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H.R. 635 (115th): CHOICE Act

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The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress, and was published on Jan 24, 2017.

Consumer Health Options and Insurance Competition Enhancement Act or the CHOICE Act

This bill amends the Public Health Service Act to require the Department of Health and Human Services (HHS) to offer, throughout the United States, a public health insurance option that provides value, choice, competition, and the stability of affordable, high-quality coverage. Plans under the public health insurance option must be qualified health plans and must include plans with bronze, silver, and gold tier benefits. (Qualified health plans are sold on health insurance exchanges, are the only plans eligible for premium subsidies, and fulfill an individual's requirement to maintain minimum essential coverage.)

HHS must establish an office of the ombudsman for the public health insurance option.

States may establish advisory councils to provide recommendations to HHS on the operations and policies of the public health insurance option.

HHS must collect data to establish rates for premiums and health care provider reimbursement and for other purposes.

Premium rates for public health insurance option plans must: (1) fully finance administrative costs and provided health benefits, and (2) include a contingency margin.

HHS must negotiate rates for health care providers and prescription drugs under the public health insurance option. If HHS is unable to reach a negotiated agreement on rates, HHS must use Medicare rates.

States may not tax federal receipts or disbursements attributable to the operation of the public health insurance option.

HHS must establish conditions for participation by health care providers in the public health insurance option. A provider participating in Medicare or Medicaid is a participant in the public health insurance option unless the provider opts out.