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<bill bill-stage="Introduced-in-Senate" dms-id="A1" public-private="public" slc-id="S1-TAM21398-6CF-V0-F30"> |
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<metadata xmlns:dc="http://purl.org/dc/elements/1.1/"> |
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<dublinCore> |
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<dc:title>117 S1002 IS: Junk Plan Accountability and Disclosure Act of 2021</dc:title> |
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<dc:publisher>U.S. Senate</dc:publisher> |
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<dc:date>2021-03-25</dc:date> |
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<dc:format>text/xml</dc:format> |
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<dc:language>EN</dc:language> |
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<dc:rights>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.</dc:rights> |
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</dublinCore> |
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</metadata> |
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<form> |
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<distribution-code display="yes">II</distribution-code> |
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<congress>117th CONGRESS</congress><session>1st Session</session> |
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<legis-num>S. 1002</legis-num> |
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<current-chamber>IN THE SENATE OF THE UNITED STATES</current-chamber> |
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<action> |
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<action-date date="20210325">March 25, 2021</action-date> |
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<action-desc><sponsor name-id="S309">Mr. Casey</sponsor> (for himself, <cosponsor name-id="S354">Ms. Baldwin</cosponsor>, and <cosponsor name-id="S284">Ms. Stabenow</cosponsor>) introduced the following bill; which was read twice and referred to the <committee-name committee-id="SSHR00">Committee on Health, Education, Labor, and Pensions</committee-name></action-desc> |
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</action> |
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<legis-type>A BILL</legis-type> |
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<official-title>To prohibit false or misleading advertising for health insurance coverage, require warnings and reporting with respect to noncomprehensive health plans, encourage enrollment in health plans, and for other purposes. </official-title> |
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</form> |
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<legis-body display-enacting-clause="yes-display-enacting-clause" id="HECBCA1E223C6411C89A8E97D8E0CEB7B"> |
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<section section-type="section-one" id="S1"><enum>1.</enum><header>Short title; table of contents</header> |
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<subsection id="idDD53CD1039124A59968B05C9CB82C763"><enum>(a)</enum><header>Short title</header><text display-inline="yes-display-inline">This Act may be cited as the <quote><short-title>Junk Plan Accountability and Disclosure Act of 2021</short-title></quote>.</text></subsection> <subsection id="id561DFEAD4D5D44D09C1E03ED841D520D"><enum>(b)</enum><header>Table of contents</header><text>The table of contents for this Act is as follows:</text> |
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<toc> |
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<toc-entry level="section" idref="S1">Sec. 1. Short title; table of contents.</toc-entry> |
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<toc-entry level="title" idref="id69AEC18A4C9849F5918AF12ACA4E9F80">TITLE I—Prohibition of false or misleading online advertising for health insurance coverage</toc-entry> |
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<toc-entry level="section" idref="id7E2D832E2D734F328E5B4D4F81390057">Sec. 101. Definitions.</toc-entry> |
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<toc-entry level="section" idref="idD244E7E6DF95436583ED588BA9AD18CF">Sec. 102. FTC oversight of online health insurance advertisements.</toc-entry> |
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<toc-entry level="title" idref="idE950514890E24FC2A9AF44C6AEE1DC5D">TITLE II—Warnings and reporting requirements for noncomprehensive health plans</toc-entry> |
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<toc-entry level="section" idref="id8C7C627E896C4CD5BFC58E7ACDCDF3E1">Sec. 201. Definitions.</toc-entry> |
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<toc-entry level="section" idref="idABCB7386F8054DDE928815A330A5474D">Sec. 202. Requirements for notice regarding benefits.</toc-entry> |
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<toc-entry level="section" idref="idA9E844446C024C32B11328F7FACAB898">Sec. 203. Reporting requirements.</toc-entry> |
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<toc-entry level="section" idref="idAF8F543520614DBFAB4E6048183B8C9A">Sec. 204. Enforcement.</toc-entry> |
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<toc-entry level="section" idref="idAC218A4B143D4458969DDE08C64AACAA">Sec. 205. Regulations.</toc-entry> |
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<toc-entry level="title" idref="id337C07D9E8AE4E7582911740D03FB31F">TITLE III—Encouraging enrollment in health plans</toc-entry> |
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<toc-entry level="section" idref="id51FE95D9547B4775BB85025EEC86AB9E">Sec. 301. Sense of Congress.</toc-entry> |
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<toc-entry level="section" idref="H8683E286B45F44E0BE24EAE28EACFE6A">Sec. 302. Requiring Marketplace outreach, educational activities, and annual enrollment targets.</toc-entry> |
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<toc-entry level="section" idref="H151A827DF6014B99B32D1349390EF9E7">Sec. 303. Report on effects of website maintenance during open enrollment.</toc-entry> |
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<toc-entry level="section" idref="H925BF0E75A2F40E5AFB97C9B92225D30">Sec. 304. Promoting consumer outreach and education.</toc-entry> |
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<toc-entry level="section" idref="HC4F1828E3D90412385A9BBD0F8F10B68">Sec. 305. Improving transparency and accountability in the Marketplace.</toc-entry> |
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<toc-entry level="section" idref="H6FEF95F738AD48F0BE10D027DC8C1E15">Sec. 306. Improving awareness of health coverage options.</toc-entry> |
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<toc-entry level="section" idref="H30EA6EA447E54BE7BAB2449EF0BB6A83">Sec. 307. Promoting State innovations to expand coverage.</toc-entry></toc></subsection></section> |
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<title id="id69AEC18A4C9849F5918AF12ACA4E9F80" style="OLC"><enum>I</enum><header>Prohibition of false or misleading online advertising for health insurance coverage</header> |
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<section id="id7E2D832E2D734F328E5B4D4F81390057"><enum>101.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text> <paragraph id="id5300E6D681EF4F68884DDFABC75D2FA3"><enum>(1)</enum><header>Commission</header><text>The term <term>Commission</term> means the Federal Trade Commission.</text></paragraph> |
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<paragraph id="idF152BF907CEA4510A59DB7045BA4EDDF"><enum>(2)</enum><header>Health insurance coverage</header><text>The term <term>health insurance coverage</term> means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care, but excluding any group health plan) that are offered to individuals, including—</text> <subparagraph id="idCFAA70C7C8D54366B112CDE050B830F5"><enum>(A)</enum><text>a plan offered through an association;</text></subparagraph> |
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<subparagraph id="idA641B7B9E6FC4860B4F629A71CBC8289"><enum>(B)</enum><text>short-term limited duration insurance;</text></subparagraph> <subparagraph id="id943527AB8AE645F0808BEBF88B88F175"><enum>(C)</enum><text>a policy for such benefits that is not offered by a health insurance issuer (as such term is defined in section 2791(b)(2) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg-91">42 U.S.C. 300gg–91(b)(2)</external-xref>); and</text></subparagraph> |
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<subparagraph id="idD257BBBDB8564ED2BD059566DF15DAF0"><enum>(D)</enum><text>other health care arrangements that are not health plans.</text></subparagraph></paragraph> <paragraph commented="no" id="id5113B926C66B40AB9BEAAF009E6FF887"><enum>(3)</enum><header>Non-ACA compliant health insurance coverage</header><text>The term <term>non-ACA compliant health insurance coverage</term> has the meaning given such term in paragraph (3) of section 1321(c) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18041">42 U.S.C. 18041(c)</external-xref>) (as added by section 302).</text></paragraph> |
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<paragraph commented="no" id="id9E3AF723C2E84345BED300821DB6941B"><enum>(4)</enum><header>Online platform</header><text>The term <term>online platform</term> means any public-facing website, web application, or digital application, including a search engine or social network.</text></paragraph> <paragraph id="idA09243DB467047AA80A9FBABE4F0859F"><enum>(5)</enum><header>Qualified health plan</header><text>The term <term>qualified health plan</term> has the meaning given such term in section 1301(a) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18021">42 U.S.C. 18021(a)</external-xref>).</text></paragraph></section> |
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<section id="idD244E7E6DF95436583ED588BA9AD18CF"><enum>102.</enum><header>FTC oversight of online health insurance advertisements</header> |
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<subsection id="idE0C3185987574B2F924BF1024CA99FFB"><enum>(a)</enum><header>Prohibitions for online private health insurance advertisement</header> |
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<paragraph id="id18EBE659583A4CBAA5C6846C1220D145"><enum>(1)</enum><header>In general</header><text>Subject to paragraph (3), a person may not post, publish, or otherwise display on the internet a deceptive advertisement for health insurance coverage. </text></paragraph> <paragraph id="idAEACC90252B54F53AC31AC8F40B05169"><enum>(2)</enum><header>Deceptive</header><text>An online advertisement for health insurance coverage shall be considered deceptive if it—</text> |
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<subparagraph id="idE7469A5D477A4CF799ECE3F8A0915790"><enum>(A)</enum><text>is likely to mislead, or has the effect of misleading, a reasonable individual to believe that such advertisement is made by, through, or on behalf of—</text> <clause id="idD40F13A1E52343679EBF4E5460601D38"><enum>(i)</enum><text>Healthcare.gov;</text></clause> |
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<clause id="id1B1952A6C0934E52A860B33658A3B356"><enum>(ii)</enum><text>a State or Federal American Health Benefit Exchange described in sections 1311 and 1321 of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18031">42 U.S.C. 18031</external-xref>, 18041); or</text></clause> <clause id="id84B7C25CA76947F6A7DD2512911EF7D9"><enum>(iii)</enum><text>any other Federal, State, or local government entity;</text></clause></subparagraph> |
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<subparagraph id="idFB22D2E0ED904809968B455BC6421594"><enum>(B)</enum><text>is likely to mislead, or has the effect of misleading, a reasonable individual about—</text> <clause id="idF520A266756547239FB1504AE6AAFDDE"><enum>(i)</enum><text>the relative cost of enrolling in non-ACA compliant health insurance coverage as compared to the cost of enrolling in a qualified health plan;</text></clause> |
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<clause commented="no" id="id2D7CE01A28934A7CAE1A7023FC94384D"><enum>(ii)</enum><text>the relative actuarial value of non-ACA compliant health insurance coverage as compared to a qualified health plan; or</text></clause> <clause commented="no" id="idEE98D1409D554B808828BA079C2DA826"><enum>(iii)</enum><text>the relative scope of benefits of non-ACA compliant health insurance coverage as compared to a qualified health plan;</text></clause></subparagraph> |
