A bill to provide for the establishment of an assistance program for health insurance consumers.

Summary: Health Care Consumers Assistance Fund Act - Directs: (1) the Secretary of Health and Human Services to establish the Health Care Consumer Assistance Fund for State grants to provide consumers with health insurance information, assistance, and referrals; and (2) States, from such amounts, to establish health care consumer assistance offices.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Care Consumers Assistance 
Fund Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) All consumers need information and assistance to 
        understand their health insurance choices and to facilitate 
        effective and efficient access to needed health services. Many 
        do not understand their health care coverage, despite the 
        current efforts of both the public and private sectors.
            (2) Federally initiated health care consumer assistance and 
        information programs targeted to consumers of long-term care 
        and to medicare beneficiaries under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.) are effective, as are a 
        number of State and local consumer assistance initiatives.
            (3) The principles, policies, and practices of health plans 
        for providing safe, effective, and accessible health care can 
        be enriched by State-based collaborative, independent 
        education, problem resolution, and feedback programs. Health 
        care consumer assistance programs have proven their ability to 
        meet this challenge.
            (4) Many states have created health care consumer 
        assistance programs. The Federal Government can assist the 
        States in developing and maintaining effective health care 
        consumer assistance programs.

SEC. 3. GRANTS.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this Act as the ``Secretary'') shall establish a fund, 
to be known as the ``Health Care Consumer Assistance Fund'', to be used 
to award grants to eligible States to enable such States to carry out 
consumer assistance activities (including programs established by 
States prior to the enactment of this Act) designed to provide 
information, assistance, and referrals to consumers of health insurance 
products.
    (b) State Eligibility.--To be eligible to receive a grant under 
this section a State shall prepare and submit to the Secretary an 
application at such time, in such manner, and containing such 
information as the Secretary may require, including a State plan that 
describes--
            (1) the manner in which the State will ensure that the 
        health care consumer assistance office (established under 
        subsection (d)) will assist health care consumers in accessing 
        needed care by educating and assisting health insurance 
        enrollees to be responsible and informed consumers;
            (2) the manner in which the State will coordinate and 
        distinguish the services provided by the health care consumer 
        assistance office with the services provided by the long-term 
        care ombudsman authorized by the Older Americans Act of 1965 
        (42 U.S.C. 3001 et seq.), the State health insurance 
        information program authorized under section 4360 of the 
        Omnibus Budget Reconciliation Act of 1990 (42 U.S.C. 1395b-4), 
        the protection and advocacy program authorized under the 
        Protection and Advocacy for Mentally Ill Individuals Act of 
        1986 (42 U.S.C. 10801 et seq.), and any other programs that 
        provide information and assistance to health care consumers;
            (3) the manner in which the State will coordinate and 
        distinguish the health care consumer assistance office and its 
        services from enrollment services provided under the medicaid 
        and State children's health insurance programs under titles XIX 
        and XXI of the Social Security Act (42 U.S.C. 1396 et seq. and 
        1397aa et seq.), and medicare and medicaid health care fraud 
        and abuse activities including those authorized by Federal law 
        under title 11 of the Social Security Act (42 U.S.C. 1301 et 
        seq.), and State health insurance departments and health plan 
        programs that perform similar functions;
            (4) the manner in which the State will provide services to 
        underserved and minority populations and populations residing 
        in rural areas;
            (5) the manner in which the State will establish and 
        implement procedures and protocols, consistent with applicable 
Federal and State confidentiality laws, to ensure the confidentiality 
of all information shared by consumers and their health care providers, 
health plans, or insurers with the office established under subsection 
(d)(1) and to ensure that no such information is used, released or 
referred without the express prior permission of the consumer in 
accordance with section 4(b), except to the extent that the office 
collects or uses aggregate information;
            (6) the manner in which the State will oversee the health 
        care consumer assistance office, its activities and product 
        materials, and evaluate program effectiveness;
            (7) the manner in which the State will provide for the 
        collection of non-Federal contributions for the operations of 
        the office in an amount that is not less than 25 percent of the 
        amount of Federal funds provided under this Act; and
            (8) the manner in which the State will ensure that funds 
        made available under this Act will be used to supplement, and 
        not supplant, any other Federal, State, or local funds expended 
        to provide services for programs described under this Act and 
        those described in paragraphs (3) and (4).
    (c) Amount of Grant.--
            (1) In general.--From amounts appropriated under section 4 
        for a fiscal year, the Secretary shall award a grant to a State 
        in an amount that bears the same ratio to such amounts as the 
        number of individuals within the State covered under a health 
        insurance plan (as determined by the Secretary) bears to the 
        total number of individuals covered under a health insurance 
        plan in all States (as determined by the Secretary). Any 
        amounts provided to a State under this section that are not 
        used by the State shall be remitted to the Secretary and 
        reallocated in accordance with this paragraph.
            (2) Minimum amount.--In no case shall the amount provided 
        to a State under a grant under this section for a fiscal year 
        be less than an amount equal to .5 percent of the amount 
        appropriated for such fiscal year under section 5.
    (d) Provision of Funds for Establishment of Office.--
            (1) In general.--From amounts provided under a grant under 
        this section, a State shall, directly or through a contract 
        with an independent, nonprofit entity with demonstrated 
        experience in serving the needs of health care consumers, 
        provide for the establishment and operation of a State health 
        care consumer assistance office.
            (2) Eligibility of entity.--To be eligible to enter into a 
        contract under paragraph (1), an entity shall demonstrate that 
        the entity has the technical, organizational, and professional 
        capacity to deliver the services described in section 4 
        throughout the State to all public and private health insurance 
        consumers.

