[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4796 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 4796
To direct the Secretary of Health and Human Services to conduct
outreach efforts to provide certain health insurance information to
individuals enrolled in qualified health plans offered through an
Exchange established under title I of the Patient Protection and
Affordable Care Act or State plans under the Medicaid program under
title XIX of the Social Security Act, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 2, 2014
Ms. Jackson Lee (for herself, Ms. Clarke of New York, Ms. Brown of
Florida, Mr. Clay, Mr. Rangel, and Ms. Norton) introduced the following
bill; which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To direct the Secretary of Health and Human Services to conduct
outreach efforts to provide certain health insurance information to
individuals enrolled in qualified health plans offered through an
Exchange established under title I of the Patient Protection and
Affordable Care Act or State plans under the Medicaid program under
title XIX of the Social Security Act, 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 ``Keeping Well by Using Your Patient
Protection and Affordable Care Act Plan''.
SEC. 2. OUTREACH TO CERTAIN INDIVIDUALS ON CERTAIN HEALTH INSURANCE
INFORMATION.
(a) In General.--Beginning not later than 90 days after the date of
the enactment of this Act, the Secretary of Health and Human Services
shall conduct outreach efforts to provide, using the most effective
means (as determined by the Secretary), the health insurance
information described in subsection (b) to--
(1) individuals enrolled in qualified health plans offered
through an Exchange established under title I of the Patient
Protection and Affordable Care Act (Public Law 111-148); and
(2) individuals enrolled in State plans (or under a waiver
of such a plan) under the Medicaid program under title XIX of
the Social Security Act.
(b) Information Described.--For purposes of subsection (a), the
information described in this subsection is any information, the
availability of which the Secretary of Health and Human Services
determines will encourage the utilization of primary care or preventive
services by the individuals described in such subsection, including the
following:
(1) Information on the extent to which the essential health
benefits specified in section 1302(b)(1) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18022(b)(1)) are
provided by a plan described in subsection (a).
(2) Information on which preventive health services are
covered under such a plan without the application of any cost-
sharing (such as a copayment or coinsurance), including
screenings for certain conditions such as diabetes and high
blood pressure, vaccinations for adults against influenza,
measles, mumps, rubella, and other infectious diseases, and
well-woman visits.
(3) With respect to qualified health plans described in
subsection (a)(1), the following information presented in a
manner that allows for comparison of plans within each State:
(A) Information on the rates of reimbursement
recognized under each such qualified health plan with
respect to items and services (as specified by the
Secretary) that are furnished to individuals enrolled
in such plan by health care providers participating in
the network of the plan, such as rates of reimbursement
applicable to emergency care services, laboratory
tests, diagnostic tests, and physician services.
(B) Information on any cost-sharing required under
each such plan with respect to such items and services
furnished to such individuals by such providers and an
explanation on the extent to which such cost-sharing is
based on such recognized rates of reimbursement.
(C) A statement that--
(i) the rates of reimbursement that are
collectable by health care providers not
participating in the network of such a plan for
furnishing such items and services to such
individuals may be more than the rates of
reimbursement recognized under such plan for
such items and services furnished to such
individuals by health care providers
participating in the network of such plan; and
(ii) any cost-sharing required under such a
plan with respect to such items and services
furnished to such individuals by health care
providers not participating in the network of
such plan may be more than such cost-sharing
with respect to such items and services
furnished to such individuals by health care
providers participating in the network of such
plan.
(4) An explanation of basic health insurance terms (as
determined by the Secretary), including deductibles, cost-
sharing, copayment, and coinsurance, and the application of
such terms to an individual enrolled in a plan described in
subsection (a), illustrated with examples of the application of
such terms with respect to such individuals under different
circumstances and in different health care settings.
(c) Report on Out-of-Pocket Costs.--Not later than 180 days after
the date of the enactment of this Act, with respect to the most recent
plan year for which information is available, the Secretary of Health
and Human Services shall submit to the Committee on Energy and Commerce
of the House of Representatives and the Committee on Health, Education,
Labor, and Pensions of the Senate a report that--
(1) contains information, for each State (including the
District of Columbia), on the median cost-sharing
responsibility, with respect to qualified health plans offered
through an Exchange in such State, of health care services--
(A) the number of which and types of which are
determined appropriate by the Secretary to be included
in the report; and
(B) that have been identified by the Secretary as
services--
(i) for which, with respect to such plan
year, payment may only be made under such a
plan after satisfaction of the deductible
applicable under such plan; and
(ii) for which reimbursement under such
plan is made most frequently during such plan
year; and
(2) describes the best method for making the information
referred to in paragraph (1) available to the public.
<all>