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<subparagraph id="id581D642C09A94B8999DB0697B59E2C70"><enum>(C)</enum><text>is likely to mislead, or has the effect of misleading, a reasonable individual to believe that the health insurance coverage advertised—</text> <clause id="id779B6E3D1A964B43A4E143DE4522B37E"><enum>(i)</enum><text>complies with the requirements for qualified health plans under the Patient Protection and Affordable Care Act (<external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>), although the health insurance coverage does not meet such requirements; or</text></clause> |
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<clause id="idD3AEB2F29DE54A678DA1C08DCDEE6048"><enum>(ii)</enum><text>provides coverage for benefits that are not covered by such health insurance coverage; or</text></clause></subparagraph> <subparagraph id="id497F2E6495164689B634DE8086600920"><enum>(D)</enum><text>is likely to mislead, or has the effect of misleading, a reasonable individual regarding the scope, cost, or duration of coverage of the health insurance coverage being advertised.</text></subparagraph></paragraph> |
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<paragraph id="idDC9CE2DBF81C4C529880A0C31A06B25E"><enum>(3)</enum><header>Liability of online platforms</header><text>If a person who is unrelated to the operator of an online platform pays or arranges to post, publish, or otherwise display an advertisement that violates paragraph (1) on the online platform—</text> <subparagraph id="ide608c527e43c427dab3c497617b91d63"><enum>(A)</enum><text>such person shall be deemed to have committed the violation of such paragraph; and</text></subparagraph> |
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<subparagraph id="id7bde3229e845437dbaf918bd0bc63d31"><enum>(B)</enum><text>the operator of the online platform shall not be liable for a violation of such paragraph.</text></subparagraph></paragraph></subsection> <subsection id="id7CBEE3822242472F9BC8FE187F524B5B"><enum>(b)</enum><header>Enforcement by the Commission</header> <paragraph id="id93BE8932430244319574DC9EF886439D"><enum>(1)</enum><header>Unfair or deceptive acts or practice</header><text>A violation of this section or a regulation promulgated under this section shall be treated as a violation of a rule defining an unfair or deceptive act or practice under section 18(a)(1)(B) of the Federal Trade Commission Act (<external-xref legal-doc="usc" parsable-cite="usc/15/57a">15 U.S.C. 57a(a)(1)(B)</external-xref>).</text></paragraph> |
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<paragraph id="idf6215867b0b94f64a2031afc6161c118"><enum>(2)</enum><header>Powers of the Federal Trade Commission</header> |
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<subparagraph id="idcaa425f6e8de4a9d9355261fce5d781f"><enum>(A)</enum><header>In general</header><text>Except as provided in subparagraph (C), the Commission shall enforce this section in the same manner, by the same means, and with the same jurisdiction, powers, and duties as though all applicable terms and provisions of the Federal Trade Commission Act (<external-xref legal-doc="usc" parsable-cite="usc/15/41">15 U.S.C. 41</external-xref> et seq.) were incorporated into and made a part of this section. </text></subparagraph> <subparagraph id="id7b8b3e3992b9426fba536e2cae1148ab"><enum>(B)</enum><header>Privileges and immunities</header><text>Any person who violates this section or a regulation promulgated under this section shall be subject to the penalties and entitled to the privileges and immunities provided in the Federal Trade Commission Act (<external-xref legal-doc="usc" parsable-cite="usc/15/41">15 U.S.C. 41</external-xref> et seq.).</text></subparagraph> |
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<subparagraph id="id82A56C840CB44CDEB4E038422EC66567"><enum>(C)</enum><header>Nonprofit organizations and insurance</header><text>Notwithstanding section 4 or 6 of the Federal Trade Commission Act (<external-xref legal-doc="usc" parsable-cite="usc/15/44">15 U.S.C. 44</external-xref>, 46), section 2 of McCarran-Ferguson Act (<external-xref legal-doc="usc" parsable-cite="usc/15/1012">15 U.S.C. 1012</external-xref>), or any other jurisdictional limitation of the Commission, the Commission shall also enforce this section and the regulations promulgated under this section, in the same manner provided in subparagraphs (A) and (B) of this paragraph, with respect to—</text> <clause id="id8ec998cd29c04b39b19a92857b313b50"><enum>(i)</enum><text>organizations not organized to carry on business for their own profit or that of their members; and</text></clause> |
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<clause id="id1e2804bf07fa4993bbf9a05d582bbccc"><enum>(ii)</enum><text>the business of insurance, and persons engaged in such business.</text></clause></subparagraph> <subparagraph id="idF9116A3DC88245DFA29926DE5878E977"><enum>(D)</enum><header>Continued applicability of State law</header> <clause id="id61AC8696EAD14BE2B88FC57B698DBBA3"><enum>(i)</enum><header>In general</header><text>This section shall only supersede a State law to the extent that this section is inconsistent with otherwise applicable State law.</text></clause> |
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<clause id="idE6E3ABCAE6E642CEBF46D2D3C9B55132"><enum>(ii)</enum><header>Clarification</header><text>A State law that provides additional protections to consumers than those protections provided in this Act shall not be considered inconsistent with this Act for purposes of clause (i).</text></clause></subparagraph></paragraph> <paragraph commented="no" id="id0c74f7d83270464583df97ce31217244"><enum>(3)</enum><header>Rulemaking</header><text>The Commission shall promulgate in accordance with section 553 of title 5, United States Code, such rules as may be necessary to carry out this Act.</text></paragraph> |
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<paragraph commented="no" id="id8CA32AD0B85E42AFA54AECA2AB137F6A"><enum>(4)</enum><header>Authority preserved</header><text>Nothing in this Act shall be construed to limit the authority of the Commission under any other provision of law.</text></paragraph></subsection> <subsection id="idD58A8C14B42346C8BE760C6AEF86F6D1"><enum>(c)</enum><header>GAO study and report</header> <paragraph id="id8E2DBE79E2744CA28EEC15A4563C4684"><enum>(1)</enum><header>Study</header><text>The Comptroller General of the United States shall conduct a study on the effectiveness of the Commission's oversight of online advertisements for health insurance coverage pursuant to this section during the period which begins on the date of enactment of this Act and ends 3 years thereafter. Such study shall include the following:</text> |
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<subparagraph id="id56AC33010C6149799990BEB382F8EDA5"><enum>(A)</enum><text>The number of enforcement actions during such period taken by the Commission related to the oversight of online advertisements for health insurance coverage under this section.</text></subparagraph> <subparagraph id="id95F8D6E9912E43C5A69B2FD2B68AF820"><enum>(B)</enum><text>A description of the outcome of any such enforcement action.</text></subparagraph> |
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<subparagraph id="idCBF93F230C194ABF8481D06391FF6DBC"><enum>(C)</enum><text>A description of any barrier to the Commission's enforcement authority under this section in relation to such advertisements.</text></subparagraph> <subparagraph id="id9005FE5419C8487C83D4080BE824BF9C"><enum>(D)</enum><text>A description of how the Commission's oversight of online advertisements for health insurance coverage has protected consumers, including through means other than enforcement actions.</text></subparagraph></paragraph> |
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<paragraph id="id7526E03BE145422584ED567E7423728F" commented="no" display-inline="no-display-inline"><enum>(2)</enum><header>Report</header><text>Not later than 4 years after the date of enactment of this Act, the Comptroller General of the United States shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.</text></paragraph></subsection></section></title> <title id="idE950514890E24FC2A9AF44C6AEE1DC5D" style="OLC"><enum>II</enum><header>Warnings and reporting requirements for noncomprehensive health plans</header> <section id="id8C7C627E896C4CD5BFC58E7ACDCDF3E1"><enum>201.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text> |
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<paragraph id="id56CD57BD40C74929AA8E4BD07A01F20F"><enum>(1)</enum><header>Applicable health plan</header><text>The term <term>applicable health plan</term>—</text> <subparagraph id="id805AC9C6610A44D291CFF8C094E1070F"><enum>(A)</enum><text>means (except as provided in subparagraph (B))—</text> |
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<clause id="id3EE4C793FE4C4F92BF623F558E42DEC2"><enum>(i)</enum><text>health insurance coverage in the individual market providing excepted benefits, excluding—</text> <subclause id="id9086717D7338461E89D2970F89462C10"><enum>(I)</enum><text>automobile liability insurance described in paragraph (1)(C) of section 2791(c) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg-91">42 U.S.C. 300gg–91(c)</external-xref>);</text></subclause> |
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<subclause id="id0B56552563FF41F79216F082C3EB60F0"><enum>(II)</enum><text>automobile medical payment insurance described in paragraph (1)(E) of such section;</text></subclause> <subclause id="idBD885F36A74A40F6B88D5C152821F6DB"><enum>(III)</enum><text>limited scope dental or vision benefits described in paragraph (2)(A) of such section;</text></subclause> |
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<subclause id="id81B9D1598745458B898680699C7ACEF1"><enum>(IV)</enum><text>workers' compensation, or similar insurance, described in paragraph (1)(D) of such section;</text></subclause> <subclause id="id5A9235409A474696BD97B17DB7E5FDAF"><enum>(V)</enum><text>coverage for on-site medical clinics described in paragraph (1)(G) of such section; or</text></subclause> |
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<subclause id="id352AD9AEC74A47F384DC3280311C2E8E"><enum>(VI)</enum><text>medicare supplemental health insurance (as defined under section 1882(g)(1) of the Social Security Act) or coverage supplemental to the coverage provided under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/10/55">chapter 55</external-xref> of title 10, United States Code; </text></subclause></clause> <clause id="idD88981390F6D47B1BDB12F35CAD5D771"><enum>(ii)</enum><text>student health insurance coverage, as defined in section 147.145(a) of title 45, Code of Federal Regulations (or a successor regulation);</text></clause> |
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<clause id="id5C9EFAFDC01B468D80CAFCF2C00514D3"><enum>(iii)</enum><text>short-term limited duration insurance, as defined in section 144.103 of title 45, Code of Federal Regulations (or a successor regulation);</text></clause> <clause id="id233D1B935298437094BA94BC622C7039"><enum>(iv)</enum><text>any health care arrangement for benefits or payments for medical care offered to individuals through an association; and</text></clause> |
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<clause id="id27185E23E9DF4C3D96B62973EB9E284A"><enum>(v)</enum><text>any other health care arrangement for benefits or payments for medical care (other than under a Federal health care program) that is not health insurance coverage, or a group health plan, for purposes of 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.), part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (<external-xref legal-doc="usc" parsable-cite="usc/29/1181">29 U.S.C. 1181</external-xref> et seq.), or <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/26/100">chapter 100</external-xref> of the Internal Revenue Code of 1986, including such an arrangement offered by a State farm bureau or a health care sharing ministry; and</text></clause></subparagraph> <subparagraph id="id75B8A100FED649CB820493CDEC04D6F1"><enum>(B)</enum><text>does not include—</text> |
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<clause id="idE7E5CF483E8348609056144E1F213B44"><enum>(i)</enum><text>any group health plan;</text></clause> <clause id="id851EA2A2D852464C932AF89C4990E9B9"><enum>(ii)</enum><text>any grandfathered health plan; and</text></clause> |
