Us Congress 2023-2024 Regular Session

Us Congress House Bill HB35 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	I
2	2	118THCONGRESS
3	3	1
4	4	STSESSION H. R. 35
5	5	To amend title XVIII of the Social Security Act to provide for certain
6	6	reforms with respect to medicare supplemental health insurance policies.
7	7	IN THE HOUSE OF REPRESENTATIVES
8	8	JANUARY9, 2023
9	9	Mr. D
10	10	OGGETT(for himself, Mr. BISHOPof Georgia, Mr. BLUMENAUER, Mr.
11	11	B
12	12	OWMAN, Mr. CARTWRIGHT, Mr. CASAR, Mr. CASTEN, Ms. CHU, Mr.
13	13	C
14	14	LEAVER, Mr. COHEN, Ms. DELAURO, Mrs. DINGELL, Mr. EVANS, Mr.
15	15	G
16	16	ARAMENDI, Mr. GARCI´Aof Illinois, Mr. GRIJALVA, Mrs. HAYES, Ms.
17	17	J
18	18	AYAPAL, Ms. KAPTUR, Mr. KHANNA, Ms. LEEof California, Mr.
19	19	M
20	20	FUME, Mr. NADLER, Ms. NORTON, Ms. OCASIO-CORTEZ, Ms. PORTER,
21	21	Ms. S
22	22	CHAKOWSKY, Mr. SHERMAN, Mr. TAKANO, Mr. THOMPSONof Cali-
23	23	fornia, Ms. T
24	24	ITUS, Mr. TONKO, Mr. TRONE, Mrs. WATSONCOLEMAN,
25	25	and Ms. W
26	26	ILLIAMSof Georgia) introduced the following bill; which was
27	27	referred to the Committee on Ways and Means, and in addition to the
28	28	Committee on Energy and Commerce, for a period to be subsequently de-
29	29	termined by the Speaker, in each case for consideration of such provisions
30	30	as fall within the jurisdiction of the committee concerned
31	31	A BILL
32	32	To amend title XVIII of the Social Security Act to provide
33	33	for certain reforms with respect to medicare supple-
34	34	mental health insurance policies.
35	35	Be it enacted by the Senate and House of Representa-1
36	36	tives of the United States of America in Congress assembled, 2
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40	40	SECTION 1. SHORT TITLE. 1
41	41	This Act may be cited as the ‘‘Close the Medigap Act 2
42	42	of 2023’’. 3
43	43	SEC. 2. GUARANTEED ISSUE. 4
44	44	(a) I
45	45	NGENERAL.—Section 1882(s) of the Social Se-5
46	46	curity Act (42 U.S.C. 1395ss(s)) is amended to read as 6
47	47	follows: 7
48	48	‘‘(s)(1) Subject to paragraph (2), the issuer of a 8
49	49	medicare supplemental policy may not, in the case of an 9
50	50	individual entitled to benefits under part A and enrolled 10
51	51	under part B— 11
52	52	‘‘(A) deny or condition the issuance or effective-12
53	53	ness of a medicare supplemental policy, or discrimi-13
54	54	nate in the pricing of the policy, because of health 14
55	55	status, claims experience, receipt of health care, or 15
56	56	medical condition; 16
57	57	‘‘(B) exclude benefits based on a preexisting 17
58	58	condition; 18
59	59	‘‘(C) provide any time period applicable to pre-19
60	60	existing conditions, waiting periods, elimination peri-20
61	61	ods, and probationary periods for any benefit; 21
62	62	‘‘(D) deny or condition the issuance or effec-22
63	63	tiveness of the policy (including the imposition of 23
64	64	any exclusion of benefits under the policy based on 24
65	65	a preexisting condition) or discriminate in the pric-25
66	66	ing of the policy (including the adjustment of pre-26
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70	70	mium rates) of an individual on the basis of the ge-1
71	71	netic information with respect to such individual; 2
72	72	‘‘(E) deny or condition the issuance or effective-3
73	73	ness of a medicare supplemental policy that is of-4
74	74	fered and is available for issuance to new enrollees 5
75	75	by such issuer; or 6
76	76	‘‘(F) establish any period limiting enrollment 7
77	77	under a medicare supplemental policy to such period 8
78	78	for any individual. 9
79	79	‘‘(2) Paragraph (1) shall not apply to an individual 10
80	80	entitled to benefits under part A solely by reason of section 11
81	81	226A. 12
82	82	‘‘(3) Nothing in this subsection or in subparagraph 13
83	83	(A) or (B) of subsection (x)(2) shall be construed to limit 14
84	84	the ability of an issuer of a medicare supplemental policy 15
85	85	from, to the extent otherwise permitted under this title— 16
