
with State insurance regulators so that data with
respect to health insurance issuers and coverage are
collected and reported in a common format.
``(B) Clearinghouse.--The Secretary shall establish
a clearinghouse for the sharing of data reported by
health insurance issuers and for the findings from
audits and investigations. Such clearinghouse may be
established in conjunction with the National
Association of Insurance Commissioners.
``(7) Coordination with departments of labor and
treasury.--The Secretary shall coordinate with the Secretaries
of Labor and Treasury with respect to requirements to report
data that affect health insurance coverage sold in connection
with group health plans.
``(d) Health Insurance Accountability Grants to States.--
``(1) In general.--The Secretary shall provide for grants
to Departments of Insurance in States to strengthen their
enforcement of Federal health insurance requirements with
respect to health insurance issuers operating in such States.
Such a grant shall only be made pursuant to an application made
to the Secretary.
``(2) Funding.--
``(A) In general.--Of the funds appropriated under
subparagraph (B) for grants under this subsection, the
Secretary shall provide a grant to each State with an
application approved under paragraph (1).
``(B) Allocation.--Funds so appropriated for any
fiscal year shall be apportioned among the States in
accordance with a formula determined by the Secretary
that takes into account the scope of health insurance
subject to regulation under this title in each State
and such other factors as the Secretary may specify.
``(C) Appropriations and authorizations.--There is
hereby appropriated, out of any funds in the Treasury
not otherwise appropriated for the first fiscal year in
which this section is in effect, $10,000,000 for grants
under this subsection, to be available until expended.
For each subsequent fiscal year there is authorized to
be appropriated such sums as may be necessary for such
grants.
``(e) Federal Health Insurance Requirements Defined.--In this part,
the term `Federal health insurance requirements' means the requirements
under this title insofar as they relate to health insurance issuers and
health insurance coverage, whether in the individual or group market,
and includes other requirements imposed under Federal law specifically
in relation to the offering of health insurance coverage by health
insurance issuers.''.
SEC. 5. HEALTH INSURANCE TRANSPARENCY INITIATIVES.
(a) In General.--Title XXVII of the Public Health Service Act, as
amended by section 3, is further amended by adding at the end the
following new section:
``SEC. 2794. TRANSPARENCY INITIATIVES.
``(a) In General.--The Secretary, acting through the Office of
Health Insurance Oversight established under section 2795, shall
undertake activities in accordance with this section to promote
transparency in costs, market practices, and other factors for health
insurance coverage, regardless of whether the coverage is offered or in
effect in the individual or group market.
``(b) Development and Disclosure of Standardized Information.--
``(1) In general.--In carrying out this section, the
Secretary shall provide for the development of--
``(A) standards for information about health
insurance issuers, their health insurance policies, and
their market practices with respect to such policies;
and
``(B) standards for the disclosure of such
information in a timely, consistent, and accurate
manner by health insurance issuers about each health
insurance policy marketed and in force.
``(2) Information to be disclosed.--
``(A) In general.--In carrying out this section,
the Secretary shall require health insurance issuers to
disclose to enrollees, potential enrollees, in-network
health care providers, and others through a publicly
available Internet website and other appropriate means
at least the following concerning each policy of health
insurance coverage marketed or in force, in such
standardized manner as the Secretary specifies:
``(i) Full policy contract language.
``(ii) A summary of the information
described in paragraph (3).
``(iii) For each of the scenarios developed
under paragraph (4), the coverage facts label
information developed under section 2709(a)(4).
``(B) Personalized statement.--In carrying out this
section, the Secretary shall require health insurance
issuers to disclose to enrollees, in such standardized
manner as the Secretary specifies, an annual
personalized statement described in section 2708(a)(5).
``(3) Information to be disclosed.--The information
described in this paragraph is at least the following:
``(A) Data on the price of each new policy of
health insurance coverage and renewal rating practices.
``(B) Information on claims payment policies and
practices, including how many and how quickly claims
were paid.
``(C) Information on provider fee schedules and
usual, customary, and reasonable fees (for both network
and out-of-network providers).
``(D) Information on provider participation and
provider directories.
``(E) Information on loss ratios, including
detailed information about amount and type of non-
claims expenses.
``(F) Information on covered benefits, cost-
sharing, and amount of payment provided toward each
type of service identified as a covered benefit,
including preventive care services recommended by the
United States Preventive Services Task Force.
``(G) Information on civil or criminal actions
successfully concluded against the issuer by any
governmental entity.