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<clause id="idAD230959CFF04422B89F535C026700C2"><enum>(iii)</enum><text>any health insurance coverage to which the transitional policy, described in the letter issued on November 14, 2013, by the Centers for Medicare & Medicaid Services to insurance commissioners, or an extension of such policy, applies.</text></clause></subparagraph></paragraph> <paragraph id="idE610D6F412C642DDB18B611060B4570F"><enum>(2)</enum><header>Applicable State authority; excepted benefits; Exchange</header><text>The terms <term>applicable State authority</term>, <term>excepted benefits</term>, and <term>Exchange</term> have the meanings given such terms in section 2791 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg-91">42 U.S.C. 300gg–91</external-xref>). </text></paragraph> |
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<paragraph commented="no" display-inline="no-display-inline" id="id0E04A596DC5E4E3EB0ED982258EC8F4A"><enum>(3)</enum><header>Federal health care program</header><text>The term <term>Federal health care program</term> has the meaning given such term under section 1128B(f) of the Social Security Act (42 U.S.C. 1320a–7b(f)), except that such term includes the health insurance program under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/89">chapter 89</external-xref> of title 5, United States Code.</text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="idD26365DBE32C4483BD38C4D6D31975B7"><enum>(4)</enum><header>Grandfathered health plan</header><text>The term <term>grandfathered health plan</term> has the meaning given such term in section 1251(e) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18011">42 U.S.C. 18011(e)</external-xref>).</text></paragraph> |
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<paragraph commented="no" display-inline="no-display-inline" id="id58AD1CAE93C344948F3B9ED86A750070"><enum>(5)</enum><header>Group health plan</header><text>The term <term>group health plan</term> has the meaning given such term in section 2791 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg-91">42 U.S.C. 300gg–91</external-xref>).</text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="id33E412EB43984C5EA3AF9E0B211CAD00"><enum>(6)</enum><header>Health care sharing ministry</header><text>The term <term>health care sharing ministry</term> has the meaning given such term in <external-xref legal-doc="usc" parsable-cite="usc/26/5000A">section 5000A(d)(2)(B)(ii)</external-xref> of the Internal Revenue Code of 1986.</text></paragraph> |
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<paragraph commented="no" display-inline="no-display-inline" id="id47EEA45AA83940C68D918C4DEAA7703C"><enum>(7)</enum><header>Health insurance coverage; health insurance issuer; individual market</header><text>The terms <term>health insurance coverage</term>, <term>health insurance issuer</term>, and <term>individual market</term> have the meanings given such terms in section 2791 of the Public Health Service Act.</text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="idD5770CDFE16F4D8C9C4F4BBAD44102F1"><enum>(8)</enum><header>Non-ACA compliant health insurance coverage</header><text>The term <term>non-ACA compliant health insurance coverage</term> has the meaning given such term in paragraph (3) of section 1321(c) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18041">42 U.S.C. 18041(c)</external-xref>) (as added by section 302), except that such term shall not include any Federal health care program. </text></paragraph> |
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<paragraph commented="no" display-inline="no-display-inline" id="id76F1704122AB4DB68DB777DF0CCE7CB3"><enum>(9)</enum><header>Plain language</header><text>The term <term>plain language</term> has the meaning given the term plain writing in section 3 of the Plain Writing Act of 2010 (<external-xref legal-doc="usc" parsable-cite="usc/5/301">5 U.S.C. 301</external-xref> note).</text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="idD830102AD46049A39D14A86ABE0FF366"><enum>(10)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Health and Human Services.</text></paragraph></section> |
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<section commented="no" display-inline="no-display-inline" id="idABCB7386F8054DDE928815A330A5474D"><enum>202.</enum><header>Requirements for notice regarding benefits</header> |
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<subsection commented="no" display-inline="no-display-inline" id="id7533417D5C4E48D9B70471D1DF94C136"><enum>(a)</enum><header>In general</header><text>Each applicable health plan shall offer to consumers, prior to enrollment, enrollment material that includes—</text> <paragraph commented="no" display-inline="no-display-inline" id="id877422750F5442C3BADB42983EC7FC9D"><enum>(1)</enum><text>a plain language explanation of the benefits included in such plan, including through forms that are culturally and linguistically appropriate for such consumers; and</text></paragraph> |
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<paragraph commented="no" display-inline="no-display-inline" id="id5B35298653C641D0AC7118CDDDA125C0"><enum>(2)</enum><text>a warning page regarding such benefits in accordance with subsection (b).</text></paragraph></subsection> <subsection commented="no" display-inline="no-display-inline" id="idC83015BEDFC445AF8932AEB46F369C34"><enum>(b)</enum><header>Warning page</header> <paragraph commented="no" display-inline="no-display-inline" id="id28AFFB9750044847A7CEFC1335E3B4C6"><enum>(1)</enum><header>In general</header><text>The warning page required under subsection (a)(2) shall include—</text> |
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<subparagraph commented="no" display-inline="no-display-inline" id="idFDC99082DE014FE797FE0EDEFD60E088"><enum>(A)</enum><text>a clear statement indicating that the applicable health plan is not a comprehensive health plan because it is not required to comply with certain requirements under the Patient Protection and Affordable Care Act (<external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>) and 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.);</text></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="id813847349B784AFB9131ECF5862788F2"><enum>(B)</enum><text>a statement encouraging the consumer to review the plan documents carefully to ensure the individual is aware of—</text> |
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<clause commented="no" display-inline="no-display-inline" id="id4C63B0F23F6A446595B14D5311754B85"><enum>(i)</enum><text>any exclusions or limitations regarding coverage of preexisting conditions or health benefits (such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services); and</text></clause> <clause commented="no" display-inline="no-display-inline" id="id34D4875575ED448BA41C786C1F301310"><enum>(ii)</enum><text> any lifetime or annual dollar limits on health benefits; </text></clause></subparagraph> |
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<subparagraph commented="no" display-inline="no-display-inline" id="idBEB9221AF13D47ABB392FFE64AC268EC"><enum>(C)</enum><text>a statement notifying the consumer that, if the plan expires or the individual loses eligibility for the plan, the individual may have to wait until the beginning of an open enrollment period to enroll in another plan; </text></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="id9F8D301E51A949F99AE8C6B439194229"><enum>(D)</enum><text>a statement notifying the consumer of the option to enroll in a qualified health plan, which is generally a more comprehensive health plan, through the Exchange operating in the State, including—</text> |
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<clause commented="no" display-inline="no-display-inline" id="idF3578F75DA0D43FD89C65CA8CE9E943F"><enum>(i)</enum><text>a statement that most consumers who enroll in a qualified health plan receive help paying for their monthly premiums;</text></clause> <clause commented="no" display-inline="no-display-inline" id="id8A4B6CC4A1D448CFAF2C308B51AF2F67"><enum>(ii)</enum><text>a statement that special enrollment periods are available through the Exchange; </text></clause> |
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<clause commented="no" display-inline="no-display-inline" id="id351E51DD793148F485D0EE46ECC9A029"><enum>(iii)</enum><text>a link to Healthcare.gov (or a successor website) or another website for the Exchange operating in the State; and</text></clause> <clause commented="no" display-inline="no-display-inline" id="id647E7E2452BE4379800A80EF7AA60E1D"><enum>(iv)</enum><text>the phone number for the Exchange operating in the State; and</text></clause></subparagraph> |
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<subparagraph commented="no" display-inline="no-display-inline" id="id812A865612004BD8977BA9C73F6F4FC5"><enum>(E)</enum><text>a line for the signature of the consumer to acknowledge that the consumer has read and understands the provisions in the warning page, and for the date on which such signature is provided. </text></subparagraph></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="id39C8D581347D43368072C85CFEB035B9"><enum>(2)</enum><header>Accessibility</header> <subparagraph commented="no" display-inline="no-display-inline" id="id8B212129DF724E779EAA2B0A244826B9"><enum>(A)</enum><header>In general</header><text>The warning page required under subsection (a)(2) shall be—</text> |
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<clause commented="no" display-inline="no-display-inline" id="id50E07846488C46CF839AA3E9A9BB9ED3"><enum>(i)</enum><text>located at the beginning of the enrollment material, </text></clause> <clause commented="no" display-inline="no-display-inline" id="idC6354A03715A42959C5E7D20D671DE1E"><enum>(ii)</enum><text>accessible to people with disabilities, including a physical, cognitive, or sensory disability, including accessibility to such people through the use of computers and other technology for receiving consumer information; and</text></clause> |
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<clause commented="no" display-inline="no-display-inline" id="id5AD582CDA57C4FC89DB9DEBAEFC9BA66"><enum>(iii)</enum><text>written in plain language that is easily understood by individuals with an intellectual or other cognitive or processing disability. </text></clause></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="id28777991D08A43568AEBB8BD2E7E417D"><enum>(B)</enum><header>Multiple languages</header><text>An applicable health plan shall make the warning page required under subsection (a)(2) available in the top 15 languages spoken by individuals with limited English proficiency in the State in which the plan is offered. </text></subparagraph> |
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<subparagraph commented="no" display-inline="no-display-inline" id="id27A6022041E64EA2A2E71F19BE4DD562"><enum>(C)</enum><header>Restriction on promoting enrollment in non-ACA compliant health insurance coverage</header><text>The warning page required under subsection (a)(2) shall not include any provision—</text> <clause commented="no" display-inline="no-display-inline" id="id516885160E284925882CAE90D99FB425"><enum>(i)</enum><text>promoting enrollment in any non-ACA compliant health insurance coverage; or </text></clause> |
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<clause commented="no" display-inline="no-display-inline" id="idC80FBAC9BA79412A8613A56B5878CD47"><enum>(ii)</enum><text>directing consumers to a source that could enroll the consumer in any non-ACA compliant health insurance coverage.</text></clause></subparagraph></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="id804202480E5D4A36907C754405710DEA"><enum>(3)</enum><header>Additional State requirements</header><text>A State may require applicable health plans to include information, in addition to the information required under this section, in the warning page required under subsection (a)(2), except that any such additional information shall not—</text> |
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<subparagraph commented="no" display-inline="no-display-inline" id="id06B21DB87E7F4C1CBB9637FD1FBC1C9F"><enum>(A)</enum><text>replace the information required under this section; </text></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="idFAE1FBFA507E45DF9EFCAC2F3E1D6E02"><enum>(B)</enum><text>promote enrollment in any non-ACA compliant health insurance coverage; </text></subparagraph> |