86	86	‘‘(A) denying or conditioning the issuance or ef-17
87	87	fectiveness of the policy or increasing the premium 18
88	88	for an employer based on the manifestation of a dis-19
89	89	ease or disorder of an individual who is covered 20
90	90	under the policy; or 21
91	91	‘‘(B) increasing the premium for any policy 22
92	92	issued to an individual based on the manifestation of 23
93	93	a disease or disorder of an individual who is covered 24
94	94	under the policy (in such case, the manifestation of 25
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98	98	a disease or disorder in one individual cannot also 1
99	99	be used as genetic information about other group 2
100	100	members.’’. 3
101	101	(b) O
102	102	UTREACHPLAN.— 4
103	103	(1) I
104	104	N GENERAL.—The Secretary of Health and 5
105	105	Human Services shall develop an outreach plan to 6
106	106	notify individuals entitled to benefits under part A 7
107	107	or enrolled under part B of title XVIII of the Social 8
108	108	Security Act (42 U.S.C. 1395 et seq.) of the effects 9
109	109	of the amendment made by subsection (a). 10
110	110	(2) C
111	111	ONSULTATION.—In implementing the out-11
112	112	reach plan developed under paragraph (1), the Sec-12
113	113	retary shall consult with consumer advocates, bro-13
114	114	kers, insurers, the National Association of Insurance 14
115	115	Commissioners, and State Health Insurance Assist-15
116	116	ance Programs. 16
117	117	(c) E
118	118	FFECTIVEDATE; PHASE-INAUTHORITY.— 17
119	119	(1) E
120	120	FFECTIVE DATE.—Subject to paragraph 18
121	121	(2), the amendment made by subsection (a) shall 19
122	122	apply to medicare supplemental policies effective on 20
123	123	or after January 1, 2024. 21
124	124	(2) P
125	125	HASE-IN AUTHORITY.— 22
126	126	(A) I
127	127	N GENERAL.—Subject to subpara-23
128	128	graph (B), the Secretary of Health and Human 24
129	129	Services may phase in the implementation of 25
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133	133	the amendment made under subsection (a) 1
134	134	(with such phase-in beginning on or after Janu-2
135	135	ary 1, 2024) in such manner as the Secretary 3
136	136	determines appropriate in order to minimize 4
137	137	any adverse impact on individuals enrolled 5
138	138	under a medicare supplemental policy. 6
139	139	(B) P
140	140	HASE-IN PERIOD MAY NOT EXCEED 5 7
141	141	YEARS.—The Secretary of Health and Human 8
142	142	Services shall ensure that the amendment made 9
143	143	by subsection (a) is fully implemented by not 10
144	144	later than January 1, 2029. 11
145	145	SEC. 3. MEDICAL LOSS RATIO. 12
146	146	Section 1882(r)(1)(A) of the Social Security Act (42 13
147	147	U.S.C. 1395ss(r)(1)(A)) is amended— 14
148	148	(1) by inserting ‘‘and periodically reviewed’’ 15
149	149	after ‘‘developed’’; and 16
150	150	(2) by striking ‘‘policy, at least 75 percent of 17
151	151	the aggregate amount of premiums collected in the 18
152	152	case of group policies and at least 65 percent in the 19
153	153	case of individual policies; and’’ and inserting the 20
154	154	following: ‘‘policy— 21
155	155	‘‘(i) with respect to periods beginning be-22
156	156	fore January 1, 2024, at least 75 percent of the 23
157	157	aggregate amount of premiums collected in the 24
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161	161	case of group policies and at least 65 percent 1
162	162	in the case of individual policies; and 2
163	163	‘‘(ii) with respect to periods beginning on 3
164	164	or after January 1, 2024, a percent of the ag-4
165	165	gregate amount of premiums collected that, in 5
166	166	the case of group policies or individual policies, 6
167	167	as applicable, is equal to or greater than both— 7
168	168	‘‘(I) the applicable percent specified in 8
169	169	clause (i) with respect to such policies; and 9
170	170	‘‘(II) such percent as the National As-10
171	171	sociation of Insurance Commissioners may 11