SEC. 4. USE OF FUNDS.

    (a) By State.--A State shall use amounts provided under a grant 
awarded under this Act to carry out consumer assistance activities 
directly or by contract with an independent, non-profit organization. 
The State shall ensure the adequate training of personnel carrying out 
such activities. Such activities shall include--
            (1) the operation of a toll-free telephone hotline to 
        respond to consumer requests for assistance;
            (2) the dissemination of appropriate educational materials 
        on how best to access health care and the rights and 
        responsibilities of health care consumers;
            (3) the provision of education to health care consumers on 
        effective methods to promptly and efficiently resolve their 
        questions, problems, and grievances;
            (4) referrals to appropriate private and public entities to 
        resolve questions, problems and grievances;
            (5) the coordination of educational and outreach efforts 
        with consumers, health plans, health care providers, payers, 
        and governmental agencies; and
            (6) the provision of information and assistance to 
        consumers regarding internal, external, or administrative 
        grievances or appeals procedures in nonlitigative settings to 
        appeal the denial, termination, or reduction of health care 
        services, or the refusal to pay for such services, under a 
        health insurance plan.
    (b) Confidentiality and Access to Information.--The health care 
consumer assistance office of a State shall establish and implement 
procedures and protocols, consistent with applicable Federal and State 
confidentiality laws, to ensure the confidentiality of all information 
shared by consumers and their health care providers, health plans, or 
insurers with the office and to ensure that no such information is 
used, released, or referred to State agencies or outside entities 
without the expressed prior permission of the consumer, except to the 
extent that the office collects or uses aggregate information that 
is not individually identifiable. Such procedures and protocols shall 
ensure that the health care consumer is provided with a description of 
the policies and procedures of the office with respect to the manner in 
which health information may be used to carry out consumer assistance 
activities.
    (c) Availability of Services.--The health care consumer assistance 
office of a State shall not discriminate in the provision of 
information and referrals regardless of the source of the individual's 
health insurance coverage or prospective coverage, including 
individuals covered under employer-provided insurance, self-funded 
plans, the medicare or medicaid programs under title XVII or XIX of the 
Social Security Act (42 U.S.C. 1395 and 1396 et seq.), or under any 
other Federal or State health care program.
    (d) Designation of Responsibilities.--
            (1) Within existing state entity.--If the health care 
        consumer assistance office of a State is located within an 
        existing State regulatory agency or office of an elected State 
        official, the State shall ensure that--
                    (A) there is a separate delineation of the funding, 
                activities, and responsibilities of the office as 
                compared to the other funding, activities, and 
                responsibilities of the agency; and
                    (B) the office establishes and implements 
                procedures and protocols to ensure the confidentiality 
                of all information shared by consumers and their health 
                care providers, health plans, or insurers with the 
                office and to ensure that no information is transferred 
                or released to the State agency or office without the 
                expressed prior permission of the consumer in 
                accordance with subsection (b).
            (2) Contract entity.--In the case of an entity that enters 
        into a contract with a State under section 3(d), the entity 
        shall provide assurances that the entity has no real or 
        perceived conflict of interest in providing advice and 
        assistance to consumers regarding health insurance and that the 
        entity is independent of health insurance plans, companies, 
        providers, payers, and regulators of care.
    (e) Subcontracts.--The health care consumer assistance office of a 
State may carry out activities and provide services through contracts 
entered into with 1 or more nonprofit entities so long as the office 
can demonstrate that all of the requirements of this Act are complied 
with by the office.
    (f) Term.--A contract entered into under this section shall be for 
a term of 3 years.

SEC. 5. FUNDING.

    There are authorized to be appropriated $100,000,000 to carry out 
this Act.

SEC. 6. REPORT OF THE SECRETARY.

    Not later than 1 year after the Secretary first awards grants under 
this Act, and annually thereafter, the Secretary shall prepare and 
submit to the appropriate committees of Congress a report concerning 
the activities funded under section 4 and the effectiveness of such 
activities in resolving health care-related problems and grievances.