[Congressional Record Volume 154, Number 22 (Monday, February 11, 2008)]
[Senate]
[Pages S850-S855]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 4014.  Mr. DODD (for himself and Mr. Shelby) submitted an 
amendment intended to be proposed by him to the bill S. 2062, to amend 
the Native American Housing Assistance and Self-Determination Act of 
1996 to reauthorize that Act, and for other purposes; which was ordered 
to lie on the table; as follows:

       On page 19, strike lines 1 through 13 and insert the 
     following:

[[Page S851]]

       ``(c) Applicability.--The provisions of paragraph (2) of 
     subsection (a) regarding binding commitments for the 
     remaining useful life of property shall not apply to a family 
     or household member who subsequently takes ownership of a 
     homeownership unit.''.

       On page 22, line 9, insert ``in accordance with section 
     202'' after ``infrastructure''.

       On page 29, strike line 18 and insert the following:
       ``(iv) any other legal impediment.
       ``(E) Subparagraphs (A) through (D) shall not apply to any 
     claim arising from a formula current assisted stock 
     calculation or count involving an Indian housing block grant 
     allocation for any fiscal year through fiscal year 2008, if a 
     civil action relating to the claim is filed by not later than 
     45 days after the date of enactment of this subparagraph.''.
                                 ______
                                 
  SA 4015.  Mr. DeMINT submitted an amendment intended to be proposed 
by him to the bill S. 1200, to amend the Indian Health Care Improvement 
Act to revise and extend the Act; which was ordered to lie on the 
table; as follows:

       On page __, between lines __ and __, insert the following 
     (at the end of title VIII of the Indian Health Care 
     Improvement Act, as amended by section 101(a) add the 
     following):

     ``SEC. 818. INDIAN HEALTH SAVINGS ACCOUNT DEMONSTRATION 
                   PROJECT.

       ``(a) In General.--The Secretary shall establish a 
     demonstration project under which eligible participants shall 
     be provided with a subsidy for the purchase of a high 
     deductible health plan (as defined under section 223(c)(2) of 
     the Internal Revenue Code of 1986) and a contribution to a 
     health savings account (as defined in section 223(d) of such 
     Code) in order to--
       ``(1) improve Indian access to high quality health care 
     services;
       ``(2) provide incentives to Indian patients to seek 
     preventive medical care services;
       ``(3) create Indian patient awareness regarding the high 
     cost of medical care; and
       ``(4) encourage appropriate use of health care services by 
     Indians.
       ``(b) Eligible Participant.--
       ``(1) Voluntary enrollment for 12-month periods.--
       ``(A) In general.--In this section, the term `eligible 
     participant' means an Indian who--
       ``(i) is an eligible individual (as defined in section 
     223(c)(1) of the Internal Revenue Code of 1986); and
       ``(ii) voluntarily agrees to enroll in the project 
     conducted under this section (or in the case of a minor, is 
     voluntarily enrolled on their behalf by a parent or 
     caretaker) for a period of not less than 12 months in lieu of 
     obtaining items or services through any Indian Health Program 
     or any other federally-funded program during any period in 
     which the Indian is enrolled in the project.
       ``(B) Voluntary extensions of enrollment.--An eligible 
     participant may voluntarily extend the participant's 
     enrollment in the project for additional 12-month periods.
       ``(2) Hardship exception.--The Secretary shall specify 
     criteria for permitting an eligible participant to disenroll 
     from the project before the end of any 12-month period of 
     enrollment to prevent undue hardship.
       ``(c) Subsidy Amount.--The amount of a subsidy provided to 
     an eligible participant for a 12-month period shall not 
     exceed the amount equal to the average per capita expenditure 
     for an Indian obtaining items or services from any Indian 
     Health Program for the most recent fiscal year for which data 
     is available with respect to the same population category as 
     the eligible participant.
       ``(d) Special Rules.--
       ``(1) No deduction allowed for subsidy.--For purposes of 
     determining the amount allowable as a deduction with respect 
     to amounts contributed to a health savings account by an 
     eligible participant under section 223 of the Internal 
     Revenue Code of 1986, the limitation which would (but for 
     this paragraph) apply under section 223(b) of such Code to 
     such participant for any taxable year shall be reduced (but 
     not below zero) by the amount of any subsidy provided to the 
     participant under this section for such taxable year.
       ``(2) Treatment.--The amount of a subsidy provided to an 
     eligible participant in the project shall not be counted as 
     income or assets for purposes of determining eligibility for 
     benefits under any Federal public assistance program.
       ``(3) Budget neutrality.--In conducting the demonstration 
     project under this section, the Secretary shall ensure that 
     the aggregate payments made to carry out the project do not 
     exceed the amount of Federal expenditures which would have 
     been made for the provision of health care items and services 
     to eligible participants if the project had not been 
     implemented.
       ``(e) Demonstration Period; Reports to Congress; Gao 
     Evaluation and Report.--
       ``(1) Demonstration period.--
       ``(A) Initial period.--The demonstration project 
     established under this section shall begin on January 1, 
     2007, and shall be conducted for a period of 5 years.
       ``(B) Extensions.--The Secretary may extend the project for 
     such additional periods as the Secretary determines 
     appropriate, unless the Secretary determines that the project 
     is unsuccessful in achieving the purposes described in 
     subsection (a), taking into account cost-effectiveness, 
     quality of care, and such other criteria as the Secretary may 
     specify.
       ``(2) Periodic reports to congress.--During the 5-year 
     period described in paragraph (1), the Secretary shall 
     periodically submit reports to Congress regarding the success 
     of demonstration project conducted under this section. Each 
     report shall include information concerning the populations 
     participating in the project and the impact of the project on 
     access to, and the availability of, high quality health care 
     services for Indians.
       ``(3) GAO evaluation and report.--
       ``(A) Evaluation.--The Comptroller General of the United 
     States shall enter into a contract with an organization with 
     expertise in health economics, health insurance markets, and 
     actuarial science for the purpose of conducting a 
     comprehensive study regarding the effects of high deductible 
     health plans and health savings accounts in the Indian 
     community. The evaluation shall include an analysis of the 
     following issues:
       ``(i) Selection of, access to, and availability of, high 
     quality health care services.
       ``(ii) The use of preventive health services.
       ``(iii) Consumer choice.
       ``(iv) The scope of coverage provided by high deductible 
     health plans purchased in conjunction with health savings 
     accounts under the project.
       ``(v) Such other issues as the Comptroller General 
     determines appropriate.
       ``(B) Report.--Not later than January 1, 2013, the 
     Comptroller General shall submit a report to Congress on the 
     evaluation of demonstration project conducted under this 
     section.''.
                                 ______
                                 