172	172	recommend to the Secretary with respect 12
173	173	to such policies for purposes of this para-13
174	174	graph; and’’. 14
175	175	SEC. 4. LIMITATIONS ON PRICING DISCRIMINATION. 15
176	176	(a) I
177	177	NGENERAL.—Section 1882 of the Social Secu-16
178	178	rity Act (42 U.S.C. 1395ss), as amended by section 6, is 17
179	179	further amended by adding at the end the following new 18
180	180	subsection: 19
181	181	‘‘(aa) D
182	182	EVELOPMENT OF NEWSTANDARDSRELAT-20
183	183	ING TOPRICINGDISCRIMINATION.— 21
184	184	‘‘(1) I
185	185	N GENERAL.—The Secretary shall request 22
186	186	the National Association of Insurance Commis-23
187	187	sioners to review and revise the standards for all 24
188	188	benefit packages under subsection (p)(1), including 25
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192	192	the core benefit package, in order to provide cov-1
193	193	erage consistent with paragraph (2). Such revisions 2
194	194	shall be made consistent with the rules applicable 3
195	195	under subsection (p)(1)(E) (with the reference to the 4
196	196	‘1991 NAIC Model Regulation’ deemed a reference 5
197	197	to the NAIC Model Regulation as most recently up-6
198	198	dated by the National Association of Insurance 7
199	199	Commissioners to reflect previous changes in law 8
200	200	and the reference to ‘date of enactment of this sub-9
201	201	section’ deemed a reference to the date of enactment 10
202	202	of this subsection). 11
203	203	‘‘(2) C
204	204	HANGES IN COST-SHARING DESCRIBED.— 12
205	205	Under the revised standards, coverage shall not be 13
206	206	available under a Medicare supplemental insurance 14
207	207	policy unless the issuer of the policy, in addition to 15
208	208	conforming to the other applicable requirements of 16
209	209	this section— 17
210	210	‘‘(A) does not discriminate in the pricing 18
211	211	of the policy because of the age of the indi-19
212	212	vidual to whom the policy is issued; 20
213	213	‘‘(B) does not, to an extent that jeopard-21
214	214	izes the access to such policy for individuals 22
215	215	who are eligible to participate in the program 23
216	216	under this title because the individuals are indi-24
217	217	viduals described in paragraph (2) or (3) of sec-25
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221	221	tion 1811, discriminate in the pricing of the 1
222	222	policy because the individual to whom the policy 2
223	223	is issued is so eligible to participate in such 3
224	224	program because the individual is an individual 4
225	225	so described in such a paragraph; and 5
226	226	‘‘(C) does not establish premiums applica-6
227	227	ble under such policy on a basis that would 7
228	228	apply to a portion of, but not the entirety of, 8
229	229	a county or equivalent area specified by the 9
230	230	Secretary. 10
231	231	‘‘(3) A
232	232	PPLICATION DATE.—The revised stand-11
233	233	ards shall apply to benefit packages sold, issued, or 12
234	234	renewed under this section to individuals who first 13
235	235	become entitled to benefits under part A or first en-14
236	236	rolls in part B on or after January 1, 2024.’’. 15
237	237	(b) C
238	238	ONFORMINGAMENDMENT.—Section 1882(o)(1) 16
239	239	of such Act (42 U.S.C. 1395ss(o)(1)) is amended by strik-17
240	240	ing ‘‘, and (y)’’ and inserting ‘‘(y), and (aa)’’. 18
241	241	SEC. 5. CLARIFYING BENEFICIARY OPTIONS ON THE MEDI-19
242	242	CARE PLAN FINDER WEBSITE. 20
243	243	Section 1804 of the Social Security Act (42 U.S.C. 21
244	244	1395b–2) is amended by adding at the end the following 22
245	245	new subsections: 23
246	246	‘‘(d) In the case that the Secretary provides for a 24
247	247	Medicare plan finder internet website of the Centers for 25
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251	251	Medicare & Medicaid Services (or a successor website), the 1
252	252	Secretary shall, with respect to such website and in ac-2
253	253	cordance with subsection (f)— 3
254	254	‘‘(1) make available on such website— 4
