[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6265 Introduced in House (IH)]

<DOC>






114th CONGRESS
  2d Session
                                H. R. 6265

To amend title XVIII of the Social Security Act to provide for certain 
    reforms with respect to medicare supplemental health insurance 
                               policies.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 28, 2016

Mr. McDermott (for himself, Mr. Levin, and Mr. Conyers) introduced the 
following bill; which was referred to the Committee on Ways and Means, 
 and in addition to the Committee on Energy and Commerce, for a period 
    to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide for certain 
    reforms with respect to medicare supplemental health insurance 
                               policies.

    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 ``Medigap Consumer Protection Act of 
2016''.

SEC. 2. GUARANTEED ISSUE.

    (a) Guaranteed Issue of Medigap Policies to All Medigap-Eligible 
Medicare Beneficiaries.--
            (1) In general.--Section 1882(s) of the Social Security Act 
        (42 U.S.C. 1395ss(s)) is amended--
                    (A) in paragraph (2)(A), by striking ``65 years of 
                age or older and is enrolled for benefits under part 
                B'' and inserting ``entitled to, or enrolled for, 
                benefits under part A and enrolled for benefits under 
                part B'';
                    (B) in paragraph (2)(D), by striking ``who is 65 
                years of age or older as of the date of issuance and'';
                    (C) in paragraph (3)(B)(ii), by striking ``is 65 
                years of age or older and''; and
                    (D) in paragraph (3)(B)(vi), by striking ``at age 
                65''.
            (2) Effective date; phase-in authority.--
                    (A) Effective date.--Subject to subparagraph (B), 
                the amendments made by paragraph (1) shall apply to 
                medicare supplemental policies effective on or after 
                January 1, 2020.
                    (B) Phase-in authority.--
                            (i) In general.--Subject to clause (ii), 
                        the Secretary of Health and Human Services may 
                        phase in the implementation of the amendments 
                        made under paragraph (1) (with such phase-in 
                        beginning on or after January 1, 2020) in such 
                        manner as the Secretary determines appropriate 
                        in order to minimize any adverse impact on 
                        individuals enrolled under a medicare 
                        supplemental policy.
                            (ii) Phase-in period may not exceed 5 
                        years.--The Secretary of Health and Human 
                        Services shall ensure that the amendments made 
                        by paragraph (1) are fully implemented by not 
                        later than January 1, 2025.
            (3) Additional enrollment period for certain individuals.--
                    (A) One-time enrollment period.--
                            (i) In general.--In the case of an 
                        individual described in subparagraph (B), the 
                        Secretary shall establish a one-time enrollment 
                        period during which such an individual may 
                        enroll in any medicare supplemental policy of 
                        the individual's choosing.
                            (ii) Period.--The enrollment period 
                        established under clause (i) shall begin on the 
                        date on which the phase-in period under 
                        paragraph (2) is completed and end 6 months 
                        after such date.
                    (B) Individual described.--An individual described 
                in this paragraph is an individual who--
                            (i) is entitled to hospital insurance 
                        benefits under part A under section 226(b) or 
                        section 226A of the Social Security Act (42 
                        U.S.C. 426(b); 426-1);
                            (ii) is enrolled for benefits under part B 
                        of such Act (42 U.S.C. 1395j et seq.); and
                            (iii) would not, but for the provisions of 
                        and amendments made by paragraphs (1) and (2), 
                        be eligible for the guaranteed issue of a 
                        medicare supplemental policy under paragraph 
                        (2) or (3) of section 1882(s) of such Act (42 
                        U.S.C. 1395ss(s)).
                    (C) Outreach plan.--
                            (i) In general.--The Secretary shall 
                        develop an outreach plan to notify individuals 
                        described in subparagraph (B) of the one-time 
                        enrollment period established under 
                        subparagraph (A).
                            (ii) Consultation.--In implementing the 
                        outreach plan developed under clause (i), the 
                        Secretary shall consult with consumer 
                        advocates, brokers, insurers, the National 
                        Association of Insurance Commissioners, and 
                        State Health Insurance Assistance Programs.
    (b) Guaranteed Issue of Medigap Policies for Medicare Advantage and 
