1.This Act may be cited as
the Consumers Health Care Act of
2009
.
2.Congress makes the following
findings:
(1)Americans need
health care coverage that is always affordable.
(2)Americans need
health care coverage that is always adequate.
(3)Americans need
health care coverage that is always accountable.
(4)A public health
insurance plan option that can compete with private insurance plans is the only
way to guarantee that all consumers have affordable, adequate, and accountable
options available in the insurance marketplace.
3.Office of Health
Plan Management
(a)Not
later than July 1, 2010, there shall be established within the Department of
Health and Human Services an Office of Health Plan Management (referred to in
this Act as the Office
). The Office shall be headed by a
Director (referred to in this Act as the Director
) who shall be
appointed by the President, by and with the advice and consent of the
Senate.
(b)The
Director shall be paid at the annual rate of pay for a position at level II of
the Executive Schedule under section 5313 of title 5, United States
Code.
(c)Neither
the Director nor the Office shall participate in the administration of the
National Health Insurance Exchange (as defined in section 7) or the
promulgation or administration of any regulation regarding the health insurance
industry.
(d)Personnel and
Operations AuthorityThe Director 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.
4.Consumer Choice
Health Plan
(a)The Office shall establish and administer the Consumer
Choice Health Plan (referred to in this Act as the Plan
) to
provide for health insurance coverage that is made available to all eligible
individuals (as described in subsection (d)(1)) in the United States and its
territories.
(b)The Plan shall comply with—
(1)all regulations
and requirements that are applicable with respect to other health insurance
plans that are offered through the National Health Insurance Exchange;
and
(2)any additional
regulations and requirements, as determined by the Director.
(c)
(1)The Plan shall offer health insurance coverage at
different benefit levels, provided that such benefits are commensurate with the
required benefit levels to be provided by a health insurance plan under the
National Health Insurance Exchange.
(2)Minimum
Benefits for Children
(A)The minimum benefit level available under the Plan for
children shall include at least the services described in the most recently
published version of the Maternal and Child Health Plan Benefit
Model
developed by the National Business Group on Health.
(B)Amendment of
Benefit LevelThe Secretary of Health and Human Services, acting
through the Director of the Agency for Healthcare Research and Quality, may
amend the benefits described in subparagraph (A) based on the most recent
peer-reviewed and evidence-based data.
(d)Eligibility and
Enrollment
(1)An
individual who is eligible to purchase coverage from a health insurance plan
through the National Health Insurance Exchange shall be eligible to enroll in
the Plan.
(2)An individual may enroll in the Plan only in such manner
and form as may be prescribed by applicable regulations, and only during an
enrollment period as prescribed by the Director.
(3)An employer shall be eligible to purchase health
insurance coverage for their employees and the employees' dependents to the
extent provided for all health benefits plans under the National Health
Insurance Exchange.
(4)Satisfaction of
Individual Mandate RequirementAn individual’s enrollment with
the Plan shall be treated as satisfying any requirement under Federal law for
such individual to demonstrate enrollment in health insurance or benefits
coverage.
(e)
(1)
(A)A
participating provider who is voluntarily providing health care services under
the Medicare program established under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) shall be required to provide services to any
individual enrolled in the Plan.
(B)A provider of health care services under the Medicaid
program established under title XIX of the Social Security Act (42 U.S.C. 1396
et seq.), or the CHIP program established under title XXI of such Act (42
U.S.C. 1397aa et seq.), shall be required to provide services to any individual
enrolled in the Plan.
(2)Paragraph
(1) shall not be construed as requiring a provider to accept new patients due
to bona fide capacity limitations of the provider.
(3)
(A)A
participating provider as described under paragraph (1)(A) shall be required to
provide services to any individual enrolled in the Plan for the 3-year period
following the establishment of the Plan. Upon the expiration of the 3-year
period, a participating provider in the Plan may elect to become a
non-participating provider without affecting their status as a participating
provider under the Medicare program.
(B)A provider as described under paragraph (1)(B) shall be
required to provide services to any individual enrolled in the Plan for the
3-year period following the establishment of the Plan. Upon the expiration of
the 3-year period, a provider in the Plan may elect to cease provision of
services under the Plan without affecting their status as a provider under the
Medicaid program or the CHIP program.
(4)
(A)
(i)During the 2-year period following the establishment of
the Plan, providers shall be reimbursed at such payment rates as are applicable
under the Medicare program.
