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[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4224 Introduced in House (IH)]

112th CONGRESS
  2d Session
                                H. R. 4224

To repeal the Patient Protection and Affordable Care Act and the Health 
 Care and Education Reconciliation Act of 2010, to amend the Internal 
Revenue Code of 1986 to repeal the percentage floor on medical expense 
 deductions, expand the use of tax-preferred health care accounts, and 
 establish a charity care credit, to amend the Social Security Act to 
    create a Medicare Premium Assistance Program and reform EMTALA 
requirements, and to amend the Public Health Service Act to provide for 
cooperative governing of individual and group health insurance coverage 
                    offered in interstate commerce.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             March 20, 2012

Mr. Broun of Georgia introduced the following bill; which was referred 
    to the Committee on Energy and Commerce, and in addition to the 
    Committees on Ways and Means, Education and the Workforce, the 
    Judiciary, Natural Resources, Rules, Appropriations, and House 
   Administration, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
To repeal the Patient Protection and Affordable Care Act and the Health 
 Care and Education Reconciliation Act of 2010, to amend the Internal 
Revenue Code of 1986 to repeal the percentage floor on medical expense 
 deductions, expand the use of tax-preferred health care accounts, and 
 establish a charity care credit, to amend the Social Security Act to 
    create a Medicare Premium Assistance Program and reform EMTALA 
requirements, and to amend the Public Health Service Act to provide for 
cooperative governing of individual and group health insurance coverage 
                    offered in interstate commerce.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS; CONSTRUCTION.

    (a) Short Title.--This Act may be cited as the ``Offering Patients 
True Individualized Options Now Act of 2012'' or the ``OPTION Act of 
2012''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents; construction.
                   TITLE I--REPEAL OF PPACA AND HCERA

Sec. 101. Repeal of PPACA and HCERA.
                    TITLE II--HEALTH CARE TAX REFORM

                         Subtitle A--HSA Reform

Sec. 201. Repeal of high deductible health plan requirement.
Sec. 202. Increase in deductible HSA contribution limitations.
Sec. 203. Medicare eligible individuals eligible to contribute to HSA.
Sec. 204. HSA Rollover to Medicare Advantage MSA.
Sec. 205. Repeal of additional tax on distributions not used for 
                            qualified medical expenses.
                Subtitle B--Other Health Care Tax Reform

Sec. 206. Elimination of 7.5-percent floor on medical expense 
                            deductions.
Sec. 207. Repeal of prescribed drug limitation on certain tax benefits 
                            for medical expenses.
Sec. 208. Repeal of 2-percent miscellaneous itemized deduction floor 
                            for medical expense deductions.
Sec. 209. Charity care credit.
Sec. 210. COBRA continuation coverage extended.
Sec. 211. HSA charitable contributions.
             TITLE III--MEDICARE PREMIUM ASSISTANCE PROGRAM

Sec. 301. Replacement of Medicare part A entitlement with Medicare 
                            Reform Premium Assistance Program.
                        TITLE IV--EMTALA REFORMS

Sec. 401. EMTALA reforms.
TITLE V--COOPERATIVE GOVERNING OF INDIVIDUAL AND GROUP HEALTH INSURANCE 
                                COVERAGE

Sec. 501. Cooperative governing of individual and group health 
                            insurance coverage.
    (c) Construction.--Nothing in this Act shall be construed to 
preclude or prohibit a health care provider or health insurance issuer 
from publicly disclosing any pricing of services provided or covered.

                   TITLE I--REPEAL OF PPACA AND HCERA

SEC. 101. REPEAL OF PPACA AND HCERA.

    The Patient Protection and Affordable Care Act and the Health Care 
and Education Reconciliation Act of 2010 are each repealed, effective 
as of the respective date of enactment of each such Act, and the 
provisions of law amended or repealed by such Acts are restored or 
revived as if such Acts had not been enacted.

                    TITLE II--HEALTH CARE TAX REFORM

                         Subtitle A--HSA Reform

SEC. 201. REPEAL OF HIGH DEDUCTIBLE HEALTH PLAN REQUIREMENT.