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<subparagraph commented="no" display-inline="no-display-inline" id="id401FD298639643CDA271DEB799378075"><enum>(C)</enum><text>direct consumers to a source that could enroll the consumer in any non-ACA compliant health insurance coverage; or</text></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="id2AA2D52B5AC14C58AE29B7FC4D394B48"><enum>(D)</enum><text>otherwise conflict with a requirement under this section.</text></subparagraph></paragraph></subsection> |
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<subsection commented="no" display-inline="no-display-inline" id="idF20BD7367F0B47EA8CF09447F351FBD5"><enum>(c)</enum><header>Records of signatures</header> |
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<paragraph commented="no" display-inline="no-display-inline" id="idCF93AE2B411E4D43B82C040AC8EFA1A0"><enum>(1)</enum><header>In general</header><text>An administrator of an applicable health plan shall maintain a record of the signature of a consumer obtained under subsection (b)(1)(E) while the consumer is enrolled in the plan and for, at a minimum, 2 years after the consumer is no longer enrolled in such plan. The Secretary may, through regulations under section 205, require an applicable health plan to maintain such record for a period longer than 2 years after the consumer is no longer enrolled in the plan. </text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="id4B427128A03648FCA20E11284176E4F3"><enum>(2)</enum><header>Reimbursement</header> <subparagraph commented="no" display-inline="no-display-inline" id="idE006126D29C14CDD8A531B42D613609C"><enum>(A)</enum><header>In general</header><text>In the case that a consumer claims, within the period and in accordance with the procedures described in subparagraph (C), that an applicable health plan did not cover a health benefit while the consumer was enrolled in such plan and the administrator of such plan is not able to provide proof of the record required under paragraph (1) with respect to that consumer, the plan shall reimburse the consumer, in an amount determined under subparagraph (B), for such benefit.</text></subparagraph> |
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<subparagraph commented="no" display-inline="no-display-inline" id="idC5B59CA7BC1D4F46A740FB6516760144"><enum>(B)</enum><header>Amount</header> |
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<clause commented="no" display-inline="no-display-inline" id="id5AEC561949AC43E98CB8B2C5AF3A971D"><enum>(i)</enum><header>In general</header><text>Except as provided under clause (ii), such reimbursement shall be equal to (the greater of)—</text> <subclause commented="no" display-inline="no-display-inline" id="idDDF490E6ADA74C8F9CB14C70450D062A"><enum>(I)</enum><text>the amount the applicable second lowest cost silver plan (as defined in <external-xref legal-doc="usc" parsable-cite="usc/26/36B">section 36B(b)(3)(B)</external-xref> of the Internal Revenue Code of 1986), available in the Exchange operating in the State in which the consumer resided at the time of enrollment, would have paid for the health benefit if the consumer were enrolled in such plan and the health benefit was provided in-network; or</text></subclause> |
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<subclause commented="no" display-inline="no-display-inline" id="idEBED31D623EC448C88767813F0C14809"><enum>(II)</enum><text>if applicable, an amount determined by the State in which the consumer resides at the time of enrollment.</text></subclause></clause> <clause commented="no" display-inline="no-display-inline" id="idB87172AF51B64C1CAF7B4337019A2F1D"><enum>(ii)</enum><header>Coverage required by plan documents</header><text>In the case described in subparagraph (A), if the Secretary or applicable State authority determines that the applicable health plan was required to provide coverage of the health benefit claimed by the consumer based on statements included in the plan documents, the applicable health plan shall reimburse the consumer in an amount determined in accordance with such plan documents.</text></clause></subparagraph> |
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<subparagraph commented="no" display-inline="no-display-inline" id="idB0A17C6618A44950AA80070D2F8FDE16"><enum>(C)</enum><header>Claims</header><text>The Secretary shall, through regulations under section 205, establish procedures for the filing of claims under subparagraph (A), including by setting the period during which a claim under such subparagraph shall be filed. Such period shall be not less than 2 years after the consumer is no longer enrolled in the plan.</text></subparagraph></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="id3A25B4232F244F3597D976F4457D43FC"><enum>(3)</enum><header>Liability under other applicable laws</header><text>The ability of an applicable health plan to produce proof of a record required under paragraph (1) shall not shield the plan, including any administrator, insurance broker, or operator of the plan, from liability under other applicable State or Federal law for any deceptive practice that the plan, including any such administrator, insurance broker, or operator, engaged in while enrolling a consumer in the plan.</text></paragraph></subsection></section> |
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<section commented="no" display-inline="no-display-inline" id="idA9E844446C024C32B11328F7FACAB898"><enum>203.</enum><header>Reporting requirements</header> |
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<subsection commented="no" display-inline="no-display-inline" id="idC8D10758D57346CABDF3756B2577B1AF"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than November 1 of the first calendar year following the date of enactment of this Act, and November 1 of each year thereafter, an applicable health plan shall submit to the Secretary a report containing each of the following (with respect to the plan year covered by the reporting period):</text> <paragraph commented="no" display-inline="no-display-inline" id="id2DD4BE5025DC46669837B248F9437BC5"><enum>(1)</enum><text>The total enrollment in the applicable health plan.</text></paragraph> |
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<paragraph commented="no" display-inline="no-display-inline" id="id5823547A1AA74BE89A1FA85ED31337BB"><enum>(2)</enum> |
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<subparagraph commented="no" display-inline="yes-display-inline" id="id8C712DC29A6142B1894D33311CAE87E3"><enum>(A)</enum><text>A statement of whether the applicable health plan used an insurance broker. </text></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="idAD1FC37742A0432D98B07AA01E216CF1" indent="up1"><enum>(B)</enum><text>If such plan used an insurance broker, an indication of the number of consumers who were enrolled in the plan through an insurance broker.</text></subparagraph></paragraph> |
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<paragraph commented="no" display-inline="no-display-inline" id="id9FE781A64D144F7E8A57DBFD028EB882"><enum>(3)</enum><text>The total amount of claims submitted for payment to the applicable health plan.</text></paragraph> <paragraph id="ida7c7c96e8ef842fda200db14a93df3c0"><enum>(4)</enum><text>The total amount of claims denied by the applicable health plan.</text></paragraph> |
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<paragraph id="id4ce5ea752c4b4a1caed42d1469003999"><enum>(5)</enum><text>Information on any marketing materials the applicable health plan used to enroll consumers in the plan, including—</text> <subparagraph id="id2B13F45DC053427CA6F82F9E6B34A7B9"><enum>(A)</enum><text>an indication of whether the plan used any online advertisements; and</text></subparagraph> |
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<subparagraph id="idD849CE585E1E4224B8136CE2C1A68DB5"><enum>(B)</enum><text>a copy of any marketing material used, including any online advertisement. </text></subparagraph></paragraph> <paragraph id="id09fa86f456974ac1b164372f947ae86e"><enum>(6)</enum><text>Any other information regarding enrollment, coverage, or advertising the Secretary determines appropriate through regulations issued under section 205. </text></paragraph></subsection> |
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<subsection id="id5FC2316198F14FF28893C21AD78BA5FC"><enum>(b)</enum><header>Exemptions</header><text>An applicable health plan shall be exempt from the requirement under subsection (a) if—</text> <paragraph id="id14D9870C9F78492297BC5772140368C0"><enum>(1)</enum><text>the plan is required under the law of each State in which the plan is offered to submit all information required under subsection (a) to the applicable State authority in each such State; and</text></paragraph> |
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<paragraph id="idB705EDED625D4F7E81A88D248AF56288"><enum>(2)</enum><text>the applicable State authority in each such State reviews such information and has a process for addressing any such information that is misleading or incorrect.</text></paragraph></subsection> <subsection id="idD1FE971654234A21A23E777FEFF3D3D4"><enum>(c)</enum><header>Transmittal to States</header><text>Not later than 2 months after receiving a report under subsection (a) from an applicable health plan, the Secretary shall transmit the report to the applicable State authority of each State in which the plan is offered.</text></subsection> |
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<subsection id="idE89834163E8B479A87612F026FD278CE"><enum>(d)</enum><header>Public availability</header> |
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<paragraph id="id466BAFC6F76D4BC080506D80E5CC141D"><enum>(1)</enum><header>In general</header><text>The Secretary shall make all information submitted under subsection (a) available to the public through a publicly accessible website.</text></paragraph> <paragraph id="id2111729623AB4CA88D6AAC6FED952399"><enum>(2)</enum><header>Publicizing website</header><text>The Secretary shall publicize the website under paragraph (1), including through agreements with applicable State authorities and national and State organizations representing consumers.</text></paragraph></subsection></section> |
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<section commented="no" display-inline="no-display-inline" id="idAF8F543520614DBFAB4E6048183B8C9A"><enum>204.</enum><header>Enforcement</header><text display-inline="no-display-inline">The Secretary shall have the authority to enforce the requirements under section 202 (except the additional State requirements under subsection (b)(3) of such section) and section 203 against an applicable health plan in the same manner as the Secretary may under section 2723(b) (without regard to the limitation under paragraph (1)(A) of such section) enforce a requirement under parts A and D of 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.) against a health insurance issuer that violates a provision of such part, including through civil money penalties and procedures for administrative and judicial review under section 2723(b)(2) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg-22">42 U.S.C. 300gg–22(b)(2)</external-xref>).</text></section> <section commented="no" display-inline="no-display-inline" id="idAC218A4B143D4458969DDE08C64AACAA"><enum>205.</enum><header>Regulations</header> <subsection commented="no" display-inline="no-display-inline" id="idCBD6ED0A4EF94B84B28CEDEDEA8CC7DE"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary may issue regulations to carry out this title, including—</text> |
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<paragraph commented="no" display-inline="no-display-inline" id="id4192F38DA2EC4B9FBDF2985016DD8314"><enum>(1)</enum><text display-inline="yes-display-inline">regulations to establish enforcement procedures authorized under section 204; and </text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="id9D3BB54BF0BE4178A21812E7FB1EC586"><enum>(2)</enum><text display-inline="yes-display-inline">subject to subsection (b), regulations for establishing requirements for the warning page required under section 202(a)(2) that are in addition to the requirements provided under section 202.</text></paragraph></subsection> |
