[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4035 Reported in Senate (RS)]

<DOC>





                                                       Calendar No. 499
118th CONGRESS
  2d Session
                                S. 4035

                          [Report No. 118-220]

 To require the Director of the Office of Personnel Management to take 
 certain actions with respect to the health insurance program carried 
  out under chapter 89 of title 5, United States Code, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 21, 2024

   Mr. Scott of Florida (for himself and Mr. Carper) introduced the 
 following bill; which was read twice and referred to the Committee on 
               Homeland Security and Governmental Affairs

                           September 10, 2024

               Reported by Mr. Peters, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
 To require the Director of the Office of Personnel Management to take 
 certain actions with respect to the health insurance program carried 
  out under chapter 89 of title 5, United States Code, and for other 
                               purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``FEHB Protection 
Act''.</DELETED>

<DELETED>SEC. 2. FEHB IMPROVEMENTS.</DELETED>

<DELETED>    (a) Definitions.--In this section:</DELETED>
        <DELETED>    (1) Director.--The term ``Director'' means the 
        Director of the Office of Personnel Management.</DELETED>
        <DELETED>    (2) Employing office.--The term ``employing 
        office'' has the meaning given the term in section 890.101(a) 
        of title 5, Code of Federal Regulations, or any successor 
        regulation.</DELETED>
        <DELETED>    (3) Health benefits plan; member of family.--The 
        terms ``health benefits plan'' and ``member of family'' have 
        the meanings given those terms in section 8901 of title 5, 
        United States Code.</DELETED>
        <DELETED>    (4) Open season.--The term ``open season'' means 
        an open season described in section 890.301(f) of title 5, Code 
        of Federal Regulations, or any successor regulation.</DELETED>
        <DELETED>    (5) Program.--The term ``Program'' means the 
        health insurance program carried out under chapter 89 of title 
        5, United States Code, including the program carried out under 
        section 8903c of that title.</DELETED>
        <DELETED>    (6) Qualifying life event.--The term ``qualifying 
        life event'' has the meaning given the term in section 892.101 
        of title 5, Code of Federal Regulations, or any successor 
        regulation.</DELETED>
<DELETED>    (b) Verification Requirements.--Beginning on the date that 
is 180 days after the date of enactment of this Act, the Director shall 
require each employing office to verify--</DELETED>
        <DELETED>    (1) the veracity of any qualifying life event 
        through which an enrollee in the Program seeks to add a member 
        of family with respect to the enrollee to a health benefits 
        plan under the Program; and</DELETED>
        <DELETED>    (2) that, when an enrollee in the Program seeks to 
        add a member of family with respect to the enrollee to the 
        health benefits plan of the enrollee under the Program during 
        any open season, the individual so added is actually a member 
        of family with respect to the enrollee.</DELETED>
<DELETED>    (c) Fraud Risk Assessment.--In any fraud risk assessment 
conducted with respect to the Program on or after the date of enactment 
of this Act, the Director shall include an assessment of individuals 
who are enrolled in, or covered under, a health benefits plan under the 
Program even though those individuals are not eligible to be so 
enrolled or covered.</DELETED>
<DELETED>    (d) Family Member Eligibility Verification Audit.--
</DELETED>
        <DELETED>    (1) In general.--During the 5-year period 
        beginning on the date of enactment of this Act, the Director 
        shall conduct a comprehensive audit regarding members of 
        family--</DELETED>
                <DELETED>    (A) who are covered under an enrollment in 
                a health benefits plan under the Program; and</DELETED>
                <DELETED>    (B) with respect to whom the basis for the 
                eligibility for the coverage described in subparagraph 
                (A) has not been verified.</DELETED>
        <DELETED>    (2) Contents.--In conducting the audit required 
        under paragraph (1), the Director shall review marriage 
        certificates, birth certificates, and other appropriate 
        documents that are necessary to determine eligibility to enroll 
        in a health benefits plan under the Program.</DELETED>
<DELETED>    (e) Disenrollment or Removal.--Beginning on the date of 
enactment of this Act, the Director may disenroll or remove from 
enrollment any individual enrolled in, or covered under, a health 
benefits plan under the Program if the Director determines that such 
individual is not eligible to be so enrolled or covered.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``FEHB Protection Act''.

SEC. 2. FEHB IMPROVEMENTS.

