111 HR 1890 IH: Health Insurance Consumer Protection Act
U.S. House of Representatives
2021-03-12
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.This Act may be cited as the Health Insurance Consumer Protection Act
.<enum>I</enum><header>No More Narrow Networks</header><section id="HA880D03EEB0142A7982DF3A082D2E669" section-type="subsequent-section"><enum>101.</enum><header>Short title</header><text display-inline="no-display-inline">This title may be cited as the <quote><short-title>No More Narrow Networks Act of 2021</short-title></quote>.</text></section><section id="H7CEDEFCAC81A49209463BBEE74839242"><enum>102.</enum><header>Requiring Exchanges to establish network adequacy standards for qualified health plans</header><subsection id="H4A2AC21C5FB24592A622B66CEA6176F6"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1311(d) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18031">42 U.S.C. 18031(d)</external-xref>) is amended by adding at the end the following new paragraph:</text><quoted-block style="OLC" id="H5C045DD6A8D14F449ACAB42D25F58C0C" display-inline="no-display-inline"><paragraph id="H854DC57D89C840FBACF66309CAE64E95"><enum>(8)</enum><header>Network adequacy standards</header><subparagraph id="HC72A3512944C4817BD6BC5DF926977CF"><enum>(A)</enum><header>Certain Exchanges</header><text display-inline="yes-display-inline">In the case of an Exchange operated by the Secretary pursuant section 1321(c)(1) or an Exchange described in section 155.200(f) of title 42, Code of Federal Regulations (or a successor regulation), the Exchange shall require each qualified health plan offered through such Exchange to meet such quantitative network adequacy standards as the Secretary may prescribe for purposes of this subparagraph.</text></subparagraph><subparagraph id="H131B7D5CF8234F129E507E409C15280F"><enum>(B)</enum><header>State Exchanges</header><text>In the case of an Exchange not described in subparagraph (A), the Exchange shall establish quantitative network adequacy standards with respect to qualified health plans offered through such Exchange and require such plans to meet such standards.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="HA50217B4EE1F4F248EED913858AF1E3B"><enum>(b)</enum><header>Effective date</header><text display-inline="yes-display-inline">The amendment made by this section shall apply with respect to plan years beginning on or after January 1, 2023. </text></subsection></section><enum>II</enum><header>Protecting Consumers from Unreasonable Rates</header><section id="H03588C5738DB446F91514575F6D0A112" section-type="subsequent-section"><enum>201.</enum><header>Short title</header><text display-inline="no-display-inline">This title may be cited as the <quote><short-title>Protecting Consumers from Unreasonable Rates Act</short-title></quote>.</text></section><section id="H31F8A2FBCBC64965851735C656857BC0" section-type="subsequent-section"><enum>202.</enum><header>Protection of consumers from excessive, unjustified, or unfairly discriminatory rates</header><subsection id="HC93BCEF02DA649C8B6769F820B6C7127"><enum>(a)</enum><header>Protection from excessive, unjustified, or unfairly discriminatory rates</header><text display-inline="yes-display-inline">The first section 2794 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg-94">42 U.S.C. 300gg–94</external-xref>), as added by section 1003 of the Patient Protection and Affordable Care Act (<external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>), is amended by adding at the end the following new subsection:</text><quoted-block display-inline="no-display-inline" id="H0AED28953F4B48C2B37F5E437C5B2DE3" style="OLC"><subsection id="HBF09C9FBB85747B58C4760982570F32B"><enum>(e)</enum><header>Protection from excessive, unjustified, or unfairly discriminatory rates</header><paragraph commented="no" id="HD986EF93B3F449ADB6FFF05548B1E102"><enum>(1)</enum><header>Authority of States</header><text display-inline="yes-display-inline">Nothing in this section shall be construed to prohibit a State from imposing requirements (including requirements relating to rate review standards and procedures and information reporting) on health insurance issuers with respect to rates that are in addition to the requirements of this section and are more protective of consumers than such requirements.</text></paragraph><paragraph commented="no" id="H95776C705FD34EE4AC139487E00FDA51"><enum>(2)</enum><header>Consultation in rate review process</header><text display-inline="yes-display-inline">In carrying out this section, the Secretary shall consult with the National Association of Insurance Commissioners and consumer groups.