  SA 4016. Mr. DeMINT submitted an amendment intended to be proposed by 
him to the bill S. 1200, to amend the Indian Health Care Improvement 
Act to revise and extend the Act; which was ordered to lie on the 
table; as follows:

       At the end, add the following:

                     TITLE III--HEALTH CARE CHOICE

     SEC. 301. SHORT TITLE.

       This title may be cited as ``Health Care Choice Act of 
     2008''.

     SEC. 302. SPECIFICATION OF CONSTITUTIONAL AUTHORITY FOR 
                   ENACTMENT OF LAW.

       This title is enacted pursuant to the power granted 
     Congress under article I, section 8, clause 3, of the United 
     States Constitution.

     SEC. 303. FINDINGS.

       Congress finds the following:
       (1) The application of numerous and significant variations 
     in State law impacts the ability of insurers to offer, and 
     individuals to obtain, affordable individual health insurance 
     coverage, thereby impeding commerce in individual health 
     insurance coverage.
       (2) Individual health insurance coverage is increasingly 
     offered through the Internet, other electronic means, and by 
     mail, all of which are inherently part of interstate 
     commerce.
       (3) In response to these issues, it is appropriate to 
     encourage increased efficiency in the offering of individual 
     health insurance coverage through a collaborative approach by 
     the States in regulating this coverage.
       (4) The establishment of risk-retention groups has provided 
     a successful model for the sale of insurance across State 
     lines, as the acts establishing those groups allow insurance 
     to be sold in multiple States but regulated by a single 
     State.

     SEC. 304. COOPERATIVE GOVERNING OF INDIVIDUAL HEALTH 
                   INSURANCE COVERAGE.

       (a) In General.--Title XXVII of the Public Health Service 
     Act (42 U.S.C. 300gg et seq.) is amended by adding at the end 
     the following new part:

``PART D--COOPERATIVE GOVERNING OF INDIVIDUAL HEALTH INSURANCE COVERAGE

     ``SEC. 2795. DEFINITIONS.

       ``In this part:
       ``(1) Primary state.--The term `primary State' means, with 
     respect to individual health insurance coverage offered by a 
     health insurance issuer, the State designated by the issuer 
     as the State whose covered laws shall govern the health 
     insurance issuer in the sale of such coverage under this 
     part. An issuer, with respect to a particular policy, may 
     only designate one such State as its primary State with 
     respect to all such coverage it offers. Such an issuer may 
     not change the designated primary State with respect to 
     individual health insurance coverage once the policy is 
     issued, except that such a change may be made upon renewal of 
     the policy. With respect to such designated State, the issuer 
     is deemed to be doing business in that State.
       ``(2) Secondary state.--The term `secondary State' means, 
     with respect to individual health insurance coverage offered 
     by a health insurance issuer, any State that is not the 
     primary State. In the case of a health insurance issuer that 
     is selling a policy in, or to a resident of, a secondary 
     State, the issuer is deemed to be doing business in that 
     secondary State.
       ``(3) Health insurance issuer.--The term `health insurance 
     issuer' has the meaning given such term in section 
     2791(b)(2), except that such an issuer must be licensed in 
     the primary State and be qualified to sell individual health 
     insurance coverage in that State.
       ``(4) Individual health insurance coverage.--The term 
     `individual health insurance coverage' means health insurance 
     coverage offered in the individual market, as defined in 
     section 2791(e)(1).