    (a) Definitions.--In this section:
            (1) Appropriate committees of congress.--The term 
        ``appropriate committees of Congress'' means--
                    (A) the Committee on Homeland Security and 
                Governmental Affairs of the Senate;
                    (B) the Committee on Appropriations of the Senate;
                    (C) the Committee on Oversight and Accountability 
                of the House of Representatives; and
                    (D) the Committee on Appropriations of the House of 
                Representatives.
            (2) Director.--The term ``Director'' means the Director of 
        the Office of Personnel Management.
            (3) Employing office.--The term ``employing office'' has 
        the meaning given the term in section 890.101(a) of title 5, 
        Code of Federal Regulations, or any successor regulation.
            (4) Health benefits plan; member of family.--The terms 
        ``health benefits plan'' and ``member of family'' have the 
        meanings given those terms in section 8901 of title 5, United 
        States Code.
            (5) Open season.--The term ``open season'' means an open 
        season described in section 890.301(f) of title 5, Code of 
        Federal Regulations, or any successor regulation.
            (6) Program.--The term ``Program'' means the health 
        insurance program carried out under chapter 89 of title 5, 
        United States Code, including the program carried out under 
        section 8903c of that title.
            (7) Qualifying life event.--The term ``qualifying life 
        event'' has the meaning given the term in section 892.101 of 
        title 5, Code of Federal Regulations, or any successor 
        regulation.
    (b) Verification Requirements.--Not later than 1 year after the 
date of enactment of this Act, the Director shall issue regulations and 
implement a process to require each employing office to verify--
            (1) the veracity of any qualifying life event through which 
        an enrollee in the Program seeks to add a member of family with 
        respect to the enrollee to a health benefits plan under the 
        Program; and
            (2) that, when an enrollee in the Program seeks to add a 
        member of family with respect to the enrollee to the health 
        benefits plan of the enrollee under the Program, including 
        during any open season, the individual so added is actually a 
        member of family with respect to the enrollee.
    (c) Fraud Risk Assessment.--In any fraud risk assessment conducted 
with respect to the Program on or after the date of enactment of this 
Act, the Director shall include an assessment of individuals who are 
enrolled in, or covered under, a health benefits plan under the Program 
even though those individuals are not eligible to be so enrolled or 
covered.
    (d) Family Member Eligibility Verification Audit.--
            (1) In general.--During the 3-year period beginning on the 
        date that is 1 year after the date of enactment of this Act, 
        the Director, in coordination with the head of each employing 
        office, shall conduct a comprehensive audit regarding members 
        of family who are enrolled in, or covered under, a health 
        benefits plan under the Program.
            (2) Contents.--In conducting the audit required under 
        paragraph (1), the Director, in coordination with the head of 
        each employing office, shall review marriage certificates, 
        birth certificates, and other appropriate documents that are 
        necessary to determine eligibility to enroll in, or be covered 
        under, a health benefits plan under the Program.
            (3) Reports.--
                    (A) In general.--Not later than 180 days after the 
                date on which the 3-year period described in paragraph 
                (1) begins, and once every 180 days thereafter until 
                the end of that 3-year period, the Director shall 
                submit to the appropriate committees of Congress a 
                report regarding the status of the audit required under 
                that paragraph.
                    (B) Contents.--Each report required under 
                subparagraph (A) shall include, for the period covered 
                by the report--
                            (i) the number of members of family who 
                        were reviewed under the audit conducted under 
                        paragraph (1), including the number of those 
                        individuals found during the audit to be 
                        ineligible to be enrolled in, or covered under, 
                        a health benefits plan under the Program;
                            (ii) the number of members of family who 
                        disenrolled from a health benefits plan, and 
                        the number of members of family who reduced the 
                        amount of coverage under a health benefits 
                        plan, under the Program before the end of a 
                        coverage year; and
                            (iii) any other information that the 
                        Director determines to be relevant.
    (e) Disenrollment or Removal.--Not later than 180 days after the 
date of enactment of this Act, the Director shall develop a process 
through which any individual enrolled in, or covered under, a health 
benefits plan under the Program who is not eligible to be so enrolled 
or covered shall be disenrolled or removed from enrollment with respect 
to that health benefits plan.
                                                       Calendar No. 499

118th CONGRESS

  2d Session

                                S. 4035

                          [Report No. 118-220]

_______________________________________________________________________

                                 A BILL

 To require the Director of the Office of Personnel Management to take 
 certain actions with respect to the health insurance program carried 
  out under chapter 89 of title 5, United States Code, and for other 
                               purposes.

_______________________________________________________________________

                           September 10, 2024

                       Reported with an amendment