(ii)The
Director may reimburse providers at rates lower or higher than applicable under
the Medicare program if the Director determines that the adjusted rates are
appropriate and ensure that enrollees in the Plan are provided with adequate
access to health care services.
(B)Subject to subparagraph (C), upon the expiration of
the 2-year period following the establishment of the Plan, the Director shall
develop payment rates for reimbursement of providers in order to maintain an
adequate provider network necessary to assure that enrollees in the Plan have
adequate access to health care. In determining such payment rates, the Director
shall consider—
(i)competitive
provider payment rates in both the public and private sectors;
(ii)best practices
among providers;
(iii)integrated
models of care delivery (including medical home and chronic care coordination
models);
(iv)geographic
variation in health care costs;
(v)evidence-based
practices;
(vi)quality
improvement;
(vii)use of health
information technology; and
(viii)any additional
measures, as determined by the Director.
(C)Payment Rate
ConsultationThe Director shall determine payment rates under
subparagraph (B) in consultation with providers participating under the Plan,
the Director of the Office of Personnel Management, the Medicare Payment
Advisory Commission, and the Medicaid and CHIP Payment and Access
Commission.
(5)Adoption of
Medicare ReformsThe Plan may adopt Medicare system delivery
reforms that provide patients with a coordinated system of care and make
changes to the provider payment structure.
(f)The
Plan shall be eligible to accept subsidies, including subsidies for the
enrollment of individuals under the Plan, in the same manner and to the same
extent as other health insurance plans offered through the National Health
Insurance Exchange.
(g)
(1)
(A)In order to provide for adequate funding of the Plan in
advance of receipt of payments as described in paragraph (2), beginning July 1,
2010, there are transferred to the Plan from the general fund of the Treasury
such amounts as may be necessary for operation of the Plan until the end of the
3-year period following the establishment of the Plan.
(B)Upon the expiration of the 3-year period following the
establishment of the Plan, the Director shall enter into a repayment schedule
with the Secretary of the Treasury to provide for repayment of funds provided
under subparagraph (A). Any expenditures made by the Plan pursuant to a
repayment schedule established under this subparagraph shall not constitute
administrative expenses as described in paragraph (2)(B).
(2)
(A)The Plan shall be financially self-sustaining insofar as
funds used for operation of the Plan (including benefits, administration, and
marketing) shall be derived from—
(i)insurance premium
payments and subsidies for individuals enrolled in the Plan; and
(ii)payments made to
the Plan by employers that do not offer health insurance coverage to their
employees.
(B)Limitation on
Administrative ExpensesNot more than 5 percent of the amounts
provided under subparagraph (A) may be used for the annual administrative costs
of the Plan.
(3)
(A)The Director shall establish and fund a contingency
reserve for the Plan in a form similar to the contingency reserve provided for
health benefits plans under the Federal Employees Health Benefits Program under
chapter 89 of title 5, United States Code.
(B)Any
revenue generated through the contingency reserve established in subparagraph
(A) shall be transferred to the Plan for the purpose of reducing enrollee
premiums, reducing enrollee cost-sharing, increasing enrollee benefits, or any
combination thereof.
(4)GAO Financial
Audit and ReportBeginning not later than October 1, 2011, the
Comptroller General shall conduct an annual audit of the financial statements
and records of the Plan, in accordance with generally accepted government
auditing standards, and submit an annual report on such audit to the
Congress.
(5)Supermajority
Requirement for Supplemental FundingUpon certification by the
Comptroller General that the financial audit described in paragraph (4)
indicates that the Plan is insolvent, supplemental funding may be appropriated
for the Plan if such measure receives not less than a three-fifths vote of
approval of the total number of Members of the House of Representatives and the
Senate.
(h)
(1)Beginning with the first year of operation of the Plan
through the National Health Insurance Exchange, the Director shall provide
standards and undertake activities for promoting transparency in costs,
benefits, and other factors for health insurance coverage provided under the
Plan.
(2)Standard
Definitions of Insurance and Medical Terms
(A)The Director shall provide for the development of
standards for the definitions of terms used in health insurance coverage under
the Plan, 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)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 Director determines are important to
define so that consumers may compare health insurance coverage and understand
the terms of their coverage.
(C)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 Director
determines are important to define so that consumers may compare the medical
benefits offered by health insurance plans and understand the extent of those
medical benefits (or exceptions to those benefits).
