[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5589 Introduced in House (IH)]

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114th CONGRESS
  2d Session
                                H. R. 5589

 To amend title I of the Patient Protection and Affordable Care Act to 
  require verification for eligibility for enrollment during special 
  enrollment periods in PPACA insurance plans, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 28, 2016

Mrs. Blackburn introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend title I of the Patient Protection and Affordable Care Act to 
  require verification for eligibility for enrollment during special 
  enrollment periods in PPACA insurance plans, 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 ``Plan Verification and Fairness Act 
of 2016''.

SEC. 2. REQUIRING VERIFICATION FOR ELIGIBILITY FOR ENROLLMENT DURING 
              SPECIAL ENROLLMENT PERIODS IN PPACA INSURANCE PLANS.

    (a) In General.--Section 1311(c) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18031(c)) is amended by adding at the 
end the following new paragraph:
            ``(7) Verification requirement for special enrollment 
        periods.--
                    ``(A) In general.--The Secretary shall provide 
                that, in the case of a special enrollment period 
                provided for under paragraph (6)(C) that is with 
                respect to a plan year that begins on or after January 
                1, 2017, qualified health plans offered through an 
                Exchange may not make coverage effective with respect 
                to an individual enrolling during such period until the 
                Exchange verifies, through an approved verification 
                process described in subparagraph (B), that the 
                individual, with respect to such Exchange, is a 
                qualified individual who is eligible to enroll during 
                such period.
                    ``(B) Approved verification process described.--For 
                purposes of subparagraph (A), an approved verification 
                process described in this subparagraph is a process 
                specified by the Secretary through interim final 
                rulemaking that requires an individual described in 
                subparagraph (A) seeking to enroll in a qualified 
                health plan described in such subparagraph to submit to 
                the Exchange such documents as the Secretary determines 
                are necessary in order for the Exchange to verify that 
                the individual, with respect to such Exchange, is a 
                qualified individual who is eligible to enroll during a 
                period described in such subparagraph. To the extent 
                practicable, such process shall be similar to the 
                review and assessment process pertaining to special 
                enrollment periods described at 81 Fed. Reg. 12274 in 
                the final rule entitled `Patient Protection and 
                Affordable Care Act; HHS Notice of Benefit and Payment 
                Parameters for 2017', published at 81 Fed. Reg. 12203 
                (March 8, 2016).''.
    (b) Study and Report.--
            (1) Study.--The Inspector General of the Department of 
        Health and Human Services shall conduct a study on enrollment 
        by individuals in qualified health plans (as defined in section 
        1301(a) of the Patient Protection and Affordable Care Act (42 
        U.S.C. 18021(a))) during special enrollment periods provided 
        for under section 1311(c)(6)(C) of such Act (42 U.S.C. 
        18031(c)(6)(C)) that are with respect to plan year 2015. Such 
        study shall include, with respect to each such period, an 
        identification of each of the following:
                    (A) The number of individuals who sought to enroll 
                in such a plan through an Exchange established under 
                such Act during such period but who were not allowed to 
                so enroll during such period.
                    (B) The number of such individuals who were not 
                allowed to so enroll through such an Exchange during 
                such period on account of each of the following:
                            (i) The individual did not provide to the 
                        Exchange documentation to demonstrate that the 
                        individual was, with respect to the Exchange, a 
                        qualified individual (as defined in section 
                        1312(f)(1) of such Act (42 U.S.C. 18032(f)(1))) 
                        who was eligible to enroll during such period.
                            (ii) Such documentation provided to the 
                        Exchange by the individual was invalid.
            (2) Report.--Not later than June 1, 2017, such Inspector 
        General shall submit to Congress a report on the findings of 
        the study conducted under paragraph (1).
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