255	255	‘‘(A) access to provider networks in order 5
256	256	to provide to individuals entitled to benefits 6
257	257	under part A or enrolled under part B informa-7
258	258	tion to assist such individuals in understanding 8
259	259	the restrictions on providers and potential costs 9
260	260	entailed by their decisions regarding enrollment 10
261	261	under parts A and B, under part C, and in 11
262	262	medicare supplemental policies under section 12
263	263	1882; 13
264	264	‘‘(B) a review of out-of-pocket expendi-14
265	265	tures, including deductibles, copayments, coin-15
266	266	surance, monthly premiums, and estimated an-16
267	267	nual out-of-pocket costs, displayed overall and 17
268	268	by components, based on the best available in-18
269	269	formation as determined by the Secretary; and 19
270	270	‘‘(C) during the period prior to January 1, 20
271	271	2024, information regarding the rules that, in 21
272	272	each State, pertain to guaranteed issue of medi-22
273	273	care supplemental health insurance policies 23
274	274	prior to implementation of the provisions of the 24
275	275	Close the Medigap Act of 2023 and, in the case 25
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279	279	that a State has no such rules pertaining to 1
280	280	guaranteed issue of such policies, clear lan-2
281	281	guage explaining the implications of such lack 3
282	282	of rules for individuals with pre-existing condi-4
283	283	tions; 5
284	284	‘‘(2) not later than January 1, 2024, and peri-6
285	285	odically thereafter, perform a review of such website 7
286	286	in order to ensure that such website makes available 8
287	287	to individuals entitled to benefits under part A or 9
288	288	enrolled under part B the information that the Sec-10
289	289	retary determines is necessary for such individuals 11
290	290	to make informed choices regarding their options 12
291	291	under the program under this title; and 13
292	292	‘‘(3) not later than 12 months after the last 14
293	293	day of each period for the request for information 15
294	294	under subsection (e), update such website, taking 16
295	295	into consideration the information collected pursuant 17
296	296	to such subsection, to clarify the presentation of con-18
297	297	sumer options for medicare supplemental health in-19
298	298	surance policy options, including by presenting such 20
299	299	information in a manner calculated to be understood 21
300	300	by the average consumer and in a manner that— 22
301	301	‘‘(A) improves consumer access to informa-23
302	302	tion regarding the applicable premiums under 24
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306	306	such policy options as of the date on which such 1
307	307	website is so updated; 2
308	308	‘‘(B) facilitates consumers’ ability to com-3
309	309	pare and sort policy options and premium infor-4
310	310	mation across plan offerings in a given location; 5
311	311	‘‘(C) clarifies and explains differences in 6
312	312	policy value; 7
313	313	‘‘(D) rates and explains the financial sta-8
314	314	bility of issuers of such policies; 9
315	315	‘‘(E) provides data on the inflation rate of 10
316	316	different policies; 11
317	317	‘‘(F) provides information regarding the 12
318	318	guaranteed issue requirements that apply to 13
319	319	medicare supplemental health insurance policies 14
320	320	under section 1882(s)(3); and 15
321	321	‘‘(G) includes such general information as 16
322	322	is determined by the Secretary to be necessary 17
323	323	for individuals entitled to benefits under part A 18
324	324	or enrolled under part B to understand costs 19
325	325	under MA plans available pursuant to part C 20
326	326	and prescription drug plans available pursuant 21
327	327	to part D. 22
328	328	‘‘(e) Not later than 6 months after the date of the 23
329	329	enactment of this subsection and beginning on December 24
330	330	7 of each year thereafter, the Secretary of Health and 25