(3)
(A)In carrying out this subsection, the Director shall
disclose to Plan enrollees, potential enrollees, in-network health care
providers, and others (through a publically available Internet website and
other appropriate means) relevant information regarding each policy of health
insurance coverage marketed or in force (in such standardized manner as
determined by the Director), including—
(i)full policy
contract language; and
(ii)a
summary of the information described in paragraph (4).
(B)The Director shall disclose to enrollees (in such
standardized manner as determined by the Director) an annual personalized
statement that summarizes use of health care services and payment of claims
with respect to an enrollee (and covered dependents) under health insurance
coverage provided through the Plan in the preceding year.
(4)The information described in this paragraph includes,
but is not limited to, the following:
(A)Data on the price
of each new policy of health insurance coverage and renewal rating
practices.
(B)Claims payment
policies and practices, including how many and how quickly claims were
paid.
(C)Provider fee
schedules and usual, customary, and reasonable fees (for both in-network and
out-of-network providers).
(D)Provider
participation and provider directories.
(E)Loss ratios,
including detailed information about amount and type of non-claims
expenses.
(F)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)Civil or criminal
actions successfully concluded against the Plan by any governmental
entity.
(H)Benefit
exclusions and limits.
(5)Development of
patient claims scenarios
(A)In order to improve the ability of individuals and
employers to compare the coverage and relative value provided under the Plan,
the Director shall develop and make publically available a series of patient
claims scenarios under which benefits (including out-of-pocket costs) under the
Plan are simulated for certain common or expensive conditions or courses of
treatment (including maternity care, breast cancer, heart disease, diabetes
management, and well-child visits).
(B)The
Director shall develop the patient claims scenarios described in subparagraph
(A)—
(i)in
consultation with the Secretary of Health and Human Services, 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 other entities as deemed necessary by the Director;
and
(ii)based upon
recognized clinical practice guidelines.
(6)The Director shall disclose the information under this
subsection—
(A)with all
marketing materials;
(B)on the website
for the Plan; and
(C)at other times
upon request.
5.Establishment of
America's Health Insurance Trust
(a)As
of the date of enactment of this Act, there is authorized to be established a
non-profit corporation that shall be known as the America's Health
Insurance Trust
(referred to in this Act as the Trust
),
which is neither an agency nor establishment of the United States
Government.
(b)Location;
Service of ProcessThe Trust shall maintain its principal office
within the District of Columbia and have a designated agent in the District of
Columbia to receive service of process for the Trust. Notice to or service on
the agent shall be deemed as notice to or service on the corporation.
(c)Application of
ProvisionsThe Trust shall be subject to the provisions of this
section and, to the extent consistent with this section, to the District of
Columbia Nonprofit Corporation Act.
(d)The Trust shall be treated as a nonprofit organization
described under section 170(c)(2)(B) and section 501(c)(3) of the Internal
Revenue Code of 1986 that is exempt from taxation under section 501(a) of the
Internal Revenue Code of 1986.
(e)
(1)The Board of Directors of the Trust (referred to in this
Act as the Board
) shall consist of 19 voting members appointed
by the Comptroller General.
(2)
(A)Subject to subparagraph (C), each member of the Board
shall serve for a term of 6 years.
(B)No
individual shall be appointed to the Board for more than 2 consecutive
terms.
(C)The initial members of the Board shall be appointed by
the Comptroller General not later than October 1, 2010, and shall serve terms
as follows:
(i)8
members shall be appointed for a term of 5 years.
(ii)8
members shall be appointed for a term of 3 years.
(iii)3
members shall be appointed for a term of 1 year.
(D)Any member of the Board whose term has expired may serve
until such member's successor has taken office, or until the end of the
calendar year in which such member's term has expired, whichever is
earlier.
(E)
(i)Any member appointed to fill a vacancy prior to the
expiration of the term for which such member's predecessor was appointed shall
be appointed for the remainder of such term.
(ii)Vacancies not
to Affect Power of BoardA vacancy on the Board shall not affect
its powers, but shall be filled in the same manner as the original appointment
was made.
(3)Chairperson and
Vice-Chairperson
(A)The Comptroller General shall designate a Chairperson and
Vice-Chairperson of the Board from among the members of the Board.
(B)The
members designated as Chairperson and Vice-Chairperson shall serve for a period
of 3 years.
