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H.R. 1890: Health Insurance Consumer Protection Act


The text of the bill below is as of Mar 12, 2021 (Introduced).


I

117th CONGRESS

1st Session

H. R. 1890

IN THE HOUSE OF REPRESENTATIVES

March 12, 2021

introduced the following bill; which was referred to the Committee on Energy and Commerce

A BILL

To amend the Patient Protection and Affordable Care Act to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates.

1.

Short title

This Act may be cited as the Health Insurance Consumer Protection Act.

I

No More Narrow Networks

101.

Short title

This title may be cited as the No More Narrow Networks Act of 2021.

102.

Requiring Exchanges to establish network adequacy standards for qualified health plans

(a)

In general

Section 1311(d) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(d)) is amended by adding at the end the following new paragraph:

(8)

Network adequacy standards

(A)

Certain Exchanges

In the case of an Exchange operated by the Secretary pursuant section 1321(c)(1) or an Exchange described in section 155.200(f) of title 42, Code of Federal Regulations (or a successor regulation), the Exchange shall require each qualified health plan offered through such Exchange to meet such quantitative network adequacy standards as the Secretary may prescribe for purposes of this subparagraph.

(B)

State Exchanges

In the case of an Exchange not described in subparagraph (A), the Exchange shall establish quantitative network adequacy standards with respect to qualified health plans offered through such Exchange and require such plans to meet such standards.

.

(b)

Effective date

The amendment made by this section shall apply with respect to plan years beginning on or after January 1, 2023.

II

Protecting Consumers from Unreasonable Rates

201.

Short title

This title may be cited as the Protecting Consumers from Unreasonable Rates Act.

202.

Protection of consumers from excessive, unjustified, or unfairly discriminatory rates

(a)

Protection from excessive, unjustified, or unfairly discriminatory rates

The first section 2794 of the Public Health Service Act (42 U.S.C. 300gg–94), as added by section 1003 of the Patient Protection and Affordable Care Act (Public Law 111–148), is amended by adding at the end the following new subsection:

(e)

Protection from excessive, unjustified, or unfairly discriminatory rates

(1)

Authority of States

Nothing in this section shall be construed to prohibit a State from imposing requirements (including requirements relating to rate review standards and procedures and information reporting) on health insurance issuers with respect to rates that are in addition to the requirements of this section and are more protective of consumers than such requirements.

(2)

Consultation in rate review process

In carrying out this section, the Secretary shall consult with the National Association of Insurance Commissioners and consumer groups.

(3)

Determination of who conducts reviews for each State

The Secretary shall determine, after the date of enactment of this section and periodically thereafter, the following:

(A)

In which markets in each State the State insurance commissioner or relevant State regulator shall undertake the corrective actions under paragraph (4), based on the Secretary’s determination that the State regulator is adequately undertaking and utilizing such actions in that market.

(B)

In which markets in each State the Secretary shall undertake the corrective actions under paragraph (4), in cooperation with the relevant State insurance commissioner or State regulator, based on the Secretary’s determination that the State is not adequately undertaking and utilizing such actions in that market.

(4)

Corrective action for excessive, unjustified, or unfairly discriminatory rates

In accordance with the process established under this section, the Secretary or the relevant State insurance commissioner or State regulator shall take corrective actions to ensure that any excessive, unjustified, or unfairly discriminatory rates are corrected prior to implementation, or as soon as possible thereafter, through mechanisms such as—

(A)

denying rates;

(B)

modifying rates; or

(C)

requiring rebates to consumers.

(5)

Noncompliance

Failure to comply with any corrective action taken by the Secretary under this subsection may result in the application of civil monetary penalties under section 2723 and, if the Secretary determines appropriate, make the plan involved ineligible for classification as a qualified health plan.

.

(b)

Clarification of Regulatory Authority

Such section is further amended—

(1)

in subsection (a)—

(A)

in the heading, by striking premium and inserting rate;

(B)

in paragraph (1), by striking unreasonable increases in premiums and inserting potentially excessive, unjustified, or unfairly discriminatory rates, including premiums,; and

(C)

in paragraph (2)—

(i)

by striking an unreasonable premium increase and inserting a potentially excessive, unjustified, or unfairly discriminatory rate;

(ii)

by striking the increase and inserting the rate; and

(iii)

by striking such increases and inserting such rates; and

(2)

in subsection (b)—

(A)

by striking premium increases each place it appears and inserting rates; and

(B)

in paragraph (2)(B), by striking premium and inserting rate.

(c)

Conforming amendments

Title XXVII of the Public Health Service Act (42 U.S.C. 300gg et seq.) is amended—

(1)

in section 2723 (42 U.S.C. 300gg–22)—

(A)

in subsection (a)—

(i)

in paragraph (1), by inserting , section 2794, after this part; and

(ii)

in paragraph (2), by inserting , section 2794, after this part; and

(B)

in subsection (b)—

(i)

in paragraph (1), by inserting , section 2794, after this part; and

(ii)

in paragraph (2)—

(I)

in subparagraph (A), by inserting , section 2794, after this part; and

(II)

in subparagraph (C)(ii), by inserting , section 2794, after this part; and

(2)

in section 2761 (42 U.S.C. 300gg–61)—

(A)

in subsection (a)—

(i)

in paragraph (1), by inserting and section 2794 after this part; and

(ii)

in paragraph (2)—

(I)

by inserting or section 2794 after set forth in this part; and

(II)

by inserting and section 2794 after the requirements of this part; and

(B)

in subsection (b)—

(i)

by inserting and section 2794 after this part; and

(ii)

by inserting and section 2794 after part A.

(d)

Applicability to grandfathered plans

Section 1251(a)(4)(A) of the Patient Protection and Affordable Care Act (Public Law 111–148), as added by section 2301 of the Health Care and Education Reconciliation Act of 2010 (Public Law 111–152), is amended by adding at the end the following:

(v)

Section 2794 (relating to reasonableness of rates with respect to health insurance coverage).

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(e)

Authorization of appropriations

There are authorized to be appropriated to carry out this Act, such sums as may be necessary.

(f)

Effective date

The amendments made by this section shall take effect on the date of enactment of this Act and shall be implemented with respect to health plans beginning not later than January 1, 2023.