</text></paragraph><paragraph commented="no" id="H59F31EF874514350B1B25DAFBEA6D87B"><enum>(3)</enum><header>Determination of who conducts reviews for each State</header><text display-inline="yes-display-inline">The Secretary shall determine, after the date of enactment of this section and periodically thereafter, the following:</text><subparagraph commented="no" id="HBAAF1EC77E7049388C4E3692CF470431"><enum>(A)</enum><text display-inline="yes-display-inline">In which markets in each State the State insurance commissioner or relevant State regulator shall undertake the corrective actions under <internal-xref idref="H229CF881100A47828F55D30419B159D2" legis-path="(e)(4)">paragraph (4)</internal-xref>, based on the Secretary’s determination that the State regulator is adequately undertaking and utilizing such actions in that market.</text></subparagraph><subparagraph commented="no" id="HE1B401851A624587820639EDF7B6E6A8"><enum>(B)</enum><text display-inline="yes-display-inline">In which markets in each State the Secretary shall undertake the corrective actions under <internal-xref idref="H229CF881100A47828F55D30419B159D2" legis-path="(e)(4)">paragraph (4)</internal-xref>, in cooperation with the relevant State insurance commissioner or State regulator, based on the Secretary’s determination that the State is not adequately undertaking and utilizing such actions in that market.</text></subparagraph></paragraph><paragraph id="H229CF881100A47828F55D30419B159D2"><enum>(4)</enum><header>Corrective action for excessive, unjustified, or unfairly discriminatory rates</header><text display-inline="yes-display-inline">In accordance with the process established under this section, the Secretary or the relevant State insurance commissioner or State regulator shall take corrective actions to ensure that any excessive, unjustified, or unfairly discriminatory rates are corrected prior to implementation, or as soon as possible thereafter, through mechanisms such as—</text><subparagraph id="HFCDC6437B7154ABCA95A2305F4AC03EC"><enum>(A)</enum><text>denying rates;</text></subparagraph><subparagraph id="H5DBC71FE372747BEA52F9F51A70F850B"><enum>(B)</enum><text display-inline="yes-display-inline">modifying rates; or</text></subparagraph><subparagraph id="HD94E11DC5CB445E4971F1F4D3A371FD3"><enum>(C)</enum><text>requiring rebates to consumers.</text></subparagraph></paragraph><paragraph id="H9937928A99C149988E464822981F552C"><enum>(5)</enum><header>Noncompliance</header><text>Failure to comply with any corrective action taken by the Secretary under this subsection may result in the application of civil monetary penalties under section 2723 and, if the Secretary determines appropriate, make the plan involved ineligible for classification as a qualified health plan.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H9E2A549B8A2044F79E1E3A81754151EF"><enum>(b)</enum><header>Clarification of Regulatory Authority</header><text display-inline="yes-display-inline">Such section is further amended—</text><paragraph id="HDBAF08DB3999433FAA3E890190DDCB06"><enum>(1)</enum><text>in subsection (a)—</text><subparagraph id="HEA682B42C5F64D189761CCE6A9D6A520"><enum>(A)</enum><text>in the heading, by striking <quote><header-in-text level="subsection" style="OLC">premium</header-in-text></quote> and inserting <quote><header-in-text level="subsection" style="OLC">rate</header-in-text></quote>;</text></subparagraph><subparagraph id="H9FE6B764CE834F948AF7A84B9090D8FF"><enum>(B)</enum><text>in paragraph (1), by striking <quote>unreasonable increases in premiums</quote> and inserting <quote>potentially excessive, unjustified, or unfairly discriminatory rates, including premiums,</quote>; and</text></subparagraph><subparagraph id="H582C1FD4FE5E4E14BB9436C80D2B8921"><enum>(C)</enum><text>in paragraph (2)—</text><clause id="H2CB4302675F14C2D886FACB2422B16D7"><enum>(i)</enum><text>by striking <quote>an unreasonable premium increase</quote> and inserting <quote>a potentially excessive, unjustified, or unfairly discriminatory rate</quote>;</text></clause><clause id="HAFC737BFBF964D659CE9587DBC724376"><enum>(ii)</enum><text>by striking <quote>the increase</quote> and inserting <quote>the rate</quote>; and</text></clause><clause id="H6F50C55917594CAE9DD7C4865346B93E"><enum>(iii)</enum><text>by striking <quote>such increases</quote> and inserting <quote>such rates</quote>; and</text></clause></subparagraph></paragraph><paragraph id="HE9D87BC8DE784C73B10C4647176CE122"><enum>(2)</enum><text>in subsection (b)—</text><subparagraph id="HA21F1B6C47E04A55865572E345B83AAA"><enum>(A)</enum><text>by striking <quote>premium increases</quote> each place it appears and inserting <quote>rates</quote>; and</text></subparagraph><subparagraph id="HE47235DD180649DF89E44E33A7040A95"><enum>(B)</enum><text>in paragraph (2)(B), by striking <quote>premium</quote> and inserting <quote>rate</quote>.