[[Page S852]]

       ``(5) Applicable state authority.--The term `applicable 
     State authority' means, with respect to a health insurance 
     issuer in a State, the State insurance commissioner or 
     official or officials designated by the State to enforce the 
     requirements of this title for the State with respect to the 
     issuer.
       ``(6) Hazardous financial condition.--The term `hazardous 
     financial condition' means that, based on its present or 
     reasonably anticipated financial condition, a health 
     insurance issuer is unlikely to be able--
       ``(A) to meet obligations to policyholders with respect to 
     known claims and reasonably anticipated claims; or
       ``(B) to pay other obligations in the normal course of 
     business.
       ``(7) Covered laws.--
       ``(A) In general.--The term `covered laws' means the laws, 
     rules, regulations, agreements, and orders governing the 
     insurance business pertaining to--
       ``(i) individual health insurance coverage issued by a 
     health insurance issuer;
       ``(ii) the offer, sale, rating (including medical 
     underwriting), renewal, and issuance of individual health 
     insurance coverage to an individual;
       ``(iii) the provision to an individual in relation to 
     individual health insurance coverage of health care and 
     insurance related services;
       ``(iv) the provision to an individual in relation to 
     individual health insurance coverage of management, 
     operations, and investment activities of a health insurance 
     issuer; and
       ``(v) the provision to an individual in relation to 
     individual health insurance coverage of loss control and 
     claims administration for a health insurance issuer with 
     respect to liability for which the issuer provides insurance.
       ``(B) Exception.--Such term does not include any law, rule, 
     regulation, agreement, or order governing the use of care or 
     cost management techniques, including any requirement related 
     to provider contracting, network access or adequacy, health 
     care data collection, or quality assurance.
       ``(8) State.--The term `State' means the 50 States and 
     includes the District of Columbia, Puerto Rico, the Virgin 
     Islands, Guam, American Samoa, and the Northern Mariana 
     Islands.
       ``(9) Unfair claims settlement practices.--The term `unfair 
     claims settlement practices' means only the following 
     practices:
       ``(A) Knowingly misrepresenting to claimants and insured 
     individuals relevant facts or policy provisions relating to 
     coverage at issue.
       ``(B) Failing to acknowledge with reasonable promptness 
     pertinent communications with respect to claims arising under 
     policies.
       ``(C) Failing to adopt and implement reasonable standards 
     for the prompt investigation and settlement of claims arising 
     under policies.
       ``(D) Failing to effectuate prompt, fair, and equitable 
     settlement of claims submitted in which liability has become 
     reasonably clear.
       ``(E) Refusing to pay claims without conducting a 
     reasonable investigation.
       ``(F) Failing to affirm or deny coverage of claims within a 
     reasonable period of time after having completed an 
     investigation related to those claims.
       ``(G) A pattern or practice of compelling insured 
     individuals or their beneficiaries to institute suits to 
     recover amounts due under its policies by offering 
     substantially less than the amounts ultimately recovered in 
     suits brought by them.
       ``(H) A pattern or practice of attempting to settle or 
     settling claims for less than the amount that a reasonable 
     person would believe the insured individual or his or her 
     beneficiary was entitled by reference to written or printed 
     advertising material accompanying or made part of an 
     application.
       ``(I) Attempting to settle or settling claims on the basis 
     of an application that was materially altered without notice 
     to, or knowledge or consent of, the insured.
       ``(J) Failing to provide forms necessary to present claims 
     within 15 calendar days of a requests with reasonable 
     explanations regarding their use.
       ``(K) Attempting to cancel a policy in less time than that 
     prescribed in the policy or by the law of the primary State.
       ``(10) Fraud and abuse.--The term `fraud and abuse' means 
     an act or omission committed by a person who, knowingly and 
     with intent to defraud, commits, or conceals any material 
     information concerning, one or more of the following:
       ``(A) Presenting, causing to be presented or preparing with 
     knowledge or belief that it will be presented to or by an 
     insurer, a reinsurer, broker or its agent, false information 
     as part of, in support of or concerning a fact material to 
     one or more of the following:
       ``(i) An application for the issuance or renewal of an 
     insurance policy or reinsurance contract.
       ``(ii) The rating of an insurance policy or reinsurance 
     contract.
       ``(iii) A claim for payment or benefit pursuant to an 
     insurance policy or reinsurance contract.
       ``(iv) Premiums paid on an insurance policy or reinsurance 
     contract.
       ``(v) Payments made in accordance with the terms of an 
     insurance policy or reinsurance contract.
       ``(vi) A document filed with the commissioner or the chief 
     insurance regulatory official of another jurisdiction.
       ``(vii) The financial condition of an insurer or reinsurer.
       ``(viii) The formation, acquisition, merger, 
     reconsolidation, dissolution or withdrawal from one or more 
     lines of insurance or reinsurance in all or part of a State 
     by an insurer or reinsurer.
       ``(ix) The issuance of written evidence of insurance.
       ``(x) The reinstatement of an insurance policy.
       ``(B) Solicitation or acceptance of new or renewal 
     insurance risks on behalf of an insurer reinsurer or other 
     person engaged in the business of insurance by a person who 
     knows or should know that the insurer or other person 
     responsible for the risk is insolvent at the time of the 
     transaction.
       ``(C) Transaction of the business of insurance in violation 
     of laws requiring a license, certificate of authority or 
     other legal authority for the transaction of the business of 
     insurance.
       ``(D) Attempt to commit, aiding or abetting in the 
     commission of, or conspiracy to commit the acts or omissions 
     specified in this paragraph.

