[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3504 Introduced in House (IH)]

113th CONGRESS
  1st Session
                                H. R. 3504

  To provide improved consumer protection and rate review for health 
  insurance coverage in the individual market, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 15, 2013

Ms. Schakowsky introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
  To provide improved consumer protection and rate review for health 
  insurance coverage in the individual market, 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.

    This Act may be cited as the ``Consumer Protection and Rate Review 
Act of 2013''.

SEC. 2. REQUIRING STATE INSURANCE COMMISSIONERS TO INVESTIGATE 
              INSTANCES OF INADEQUATE NOTICES OF CANCELLATION OR 
              CONVERSION OF INDIVIDUAL HEALTH INSURANCE POLICIES.

    (a) In General.--Each State insurance commissioner shall 
investigate and take appropriate administrative or other actions (such 
as the imposition of a fine) on cases of inadequate notices of 
cancellations or conversions of health insurance coverage in the 
individual market that take effect on or after January 1, 2014.
    (b) Inadequate Notice.--In this section, a notice of the 
cancellation or conversion of individual health insurance coverage 
shall be treated as inadequate if the notice--
            (1) fails to contain information--
                    (A) on obtaining health insurance coverage through 
                an Exchange under the Patient Protection and Affordable 
                Care Act;
                    (B) on the possible availability of assistance 
                under such Act towards payment of the premiums and 
                cost-sharing for such coverage; and
                    (C) on the improved benefits for coverage through 
                an Exchange, compared to health insurance coverage not 
                offered through an Exchange;
            (2) fails to be transparent by inappropriately steering 
        individuals to more expensive plans provided by the cancelling 
        issuer; or
            (3) fails to otherwise comply with requirements of law.
    (c) Reports.--
            (1) State commissioners to hhs.--Not later than March 31, 
        2014, each State insurance commissioner shall submit to the 
        Secretary of Health and Human Services a report on the 
        investigations and actions described in subsection (a).
            (2) HHS report to congress.--Not later than April 30, 2014, 
        the Secretary shall submit to Congress a report on such 
        investigations and actions.
    (d) Definitions of State, Health Insurance Coverage, and Individual 
Market.--In this section, the terms ``State'', ``health insurance 
coverage'', and ``individual market'' have the meanings given such 
terms for purposes of title I of the Patient Protection and Affordable 
Care Act.

SEC. 3. PROTECTION OF CONSUMERS FROM EXCESSIVE, UNJUSTIFIED, OR 
              UNFAIRLY DISCRIMINATORY RATES [FROM H.R. 1019].