</text></subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H52C6AF13720E4F97AE6D87709B9B8534"><enum>(c)</enum><header>Conforming amendments</header><text>Title XXVII of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg">42 U.S.C. 300gg</external-xref> et seq.) is amended—</text><paragraph commented="no" id="H3504892D0B73437F998508A39E778596"><enum>(1)</enum><text display-inline="yes-display-inline">in section 2723 (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg-22">42 U.S.C. 300gg–22</external-xref>)—</text><subparagraph commented="no" id="H39BA1684729D4EF5B18FD9D66C521057"><enum>(A)</enum><text>in subsection (a)—</text><clause commented="no" id="HB693A64D59BE443599BD169B42BF9BCA"><enum>(i)</enum><text>in paragraph (1), by inserting <quote>, section 2794,</quote> after <quote>this part</quote>; and</text></clause><clause commented="no" id="H727F4C31F40D47E48800CE19A7435281"><enum>(ii)</enum><text>in paragraph (2), by inserting <quote>, section 2794,</quote> after <quote>this part</quote>; and</text></clause></subparagraph><subparagraph commented="no" id="H50CEAEE7FE1F4DB0B597DD2C07E8A5C8"><enum>(B)</enum><text>in subsection (b)—</text><clause commented="no" id="H748AEA7C460E4410A2DF3B07831F72A6"><enum>(i)</enum><text>in paragraph (1), by inserting <quote>, section 2794,</quote> after <quote>this part</quote>; and</text></clause><clause commented="no" id="H748D60EE5D12488B87227F832A814915"><enum>(ii)</enum><text>in paragraph (2)—</text><subclause id="HC2531BC3ABF749CEAF4F10967BBB96A4"><enum>(I)</enum><text>in subparagraph (A), by inserting <quote>, section 2794,</quote> after <quote>this part</quote>; and</text></subclause><subclause id="HF26AF1D1E1E24D9AA556AC91CA8C1EFE"><enum>(II)</enum><text display-inline="yes-display-inline">in subparagraph (C)(ii), by inserting <quote>, section 2794,</quote> after <quote>this part</quote>; and</text></subclause></clause></subparagraph></paragraph><paragraph commented="no" id="HCCF1B57795DD45DFBDBC934272DC7244"><enum>(2)</enum><text display-inline="yes-display-inline">in section 2761 (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg-61">42 U.S.C. 300gg–61</external-xref>)—</text><subparagraph id="H0BB67493344B434085032C292D9447BD"><enum>(A)</enum><text>in subsection (a)—</text><clause id="HD3854544E9E0405CAEE25A2BF5789E77"><enum>(i)</enum><text>in paragraph (1), by inserting <quote>and section 2794</quote> after <quote>this part</quote>; and</text></clause><clause id="H5D125D385D6E415AAFC644F34B8EFB36"><enum>(ii)</enum><text>in paragraph (2)—</text><subclause id="H66444A09D9224EA6920DD10AB1E84997"><enum>(I)</enum><text>by inserting <quote>or section 2794</quote> after <quote>set forth in this part</quote>; and</text></subclause><subclause id="H92964A545B1A42899974198836148837"><enum>(II)</enum><text>by inserting <quote>and section 2794</quote> after <quote>the requirements of this part</quote>; and</text></subclause></clause></subparagraph><subparagraph id="HBA7D722E7B2E43749D8C634065B5ACF2"><enum>(B)</enum><text>in subsection (b)—</text><clause id="HF40299F44EC04AC1A437888264E9B7A4"><enum>(i)</enum><text>by inserting <quote>and section 2794</quote> after <quote>this part</quote>; and</text></clause><clause id="H04A17D87BEC5484F8F704DD3DAB7B9D3"><enum>(ii)</enum><text>by inserting <quote>and section 2794</quote> after <quote>part A</quote>.</text></clause></subparagraph></paragraph></subsection><subsection commented="no" id="H696FFC3D69124FD3BEE90BB976871204"><enum>(d)</enum><header>Applicability to grandfathered plans</header><text>Section 1251(a)(4)(A) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>), as added by section 2301 of the Health Care and Education Reconciliation Act of 2010 (<external-xref legal-doc="public-law" parsable-cite="pl/111/152">Public Law 111–152</external-xref>), is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="H17FFED68A80449CAAA48BD2319F76543" style="OLC"><clause commented="no" id="H12F9144A3CE04F2D9DE8E46BFE6A4E07"><enum>(v)</enum><text display-inline="yes-display-inline">Section 2794 (relating to reasonableness of rates with respect to health insurance coverage).</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection commented="no" id="H769695F775AA4F29A9CEDAABDF4BB105"><enum>(e)</enum><header>Authorization of appropriations</header><text>There are authorized to be appropriated to carry out this Act, such sums as may be necessary.</text></subsection><subsection commented="no" display-inline="no-display-inline" id="H09A930C5B7D944048662B5796C403304"><enum>(f)</enum><header>Effective date</header><text>The amendments made by this section shall take effect on the date of enactment of this Act and shall be implemented with respect to health plans beginning not later than January 1, 2023.</text></subsection></section>