     ``SEC. 2796. APPLICATION OF LAW.

       ``(a) In General.--The covered laws of the primary State 
     shall apply to individual health insurance coverage offered 
     by a health insurance issuer in the primary State and in any 
     secondary State, but only if the coverage and issuer comply 
     with the conditions of this section with respect to the 
     offering of coverage in any secondary State.
       ``(b) Exemptions From Covered Laws in a Secondary State.--
     Except as provided in this section, a health insurance issuer 
     with respect to its offer, sale, rating (including medical 
     underwriting), renewal, and issuance of individual health 
     insurance coverage in any secondary State is exempt from any 
     covered laws of the secondary State (and any rules, 
     regulations, agreements, or orders sought or issued by such 
     State under or related to such covered laws) to the extent 
     that such laws would--
       ``(1) make unlawful, or regulate, directly or indirectly, 
     the operation of the health insurance issuer operating in the 
     secondary State, except that any secondary State may require 
     such an issuer--
       ``(A) to pay, on a nondiscriminatory basis, applicable 
     premium and other taxes (including high risk pool 
     assessments) which are levied on insurers and surplus lines 
     insurers, brokers, or policyholders under the laws of the 
     State;
       ``(B) to register with and designate the State insurance 
     commissioner as its agent solely for the purpose of receiving 
     service of legal documents or process;
       ``(C) to submit to an examination of its financial 
     condition by the State insurance commissioner in any State in 
     which the issuer is doing business to determine the issuer's 
     financial condition, if--
       ``(i) the State insurance commissioner of the primary State 
     has not done an examination within the period recommended by 
     the National Association of Insurance Commissioners; and
       ``(ii) any such examination is conducted in accordance with 
     the examiners' handbook of the National Association of 
     Insurance Commissioners and is coordinated to avoid 
     unjustified duplication and unjustified repetition;
       ``(D) to comply with a lawful order issued--
       ``(i) in a delinquency proceeding commenced by the State 
     insurance commissioner if there has been a finding of 
     financial impairment under subparagraph (C); or
       ``(ii) in a voluntary dissolution proceeding;
       ``(E) to comply with an injunction issued by a court of 
     competent jurisdiction, upon a petition by the State 
     insurance commissioner alleging that the issuer is in 
     hazardous financial condition;
       ``(F) to participate, on a nondiscriminatory basis, in any 
     insurance insolvency guaranty association or similar 
     association to which a health insurance issuer in the State 
     is required to belong;
       ``(G) to comply with any State law regarding fraud and 
     abuse (as defined in section 2795(10)), except that if the 
     State seeks an injunction regarding the conduct described in 
     this subparagraph, such injunction must be obtained from a 
     court of competent jurisdiction;
       ``(H) to comply with any State law regarding unfair claims 
     settlement practices (as defined in section 2795(9)); or
       ``(I) to comply with the applicable requirements for 
     independent review under section 2798 with respect to 
     coverage offered in the State;
       ``(2) require any individual health insurance coverage 
     issued by the issuer to be countersigned by an insurance 
     agent or broker residing in that Secondary State; or
       ``(3) otherwise discriminate against the issuer issuing 
     insurance in both the primary State and in any secondary 
     State.
       ``(c) Clear and Conspicuous Disclosure.--A health insurance 
     issuer shall provide the following notice, in 12-point bold 
     type, in any insurance coverage offered in a secondary State 
     under this part by such a health insurance issuer and at 
     renewal of the policy, with the 5 blank spaces therein being 
     appropriately filled with the name of the health insurance 
     issuer, the name of primary State, the name of the secondary 
     State, the name of the secondary State, and the name of the 
     secondary State, respectively, for the coverage concerned:
     `This policy is issued by _____ and is governed by the laws 
     and regulations of the State of _____, and it has met all the 
     laws of that State as determined by that State's Department 
     of Insurance. This policy