Medicaid Enrollees; Treatment of Individuals With COBRA.--
            (1) In general.--Section 1882(s)(3) of the Social Security 
        Act (42 U.S.C. 1395ss(s)(3)), as amended by subsection (a), is 
        further amended--
                    (A) in subparagraph (B), by adding at the end the 
                following new clauses:
            ``(vii) The individual was enrolled in a Medicare Advantage 
        plan under part C for not less than 12 months and subsequently 
        disenrolled from such plan and elects to receive benefits under 
        this title through the original Medicare fee-for-service 
        program under parts A and B.
            ``(viii) The individual--
                    ``(I) is entitled to, or enrolled for, benefits 
                under part A and enrolled for benefits under part B; 
                and
                    ``(II) either--
                            ``(aa) is eligible for medical assistance 
                        under a State plan or waiver under title XIX 
                        based on a reduction of income of the 
                        individual based on costs incurred for medical 
                        or other remedial care and was enrolled in such 
                        plan or waiver; or
                            ``(bb) was otherwise eligible for medical 
                        assistance under a State plan or waiver under 
                        title XIX and subsequently lost eligibility for 
                        such medical assistance.'';
                    (B) by striking subparagraph (C)(iii) and inserting 
                the following:
            ``(iii) Subject to subsection (v)(1), for purposes of an 
        individual described in clause (vi), (vii), or (viii) of 
        subparagraph (B), a medicare supplemental policy described in 
        this subparagraph shall include any medicare supplemental 
        policy.''; and
                    (C) in subparagraph (E)--
                            (i) in clause (iv), by striking ``and'' at 
                        the end;
                            (ii) in clause (v), by striking the period 
                        at the end and inserting a semicolon; and
                            (iii) by adding at the end the following 
                        new clauses--
            ``(vi) in the case of an individual described in 
        subparagraph (B)(vii), the annual, coordinated election period 
        (as defined in section 1851(e)(3)(B)) or a continuous open 
        enrollment period (as defined in section 1851(e)(2)) during 
        which the individual disenrolls from a Medicare Advantage plan 
        under part C;
            ``(vii) in the case of an individual described in 
        subparagraph (B)(viii) who is eligible for medical assistance 
        under a State plan or waiver under title XIX for a reason 
        described in item (aa), such period as is specified by the 
        Secretary;
            ``(viii) in the case of an individual described in 
        subparagraph (B)(viii) who is eligible for medical assistance 
        under a State plan or waiver under title XIX for a reason 
        described in item (bb), the period beginning on the date that 
        the individual receives a notice of cessation of such 
        individual's eligibility for medical assistance under the State 
        plan or waiver under title XIX and ending on the date that is 
        four months after the individual receives such notice; and''.
            (2) Treatment of individuals with cobra.--
                    (A) In general.--Section 1882(s)(3) of the Social 
                Security Act (42 U.S.C. 1395ss(s)(3)), as amended by 
                subsection (a) and paragraph (1), is further amended--
                            (i) in subparagraph (B)(i) by inserting 
                        ``or, in the case of an individual enrolled in 
                        such an employee welfare benefit plan pursuant 
                        to a COBRA continuation provision (as defined 
                        in section 2791(d)(4) of the Public Health 
                        Service Act), that the individual disenrolls 
                        from such plan and enrolls under part B'' 
                        before the period at the end; and
                            (ii) in subparagraph (E), as amended by 
                        paragraph (1), by adding at the end the 
                        following new clause:
            ``(viii) in the case of an individual described in 
        subparagraph (B)(i) who enrolled in an employee welfare benefit 
        plan described in such subparagraph pursuant to a COBRA 
        continuation provision (as defined in section 2791(d)(4) of the 
        Public Health Service Act) and who disenrolls from such plan 
        and enrolls under part B, the period beginning on 60 days 
        before the effective date of such disenrollment and ending on 
        the date that is 63 days after such effective date.''.
                    (B) Technical correction.--Section 1882(s)(2)(D) of 
                the Social Security Act (42 U.S.C. 1395ss(s)(2)(D)) is 
                amended--
                            (i) by striking ``2701(c)'' and inserting 
                        ``2704(c)''; and
                            (ii) by striking ``2701(a)(3)'' and 
                        inserting ``2704(a)(3)''.
            (3) Effective date.--The amendments made by paragraphs (1) 
        and (2)(A) shall apply to medicare supplemental policies 
        effective on or after January 1, 2020.

SEC. 3. MEDICAL LOSS RATIO.