(4)An individual may not serve on the Board if such
individual (or an immediate family member of such individual) is employed by or
has a financial interest in—
(A)an organization
that provides a health insurance plan;
(B)a pharmaceutical
manufacturer; or
(C)any subsidiary
entities of an organization described in subparagraphs (A) or (B).
(5)
(A)Not more than 10 members of the Board may be affiliated
with the same political party.
(B)In
appointing members under this paragraph, the Comptroller General shall ensure
that such members provide appropriately diverse representation with respect to
race, ethnicity, age, gender, and geography.
(C)10 members of the Board shall be independent and
non-conflicted individuals representing the interests of health care consumers.
Each member selected under this subparagraph shall represent 1 of the 10
Department of Health and Human Services regions in the United States.
(D)
(i)9 members of the Board shall be selected based on
relevant experience, including expertise in—
(I)community
affairs;
(II)Federal, State,
and local government;
(III)health
professions and administration;
(IV)business,
finance, and accounting;
(V)legal
affairs;
(VI)insurance;
(VII)trade
unions;
(VIII)social
services; and
(IX)any additional
areas as determined by the Comptroller General.
(ii)Income from
Health Care IndustryNot more than 4 of the members selected
under this subparagraph shall earn more than 10 percent of their income from
the health care industry.
(6)The Board shall meet and hold hearings at the call of
the Chairperson or a majority of its members. Meetings of the Board on matters
not related to personnel shall be open to the public and advertised through
public notice at least 7 days prior to the meeting.
(7)A
majority of the members of the Board shall constitute a quorum for purposes of
conducting the duties of the Trust, but a lesser number of members may meet and
hold hearings.
(8)Executive
Director and Staff; Performance of DutiesThe Board may—
(A)employ and fix
the compensation of an Executive Director and such other personnel as may be
necessary to carry out the duties of the Trust;
(B)seek such
assistance and support as may be required in the performance of the duties of
the Trust from appropriate departments and agencies of the Federal
Government;
(C)enter into
contracts or other arrangements and make such payments as may be necessary for
performance of the duties of the Trust;
(D)provide travel,
subsistence, and per diem compensation for individuals performing the duties of
the Trust, including members of the Advisory Council (as described in
subsection (f)); and
(E)prescribe such
rules, regulations, and bylaws as the Board determines necessary with respect
to the internal organization and operation of the Trust.
(9)Lobbying
Cooling-Off Period for Members of the BoardSection 207(c) of
title 18, United States Code, is amended by inserting at the end the
following:
(3)Members of the
Board of Directors of the America's Health Insurance
TrustParagraph (1) shall apply to a member of the Board of
Directors of the America's Health Insurance Trust who was appointed to the
Board as of the day before the date of enactment of the
Consumers Health Care Act of
2009.
.
(f)
(1)The
Board shall establish an advisory council that shall be comprised of the
insurance commissioners of each State (including the District of Columbia) to
advise the Board on the development and impact of measures to improve the
transparency and accountability of health insurance plans provided through the
National Health Insurance Exchange.
(2)The
advisory council shall meet not less than twice a year and at the request of
the Board.
(g)
(1)The Trust shall provide for financial audits of the Trust
on an annual basis by a private entity with expertise in conducting financial
audits.
(2)Review and
Report on AuditsThe Comptroller General shall—
(A)review and
evaluate the results of the audits conducted pursuant to paragraph (1);
and
(B)submit a report
to Congress containing the results and review of such audits, including an
analysis of the adequacy and use of the funding for the Trust and its
activities.
(h)Rules on Gifts
and Outside Contributions
(1)The
Trust (including the Board and any staff acting on behalf of the Trust) shall
not accept gifts, bequeaths, or donations of services or property.
(2)Prohibition on
Outside Funding or ContributionsThe Trust shall not—
(A)establish a
corporation other than as provided under this section; or
(B)accept any funds
or contributions other than as provided under this section.
(i)America's
Health Insurance Trust Fund
(1)There is established in the Treasury a trust fund to be
known as the America's Health Insurance Trust Fund
(referred to
in this section as the Trust Fund
), consisting of such amounts
as may be credited to the Trust Fund as provided under this subsection.
(2)The
Secretary of the Treasury shall transfer to the Trust Fund out of the general
fund of the Treasury amounts determined by the Secretary to be equivalent to
the amounts received into such general fund that are attributable to the fees
collected under sections 4375 and 4376 of the Internal Revenue Code of 1986
(relating to fees on health insurance policies and self-insured health
plans).