[[Page S853]]

     may be less expensive than others because it is not subject 
     to all of the insurance laws and regulations of the State of 
     _____, including coverage of some services or benefits 
     mandated by the law of the State of _____. Additionally, this 
     policy is not subject to all of the consumer protection laws 
     or restrictions on rate changes of the State of _____. As 
     with all insurance products, before purchasing this policy, 
     you should carefully review the policy and determine what 
     health care services the policy covers and what benefits it 
     provides, including any exclusions, limitations, or 
     conditions for such services or benefits.'.
       ``(d) Prohibition on Certain Reclassifications and Premium 
     Increases.--
       ``(1) In general.--For purposes of this section, a health 
     insurance issuer that provides individual health insurance 
     coverage to an individual under this part in a primary or 
     secondary State may not upon renewal--
       ``(A) move or reclassify the individual insured under the 
     health insurance coverage from the class such individual is 
     in at the time of issue of the contract based on the health-
     status related factors of the individual; or
       ``(B) increase the premiums assessed the individual for 
     such coverage based on a health status-related factor or 
     change of a health status-related factor or the past or 
     prospective claim experience of the insured individual.
       ``(2) Construction.--Nothing in paragraph (1) shall be 
     construed to prohibit a health insurance issuer--
       ``(A) from terminating or discontinuing coverage or a class 
     of coverage in accordance with subsections (b) and (c) of 
     section 2742;
       ``(B) from raising premium rates for all policy holders 
     within a class based on claims experience;
       ``(C) from changing premiums or offering discounted 
     premiums to individuals who engage in wellness activities at 
     intervals prescribed by the issuer, if such premium changes 
     or incentives--
       ``(i) are disclosed to the consumer in the insurance 
     contract;
       ``(ii) are based on specific wellness activities that are 
     not applicable to all individuals; and
       ``(iii) are not obtainable by all individuals to whom 
     coverage is offered;
       ``(D) from reinstating lapsed coverage; or
       ``(E) from retroactively adjusting the rates charged an 
     insured individual if the initial rates were set based on 
     material misrepresentation by the individual at the time of 
     issue.
       ``(e) Prior Offering of Policy in Primary State.--A health 
     insurance issuer may not offer for sale individual health 
     insurance coverage in a secondary State unless that coverage 
     is currently offered for sale in the primary State.
       ``(f) Licensing of Agents or Brokers for Health Insurance 
     Issuers.--Any State may require that a person acting, or 
     offering to act, as an agent or broker for a health insurance 
     issuer with respect to the offering of individual health 
     insurance coverage obtain a license from that State, with 
     commissions or other compensation subject to the provisions 
     of the laws of that State, except that a State may not impose 
     any qualification or requirement which discriminates against 
     a nonresident agent or broker.
       ``(g) Documents for Submission to State Insurance 
     Commissioner.--Each health insurance issuer issuing 
     individual health insurance coverage in both primary and 
     secondary States shall submit--
       ``(1) to the insurance commissioner of each State in which 
     it intends to offer such coverage, before it may offer 
     individual health insurance coverage in such State--
       ``(A) a copy of the plan of operation or feasibility study 
     or any similar statement of the policy being offered and its 
     coverage (which shall include the name of its primary State 
     and its principal place of business);
       ``(B) written notice of any change in its designation of 
     its primary State; and
       ``(C) written notice from the issuer of the issuer's 
     compliance with all the laws of the primary State; and
       ``(2) to the insurance commissioner of each secondary State 
     in which it offers individual health insurance coverage, a 
     copy of the issuer's quarterly financial statement submitted 
     to the primary State, which statement shall be certified by 
     an independent public accountant and contain a statement of 
     opinion on loss and loss adjustment expense reserves made 
     by--
       ``(A) a member of the American Academy of Actuaries; or
       ``(B) a qualified loss reserve specialist.
       ``(h) Power of Courts To Enjoin Conduct.--Nothing in this 
     section shall be construed to affect the authority of any 
     Federal or State court to enjoin--
       ``(1) the solicitation or sale of individual health 
     insurance coverage by a health insurance issuer to any person 
     or group who is not eligible for such insurance; or
       ``(2) the solicitation or sale of individual health 
     insurance coverage that violates the requirements of the law 
     of a secondary State which are described in subparagraphs (A) 
     through (H) of section 2796(b)(1).
       ``(i) Power of Secondary States To Take Administrative 
     Action.--Nothing in this section shall be construed to affect 
     the authority of any State to enjoin conduct in violation of 
     that State's laws described in section 2796(b)(1).
       ``(j) State Powers To Enforce State Laws.--
       ``(1) In general.--Subject to the provisions of subsection 
     (b)(1)(G) (relating to injunctions) and paragraph (2), 
     nothing in this section shall be construed to affect the 
     authority of any State to make use of any of its powers to 
     enforce the laws of such State with respect to which a health 
     insurance issuer is not exempt under subsection (b).
       ``(2) Courts of competent jurisdiction.--If a State seeks 
     an injunction regarding the conduct described in paragraphs 
     (1) and (2) of subsection (h), such injunction must be 
     obtained from a Federal or State court of competent 
     jurisdiction.
       ``(k) States' Authority To Sue.--Nothing in this section 
     shall affect the authority of any State to bring action in 
     any Federal or State court.
       ``(l) Generally Applicable Laws.--Nothing in this section 
     shall be construed to affect the applicability of State laws 
     generally applicable to persons or corporations.
       ``(m) Guaranteed Availability of Coverage to HIPAA Eligible 
     Individuals.--To the extent that a health insurance issuer is 
     offering coverage in a primary State that does not 
     accommodate residents of secondary States or does not provide 
     a working mechanism for residents of a secondary State, and 
     the issuer is offering coverage under this part in such 
     secondary State which has not adopted a qualified high risk 
     pool as its acceptable alternative mechanism (as defined in 
     section 2744(c)(2)), the issuer shall, with respect to any 
     individual health insurance coverage offered in a secondary 
     State under this part, comply with the guaranteed 
     availability requirements for eligible individuals in section 
     2741.