    Section 1882(r)(1)(A) of the Social Security Act (42 U.S.C. 
1395ss(r)(1)(A)) is amended--
            (1) by inserting ``and periodically reviewed'' after 
        ``developed'';
            (2) by striking ``policy, at least 75 percent of the 
        aggregate amount of premiums collected in the case of group 
        policies and at least 65 percent in the case of individual 
        policies; and'' and inserting the following: ``policy--
                    ``(i) with respect to periods beginning before 
                January 1, 2020, at least 75 percent of the aggregate 
                amount of premiums collected in the case of group 
                policies and at least 65 percent in the case of 
                individual policies; and
                    ``(ii) with respect to periods beginning on or 
                after January 1, 2020, a percent of the aggregate 
                amount of premiums collected that, in the case of group 
                policies or individual policies, as applicable, is 
                equal to or greater than both--
                            ``(I) the applicable percent specified in 
                        clause (i) with respect to such policies; and
                            ``(II) such percent as the National 
                        Association of Insurance Commissioners may 
                        recommend to the Secretary with respect to such 
                        policies for purposes of this paragraph; and''.

SEC. 4. LIMITATIONS ON PRICING DISCRIMINATION.

    (a) In General.--Section 1882 of the Social Security Act (42 U.S.C. 
1395ss), as amended by section 6, is further amended by adding at the 
end the following new subsection:
    ``(aa) Development of New Standards Relating to Pricing 
Discrimination.--
            ``(1) In general.--The Secretary shall request the National 
        Association of Insurance Commissioners to review and revise the 
        standards for all benefit packages under subsection (p)(1), 
        including the core benefit package, in order to provide 
        coverage consistent with paragraph (2). Such revisions shall be 
        made consistent with the rules applicable under subsection 
        (p)(1)(E) (with the reference to the `1991 NAIC Model 
        Regulation' deemed a reference to the NAIC Model Regulation as 
        most recently updated by the National Association of Insurance 
        Commissioners to reflect previous changes in law and the 
        reference to `date of enactment of this subsection' deemed a 
        reference to the date of enactment of this subsection).
            ``(2) Changes in cost-sharing described.--Under the revised 
        standards, coverage shall not be available under a Medicare 
        supplemental insurance policy unless the issuer of the policy, 
        in addition to conforming to the other applicable requirements 
        of this section--
                    ``(A) does not discriminate in the pricing of the 
                policy because of the age of the individual to whom the 
                policy is issued;
                    ``(B) does not, to an extent that jeopardizes the 
                access to such policy for individuals who are eligible 
                to participate in the program under this title because 
                the individuals are individuals described in paragraph 
                (2) or (3) of section 1811, discriminate in the pricing 
                of the policy because the individual to whom the policy 
                is issued is so eligible to participate in such program 
                because the individual is an individual so described in 
                such a paragraph; and
                    ``(C) does not establish premiums applicable under 
                such policy on a basis that would apply to a portion 
                of, but not the entirety of, a county or equivalent 
                area specified by the Secretary.
            ``(3) Application date.--The revised standards shall apply 
        to benefit packages sold, issued, or renewed under this section 
        to individuals who first become entitled to benefits under part 
        A or first enrolls in part B on or after January 1, 2020.''.
    (b) Conforming Amendment.--Section 1882(o)(1) of such Act (42 
U.S.C. 1395ss(o)(1)) is amended by striking ``, and (y)'' and inserting 
``(y), and (aa)''.

SEC. 5. CLARIFYING BENEFICIARY OPTIONS ON THE MEDICARE PLAN FINDER 
              WEBSITE.