(3)Financing for
Fund from fees on insured and self-insured health plans
(A)Chapter 34 of the Internal
Revenue Code of 1986 is amended by adding at the end the following new
subchapter:
BInsured and
Self-Insured Health Plans
Sec. 4375. Health insurance.
Sec. 4376. Self-insured health
plans.
Sec. 4377. Definitions and special
rules.
4375.
(a)In the case of any
specified health insurance policy issued after October 1, 2009, there is hereby
imposed a fee equal to—
(1)for policies issued during fiscal years
2010 through 2013, 50 cents multiplied by the average number of lives covered
under the policy; and
(2)for policies
issued after September 30, 2013, $1 multiplied by the average number of lives
covered under the policy.
(b)The fee imposed by subsection (a) shall be paid by the issuer
of the policy.
(c)Specified Health
Insurance PolicyFor purposes of this section:
(1)Except as otherwise provided in this section, the term
specified health insurance policy means any accident or health
insurance policy (including a policy under a group health plan) issued with
respect to individuals residing in the United States.
(2)Exemption for
certain policiesThe term specified health insurance
policy
does not include any insurance if substantially all of its
coverage is of excepted benefits described in section 9832(c).
(3)Treatment of
prepaid health coverage arrangements
(A)In the case of any arrangement described in subparagraph
(B)—
(i)such arrangement
shall be treated as a specified health insurance policy, and
(ii)the person
referred to in such subparagraph shall be treated as the issuer.
(B)Description of
arrangementsAn arrangement is described in this subparagraph if
under such arrangement fixed payments or premiums are received as consideration
for any person’s agreement to provide or arrange for the provision of accident
or health coverage to residents of the United States, regardless of how such
coverage is provided or arranged to be provided.
(d)Adjustments for
increases in health care spendingIn the case of any policy
issued in any fiscal year beginning after September 30, 2014, the dollar amount
in effect under subsection (a) for such policy shall be equal to the sum of
such dollar amount for policies issued in the previous fiscal year (determined
after the application of this subsection), plus an amount equal to the product
of—
(1)such dollar
amount for policies issued in the previous fiscal year, multiplied by
(2)the percentage
increase in the projected per capita amount of National Health Expenditures
from the calendar year in which the previous fiscal year ends to the calendar
year in which the fiscal year involved ends, as most recently published by the
Secretary of Health and Human Services before the beginning of the fiscal
year.
(e)This
section shall not apply to policy years ending after September 30, 2019.
4376.Self-Insured
health plans
(a)In the case of any
applicable self-insured health plan issued after October 1, 2009, there is
hereby imposed a fee equal to—
(1)for plans issued during fiscal years 2010
through 2013, 50 cents multiplied by the average number of lives covered under
the plan; and
(2)for plans issued
after September 30, 2013, $1 multiplied by the average number of lives covered
under the plans.
(b)
(1)The fee imposed by subsection (a) shall be paid by the
plan sponsor.
(2)For purposes of paragraph (1) the term plan
sponsor means—
(A)the employer in
the case of a plan established or maintained by a single employer,
(B)the employee
organization in the case of a plan established or maintained by an employee
organization,
(C)in the case
of—
(i)a plan established
or maintained by 2 or more employers or jointly by 1 or more employers and 1 or
more employee organizations,
(ii)a multiple
employer welfare arrangement, or
(iii)a voluntary
employees’ beneficiary association described in section 501(c)(9),
the association, committee, joint
board of trustees, or other similar group of representatives of the parties who
establish or maintain the plan, or(D)the cooperative or
association described in subsection (c)(2)(F) in the case of a plan established
or maintained by such a cooperative or association.
(c)Applicable
Self-Insured Health PlanFor purposes of this section, the term
applicable self-insured health plan means any plan for providing
accident or health coverage if—
(1)any portion of
such coverage is provided other than through an insurance policy, and
(2)such plan is
established or maintained—
(A)by one or more
employers for the benefit of their employees or former employees,
(B)by one or more
employee organizations for the benefit of their members or former
members,
(C)jointly by 1 or
more employers and 1 or more employee organizations for the benefit of
employees or former employees,
(D)by a voluntary
employees’ beneficiary association described in section 501(c)(9),
(E)by any
organization described in section 501(c)(6), or
(F)in the case of a
plan not described in the preceding subparagraphs, by a multiple employer
welfare arrangement (as defined in section 3(40) of
Employee Retirement Income Security Act of
1974), a rural electric cooperative (as defined in section
3(40)(B)(iv) of such Act), or a rural telephone cooperative association (as
defined in section 3(40)(B)(v) of such Act).