     ``SEC. 2797. PRIMARY STATE MUST MEET FEDERAL FLOOR BEFORE 
                   ISSUER MAY SELL INTO SECONDARY STATES.

       ``A health insurance issuer may not offer, sell, or issue 
     individual health insurance coverage in a secondary State if 
     the State insurance commissioner does not use a risk-based 
     capital formula for the determination of capital and surplus 
     requirements for all health insurance issuers.

     ``SEC. 2798. INDEPENDENT EXTERNAL APPEALS PROCEDURES.

       ``(a) Right to External Appeal.--A health insurance issuer 
     may not offer, sell, or issue individual health insurance 
     coverage in a secondary State under the provisions of this 
     title unless--
       ``(1) both the secondary State and the primary State have 
     legislation or regulations in place establishing an 
     independent review process for individuals who are covered by 
     individual health insurance coverage, or
       ``(2) in any case in which the requirements of subparagraph 
     (A) are not met with respect to the either of such States, 
     the issuer provides an independent review mechanism 
     substantially identical (as determined by the applicable 
     State authority of such State) to that prescribed in the 
     `Health Carrier External Review Model Act' of the National 
     Association of Insurance Commissioners for all individuals 
     who purchase insurance coverage under the terms of this part, 
     except that, under such mechanism, the review is conducted by 
     an independent medical reviewer, or a panel of such 
     reviewers, with respect to whom the requirements of 
     subsection (b) are met.
       ``(b) Qualifications of Independent Medical Reviewers.--In 
     the case of any independent review mechanism referred to in 
     subsection (a)(2)--
       ``(1) In general.--In referring a denial of a claim to an 
     independent medical reviewer, or to any panel of such 
     reviewers, to conduct independent medical review, the issuer 
     shall ensure that--
       ``(A) each independent medical reviewer meets the 
     qualifications described in paragraphs (2) and (3);
       ``(B) with respect to each review, each reviewer meets the 
     requirements of paragraph (4) and the reviewer, or at least 1 
     reviewer on the panel, meets the requirements described in 
     paragraph (5); and
       ``(C) compensation provided by the issuer to each reviewer 
     is consistent with paragraph (6).
       ``(2) Licensure and expertise.--Each independent medical 
     reviewer shall be a physician (allopathic or osteopathic) or 
     health care professional who--
       ``(A) is appropriately credentialed or licensed in 1 or 
     more States to deliver health care services; and
       ``(B) typically treats the condition, makes the diagnosis, 
     or provides the type of treatment under review.
       ``(3) Independence.--
       ``(A) In general.--Subject to subparagraph (B), each 
     independent medical reviewer in a case shall--
       ``(i) not be a related party (as defined in paragraph (7));
       ``(ii) not have a material familial, financial, or 
     professional relationship with such a party; and
       ``(iii) not otherwise have a conflict of interest with such 
     a party (as determined under regulations).
       ``(B) Exception.--Nothing in subparagraph (A) shall be 
     construed to--
       ``(i) prohibit an individual, solely on the basis of 
     affiliation with the issuer, from serving as an independent 
     medical reviewer if--

