Protecting Consumers from Unreasonable Rates Act

Summary: Protecting Consumers from Unreasonable Rates Act This bill amends the Public Health Service Act to declare that the review by the Department of Health and Human Services (HHS) of unreasonable increases in health care coverage premiums does not prohibit a state from imposing on health insurers additional rate requirements that are more protective of consumers. The HHS review, which currently covers only premium increases, is expanded to include all rate increases. HHS or the relevant state agency must ensure that any excessive, unjustified, or unfairly discriminatory rates are corrected before, or as soon as possible after, implementation, including through mechanisms such as denying rates, modifying rates, or requiring rebates to consumers. HHS may apply civil monetary penalties to health insurers that fail to comply with a corrective action taken by HHS and may make the plan involved ineligible for classification as a qualified health plan. (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 determine whether HHS or the state will undertake the corrective actions based on whether the state can adequately undertake the actions.  This bill applies to health plans grandfathered under the Patient Protection and Affordable Care Act.

SECTION 1. SHORT TITLE.

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

SEC. 2. 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), as redesignated 
        by the Patient Protection and Affordable Care Act--
                    (A) in subsection (a)--
                            (i) in paragraph (1), by inserting ``and 
                        section 2794'' after ``this part''; and
                            (ii) in paragraph (2), by inserting ``or 
                        section 2794'' after ``this part''; and
                    (B) in subsection (b)--
                            (i) in paragraph (1), by inserting ``and 
                        section 2794'' after ``this part''; and
                            (ii) in paragraph (2)--
                                    (I) in subparagraph (A), by 
                                inserting ``or section 2794 that is'' 
                                after ``this part''; and
                                    (II) in subparagraph (C)(ii), by 
                                inserting ``or 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).''.
    (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, 2018.