``(H) Benefit exclusions and limits.
``(4) Development of patient claims scenarios.--
``(A) In general.--In order to improve the ability
of individuals and group health plans to compare the
coverage and value provided under different health
insurance coverage, the Secretary shall develop a
series of patient claims scenarios under which benefits
(including out-of-pocket costs) under such coverage can
be simulated for certain common or expensive conditions
or courses of treatment, such as maternity care, breast
cancer, heart disease, diabetes management, and well-
child visits.
``(B) Consultation and basis.--The Secretary shall
develop the scenarios under this paragraph--
``(i) in consultation with the National
Institutes of Health, the Centers for Disease
Control and Prevention, the Agency for
Healthcare Research and Quality, health
professional societies, patient advocates, and
others as deemed necessary by the Secretary;
and
``(ii) based upon recognized clinical
practice guidelines.
``(5) Manner of disclosure.--
``(A) In general.--The standards under paragraph
(1)(B) shall provide for health insurance issuers to
disclose the information under this subsection--
``(i) with all marketing materials;
``(ii) on the web-site of the issuer; and
``(iii) at other times upon request.
``(B) Contract language.--Such standards also shall
require the disclosure of full policy contract language
in printed form upon request.
``(c) Application of Enforcement Provisions.--The provisions of
sections 2722 and 2671 shall apply to enforcement of the requirements
of this section in the same manner as such provisions apply to the
provisions of part A or part B, respectively. Under such provisions the
States shall have initial (and primary) enforcement authority with
respect to such requirements, except that the Secretary under section
2793 may directly monitor compliance with such provisions as well.''.
(b) Conforming Amendments Regarding Disclosure of Information.--
(1) Reference in the group market.--Section 2713 of the
Public Health Service Act (42 U.S.C. 300gg-13) is amended by
adding at the end the following new subsection:
``(c) Reference to Disclosure of Information.--For provision
requiring disclosure of information by health insurance issuers, see
section 2794(d).''.
(2) Reference in the individual market.--Section 2761 of
the Public Health Service Act is amended by adding at the end
the following new subsection:
``(c) Reference to Disclosure of Information.--For provision
requiring disclosure of information by health insurance issuers, see
section 2794(d).''.
SEC. 6. OFFICE OF HEALTH INSURANCE OVERSIGHT.
(a) In General.--Title XXVII of the Public Health Service Act, as
amended by sections 3 and 4, is amended by adding at the end of part C
the following new section:
``SEC. 2795. OFFICE OF HEALTH INSURANCE OVERSIGHT.
``(a) Establishment.--There is established within the Department of
Health and Human Services an Office of Health Insurance Oversight
(referred to in this section as the `Office'). The Office shall be
headed by a Director of Health Insurance Oversight (referred to in this
section as the `Director') who shall be appointed by and report
directly to the Secretary.
``(b) Duties.--
``(1) Promotion of accountability in health insurance.--
``(A) In general.--The Director shall implement
accountability initiatives under section 2793.
``(B) Clearinghouse.--The Director shall provide,
in consultation with the National Association of
Insurance Commissioners, for a clearinghouse for State
health insurance regulators to share information
concerning, and help them to enact and enforce, Federal
health insurance requirements.
``(2) Promote transparency in health insurance.--The
Director shall implement transparency initiatives under section
2794.
``(3) Consumer information, assistance.--
``(A) In general.--The Director shall provide for
consumer information assistance on health insurance
coverage, and Federal health insurance consumer
protections under this title, including through
carrying out activities under this paragraph.
``(B) Information resources.--The Director shall
develop health insurance information resources for
consumers, including coverage facts labels for patient
claims scenarios developed under section 2794(b)(4) and
web-based information on average price ranges for out-
of-network services based on geography.
``(C) Service.--The Director shall establish a
consumer assistance service that, directly or in
coordination with State health insurance regulators and
consumer assistance organizations, receives and
responds to inquiries and complaints concerning health
insurance coverage with respect to Federal health
insurance requirements and under State law.
``(4) Health insurance consumer assistance grants.--
``(A) In general.--The Director shall provide for
grants to public, private or not-for-profit consumer
assistance organizations to develop, support, and
evaluate consumer assistance programs related to
selecting and navigating health care coverage. Such a
grant shall only be made pursuant to an application
made to the Director. In making such grants, the
Director shall attempt to ensure regional and
geographic equity.