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334	334	Human Services shall provide an opportunity for public 1
335	335	comment during which the Secretary requests informa-2
336	336	tion, including recommendations, from stakeholders re-3
337	337	garding potential improvements to the presentation of 4
338	338	medicare supplemental health insurance policy options 5
339	339	under section 1882 on the Medicare plan finder internet 6
340	340	website of the Centers for Medicare & Medicaid Services 7
341	341	(or a successor website). 8
342	342	‘‘(f) With respect to any information that the Sec-9
343	343	retary makes available on the Medicare plan finder inter-10
344	344	net website of the Centers for Medicare & Medicaid Serv-11
345	345	ices (or a successor website) pursuant to subsection (d), 12
346	346	the Secretary shall, prior to making such information 13
347	347	available— 14
348	348	‘‘(1) provide, in consultation with the National 15
349	349	Association of Insurance Commissioners, an oppor-16
350	350	tunity for consumer testing of such information; 17
351	351	‘‘(2) share the results of such consumer testing 18
352	352	of such information with interested stakeholders; 19
353	353	and 20
354	354	‘‘(3) provide a 60-day public comment period 21
355	355	with respect to such information.’’. 22
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359	359	SEC. 6. RESTORING ACCESS TO FIRST-DOLLAR MEDIGAP 1
360	360	COVERAGE. 2
361	361	Section 1882 of the Social Security Act (42 U.S.C. 3
362	362	1395ss) is amended by striking subsection (z). 4
363	363	SEC. 7. BROKER TRANSPARENCY. 5
364	364	Section 1128G of the Social Security Act (42 U.S.C. 6
365	365	1320a–7h) is amended— 7
366	366	(1) in subsection (c)(1)(A), by striking ‘‘2011,’’ 8
367	367	and inserting ‘‘2011 (or, with respect to information 9
368	368	required to be submitted under subsection (f)(1), not 10
369	369	later than six months after the date of the enact-11
370	370	ment of such subsection),’’; and 12
371	371	(2) by adding at the end the following new sub-13
372	372	section: 14
373	373	‘‘(f) A
374	374	PPLICATION TOMEDIGAPINSURANCEBRO-15
375	375	KERS.— 16
376	376	‘‘(1) I
377	377	N GENERAL.—Beginning not later than 17
378	378	12 months after the date of enactment of this sub-18
379	379	section, each issuer of a medicare supplemental 19
380	380	health insurance policy shall annually submit to the 20
381	381	Secretary a report regarding payments or other 21
382	382	transfers of value made during the previous year to 22
383	383	agents, brokers, and other third parties representing 23
384	384	such policy. Each such report shall include the fol-24
385	385	lowing information, with respect to such a payment 25
386	386	or other transfer of value: 26
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390	390	‘‘(A) The name of the recipient of the pay-1
391	391	ment or other transfer of value. 2
392	392	‘‘(B) The business address of the recipient. 3
393	393	‘‘(C) The amount of the payment or other 4
394	394	transfer of value. 5
395	395	‘‘(D) The dates on which the payment or 6
396	396	transfer of value was provided. 7
397	397	‘‘(E) A description of the form of the pay-8
398	398	ment or transfer of value. 9
399	399	‘‘(F) Any other categories of information 10
400	400	the Secretary determines appropriate. 11
401	401	‘‘(2) A
402	402	PPLICATION OF TRANSPARENCY SYS -12
403	403	TEM.—The provisions of subsections (b) through (d) 13
404	404	shall apply to an issuer described in paragraph (1), 14
405	405	information required to be reported under such 15
406	406	paragraph, and agents, brokers, and other third par-16
407	407	ties described in such paragraph in the same manner 17
408	408	and to the same extent as such provisions apply to 18
409	409	an applicable manufacturer, information required to 19
410	410	be reported under subsection (a), and a covered re-20
411	411	cipient.’’. 21
412	412	Æ
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