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<subsection commented="no" display-inline="no-display-inline" id="id97ED5CDAF17D49C19630BD6E2A947FBA"><enum>(b)</enum><header>Limitation on requirements for warning page</header><text>A requirement in a regulation described in subsection (a)(2) shall not—</text> <paragraph commented="no" display-inline="no-display-inline" id="idA992996C9DB64F1FBF807B6EB37EECAC"><enum>(1)</enum><text>use any language to promote enrollment in any non-ACA compliant health insurance coverage;</text></paragraph> |
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<paragraph commented="no" display-inline="no-display-inline" id="id0DDAD980F5DF4B9AA2ED78719BC368AF"><enum>(2)</enum><text>direct consumers to a source that could enroll the consumer in any non-ACA compliant health insurance coverage; or</text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="idC6DE13B708A84E7A8B98D0782F449073"><enum>(3)</enum><text>otherwise conflict with a requirement under this title.</text></paragraph></subsection></section></title> |
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<title id="id337C07D9E8AE4E7582911740D03FB31F" style="OLC"><enum>III</enum><header>Encouraging enrollment in health plans</header> |
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<section commented="no" id="id51FE95D9547B4775BB85025EEC86AB9E"><enum>301.</enum><header>Sense of Congress</header><text display-inline="no-display-inline">It is the sense of Congress that—</text> <paragraph commented="no" id="idA1F1136304EE460587371C2739E0541A"><enum>(1)</enum><text display-inline="yes-display-inline">when individuals search for phrases related to health insurance, internet search engines, including Google, Bing, and Yahoo, should display an answer box that directs individuals to—</text> |
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<subparagraph commented="no" id="id0EF66BF83D6B4D00938CA21CC0563C1F"><enum>(A)</enum><text display-inline="yes-display-inline">Healthcare.gov and the associated toll free number, 1–800–318–2596, with respect to searches originating in States in which a Federal Exchange is operating; and</text></subparagraph> <subparagraph commented="no" id="id3B2C014D9A5C45EDBD1608D5A097C9A3"><enum>(B)</enum><text>a link and phone number for the appropriate State-based Exchange, with respect to searches originating in States in which a State Exchange is operating; and</text></subparagraph></paragraph> |
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<paragraph commented="no" id="id9E9EA7BE82D547D4A2441DE19DC0213E"><enum>(2)</enum><text display-inline="yes-display-inline">the answer box related to Healthcare.Gov in response to a search described in paragraph (1) should be placed in <quote>position zero</quote>, above all other content, including advertisements.</text></paragraph></section> <section display-inline="no-display-inline" section-type="subsequent-section" id="H8683E286B45F44E0BE24EAE28EACFE6A"><enum>302.</enum><header>Requiring Marketplace outreach, educational activities, and annual enrollment targets</header> <subsection id="H616FCD9FF8664B75B6D1F9CE827968BD"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1321(c) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18041">42 U.S.C. 18041(c)</external-xref>) is amended by adding at the end the following:</text> |
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<quoted-block style="OLC" display-inline="no-display-inline" id="H93E71B544217494EA098AF06B829D682"> |
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<paragraph id="H59D14D616610496B9EA4745289F6458F"><enum>(3)</enum><header>Outreach and educational activities</header> |
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<subparagraph id="H1E9F5A459BC24E0B8217A677C8A6154E"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">In the case of an Exchange established or operated by the Secretary within a State pursuant to this subsection, the Secretary shall carry out outreach and educational activities for purposes of informing individuals about qualified health plans offered through the Exchange, including by informing such individuals of the availability of coverage under such plans and financial assistance for coverage under such plans. Such outreach and educational activities shall be provided in a manner that is culturally and linguistically appropriate to the needs of the populations being served by the Exchange (including hard-to-reach populations, such as racial and sexual minorities, limited English proficient populations, individuals in rural areas, veterans, and young adults) and shall be provided to populations residing in high health disparity areas (as defined in subparagraph (E)) served by the Exchange, in addition to other populations served by the Exchange.</text></subparagraph> <subparagraph id="H9DE34EB229154992B9E873DCB40185D9"><enum>(B)</enum><header>Limitation on use of funds</header><text display-inline="yes-display-inline">No funds appropriated under this paragraph shall be used for expenditures for promoting non-ACA compliant health insurance coverage.</text></subparagraph> |
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<subparagraph id="H43973F8B09AE463C84BDF5337F59DF60"><enum>(C)</enum><header>Non-ACA compliant health insurance coverage</header><text>For purposes of subparagraph (B):</text> <clause id="H7113D55E654247FB985B470A9AFBE8DA"><enum>(i)</enum><text>The term <term>non-ACA compliant health insurance coverage</term> means—</text> |
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<subclause commented="no" id="id197C8BFCEE8F464EA039B3C0D2B48490"><enum>(I)</enum><text>health insurance coverage, or a group health plan, that is not a qualified health plan; and</text></subclause> <subclause id="id678409E3C81344B58AD400D045321F20"><enum>(II)</enum><text>other health care arrangements that are not health plans.</text></subclause></clause> |
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<clause id="HF8B94F32955C47EFBEEDB9B768A05B94"><enum>(ii)</enum><text>Such term includes the following:</text> <subclause id="HD7DA598BEED544B588DA89B8DBD2824F"><enum>(I)</enum><text>An association health plan.</text></subclause> |
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<subclause id="H3FAD7A4C4D9F4EB190591BB7904D6A5B"><enum>(II)</enum><text>Short-term limited duration insurance (as defined in section 144.103 of title 45, Code of Federal Regulations (or a successor regulation)).</text></subclause></clause></subparagraph> <subparagraph id="H54866CF5F14E4854BB1EF26968707D62"><enum>(D)</enum><header>Funding</header><text display-inline="yes-display-inline">Out of any funds in the Treasury not otherwise appropriated, there are hereby appropriated for fiscal year 2023 and each subsequent fiscal year, $100,000,000 to carry out this paragraph. Funds appropriated under this subparagraph shall remain available until expended.</text></subparagraph> |
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<subparagraph id="H8054111A23B74C1BAFD9857814F498C6"><enum>(E)</enum><header>High health disparity area defined</header><text display-inline="yes-display-inline">For purposes of subparagraph (A), the term <term>high health disparity area</term> means a contiguous geographic area that—</text> <clause id="H27DC542EF0DB48EC99884B1B22B7297C"><enum>(i)</enum><text>is located in one census tract or ZIP code;</text></clause> |
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<clause id="HF53D34DD1A004545B3809589B61E7E55"><enum>(ii)</enum><text display-inline="yes-display-inline">has measurable and documented racial, ethnic, or geographic health disparities;</text></clause> <clause id="HFBCD8496B0D64756A7B313236295A3DA"><enum>(iii)</enum><text>has a low-income population, as demonstrated by—</text> |
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<subclause id="H4AC0CF0706BE401791B11D2985533635"><enum>(I)</enum><text display-inline="yes-display-inline">average income below 138 percent of the Federal poverty line; or</text></subclause> <subclause id="H580BB794905B45BE923DE544645EBD47"><enum>(II)</enum><text display-inline="yes-display-inline">a rate of participation in the special supplemental nutrition program under section 17 of the Child Nutrition Act of 1966 (<external-xref legal-doc="usc" parsable-cite="usc/42/1786">42 U.S.C. 1786</external-xref>) that is higher than the national average rate of participation in such program;</text></subclause></clause> |
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<clause id="H5922DD52E8DC4E498341FD67EF661E68"><enum>(iv)</enum><text>has poor health outcomes, as demonstrated by—</text> <subclause id="HB2D0DF57F94543D39E00D0B315128973"><enum>(I)</enum><text display-inline="yes-display-inline">lower life expectancy than the national average; or</text></subclause> |
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<subclause id="HC987A8814E8C47D4A7625FEB1422591A"><enum>(II)</enum><text display-inline="yes-display-inline">a higher percentage of instances of low birth weight than the national average; and</text></subclause></clause> <clause id="HF44573FE8C40486CAE609696BB551B99"><enum>(v)</enum><text display-inline="yes-display-inline">is part of a Metropolitan Statistical Area identified by the Office of Management and Budget.</text></clause></subparagraph></paragraph> |
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<paragraph display-inline="no-display-inline" id="H4679EE308E334B909B2FA04D7F344238"><enum>(4)</enum><header>Annual enrollment targets</header><text display-inline="yes-display-inline">For plan year 2022 and each subsequent plan year, in the case of an Exchange established or operated by the Secretary within a State pursuant to this subsection, the Secretary shall establish annual enrollment targets for such Exchange for such year.</text></paragraph><after-quoted-block>. </after-quoted-block></quoted-block></subsection> <subsection commented="no" id="idBF0F724108D44ABDA07C34E717E68B89"><enum>(b)</enum><header>Grants for State Exchanges</header><text>Section 1311 of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18031">42 U.S.C. 18031</external-xref>) is amended by adding at the end the following:</text> |
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<quoted-block style="OLC" display-inline="no-display-inline" id="id34DC66AE1D2B4B0FA121C0FE98C4E2DA"> |
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<subsection commented="no" id="idD06515643A504818B224A871D7AB66D4"><enum>(l)</enum><header>Open enrollment outreach grants</header> |
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<paragraph commented="no" id="id1A15BAF6C50044C6A9CD8866D5EBAFC0"><enum>(1)</enum><header>In general</header><text>The Secretary shall award grants to States that have established an Exchange pursuant to this section, for purposes of assisting such States in conducting open enrollment outreach with respect to qualified health plans.</text></paragraph> <paragraph commented="no" id="id8A4283FC7CDE4DA88BDF05EB2F68FD20"><enum>(2)</enum><header>Applications</header><text>A State desiring a grant under this subsection shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including a plan demonstrating how the State will use the grant funds to carry out outreach and educational activities consistent with the requirements under section 1321(c)(3). </text></paragraph> |
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<paragraph commented="no" id="id284EEA652549498AB2A944B427E4DF8C"><enum>(3)</enum><header>Awards</header> |
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<subparagraph commented="no" id="id427EE383E4DD419D97122E4201E1A47B"><enum>(A)</enum><header>In general</header><text>The Secretary shall award grants under this subsection as follows:</text> <clause commented="no" id="id73DFDC4F49154E6D86E4FD241D8C5A99"><enum>(i)</enum><text>The Secretary shall award an initial round of grants to each qualifying State in the amount of $1,000,000.</text></clause> |
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<clause commented="no" id="idD4B9636CCB7D47FB8CB103967D88FD53"><enum>(ii)</enum><text>If amounts remain available under this subsection after awards are made under clause (i), the Secretary shall award eligible States that received an award under clause (i) an amount determined appropriate by the Secretary based on—</text> <subclause commented="no" id="idA53BE50C7CE64F11907DB1EA96EF30A6"><enum>(I)</enum><text>the State's total population;</text></subclause> |