    Section 1804 of the Social Security Act (42 U.S.C. 1395b-2) is 
amended by adding at the end the following new subsections:
    ``(d) In the case that the Secretary provides for a Medicare plan 
finder Internet website of the Centers for Medicare & Medicaid Services 
(or a successor website), the Secretary shall, with respect to such 
website and in accordance with subsection (f)--
            ``(1) make available on such website--
                    ``(A) access to provider networks in order to 
                provide to individuals entitled to benefits under part 
                A or enrolled under part B information to assist such 
                individuals in understanding the restrictions on 
                providers and potential costs entailed by their 
                decisions regarding enrollment under parts A and B, 
                under part C, and in medicare supplemental policies 
                under section 1882;
                    ``(B) a review of out-of-pocket expenditures, 
                including deductibles, copayments, coinsurance, monthly 
                premiums, and estimated annual out-of-pocket costs, 
                displayed overall and by components, based on the best 
                available information as determined by the Secretary; 
                and
                    ``(C) during the period prior to January 1, 2023, 
                information regarding the rules that, in each State, 
                pertain to guaranteed issue of medicare supplemental 
                health insurance policies prior to implementation of 
                the provisions of the Medigap Consumer Protection Act 
                of 2016 and, in the case that a State has no such rules 
                pertaining to guaranteed issue of such policies, clear 
                language explaining the implications of such lack of 
                rules for individuals with pre-existing conditions;
            ``(2) not later than January 1, 2018, and periodically 
        thereafter, perform a review of such website in order to ensure 
        that such website makes available to individuals entitled to 
        benefits under part A or enrolled under part B the information 
        that the Secretary determines is necessary for such individuals 
        to make informed choices regarding their options under the 
        program under this title; and
            ``(3) not later than 12 months after the last day of each 
        period for the request for information under subsection (e), 
        update such website, taking into consideration the information 
        collected pursuant to such subsection, to clarify the 
        presentation of consumer options for medicare supplemental 
        health insurance policy options, including by presenting such 
        information in a manner calculated to be understood by the 
        average consumer and in a manner that--
                    ``(A) improves consumer access to information 
                regarding the applicable premiums under such policy 
                options as of the date on which such website is so 
                updated;
                    ``(B) facilitates consumers' ability to compare and 
                sort policy options and premium information across plan 
                offerings in a given location;
                    ``(C) clarifies and explains differences in policy 
                value;
                    ``(D) rates and explains the financial stability of 
                issuers of such policies;
                    ``(E) provides data on the inflation rate of 
                different policies;
                    ``(F) provides information regarding the guaranteed 
                issue requirements that apply to medicare supplemental 
                health insurance policies under section 1882(s)(3); and
                    ``(G) includes such general information as is 
                determined by the Secretary to be necessary for 
                individuals entitled to benefits under part A or 
                enrolled under part B to understand costs under MA 
                plans available pursuant to part C and prescription 
                drug plans available pursuant to part D.
    ``(e) Not later than 6 months after the date of the enactment of 
this subsection and beginning on December 7 of each year thereafter, 
the Secretary of Health and Human Services shall provide an opportunity 
for public comment during which the Secretary requests information, 
including recommendations, from stakeholders regarding potential 
improvements to the presentation of medicare supplemental health 
insurance policy options under section 1882 on the Medicare plan finder 
Internet website of the Centers for Medicare & Medicaid Services (or a 
successor website).
    ``(f) With respect to any information that the Secretary makes 
available on the Medicare plan finder Internet website of the Centers 
for Medicare & Medicaid Services (or a successor website) pursuant to 
subsection (d), the Secretary shall, prior to making such information 
available--
            ``(1) provide, in consultation with the National 
        Association of Insurance Commissioners, an opportunity for 
        consumer testing of such information;
            ``(2) share the results of such consumer testing of such 
        information with interested stakeholders; and
            ``(3) provide a 60-day public comment period with respect 
        to such information.''.

SEC. 6. RESTORING ACCESS TO FIRST-DOLLAR MEDIGAP COVERAGE.

    Section 1882 of the Social Security Act (42 U.S.C. 1395ss) is 
amended by striking subsection (z).

SEC. 7. BROKER CONFLICTS OF INTEREST.

    Section 1128G of the Social Security Act (42 U.S.C. 1320a-7h) is 
amended--
            (1) in subsection (c)(1)(A), by striking ``2011,'' and 
        inserting ``2011 (or, with respect to information required to 
        be submitted under subsection (f)(1), not later than six months 
        after the date of the enactment of such subsection),''; and
            (2) by adding at the end the following new subsection:
    ``(f) Application to Medigap Insurance Brokers.--
            ``(1) In general.--Beginning not later than 12 months after 
        the date of enactment of this subsection, each issuer of a 
        medicare supplemental health insurance policy shall annually 
        submit to the Secretary a report regarding payments or other 
        transfers of value made during the previous year to agents, 
        brokers, and other third parties representing such policy. Each 
        such report shall include the following information, with 
        respect to such a payment or other transfer of value:
                    ``(A) The name of the recipient of the payment or 
                other transfer of value.
                    ``(B) The business address of the recipient.
                    ``(C) The amount of the payment or other transfer 
                of value.
                    ``(D) The dates on which the payment or transfer of 
                value was provided.
                    ``(E) A description of the form of the payment or 
                transfer of value.
                    ``(F) Any other categories of information the 
                Secretary determines appropriate.
            ``(2) Application of transparency system.--The provisions 
        of subsections (b) through (d) shall apply to an issuer 
        described in paragraph (1), information required to be reported 
        under such paragraph, and agents, brokers, and other third 
        parties described in such paragraph in the same manner and to 
        the same extent as such provisions apply to an applicable 
        manufacturer, information required to be reported under 
        subsection (a), and a covered recipient.''.
                                 <all>