       ``(I) a non-affiliated individual is not reasonably 
     available;
       ``(II) the affiliated individual is not involved in the 
     provision of items or services in the case under review;
       ``(III) the fact of such an affiliation is disclosed to the 
     issuer and the enrollee (or authorized representative) and 
     neither party objects; and

[[Page S854]]

       ``(IV) the affiliated individual is not an employee of the 
     issuer and does not provide services exclusively or primarily 
     to or on behalf of the issuer;

       ``(ii) prohibit an individual who has staff privileges at 
     the institution where the treatment involved takes place from 
     serving as an independent medical reviewer merely on the 
     basis of such affiliation if the affiliation is disclosed to 
     the issuer and the enrollee (or authorized representative), 
     and neither party objects; or
       ``(iii) prohibit receipt of compensation by an independent 
     medical reviewer from an entity if the compensation is 
     provided consistent with paragraph (6).
       ``(4) Practicing health care professional in same field.--
       ``(A) In general.--In a case involving treatment, or the 
     provision of items or services--
       ``(i) by a physician, a reviewer shall be a practicing 
     physician (allopathic or osteopathic) of the same or similar 
     specialty, as a physician who, acting within the appropriate 
     scope of practice within the State in which the service is 
     provided or rendered, typically treats the condition, makes 
     the diagnosis, or provides the type of treatment under 
     review; or
       ``(ii) by a non-physician health care professional, the 
     reviewer, or at least 1 member of the review panel, shall be 
     a practicing non-physician health care professional of the 
     same or similar specialty as the non-physician health care 
     professional who, acting within the appropriate scope of 
     practice within the State in which the service is provided or 
     rendered, typically treats the condition, makes the 
     diagnosis, or provides the type of treatment under review.
       ``(B) Practicing defined.--For purposes of this paragraph, 
     the term `practicing' means, with respect to an individual 
     who is a physician or other health care professional, that 
     the individual provides health care services to individual 
     patients on average at least 2 days per week.
       ``(5) Pediatric expertise.--In the case of an external 
     review relating to a child, a reviewer shall have expertise 
     under paragraph (2) in pediatrics.
       ``(6) Limitations on reviewer compensation.--Compensation 
     provided by the issuer to an independent medical reviewer in 
     connection with a review under this section shall--
       ``(A) not exceed a reasonable level; and
       ``(B) not be contingent on the decision rendered by the 
     reviewer.
       ``(7) Related party defined.--For purposes of this section, 
     the term `related party' means, with respect to a denial of a 
     claim under a coverage relating to an enrollee, any of the 
     following:
       ``(A) The issuer involved, or any fiduciary, officer, 
     director, or employee of the issuer.
       ``(B) The enrollee (or authorized representative).
       ``(C) The health care professional that provides the items 
     or services involved in the denial.
       ``(D) The institution at which the items or services (or 
     treatment) involved in the denial are provided.
       ``(E) The manufacturer of any drug or other item that is 
     included in the items or services involved in the denial.
       ``(F) Any other party determined under any regulations to 
     have a substantial interest in the denial involved.
       ``(8) Definitions.--For purposes of this subsection:
       ``(A) Enrollee.--The term `enrollee' means, with respect to 
     health insurance coverage offered by a health insurance 
     issuer, an individual enrolled with the issuer to receive 
     such coverage.
       ``(B) Health care professional.--The term `health care 
     professional' means an individual who is licensed, 
     accredited, or certified under State law to provide specified 
     health care services and who is operating within the scope of 
     such licensure, accreditation, or certification.

     ``SEC. 2799. ENFORCEMENT.

       ``(a) In General.--Subject to subsection (b), with respect 
     to specific individual health insurance coverage the primary 
     State for such coverage has sole jurisdiction to enforce the 
     primary State's covered laws in the primary State and any 
     secondary State.
       ``(b) Secondary State's Authority.--Nothing in subsection 
     (a) shall be construed to affect the authority of a secondary 
     State to enforce its laws as set forth in the exception 
     specified in section 2796(b)(1).
       ``(c) Court Interpretation.--In reviewing action initiated 
     by the applicable secondary State authority, the court of 
     competent jurisdiction shall apply the covered laws of the 
     primary State.
       ``(d) Notice of Compliance Failure.--In the case of 
     individual health insurance coverage offered in a secondary 
     State that fails to comply with the covered laws of the 
     primary State, the applicable State authority of the 
     secondary State may notify the applicable State authority of 
     the primary State.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to individual health insurance coverage offered, 
     issued, or sold after the date that is one year after the 
     date of the enactment of this Act.
       (c) GAO Ongoing Study and Reports.--
       (1) Study.--The Comptroller General of the United States 
     shall conduct an ongoing study concerning the effect of the 
     amendment made by subsection (a) on--
       (A) the number of uninsured and under-insured;
       (B) the availability and cost of health insurance policies 
     for individuals with pre-existing medical conditions;
       (C) the availability and cost of health insurance policies 
     generally;
       (D) the elimination or reduction of different types of 
     benefits under health insurance policies offered in different 
     States; and
       (E) cases of fraud or abuse relating to health insurance 
     coverage offered under such amendment and the resolution of 
     such cases.
       (2) Annual reports.--The Comptroller General shall submit 
     to Congress an annual report, after the end of each of the 5 
     years following the effective date of the amendment made by 
     subsection (a), on the ongoing study conducted under 
     paragraph (1).