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<subclause commented="no" id="id0388221050D94A60BFD4EC0B54E6B9A5"><enum>(II)</enum><text>the percentage of the State's population that is uninsured;</text></subclause> <subclause commented="no" id="id8271DE46F5EF47E8AEB09925E4B2CC1D"><enum>(III)</enum><text>the percentage of the State's population that is difficult to insure; and</text></subclause> |
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<subclause commented="no" id="id8966536222EE4EBDBEF950E60D457E1B"><enum>(IV)</enum><text>such other factors as the Secretary determines appropriate.</text></subclause></clause></subparagraph> <subparagraph commented="no" id="id178ED610AFEB4DE6B7751C24B97250B1"><enum>(B)</enum><header>Available until expended</header><text>With respect to a State receiving a grant under this subsection, the grant funds shall remain available until expended.</text></subparagraph> |
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<subparagraph commented="no" id="id7C8B43022759441C9348D604BF77A015"><enum>(C)</enum><header>Matching requirement</header> |
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<clause commented="no" id="id152221C8ACE04600807CEDAC861E52DA"><enum>(i)</enum><header>In general</header><text>Subject to clause (iii), as a condition for receiving a grant under this section, a State shall be required to expend non-Federal funds, at minimum, in an amount equal to the lesser of—</text> <subclause commented="no" id="id8F884EF3B9DD4E48AF7F74FA530D01EB"><enum>(I)</enum><text>25 percent of the amount received under the grant for the purpose described in paragraph (1); or </text></subclause> |
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<subclause commented="no" id="id4ECCAB60E0B143C3B070D822A5511E6C"><enum>(II)</enum><text>$1,000,000. </text></subclause></clause> <clause commented="no" id="id4D3D95B034F24CB286586146E1A06CE4"><enum>(ii)</enum><header>Previous allocations</header><text>A State may apply funding allocated to the purpose described in paragraph (1) prior to receipt of the grant to satisfy the requirement of clause (i).</text></clause> |
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<clause commented="no" id="id416338727A694CADBCF6C9B24EEEBCA2"><enum>(iii)</enum><header>Waiver</header><text>The Secretary may waive the requirement under clause (i) in response to—</text> <subclause commented="no" id="id67EE9C7A65CF4493AD21D88261E0A892"><enum>(I)</enum><text>a public health emergency or a disaster; or</text></subclause> |
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<subclause commented="no" id="id1691624ED1DC4EC1A3FF45FD87FF53FC"><enum>(II)</enum><text>an economic recession or other economic hardship that results in an increase in uninsured individuals. </text></subclause></clause></subparagraph></paragraph> <paragraph commented="no" id="idAEE4C5723FCB440F822D5D5506C8DF42"><enum>(4)</enum><header>Limitation on use of funds</header><text>No funds appropriated under this subsection shall be used for expenditures for promoting non-ACA compliant health insurance coverage (as such term is defined in section 1321(c)(3)(C)). </text></paragraph> |
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<paragraph id="id73DE6DAD16464456A4AAC8D2B6CD3E72"><enum>(5)</enum><header>Application to Medicaid and CHIP outreach and enrollment grants</header><text>Funds received by a State under a grant awarded under this subsection—</text> <subparagraph id="id8917C990193C48479234D6F0DE69D188"><enum>(A)</enum><text>shall not be taken into consideration by the Secretary when determining whether to award the State a grant under section 2113 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397mm">42 U.S.C. 1397mm</external-xref>); and</text></subparagraph> |
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<subparagraph id="id886CDB5BECA64AE683FBF63F06143180"><enum>(B)</enum><text>may not be used by the State to satisfy the maintenance of effort requirement under subsection (e) of such section. </text></subparagraph></paragraph> <paragraph commented="no" id="idE864709F4DF74EE3A77468322A93FA2E"><enum>(6)</enum><header>Funding</header><text>To carry out this subsection, there are appropriated, out of amounts in the Treasury not otherwise appropriated, $50,000,000 for fiscal year 2023 and each subsequent fiscal year.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection> |
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<subsection id="H0AF4ED9AEC2A462E94A5C2D17C0D5832"><enum>(c)</enum><header>Study and report</header><text display-inline="yes-display-inline">Not later than 30 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall release to Congress all aggregated documents relating to studies and data sets that were created on or after January 1, 2014, and related to marketing and outreach with respect to qualified health plans offered through Exchanges under title I of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18001">42 U.S.C. 18001</external-xref> et seq.).</text></subsection></section> <section id="H151A827DF6014B99B32D1349390EF9E7"><enum>303.</enum><header>Report on effects of website maintenance during open enrollment</header><text display-inline="no-display-inline">Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report examining whether the Department of Health and Human Services has been conducting maintenance on the website commonly referred to as <quote>HealthCare.gov</quote> during annual open enrollment periods (as described in section 1311(c)(6)(B) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18031">42 U.S.C. 18031(c)(6)(B)</external-xref>) in such a manner so as to minimize any disruption to the use of such website resulting from such maintenance.</text></section> |
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<section commented="no" display-inline="no-display-inline" section-type="subsequent-section" id="H925BF0E75A2F40E5AFB97C9B92225D30"><enum>304.</enum><header>Promoting consumer outreach and education</header> |
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<subsection commented="no" id="idE0AB34AC30834DA6BAF576C298D1AB2A"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1311(i) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18031">42 U.S.C. 18031(i)</external-xref>) is amended—</text> <paragraph commented="no" id="H8880737B376740DD900A5B1743FD75BD"><enum>(1)</enum><text>in paragraph (2), by adding at the end the following new subparagraph:</text> |
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<quoted-block style="OLC" display-inline="no-display-inline" id="H3F49F905578F4D108A304D580D561194"> |
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<subparagraph commented="no" id="H1C27A05024484B49AE36BADCDC713D58"><enum>(C)</enum><header>Selection of recipients</header><text display-inline="yes-display-inline">In the case of an Exchange established and operated by the Secretary within a State pursuant to section 1321(c), in awarding grants under paragraph (1), the Exchange shall—</text> <clause commented="no" id="H4BFB4C5D03104A47B6410803B5414FE6"><enum>(i)</enum><text>select entities to receive such grants based on an entity’s demonstrated capacity to carry out each of the duties specified in paragraph (3);</text></clause> |
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<clause commented="no" id="HDE9D3CCA8DC94B098D6D6CB467920552"><enum>(ii)</enum><text>not take into account whether or not the entity has demonstrated how the entity will provide information to individuals relating to group health plans offered by a group or association of employers described in section 2510.3–5(b) of title 29, Code of Federal Regulations (or any successor regulation), or short-term limited duration insurance (as defined in section 144.103 of title 45, Code of Federal Regulations (or a successor regulation)); and</text></clause> <clause commented="no" id="HBED6134649FE493588BB6EEE525FBD58"><enum>(iii)</enum><text>ensure that, each year, the Exchange awards such a grant to—</text> |
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<subclause commented="no" id="H668300D5FA9B49B680066698124A4739"><enum>(I)</enum><text>at least one entity described in this paragraph that is a community and consumer-focused nonprofit group; and</text></subclause> <subclause commented="no" id="H70C60F0A4B93418392526DFAE15711F3"><enum>(II)</enum><text>at least one entity described in subparagraph (B), which may include another community and consumer-focused nonprofit group in addition to any such group awarded a grant pursuant to subclause (I).</text></subclause></clause><continuation-text commented="no" continuation-text-level="subparagraph">In awarding such grants, an Exchange may consider an entity’s record with respect to waste, fraud, and abuse for purposes of maintaining the integrity of such Exchange.</continuation-text></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></paragraph> |
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<paragraph commented="no" id="H37BB63AF9F4447F8AAEDE8EE7661CCE8"><enum>(2)</enum><text>in paragraph (3)—</text> <subparagraph id="H59F88089846A4ADFA5180BF3850A3110"><enum>(A)</enum><text display-inline="yes-display-inline">by amending subparagraph (C) to read as follows:</text> |
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<quoted-block style="OLC" display-inline="no-display-inline" id="HA0B2CEBFD0294835A6E7C508DD6D35F6"> |
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<subparagraph id="H8844AEC5A5BD47A38E8BCBFB583100CD"><enum>(C)</enum><text display-inline="yes-display-inline">facilitate enrollment, including with respect to individuals with limited English proficiency and individuals with chronic illnesses, in qualified health plans, State Medicaid plans under title XIX of the Social Security Act, and State child health plans under title XXI of such Act;</text></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph> <subparagraph display-inline="no-display-inline" id="H5B6D793CB82C44C3BFB47D40065DE18F"><enum>(B)</enum><text display-inline="yes-display-inline">in subparagraph (D), by striking <quote>and</quote> at the end;</text></subparagraph> |
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<subparagraph display-inline="no-display-inline" id="HCE68459297CF401B912A6E035CA93B77"><enum>(C)</enum><text>in subparagraph (E), by striking the period at the end and inserting <quote>; and</quote>;</text></subparagraph> <subparagraph display-inline="no-display-inline" id="HA9976E46AD6D42BEA84BC5EFE8C7AFCB"><enum>(D)</enum><text>by inserting after subparagraph (E) the following new subparagraph:</text> |
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<quoted-block style="OLC" display-inline="no-display-inline" id="H8D4A336193B3443E979687F7E16A87EA"> |
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<subparagraph id="HE27ABACD815147968EAE364E606DF293"><enum>(F)</enum><text display-inline="yes-display-inline">provide referrals to community-based organizations that address social needs related to health outcomes.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph> <subparagraph commented="no" id="H7C51DD48BE31499391984D4578C7214A"><enum>(E)</enum><text>by adding at the end the following flush left sentence:</text> |
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<quoted-block style="OLC" display-inline="no-display-inline" id="HBEE0C3FEFBCD45CBAC8A2C55A0341909"> |
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<quoted-block-continuation-text commented="no" quoted-block-continuation-text-level="paragraph">The duties specified in the preceding sentence may be carried out by such a navigator at any time during a year.</quoted-block-continuation-text><after-quoted-block>; </after-quoted-block></quoted-block></subparagraph></paragraph> |
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<paragraph commented="no" id="H82AACD930CFF4F25A46E4A55C570DFF5"><enum>(3)</enum><text display-inline="yes-display-inline">in paragraph (4)(A)—</text> <subparagraph commented="no" id="H1E45A067A106441082EFF60BE3BCB80C"><enum>(A)</enum><text>in the matter preceding clause (i), by striking <quote>not</quote>;</text></subparagraph> |
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<subparagraph commented="no" id="H0E490CC1E8D142AB955C49B64EAD4C04"><enum>(B)</enum><text>in clause (i)—</text> <clause commented="no" id="HDDD901D3C6B64026B1CA736375835999"><enum>(i)</enum><text>by inserting <quote>not</quote> before <quote>be</quote>; and</text></clause> |
