[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.
                                 <all>