[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.
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