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<clause commented="no" id="HF4B6861410854E7CA98E42D9701809F3"><enum>(ii)</enum><text>by striking <quote>; or</quote> and inserting a semicolon;</text></clause></subparagraph> <subparagraph commented="no" id="H4865398AED9C4A2CAF7386D0DC489C06"><enum>(C)</enum><text>in clause (ii)—</text> |
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<clause commented="no" id="H5CADCFFCF97747EFA1CCF0C7CDF557F2"><enum>(i)</enum><text>by inserting <quote>not</quote> before <quote>receive</quote>; and</text></clause> <clause id="HC6907C066AF647449E26BAFDFBA165FC"><enum>(ii)</enum><text display-inline="yes-display-inline">by striking the period and inserting a semicolon; and</text></clause></subparagraph> |
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<subparagraph commented="no" id="HA9ABCEC4E6BD495BA8EC2278EC88CC6C"><enum>(D)</enum><text>by adding at the end the following:</text> <quoted-block style="OLC" display-inline="no-display-inline" id="HDB7F7685417C4E51A99A13BB77FEFF34"> <clause commented="no" id="H0200C3B5AD6A4DF7B9463AADA2956113"><enum>(iii)</enum><text display-inline="yes-display-inline">maintain physical presence in the State of the Exchange so as to allow in-person assistance to consumers; and</text></clause> |
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<clause id="HF37C9B2C921F4BB7B6C5783C112B6131"><enum>(iv)</enum><text display-inline="yes-display-inline">receive opioid specific education and training that ensures the navigator can best educate individuals on qualified health plans offered through an Exchange, specifically coverage under such plans for opioid health care treatment.</text></clause><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph> <paragraph commented="no" id="H38B63C8BD6A347E696EDF0D2FA91E472"><enum>(4)</enum><text>in paragraph (6)—</text> |
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<subparagraph commented="no" id="H1405E55A3C6A4799A6AFB040FD0322D0"><enum>(A)</enum><text>by striking <quote><header-in-text level="paragraph" style="OLC">Funding.—</header-in-text>Grants under</quote> and inserting</text> <quoted-block style="OLC" display-inline="yes-display-inline" id="H6FFA1EA22CD14406B77C418FCC8C198E"><text><header-in-text level="paragraph" style="OLC">Funding.—</header-in-text></text> |
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<subparagraph commented="no" id="HBBBAE2B025294F359678196601A9F32C"><enum>(A)</enum><header>State Exchanges</header><text display-inline="yes-display-inline">Grants under</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph> <subparagraph commented="no" id="H79CAC63DF12541BCA6FDDCB47DBCD0A7"><enum>(B)</enum><text>by adding at the end the following new subparagraph:</text> |
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<quoted-block style="OLC" display-inline="no-display-inline" id="H0FC9E11A780B424381FEF750D4071F23"> |
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<subparagraph commented="no" id="HCD5EE3D2C27D4F86A88AEE621EC2AE4E"><enum>(B)</enum><header>Federal Exchanges</header><text display-inline="yes-display-inline">For purposes of carrying out this subsection, with respect to an Exchange established and operated by the Secretary within a State pursuant to section 1321(c), the Secretary shall obligate $100,000,000 out of amounts collected through the user fees on participating health insurance issuers pursuant to section 156.50 of title 45, Code of Federal Regulations (or any successor regulations), for fiscal year 2022 and each subsequent fiscal year. Such amount for a fiscal year shall remain available until expended.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph></subsection> <subsection commented="no" id="H963E879F3C2B44499ABF2AC6B904530C"><enum>(b)</enum><header>Effective date</header><text>The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2022.</text></subsection></section> |
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<section id="HC4F1828E3D90412385A9BBD0F8F10B68"><enum>305.</enum><header>Improving transparency and accountability in the Marketplace</header> |
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<subsection id="H1879E17E6FAB4E1B9D31AAB60B1B5C63"><enum>(a)</enum><header>Open enrollment reports</header><text display-inline="yes-display-inline">For plan year 2022 and each subsequent year, the Secretary of Health and Human Services (referred to in this section as the <quote>Secretary</quote>), in coordination with the Secretary of the Treasury and the Secretary of Labor, shall issue biweekly public reports during the annual open enrollment period on the performance of the federally facilitated Exchange operated pursuant to section 1321(c) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18041">42 U.S.C. 18041(c)</external-xref>). Each such report shall include a summary, including information on a State-by-State basis where available, of—</text> <paragraph id="H59C33250007241DFB43CF58BD77B99EB"><enum>(1)</enum><text>the number of unique website visits;</text></paragraph> |
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<paragraph id="HA237300D04AF474B8323F50769EC3A79"><enum>(2)</enum><text>the number of individuals who create an account;</text></paragraph> <paragraph id="H02A84D2A008D4820AF3504F5ECD5755A"><enum>(3)</enum><text>the number of calls to the call center;</text></paragraph> |
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<paragraph id="HDF0C98572C1B49658842DA7679A8C221"><enum>(4)</enum><text>the average wait time for callers contacting the call center; </text></paragraph> <paragraph id="id83be01fa25bd45ef98d84620a72d49a3"><enum>(5)</enum><text>with respect to applications for enrollment—</text> |
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<subparagraph id="id616B3A79D1DD4685924A25E770E35934"><enum>(A)</enum><text>the number of such applications submitted;</text></subparagraph> <subparagraph id="id399ad4acb40e4f1e871854ef7f67df13"><enum>(B)</enum><text>the total number of individuals on submitted applications for enrollment;</text></subparagraph> |
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<subparagraph id="id3765258463ef41b6a323fcda75695240"><enum>(C)</enum><text>the number of individuals on such submitted applications who are determined eligible for enrollment in a qualified health plan;</text></subparagraph> <subparagraph id="id970a49fd7e124877ac21ff2cc86e4949"><enum>(D)</enum><text>the number of individuals on such submitted applications who are determined or assessed eligible for the Medicaid program under title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.);</text></subparagraph> |
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<subparagraph id="id3084f2223320449aa2dedbdec4361364"><enum>(E)</enum><text>the number of individuals on such submitted applications who are determined or assessed eligible for the State Children's Health Insurance Program under title XXI of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397aa">42 U.S.C. 1397aa</external-xref> et seq.);</text></subparagraph> <subparagraph id="idc6586dfe4e0b40ae98b5f4342dd15435"><enum>(F)</enum><text>the number of individuals on such submitted applications who are determined eligible for a premium assistance credit under <external-xref legal-doc="usc" parsable-cite="usc/26/36B">section 36B</external-xref> of the Internal Revenue Code of 1986;</text></subparagraph> |
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<subparagraph id="id3f3dc96003c74bd3aa08762d7a23ae54"><enum>(G)</enum><text>The number of individuals on such submitted applications who are determined eligible for cost-sharing reduction under section 1402 of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18071">42 U.S.C. 18071</external-xref>); and</text></subparagraph> <subparagraph id="id0d31524a07c0414d8741309322310a00"><enum>(H)</enum><text>a breakdown of the data described in subparagraphs (A) through (G) by age, sex, race and preferred language, where such information is available;</text></subparagraph></paragraph> |
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<paragraph id="HF4E5143163074B68897FE1987754BEAB"><enum>(6)</enum><text>the number of individuals who enroll in a qualified health plan; and</text></paragraph> <paragraph id="H024737375C2F421D926ED72B8C03EA3F"><enum>(7)</enum><text>the percentage of individuals who enroll in a qualified health plan through each of—</text> |
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<subparagraph id="H76FE091362164022BB65E71DBFB8FD9C"><enum>(A)</enum><text>the website;</text></subparagraph> <subparagraph id="HAA1F4A3ED8184A5AB5268EC3E5F340B2"><enum>(B)</enum><text>the call center;</text></subparagraph> |
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<subparagraph id="HDCF55C4EAD984087908F83836B5E8245"><enum>(C)</enum><text>navigators;</text></subparagraph> <subparagraph id="H1EEEA36025314E729CCF1A95A8D78CC2"><enum>(D)</enum><text>agents and brokers;</text></subparagraph> |
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<subparagraph id="H89BE2B953B2448ACA49B68BBAF50B430"><enum>(E)</enum><text>the enrollment assistant program;</text></subparagraph> <subparagraph id="H0A405AF9AB5B4C00BA8B1E507E869F55"><enum>(F)</enum><text>directly from issuers or web brokers; and</text></subparagraph> |
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<subparagraph id="H365206578DCD4D0A9BB84E521ACBEFC8"><enum>(G)</enum><text>other means.</text></subparagraph></paragraph></subsection> <subsection id="H243BC8188D0E4FE2AB693727AC1052D1"><enum>(b)</enum><header>Open Enrollment After Action Report</header><text>For plan year 2022 and each subsequent year, the Secretary, in coordination with the Secretary of the Treasury and the Secretary of Labor, shall publish an after action report not later than 3 months after the completion of the annual open enrollment period regarding the performance of the Exchange described in subsection (a) for the applicable plan year. Each such report shall include a summary, including information on a State-by-State basis where available, of—</text> |
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<paragraph id="H6460DDCD7A2B4902B629B2B1FDFAB467"><enum>(1)</enum><text>the open enrollment data reported under subsection (a) for the entirety of the enrollment period; and</text></paragraph> <paragraph id="HBFC76A9E5DA34030B30E1EA96FCFDD3B"><enum>(2)</enum><text>activities related to patient navigators described in section 1311(i) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18031">42 U.S.C. 18031(i)</external-xref>), including—</text> |
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<subparagraph id="H5E8223CE50474CE9AEA41E85EDA6BFE2"><enum>(A)</enum><text>the performance objectives established by the Secretary for such patient navigators;</text></subparagraph> <subparagraph id="H60E10EE80FBA4CCA86339AD8EA452FDD"><enum>(B)</enum><text>the number of consumers enrolled by such a patient navigator;</text></subparagraph> |
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<subparagraph id="HD7E674A69965485AB07A94F0620B5393"><enum>(C)</enum><text>an assessment of how such patient navigators have met established performance metrics, including a detailed list of all patient navigators, funding received by patient navigators, and whether established performance objectives of patient navigators were met; and</text></subparagraph> <subparagraph id="HACF6F81590E14D7B82007BD71D761123"><enum>(D)</enum><text>with respect to the performance objectives described in subparagraph (A)—</text> |
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<clause id="H164F1F67A39F4621BF6C50F22BCC24FF"><enum>(i)</enum><text>whether such objectives assess the full scope of patient navigator responsibilities, including general education, plan selection, and determination of eligibility for tax credits, cost-sharing reductions, or other coverage;</text></clause> <clause id="H01918B3BC98544438A3BC612B05661E0"><enum>(ii)</enum><text>how the Secretary worked with patient navigators to establish such objectives; and</text></clause> |
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<clause id="H403CD3B2EFF9485DB63EDA1143DAFC0A"><enum>(iii)</enum><text>how the Secretary adjusted such objectives for case complexity and other contextual factors.</text></clause></subparagraph></paragraph></subsection> <subsection id="HA1A9C4E21D744B7E8036412749AB27C3"><enum>(c)</enum><header>Report on advertising and consumer outreach</header><text>Not later than 3 months after the completion of the annual open enrollment period for plan year 2022, the Secretary shall issue a report on advertising and outreach to consumers for the open enrollment period for plan year 2022. Such report shall include a description of—</text> |
