[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 97 Introduced in Senate (IS)]
114th CONGRESS
1st Session
S. 97
To clarify that the anti-kickback laws apply to qualified health plans,
the federally-facilitated marketplaces, and other plans and programs
under title I of the Patient Protection and Affordable Care Act, and
for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
January 7, 2015
Mr. Vitter introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To clarify that the anti-kickback laws apply to qualified health plans,
the federally-facilitated marketplaces, and other plans and programs
under title I of the Patient Protection and Affordable Care 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 ``No Obamacare Kickbacks Act of
2015''.
SEC. 2. FINDINGS.
The Congress finds the following:
(1) Section 6402(f) of the Patient Protection and
Affordable Care Act (Public Law 111-148) applies the civil
penalties and damages for violations of the False Claims Act to
kickbacks and other acts involving Federal health care programs
that are subject to criminal penalties under section 1128B of
the Social Security Act (42 U.S.C. 1320a-7b).
(2) In guidance issued on November 4, 2013, by the Center
for Consumer Information & Insurance Oversight (CCIIO) of the
Centers for Medicare & Medicaid Services, the CCIIO stated that
the ``Department of Health and Human Services (HHS) has broad
authority to regulate the Federal and State Marketplaces (e.g.
section 1321(a) of the Affordable Care Act)''. The November 4,
2013 statement from the CCIIO suggests that qualified health
plans and other health care plans and programs established
under title I of the Patient Protection and Affordable Care Act
are similar to other Federal health care programs, such as the
Medicare Advantage program, over which the Secretary of Health
and Human Services also has broad regulatory authority.
(3) The private health insurance issuers who offer
qualified health plans through marketplaces established under
the Patient Protection and Affordable Care Act and the private
health insurance issuers that offer Medicare Advantage plans
under the Medicare program both receive Federal dollars
directly from the Federal Government, with the issuers of
qualified health plans receiving Federal dollars through tax
credit subsidies and the issuers of Medicare Advantage plans
receiving payments from the Medicare Trust Funds.
(4) The Federal Government facilitates applications for and
enrollment in qualified health plans through the federally-
facilitated marketplaces and State exchanges in a similar
manner to the way the Federal Government facilitates
applications for and enrollment in plans under the Medicare
Advantage program and the Voluntary Prescription Drug Benefit
Program through federally funded call centers, web portals, and
consumer assistance personnel.
(5) The Medicare Advantage program is a Federal health care
program to which the anti-kickback provisions of section
1128B(b) of the Social Security Act and other prohibited acts
involving Federal health care programs are subject to civil and
criminal penalties under the Social Security Act as well as
civil penalties under the False Claims Act.
SEC. 3. CLARIFICATION OF APPLICATION OF ANTI-KICKBACK LAWS TO QUALIFIED
HEALTH PLANS, MARKETPLACES, AND OTHER PLANS AND PROGRAMS
UNDER PPACA.
(a) In General.--Section 1128B(f)(1) of the Social Security Act (42
U.S.C. 1320a-7b(f)(1)) is amended by inserting before the semicolon the
following: ``, including any plan or program established or funded
under subtitle D or E (or the amendments made by such subtitles) of
title I of the Patient Protection and Affordable Care Act (including
the federally-facilitated marketplaces and State Exchanges, patient
navigators, and related programs established by such Act, as well as
any contract with an individual or entity hired by the Federal
Government to facilitate enrollment in the federally-facilitated
marketplaces)''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect as if included in the enactment of the Patient Protection
and Affordable Care Act.
SEC. 4. HHS OIG AND GAO JOINT STUDY AND REPORT.
(a) Study.--The Inspector General of the Department of Health and
Human Services and the Comptroller General of the United States shall
jointly conduct a study regarding the effect of applying the anti-
kickback laws and other prohibited acts involving Federal health care
programs to qualified health plans, federally-facilitated marketplaces
and State Exchanges, and any other plan or program established or
funded under subtitle D or E (or the amendments made by such subtitles)
of title I of the Patient Protection and Affordable Care Act. In
conducting the study, the Inspector General and Comptroller General
shall--
(1) identify all plans and programs that satisfy the
definition of ``Federal health care program'' under section
1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)) (as
amended by section 3(a));
(2) identify any entity or individual that would benefit
from having qualified health plans, federally-facilitated
marketplaces, and any other plan or program established or
funded under subtitle D or E (or the amendments made by such
subtitles) of title I of the Patient Protection and Affordable
Care Act excluded from the definition of ``Federal health care
program'' under section 1128B(f) of the Social Security Act (as
so amended); and
(3) separately estimate with respect to each of the
following, the impact of excluding qualified health plans,
federally-facilitated marketplaces and State Exchanges, and any
other plan or program established or funded under subtitle D or
E (or the amendments made by such subtitles) of title I of the
Patient Protection and Affordable Care Act from the definition
of ``Federal health care program'' under section 1128B(f) of
the Social Security Act (as so amended):
(A) Health care premiums (with and without non-
federally funded subsidies).
(B) Consumer choice in health insurance coverage.
(C) The use of brand name versus generic drugs.
(D) The net cost of the Patient Protection and
Affordable Care Act to the Federal Government and to
all States and territories.
(b) Report.--Not later than 1 year after the date of enactment of
this Act, the Inspector General of the Department of Health and Human
Services and the Comptroller General of the United States shall jointly
submit a report to Congress on the results of the study conducted under
subsection (a) that includes the information specified in paragraphs
(1) through (3) of that subsection, together with such recommendations
for legislative or administrative action as the Inspector General and
Comptroller General determine appropriate.
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