     SEC. 305. SEVERABILITY.

       If any provision of this title or the application of such 
     provision to any person or circumstance is held to be 
     unconstitutional, the remainder of this title and the 
     application of the provisions of such to any other person or 
     circumstance shall not be affected.
                                 ______
                                 
  SA 4017. Mr. DURBIN (for Mrs. Feinstein) submitted an amendment 
intended to be proposed by Mr. Durbin to the bill S. 2071, to enhance 
the ability to combat methamphetamine; as follows:

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Combat Methamphetamine 
     Enhancement Act of 2007''.

     SEC. 2. REQUIREMENT OF SELF-CERTIFICATION BY ALL REGULATED 
                   PERSONS SELLING SCHEDULED LISTED CHEMICALS.

       Section 310(e)(2) of the Controlled Substances Act (21 
     U.S.C. 830(e)(2)) is amended by inserting at the end the 
     following:
       ``(C) Each regulated person who makes a sale at retail of a 
     scheduled listed chemical product and is required under 
     subsection (b)(3) to submit a report of the sales transaction 
     to the Attorney General may not sell any scheduled listed 
     chemical product at retail unless such regulated person has 
     submitted to the Attorney General a self-certification 
     including a statement that the seller understands each of the 
     requirements that apply under this paragraph and under 
     subsection (d) and agrees to comply with the requirements. 
     The Attorney General shall by regulation establish criteria 
     for certifications of mail-order distributors that are 
     consistent with the criteria established for the 
     certifications of regulated sellers under paragraph 
     (1)(B).''.

     SEC. 3. PUBLICATION OF SELF-CERTIFIED REGULATED SELLERS AND 
                   REGULATED PERSONS LISTS.

       Section 310(e)(1)(B) of the Controlled Substances Act (21 
     U.S.C. 830(e)(1)(B)) is amended by inserting at the end the 
     following:
       ``(v) Publication of list of self-certified persons.--The 
     Attorney General shall develop and make available a list of 
     all persons who are currently self-certified in accordance 
     with this section. This list shall be made publicly available 
     on the website of the Drug Enforcement Administration in an 
     electronically downloadable format.''.

     SEC. 4. REQUIREMENT THAT DISTRIBUTORS OF LISTED CHEMICALS 
                   SELL ONLY TO SELF-CERTIFIED REGULATED SELLERS 
                   AND REGULATED PERSONS.

       Section 402(a) of the Controlled Substances Act (21 U.S.C. 
     842(a)) is amended--
       (1) in paragraph (13), by striking ``or'' after the 
     semicolon;
       (2) in paragraph (14), by striking the period and inserting 
     ``; or'';
       (3) by inserting after paragraph (14) the following:
       ``(15) to distribute a scheduled listed chemical product to 
     a regulated seller, or to a regulated person referred to in 
     section 310(b)(3)(B), unless such regulated seller or 
     regulated person is, at the time of such distribution, 
     currently registered with the Drug Enforcement 
     Administration, or on the list of persons referred to under 
     section 310(e)(1)(B)(v).''; and
       (4) inserting at the end the following: ``For purposes of 
     paragraph (15), if the distributor is temporarily unable to 
     access the list of persons referred to under section 
     310(e)(1)(B)(v), the distributor may rely on a written, 
     faxed, or electronic copy of a certificate of self-
     certification submitted by the regulated seller or regulated 
     person, provided the distributor confirms within 7 business 
     days of the distribution that such regulated seller or 
     regulated person is on the list referred to under section 
     310(e)(1)(B)(v).''.

     SEC. 5. NEGLIGENT FAILURE TO SELF-CERTIFY AS REQUIRED.

       Section 402(a) of the Controlled Substances Act (21 U.S.C. 
     842(a)(10)) is amended by inserting before the semicolon the 
     following: ``or negligently to fail to self-certify as 
     required under section 310 (21 U.S.C. 830)''.

     SEC. 6. EFFECTIVE DATE AND REGULATIONS.

       (a) Effective Date.--This Act and the amendments made by 
     this Act shall take effect 180 days after the date of 
     enactment of this Act.
       (b) Regulations.--In promulgating the regulations 
     authorized by section 2, the Attorney General may issue 
     regulations on an interim basis as necessary to ensure the 
     implementation of this Act by the effective date.

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