[Congressional Record Volume 145, Number 32 (Tuesday, March 2, 1999)]
[Senate]
[Pages S2106-S2107]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. REED (for himself and Mr. Wyden):
  S. 496. A bill to provide for the establishment of an assistance 
program for health insurance consumers; to the Committee on Health, 
Education, Labor, and Pensions.


                the health care consumer assistance act

  Mr. REED. Mr. President, I rise today to introduce the Health Care 
Consumer Assistance Act, along with my colleague from Oregon, Mr. 
Wyden. This legislation creates a consumer assistance program that is 
key to patient protections in the health insurance market.
  In 1997, President Clinton's Health Quality Commission identified the 
need for consumer assistance programs that allow consumers access to 
accurate, easily understood information and get assistance in making 
informed decisions about health plans and providers. Today, only a 
loose patchwork of consumer assistance services exists. And, while a 
number of sources provide assistance, most are limited. Many consumer 
groups have advocated for the establishment of consumer assistance 
programs to support consumers' growing need of information.
  The legislation I am introducing today gives states grants to 
establish nonprofit, private health care ombudsman programs designed to 
help consumers understand and act on their health care choices, rights, 
and responsibilities. Under my bill, the Secretary of Health and Human 
Services will offer funds for states to select an independent, 
nonprofit agency to provide the following services to consumers: 
information relating to choices, rights, and responsibilities within 
the plans they select; operate a 1-800 telephone hotline to respond to 
consumer requests for information, advice and assistance; produce and 
disseminate educational materials about patients' rights; provide 
assistance and representation to people who wish to appeal the denial, 
termination, or reduction of health care services, or a refusal to pay 
for health services; and collect and disseminate data about inquiries, 
problems and grievances handled by the consumer assistance program.
  This program has been championed by Ron Pollack of Families USA and 
Beverly Malone of the American Nurses Association, who served as 
members of the President's Commission on Quality, as well as numerous 
other consumer advocates.
  Mr. President, I have joined with many of my Democratic colleagues in 
sponsoring S. 6, the Patients' Bill of Rights Act of 1999. I am pleased 
that S. 6 would establish a consumer assistance program, similar to 
that established by my legislation. My purpose today is to emphasize 
the importance of such a consumer protection program. This legislation 
is not without controversy, but I believe that American consumers 
deserve protection and assistance as they attempt to navigate the often 
confusing and complex world of health insurance.
  Mr. President, I ask unanimous consent to have the text of my bill 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 496

       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 ``Health Care Consumer 
     Assistance Act''.

     SEC. 2. GRANTS.

       (a) In General.--The Secretary of Health and Human Services 
     (referred to in this Act as the ``Secretary'') shall award 
     grants to States to enable such States to enter into 
     contracts for the establishment of consumer assistance 
     programs designed to assist consumers of health insurance in 
     understanding their rights, responsibilities and choices 
     among health insurance products.
       (b) Eligibility.--To be eligible to receive a grant under 
     this section a State shall prepare and submit to the 
     Secretary an application at such time, in such manner, and 
     containing such information as the Secretary may require, 
     including a State plan that describes--
       (1) the manner in which the State will solicit proposals 
     for, and enter into a contract with, an entity eligible under 
     section 3 to serve as the health insurance consumer office 
     for the State; and
       (2) the manner in which the State will ensure that advice 
     and assistance services for health insurance consumers are 
     coordinated through the office described in paragraph (1).
       (c) Amount of Grant.--
       (1) In general.--From amounts appropriated under section 5 
     for a fiscal year, the Secretary shall award a grant to a 
     State in an amount that bears the same ratio to such amounts 
     as the number of individuals within the State covered under a 
     health insurance plan (as determined by the Secretary) bears 
     to the total number of individuals covered under a health 
     insurance plan in all States (as determined by the 
     Secretary). Any amounts provided to a State under this 
     section that are not used by the State shall be remitted to 
     the Secretary and reallocated in accordance with this 
     paragraph.
       (2) Minimum amount.--In no case shall the amount provided 
     to a State under a grant under this section for a fiscal year 
     be less

[[Page S2107]]

     than an amount equal to .5 percent of the amount appropriated 
     for such fiscal year under section 5.

     SEC. 3. ELIGIBILITY OF STATE ENTITIES.