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<paragraph id="H664F46DFA44E4B7FA1C6F0AACDA4D536"><enum>(1)</enum><text>the division of spending on individual advertising platforms, including television and radio advertisements and digital media, to raise consumer awareness of open enrollment;</text></paragraph> <paragraph id="HD3A3F0B13DAB4DECB99300CAFCA3F8C6"><enum>(2)</enum><text>the division of spending on individual outreach platforms, including email and text messages, to raise consumer awareness of open enrollment; and</text></paragraph> |
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<paragraph id="HCB50B884CA0A4C76AE5C9486160A4BDA"><enum>(3)</enum><text>whether the Secretary conducted targeted outreach to specific demographic groups and geographic areas.</text></paragraph></subsection> <subsection display-inline="no-display-inline" id="H89E40AB60F584ED28C3696D063F31EC5"><enum>(d)</enum><header>Promoting transparency and accountability in the administration’s expenditures of exchange user fees</header><text display-inline="yes-display-inline">For plan year 2022 and each subsequent plan year, not later than the date that is 3 months after the end of such plan year, the Secretary of Health and Human Services shall submit to the appropriate committees of Congress and make available to the public an annual report on the expenditures by the Department of Health and Human Services of user fees collected pursuant to section 156.50 of title 45, Code of Federal Regulations (or any successor regulations). Each such report for a plan year shall include a detailed accounting of the amount of such user fees collected during such plan year and of the amount of such expenditures used during such plan year for the federally facilitated Exchange operated pursuant to section 1321(c) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18041">42 U.S.C. 18041(c)</external-xref>) on outreach and enrollment activities, navigators, maintenance of Healthcare.gov, and operation of call centers.</text></subsection></section> |
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<section id="H6FEF95F738AD48F0BE10D027DC8C1E15"><enum>306.</enum><header>Improving awareness of health coverage options</header> |
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<subsection id="H2D208AE63936489C900A7C3A3BE1514A"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 90 days after the date of the enactment of this Act, the Secretary of Labor, in consultation with the Secretary of Health and Human Services, shall update, and make publicly available in a prominent location on the website of the Department of Labor, the model Consolidated Omnibus Budget Reconciliation Act of 1985 (referred to in this section as <quote>COBRA</quote>) continuation coverage general notice and the model COBRA continuation coverage election notice developed by the Secretary of Labor for purposes of facilitating compliance of group health plans with the notification requirements under section 606 of the Employee Retirement Income Security Act of 1974 (<external-xref legal-doc="usc" parsable-cite="usc/29/1166">29 U.S.C. 1166</external-xref>). In updating each such notice, the Secretary of Labor shall include information regarding any Exchange established under title I of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18001">42 U.S.C. 18001</external-xref> et seq.) through which a qualified beneficiary may be eligible to enroll in a qualified health plan, including—</text> <paragraph id="HDD5779905EF4475091BD67C979155B6A"><enum>(1)</enum><text>the publicly accessible Internet website address for such Exchange;</text></paragraph> |
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<paragraph commented="no" id="HFA2A5FCCC2AD46368AAA224B9B11B94A"><enum>(2)</enum><text>the publicly accessible Internet website address for the Find Local Help directory maintained by the Department of Health and Human Services on the healthcare.gov Internet website (or a successor website);</text></paragraph> <paragraph commented="no" id="HDFBB935A3A94468DBDC3510416CD5014"><enum>(3)</enum><text display-inline="yes-display-inline">a clear explanation that—</text> |
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<subparagraph commented="no" id="H12C9BEC4813F49CB9C3FFC7F7ED53D1C"><enum>(A)</enum><text>an individual who is eligible for continuation coverage may also be eligible to enroll, with financial assistance, in a qualified health plan offered through such Exchange, but, in the case that such individual elects to enroll in such continuation coverage and subsequently elects to terminate such continuation coverage before the period of such continuation coverage expires, such individual will not be eligible to enroll in a qualified health plan offered through such Exchange during a special enrollment period; and</text></subparagraph> <subparagraph commented="no" id="H9D83278AB497493A8033587DED13E868"><enum>(B)</enum><text>an individual who elects to enroll in continuation coverage will remain eligible to enroll in a qualified health plan offered through such Exchange during an open enrollment period and may be eligible for financial assistance with respect to enrolling in such a qualified health plan;</text></subparagraph></paragraph> |
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<paragraph id="HF6B6550A3E5B441D8D0B2D831E8D8BD5"><enum>(4)</enum><text>information on consumer protections with respect to enrolling in a qualified health plan offered through such Exchange, including the requirement for such a qualified health plan to provide coverage for essential health benefits (as defined in section 1302(b) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18022">42 U.S.C. 18022(b)</external-xref>) and the requirements applicable to such a qualified health plan under parts A and D of 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.); and</text></paragraph> <paragraph commented="no" id="HFF0EF112208A43339926E41CE49B7359"><enum>(5)</enum><text display-inline="yes-display-inline">information on the availability of financial assistance with respect to enrolling in a qualified health plan, including the maximum income limit for eligibility for a premium tax credit under <external-xref legal-doc="usc" parsable-cite="usc/26/36B">section 36B</external-xref> of the Internal Revenue Code of 1986.</text></paragraph></subsection> |
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<subsection id="H79AEA8DCD9B941CE95233D8EDC4F0640"><enum>(b)</enum><header>Name of notices</header><text>In addition to updating the model COBRA continuation coverage general notice and the model COBRA continuation coverage election notice under paragraph (1), the Secretary of Labor shall rename each such notice as the <quote>model COBRA continuation coverage and Affordable Care Act coverage general notice</quote> and the <quote>model COBRA continuation coverage and Affordable Care Act coverage election notice</quote>, respectively.</text></subsection> <subsection commented="no" id="HF9D0F86D11C84A97B5D1A4AF6F829E5B"><enum>(c)</enum><header>Consumer testing</header><text display-inline="yes-display-inline">Prior to making publicly available the model COBRA continuation coverage general notice and the model COBRA continuation coverage election notice updated under paragraph (1), the Secretary of Labor shall provide an opportunity for consumer testing of each such notice, as so updated, to ensure that each such notice is clear and understandable to the average participant or beneficiary of a group health plan.</text></subsection> |
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<subsection id="HA543B1D2AECE45B5A7E65B126BA37B3B"><enum>(d)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this subsection:</text> <paragraph id="HBECC19EF00434E519289EDC0500073EF"><enum>(1)</enum><header>Continuation coverage</header><text display-inline="yes-display-inline">The term <term>continuation coverage</term>, with respect to a group health plan, has the meaning given such term in section 602 of the Employee Retirement Income Security Act of 1974 (<external-xref legal-doc="usc" parsable-cite="usc/29/1162">29 U.S.C. 1162</external-xref>).</text></paragraph> |
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<paragraph id="HBD53A410D02A4A4CB332B415D80D27A6"><enum>(2)</enum><header>Group health plan</header><text display-inline="yes-display-inline">The term <term>group health plan</term> has the meaning given such term in section 607 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/1167">29 U.S.C. 1167</external-xref>).</text></paragraph> <paragraph id="HE8AC88C1920A41FB8EDE3672C9E98C7B"><enum>(3)</enum><header>Qualified beneficiary</header><text display-inline="yes-display-inline">The term <term>qualified beneficiary</term> has the meaning given such term in such section 607.</text></paragraph> |
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<paragraph id="H88BC944069B44773B8102B48394FBE97"><enum>(4)</enum><header>Qualified health plan</header><text>The term <term>qualified health plan</term> has the meaning given such term in section 1301 of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18021">42 U.S.C. 18021</external-xref>). </text></paragraph></subsection></section> <section id="H30EA6EA447E54BE7BAB2449EF0BB6A83"><enum>307.</enum><header>Promoting State innovations to expand coverage</header> <subsection id="HDCD25B7257C84BEA9CF7C28BCAC9D18D"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Subject to subsection (d), the Secretary of Health and Human Services shall award grants to eligible State agencies to enable such States to explore innovative solutions to promote greater enrollment in health insurance coverage in the individual and small group markets, including activities described in subsection (c).</text></subsection> |
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<subsection id="H1E2480E5A3664FCEA4D902295306E98E"><enum>(b)</enum><header>Eligibility</header><text display-inline="yes-display-inline">For purposes of subsection (a), eligible State agencies are Exchanges established by a State under title I of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18001">42 U.S.C. 18001</external-xref> et seq.) and State agencies with primary responsibility over health and human services for the State involved.</text></subsection> <subsection commented="no" id="HCFA0D9A84C994B1D94FC5FC1D0ED2959"><enum>(c)</enum><header>Use of funds</header><text>For purposes of subsection (a), the activities described in this subsection are the following:</text> |
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<paragraph commented="no" id="H35F3012296AF40B494322BEE07E45782"><enum>(1)</enum><text display-inline="yes-display-inline">State efforts to streamline health insurance enrollment procedures in order to reduce burdens on consumers and facilitate greater enrollment in health insurance coverage in the individual and small group markets, including automatic enrollment and reenrollment of, or pre-populated applications for, individuals without health insurance who are eligible for tax credits under <external-xref legal-doc="usc" parsable-cite="usc/26/36B">section 36B</external-xref> of the Internal Revenue Code of 1986, with the ability to opt out of such enrollment.</text></paragraph> <paragraph commented="no" id="H97D90A310C5B4238B9003403C018DD7F"><enum>(2)</enum><text>State investment in technology to improve data sharing and collection for the purposes of facilitating greater enrollment in health insurance coverage in such markets.</text></paragraph> |
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<paragraph commented="no" id="H3EB4642CE000474AA51447E40406AB58"><enum>(3)</enum><text>Feasibility studies to develop comprehensive and coherent State plan for increasing enrollment in the individual and small group market.</text></paragraph></subsection> <subsection id="H80C27351277645869C9F2D106664FE73"><enum>(d)</enum><header>Funding</header><text display-inline="yes-display-inline">For purposes of carrying out this section, there is hereby appropriated, out of any funds in the Treasury not otherwise appropriated, $200,000,000 for each of the fiscal years 2022 through 2024. Such amount shall remain available until expended.</text></subsection></section></title> |
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</legis-body> |
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</bill> |
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