(d)Adjustments for
increases in health care spendingIn the case of any plan issued
in any fiscal year beginning after September 30, 2014, the dollar amount in
effect under subsection (a) for such plan shall be equal to the sum of such
dollar amount for plans issued in the previous fiscal year (determined after
the application of this subsection), plus an amount equal to the product
of—
(1)such dollar
amount for plans issued in the previous fiscal year, multiplied by
(2)the percentage
increase in the projected per capita amount of National Health Expenditures
from the calendar year in which the previous fiscal year ends to the calendar
year in which the fiscal year involved ends, as most recently published by the
Secretary of Health and Human Services before the beginning of the fiscal
year.
(e)This
section shall not apply to plans issued after September 30, 2019.
4377.Definitions
and special rules
(a)For
purposes of this subchapter—
(1)Accident and
health coverageThe term accident and health
coverage means any coverage which, if provided by an insurance policy,
would cause such policy to be a specified health insurance policy (as defined
in section 4375(c)).
(2)The term insurance policy means any policy or
other instrument whereby a contract of insurance is issued, renewed, or
extended.
(3)The term United States includes any
possession of the United States.
(b)Treatment of
Governmental Entities
(1)For purposes of this subchapter—
(A)the term
person includes any governmental entity, and
(B)notwithstanding
any other law or rule of law, governmental entities shall not be exempt from
the fees imposed by this subchapter except as provided in paragraph (2).
(2)Treatment of
exempt governmental programsIn the case of an exempt governmental
program, no fee shall be imposed under section 4375 or section 4376 on any
covered policy or plan under such program.
(3)Exempt
governmental program definedFor purposes of this subchapter, the
term exempt governmental program means—
(A)any insurance
program established under title XVIII of the Social Security Act,
(B)the medical
assistance program established by title XIX or XXI of the
Social Security Act,
(C)the Federal
Employees Health Benefits Program under chapter 89 of title 5, United States
Code,
(D)the Consumer
Choice Health Plan established under the Consumers Health Care Act of
2009,
(E)any program
established by Federal law for providing medical care (other than through
insurance policies) to individuals (or the spouses and dependents thereof) by
reason of such individuals being—
(i)members of the
Armed Forces of the United States, or
(ii)veterans,
and
(F)any program
established by Federal law for providing medical care (other than through
insurance policies) to members of Indian tribes (as defined in section 4(d) of
the Indian Health Care Improvement
Act).
(c)For purposes of subtitle F, the fees imposed by this
subchapter shall be treated as if they were taxes.
(d)No Cover Over to
PossessionsNotwithstanding any other provision of law, no amount
collected under this subchapter shall be covered over to any possession of the
United
States.
.
(B)
(i)Chapter 34 of such
Code is amended by striking the chapter heading and inserting the
following:
34TAXES ON CERTAIN
INSURANCE POLICIES
Subchapter A. Policies issued by
foreign insurers
Subchapter B. Insured and
self-insured health plans
APolicies Issued By
Foreign
Insurers
.
(ii)The
table of chapters for subtitle D of such Code is amended by striking the item
relating to chapter 34 and inserting the following new item:
Chapter 34—Taxes on Certain Insurance
Policies
.
6.Duties of
America's Health Insurance Trust
(a)Insurance Plan
Rankings and Website
(1)The Trust shall establish and maintain a website that
provides informational materials regarding the health insurance plans provided
through the National Health Insurance Exchange, including appropriate links for
all available State insurance commissioner websites.
(2)The Trust shall develop and publish annual rankings of
the health insurance plans provided through the National Health Insurance
Exchange, based on the assignment of a letter grade between grade
A
(highest) and grade F
(lowest). The Trust shall
provide for a comparative evaluation of each plan based upon—
(A)administrative
expenditures;
(B)affordability of
coverage;
(C)adequacy of
coverage;
(D)timeliness and
adequacy of consumer claims processing;
(E)available
consumer complaint systems;
(F)grievance and
appeals processes;
(G)transparency;
(H)consumer
satisfaction; and
(I)any additional
measures as determined by the Board.