    (a) Protection From Excessive, Unjustified, or Unfairly 
Discriminatory Rates.--The first section 2794 of the Public Health 
Service Act (42 U.S.C. 300gg-94), as added by section 1003 of the 
Patient Protection and Affordable Care Act (Public Law 111-148), is 
amended by adding at the end the following new subsection:
    ``(e) Protection From Excessive, Unjustified, or Unfairly 
Discriminatory Rates.--
            ``(1) Authority of states.--Nothing in this section shall 
        be construed to prohibit a State from imposing requirements 
        (including requirements relating to rate review standards and 
        procedures and information reporting) on health insurance 
        issuers with respect to rates that are in addition to the 
        requirements of this section and are more protective of 
        consumers than such requirements.
            ``(2) Consultation in rate review process.--In carrying out 
        this section, the Secretary shall consult with the National 
        Association of Insurance Commissioners and consumer groups.
            ``(3) Determination of who conducts reviews for each 
        state.--The Secretary shall determine, after the date of 
        enactment of this section and periodically thereafter, the 
        following:
                    ``(A) In which markets in each State the State 
                insurance commissioner or relevant State regulator 
                shall undertake the corrective actions under paragraph 
                (4), as a condition of the State receiving the grant in 
                subsection (c), based on the Secretary's determination 
                that the State regulator is adequately undertaking and 
                utilizing such actions in that market.
                    ``(B) In which markets in each State the Secretary 
                shall undertake the corrective actions under paragraph 
                (4), in cooperation with the relevant State insurance 
                commissioner or State regulator, based on the 
                Secretary's determination that the State is not 
                adequately undertaking and utilizing such actions in 
                that market.
            ``(4) Corrective action for excessive, unjustified, or 
        unfairly discriminatory rates.--In accordance with the process 
        established under this section, the Secretary or the relevant 
        State insurance commissioner or State regulator shall take 
        corrective actions to ensure that any excessive, unjustified, 
        or unfairly discriminatory rates are corrected prior to 
        implementation, or as soon as possible thereafter, through 
        mechanisms such as--
                    ``(A) denying rates;
                    ``(B) modifying rates; or
                    ``(C) requiring rebates to consumers.
            ``(5) Noncompliance.--Failure to comply with any corrective 
        action taken by the Secretary under this subsection may result 
        in the application of civil monetary penalties and, if the 
        Secretary determines appropriate, make the plan involved 
        ineligible for classification as a Qualified Health Plan.''.
    (b) Clarification of Regulatory Authority.--Such section is further 
amended--
            (1) in subsection (a)--
                    (A) in the heading, by striking ``Premium'' and 
                inserting ``Rate'';
                    (B) in paragraph (1), by striking ``unreasonable 
                increases in premiums'' and inserting ``potentially 
                excessive, unjustified, or unfairly discriminatory 
                rates, including premiums,''; and
                    (C) in paragraph (2)--
                            (i) by striking ``an unreasonable premium 
                        increase'' and inserting ``a potentially 
                        excessive, unjustified, or unfairly 
                        discriminatory rate'';
                            (ii) by striking ``the increase'' and 
                        inserting ``the rate''; and
                            (iii) by striking ``such increases'' and 
                        inserting ``such rates'';
            (2) in subsection (b)--
                    (A) by striking ``premium increases'' each place it 
                appears and inserting ``rates''; and
                    (B) in paragraph (2)(B), by striking ``premium'' 
                and inserting ``rate''; and
            (3) in subsection (c)(1)--
                    (A) in the heading, by striking ``Premium'' and 
                inserting ``Rate'';
                    (B) by inserting ``that satisfy the condition under 
                subsection (e)(3)(A)'' after ``award grants to 
                States''; and
                    (C) in subparagraph (A), by striking ``premium 
                increases'' and inserting ``rates''.
    (c) Conforming Amendment.--Title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg et seq.) is amended--
            (1) in section 2723 (42 U.S.C. 300gg-22), as redesignated 
        by the Patient Protection and Affordable Care Act--
                    (A) in subsection (a)--
                            (i) in paragraph (1), by inserting ``and 
                        section 2794'' after ``this part''; and
                            (ii) in paragraph (2), by inserting ``or 
                        section 2794'' after ``this part''; and
                    (B) in subsection (b)--
                            (i) in paragraph (1), by inserting ``and 
                        section 2794'' after ``this part''; and
                            (ii) in paragraph (2)--
                                    (I) in subparagraph (A), by 
                                inserting ``or section 2794 that is'' 
                                after ``this part''; and
                                    (II) in subparagraph (C)(ii), by 
                                inserting ``or section 2794'' after 
                                ``this part''; and
            (2) in section 2761 (42 U.S.C. 300gg-61)--
                    (A) in subsection (a)--
                            (i) in paragraph (1), by inserting ``and 
                        section 2794'' after ``this part''; and
                            (ii) in paragraph (2)--
                                    (I) by inserting ``or section 
                                2794'' after ``set forth in this 
                                part''; and
                                    (II) by inserting ``and section 
                                2794'' after ``the requirements of this 
                                part''; and
                    (B) in subsection (b)--
                            (i) by inserting ``and section 2794'' after 
                        ``this part''; and
                            (ii) by inserting ``and section 2794'' 
                        after ``part A''.
    (d) Applicability to Grandfathered Plans.--Section 1251(a)(4)(A) of 
the Patient Protection and Affordable Care Act (Public Law 111-148), as 
added by section 2301 of the Health Care and Education Reconciliation 
Act of 2010 (Public Law 111-152), is amended by adding at the end the 
following:
                            ``(v) Section 2794 (relating to 
                        reasonableness of rates with respect to health 
                        insurance coverage).''.
    (e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary.
    (f) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act and shall be implemented 
with respect to health plans beginning not later than January 1, 2014.
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