       To be eligible to enter into a contract with a State and 
     operate as the health insurance consumer office for the State 
     under this Act, an entity shall--
       (1) be an independent, nonprofit entity with demonstrated 
     experience in serving the needs of health care consumers 
     (particularly low income and other consumers who are most in 
     need of consumer assistance);
       (2) prepare and submit to the State a proposal containing 
     such information as the State may require;
       (3) demonstrate that the entity has the technical, 
     organizational, and professional capacity to operate the 
     health insurance consumer office within the State;
       (4) provide assurances that the entity has no real or 
     perceived conflict of interest in providing advice and 
     assistance to consumers regarding health insurance and that 
     the entity is independent of health insurance plans, 
     companies, providers, payers, and regulators of care; and
       (5) demonstrate that, using assistance provided by the 
     State, the entity has the capacity to provide assistance and 
     advice throughout the State to public and private health 
     insurance consumers regardless of the source of coverage.

     SEC. 4. USE OF FUNDS.

       (a) By State.--A State shall use amounts received under a 
     grant under this Act to enter into a contract described in 
     section 2(a) to provide funds for the establishment and 
     operation of a health insurance consumer office.
       (b) By Entity.--
       (1) In general.--An entity that enters into a contract with 
     a State under this Act shall use amounts received under the 
     contract to establish and operate a health insurance consumer 
     office.
       (2) Noncompliance.--If the State fails to enter into a 
     contract under subsection (a), the Secretary shall withhold 
     amounts to be provided to the State under this Act and use 
     such amounts to enter into the contract described in 
     paragraph (1) for the State.
       (c) Activities of Office.--A health insurance consumer 
     office established under this Act shall--
       (1) provide information to health insurance consumers 
     within the State relating to choice of health insurance 
     products and the rights and responsibilities of consumers and 
     insurers under such products;
       (2) operate toll-free telephone hotlines to respond to 
     requests for information, advice or assistance concerning 
     health insurance in a timely and efficient manner;
       (3) produce and disseminate educational materials 
     concerning health insurance consumer and patient rights;
       (4) provide assistance and representation (in nonlitigative 
     settings) to individuals who desire to appeal the denial, 
     termination, or reduction of health care services, or the 
     refusal to pay for such services, under a health insurance 
     plan;
       (5) make referrals to appropriate private and public 
     individuals or entities so that inquiries, problems, and 
     grievances with respect to health insurance can be handled 
     promptly and efficiently; and
       (6) collect data concerning inquiries, problems, and 
     grievances handled by the office and periodically disseminate 
     a compilation and analysis of such information to employers, 
     health plans, health insurers, regulatory agencies, and the 
     general public.
       (d) Availability of Services.--The office shall not 
     discriminate in the provision of services regardless of the 
     source of the individual's health insurance coverage or 
     prospective coverage, including individuals covered under 
     employer-provided insurance, self-funded plans, the medicare 
     or medicaid programs under title XVIII or XIX of the Social 
     Security Act (42 U.S.C. 1395 and 1396 et seq.), or under any 
     other Federal or State health care program.
       (e) Subcontracts.--An office established under this section 
     may carry out activities and provide services through 
     contracts entered into with 1 or more nonprofit entities so 
     long as the office can demonstrate that all of the 
     requirements of this Act are met by the office.
       (f) Training.--
       (1) In general.--An office established under this section 
     shall ensure that personnel employed by the office possess 
     the skills, expertise, and information necessary to provide 
     the services described in subsection (c).
       (2) Contracts.--To meet the requirement of paragraph (1), 
     an office may enter into contracts with 1 or more nonprofit 
     entities for the training (both through technical and 
     educational assistance) of personnel and volunteers. To be 
     eligible to receive a contract under this paragraph, an 
     entity shall be independent of health insurance plans, 
     companies, providers, payers, and regulators of care.
       (3) Limitation.--Not to exceed 7 percent of the amount 
     awarded to an entity under a contract under subsection (a) 
     for a fiscal year may be used for the provision of training 
     under this section.
       (g) Administrative Costs.--Not to exceed 1 percent of the 
     amount of a block grant awarded to the State under subsection 
     (a) for a fiscal year may be used for administrative expenses 
     by the State.
       (h) Term.--A contract entered into under subsection (a) 
     shall be for a term of 3 years.

     SEC. 5. FUNDING.

       (a) Authorization of Appropriations.--There are authorized 
     to be appropriated such sums as may be necessary in each 
     fiscal year to carry out this Act.
       (b) Report of Secretary.--Not later than 1 year after the 
     date of enactment of this Act, and annually thereafter, the 
     Secretary shall prepare and submit to the appropriate 
     committees of Congress a report that contains--
       (1) a determination by the Secretary of whether amounts 
     appropriated to carry out this Act for the fiscal year for 
     which this report is being prepared are sufficient to fully 
     fund this Act in such fiscal year; and
       (2) with respect to a fiscal year for which the Secretary 
     determines under paragraph (1) that sufficient amounts are 
     not appropriated, the recommendations of the Secretary for 
     fully funding this Act through the use of additional funding 
     sources.
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