``(B) Grant requirement.--As a condition of
receiving such a grant, an organization shall be
required to collect and report data to the Director on
the types of problems and inquiries encountered by
consumers they serve. Data shall be used by the
Director to inform enforcement activities and be shared
with State insurance regulators, the Department of
Labor, and the Secretary of the Treasury.
``(C) Appropriations and authorizations.--There is
hereby appropriated, out of any funds in the Treasury
not otherwise appropriated for the first fiscal year in
which this section is in effect, $30,000,000 for grants
under this paragraph, to be available until expended.
For each subsequent fiscal year there are authorized to
be appropriated such sums as may be necessary for such
grants.
``(5) Administration of high risk pool.--The Director shall
administer the high risk pool program under section 2745.
``(6) Administration of grants to state insurance
departments.--The Director shall administer the program of
grants to State insurance departments under section 2793(d).
``(c) Periodic Reports.--The Director shall submit periodic reports
to Congress on the Office's activities.
``(d) Coordination.--
``(1) Federal officials.--The Director shall coordinate,
with the Secretaries of Labor and Treasury, activities under
this section with respect to requirements that affect health
insurance coverage offered in connection with group health
plans, including coordination in --
``(A) development and dissemination of information;
and
``(B) consumer inquiries and complaints relating to
Federal health insurance requirements.
``(2) State health insurance regulators.--In carrying out
the Office's activities, the Director shall--
``(A) coordinate with State health insurance
regulators regarding data collection and disclosure and
audit and enforcement activities in order to avoid
duplication and to use regulatory resources most
efficiently;
``(B) monitor State efforts to implement and
enforce consumer protections consistent with Federal
health insurance requirements;
``(C) provide technical assistance to States
seeking to implement and enforce consumer protections
consistent with such requirements; and
``(D) provide for regular communication with such
regulators to coordinate enforcement efforts and
sharing of information.
``(e) Transfer of Personnel and Resources.--The Secretary shall
provide for the transfer to the Office of those personnel and resources
within the Department of Health and Human Services that, as of the date
of the enactment of this section, relate directly to the
responsibilities of the Director under this section.
``(f) Authorization of Appropriations.--In addition to amounts made
available under subsection (b)(4)(C), there are authorized to be
appropriated to carry out this section $20,000,000 for the first fiscal
year beginning after the date of the enactment of this section and such
sums as may be necessary for subsequent fiscal years.''.
(b) Conforming Amendments Regarding Additional Authority.--
(1) Group market.--Section 2722 of such Act (42 U.S.C.
300gg-22) is amended by adding at the end the following new
subsection:
``(c) Reference to Additional Authority.--For additional
Secretarial authorities with respect to requirements under this part,
see sections 2793 and 2794.''.
(2) Individual market.--Section 2761 of such Act (42 U.S.C.
300gg-61) is amended by adding at the end the following new
subsection:
``(c) Reference to Additional Authority.--For additional
Secretarial authorities with respect to requirements under this part,
see sections 2793 and 2794.''.
SEC. 7. STANDARDS AND ACCOUNTABILITY AND TRANSPARENCY INITIATIVES FOR
GROUP HEALTH PLANS THROUGH DEPARTMENTS OF LABOR AND THE
TREASURY.
(a) Standards.--In coordination with the Secretary of Health and
Human Services, the Secretaries of Labor and the Treasury shall
establish for group health plans standards comparable to the standards
developed by the Secretary of Health and Human Services for group
health insurance coverage under section 2708 of the Public Health
Service Act, as added by section 3(a), in order to promote quality,
fair marketing, and honesty in out-of-network coverage under such plans
and to permit participants to make an informed decision in cases where
they are offered a choice of coverage under such a plan.
(b) Accountability and Transparency Initiatives.--In coordination
with the Secretary of Health and Human Services, the Secretaries of
Labor and the Treasury shall jointly undertake accountability and
transparency initiatives with respect to group health plans similar to
those undertaken by the Secretary of Health and Human Services with
respect to group and individual health insurance coverage under
sections 2793 and 2794 of the Public Health Service Act, as added by
sections 4 and 5 of this Act.
(c) Group Health Plan Defined.--In this section, with respect to
the Secretary of Labor and the Secretary of the Treasury, the term
``group health plan'' has the meaning given such term for purposes of
part 7 of subtitle B of title I of the Employee Retirement Income
Security Act of 1974 and chapter 100 of the Internal Revenue Code of
1986, respectively.
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