(3)Information
available on website by ZIP CodeThe annual rankings of the
health insurance plans (as described in paragraph (2)) shall be available on
the website for the Trust (as described in paragraph (1)), and the website for
the National Health Insurance Exchange, in a manner that is searchable and
sortable by zip code.
(4)
(A)The Trust shall develop written and web-based methods
for individuals to provide recommendations and complaints regarding the health
insurance plans provided through the National Health Insurance Exchange.
(B)The Trust shall obtain meaningful consumer input,
including consumer surveys, that measure the extent to which an individual
receives the services and supports described in the individual's health
insurance plan and the individual's satisfaction with such services and
supports.
(b)
(1)An organization that provides a health insurance plan
through the National Health Insurance Exchange shall provide the Trust with all
information and data that is necessary for improving transparency, monitoring,
and oversight of such plans.
(2)Beginning with the first full year of operation of the
National Health Insurance Exchange, an organization that provides a health
insurance plan through the National Health Insurance Exchange shall annually
provide the Trust with appropriate information regarding the following:
(A)Name of the
plan.
(B)Levels of
available plan benefits.
(C)Description of
plan benefits.
(D)Number of
enrollees under the plan.
(E)Demographic
profile of enrollees under the plan.
(F)Number of claims
paid to enrollees.
(G)Number of
enrollees that terminated their coverage under the plan.
(H)Total operating
cost for the plan (including administrative costs).
(I)Patterns of
utilization of the plan's services.
(J)Availability,
accessibility, and acceptability of the plan's services.
(K)Such information
as the Trust may require demonstrating that the organization has a fiscally
sound operation.
(L)Any additional
information as determined by the Trust.
(3)Form and Manner
of InformationInformation to be provided to the Trust under
paragraphs (1) and (2) shall be provided—
(A)in such form and
manner as specified by the Trust; and
(B)within 30 days of
the date of receipt of the request for such information, or within such
extended period as the Trust deems appropriate.
(4)Information
from the Department of Health and Human Services
(A)Any information regarding the health insurance plans that
are offered through the National Health Insurance Exchange that has been
provided to the Secretary of Health and Human Services shall also be made
available (as deemed appropriate by the Secretary) to the Trust for the purpose
of improving transparency, monitoring, and oversight of such plans. Such
information may include, but is not limited to, the following:
(i)Underwriting
guidelines to ensure compliance with applicable Federal health insurance
requirements.
(ii)Rating practices
to ensure compliance with applicable Federal health insurance
requirements.
(iii)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 applicable Federal health insurance
requirements (including non-discrimination in group coverage, guaranteed issue,
and guaranteed renewability requirements applicable in all markets).
(iv)Post-claims
underwriting and rescission practices to ensure compliance with applicable
Federal health insurance requirements relating to guaranteed
renewability.
(v)Marketing
materials and agent guidelines to ensure compliance with applicable Federal
health insurance requirements.
(vi)Data on the
imposition of pre-existing condition exclusion periods and claims subjected to
such exclusion periods.
(vii)Information on
issuance of certificates of creditable coverage.
(viii)Information on
cost-sharing and payments with respect to any out-of-network coverage.
(ix)The application
to issuers of penalties for violation of applicable Federal health insurance
requirements (including failure to produce requested information).
(x)Such other
information as the Trust may determine to be necessary to verify compliance
with the requirements of this Act.
(B)The Secretary of Health and Human Services shall
provide the Trust with all consumer claims data or information that has been
provided to the Secretary by any health insurance plan that is offered through
the National Health Insurance Exchange.
(C)Period for
Providing InformationInformation to be provided to the Trust
under this paragraph shall be provided by the Secretary within 30 days of the
date of receipt of the request for such information, or within such extended
period as the Secretary and the Trust mutually deem appropriate.
(5)Non-Disclosure
of Health Insurance DataThe Trust shall prevent disclosure of
any data or information provided under this paragraph that the Trust determines
is proprietary or qualifies as a trade secret subject to withholding from
public dissemination. Any data or information provided under this paragraph
shall not be subject to disclosure under section 552 of title 5, United States
Code (commonly referred to as the Freedom of Information Act).
7.Definition of
National Health Insurance ExchangeIn this Act, the term National Health
Insurance Exchange means a mechanism established or recognized under
Federal law for coordinating the offering of health insurance coverage to
individuals in the United States through the establishment of standards for
benefits, cost-sharing, and premiums for such health insurance coverage.