    (a) In General.--Section 223 of the Internal Revenue Code of 1986 
is amended by striking subsection (c) and redesignating subsections (d) 
through (h) as subsections (c) through (g), respectively.
    (b) Conforming Amendments.--
            (1) Subsection (a) of section 223 of such Code is amended 
        to read as follows:
    ``(a) Deduction Allowed.--In the case of an individual, there shall 
be allowed as a deduction for a taxable year an amount equal to the 
aggregate amount paid in cash during such taxable year by or on behalf 
of such individual to a health savings account of such individual.''.
            (2) Subsection (b) of section 223 of such Code is amended 
        by striking paragraph (8).
            (3) Subparagraph (A) of section 223(c)(1) of the Internal 
        Revenue Code of 1986 (as redesignated by subsection (b)(1)) is 
        amended--
                    (A) by striking ``subsection (f)(5)'' and inserting 
                ``subsection (e)(5)'', and
                    (B) in clause (ii)--
                            (i) by striking ``the sum of--'' and all 
                        that follows and inserting ``the dollar amount 
                        in effect under subsection (b)(1).''.
            (4) Section 223(f)(1) of such Code (as redesignated by 
        subsection (b)(1)) is amended by striking ``Each dollar amount 
        in subsections (b)(2) and (c)(2)(A)'' and inserting ``In the 
        case of a taxable year beginning after December 31, 2010, each 
        dollar amount in subsection (b)(1)''.
            (5) Section 26(b)(U) of such Code is amended by striking 
        ``section 223(f)(4)'' and inserting ``section 223(e)(4)''.
            (6) Sections 35(g)(3), 220(f)(5)(A), 848(e)(1)(v), 
        4973(a)(5), and 6051(a)(12) of such Code are each amended by 
        striking ``section 223(d)'' each place it appears and inserting 
        ``section 223(c)''.
            (7) Section 106(d)(1) of such Code is amended--
                    (A) by striking ``who is an eligible individual (as 
                defined in section 223(c)(1))'', and
                    (B) by striking ``section 223(d)'' and inserting 
                ``section 223(c)''.
            (8) Section 408(d)(9) of such Code is amended--
                    (A) in subparagraph (A) by striking ``who is an 
                eligible individual (as defined in section 223(c)) 
                and'', and
                    (B) in subparagraph (C) by striking ``computed on 
                the basis of the type of coverage under the high 
                deductible health plan covering the individual at the 
                time of the qualified HSA funding distribution''.
            (9) Section 877A(g)(6) of such Code is amended by striking 
        ``223(f)(4)'' and inserting ``223(e)(4)''.
            (10) Section 4973(g) of such Code is amended--
                    (A) by striking ``section 223(d)'' and inserting 
                ``section 223(c)'',
                    (B) in paragraph (2), by striking ``section 
                223(f)(2)'' and inserting ``section 223(e)(2)'', and
                    (C) by striking ``section 223(f)(3)'' and inserting 
                ``section 223(e)(3)''.
            (11) Section 4975 of such Code is amended--
                    (A) in subsection (c)(6)--
                            (i) by striking ``section 223(d)'' and 
                        inserting ``section 223(c)'', and
                            (ii) by striking ``section 223(e)(2)'' and 
                        inserting ``section 223(d)(2)'', and
                    (B) in subsection (e)(1)(E), by striking ``section 
                223(d)'' and inserting ``section 223(c)''.
            (12) Section 6693(a)(2)(C) of such Code is amended by 
        striking ``section 223(h)'' and inserting ``section 223(g)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2011.

SEC. 202. INCREASE IN DEDUCTIBLE HSA CONTRIBUTION LIMITATIONS.

    (a) In General.--Paragraph (1) of section 223(b) of the Internal 
Revenue Code of 1986 is amended by striking ``the sum of the monthly'' 
and all that follows through ``eligible individual'' and inserting 
``$10,000 ($20,000 in the case of a joint return)''.
    (b) Conforming Amendments.--
            (1) Subsection (b) of such Code is amended by striking 
        paragraphs (2), (3), and (5) and by redesignating paragraphs 
        (4), (6), and (7) as paragraphs (2), (3), and (4), 
        respectively.
            (2) Paragraph (2) of section 223(b) of such Code (as 
        redesignated by paragraph (1)) is amended by striking the last 
        sentence.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2011.

SEC. 203. MEDICARE ELIGIBLE INDIVIDUALS ELIGIBLE TO CONTRIBUTE TO HSA.

    (a) Subsection (b) of section 223 of the Internal Revenue Code of 
1986 is amended by striking paragraph (7).
    (b) Paragraph (1) of section 223(c) of such Code is amended by 
adding at the end the following new subparagraph:
                    ``(C) Special rule for individuals entitled to 
                benefits under medicare.--In the case of an 
                individual--
                            ``(i) who is entitled to benefits under 
                        title XVIII of the Social Security Act, and
                            ``(ii) with respect to whom a health 
                        savings account is established in a month 
                        before the first month such individual is 
                        entitled to such benefits,
                such individual shall be deemed to be an eligible 
                individual.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2011.

SEC. 204. HSA ROLLOVER TO MEDICARE ADVANTAGE MSA.

    (a) In General.--Paragraph (2) of section 138(b) of the Internal 
Revenue Code of 1986 is amended by striking ``or'' at the end of 
subparagraph (A), by adding ``or'' at the end of subparagraph (C), and 
by adding at the end the following new subparagraph:
                    ``(C) a HSA rollover contribution described in 
                subsection (d)(5),''.
    (b) HSA Rollover Contribution.--Subsection (c) of section 138 of 
such Code is amended by adding at the end the following new paragraph:
            ``(5) Rollover contribution.--An amount is described in 
        this paragraph as a rollover contribution if it meets the 
        requirement of subparagraphs (A) and (B).
                    ``(A) In general.--The requirements of this 
                subparagraph are met in the case of an amount paid or 
                distributed from a health savings to the account 
                beneficiary to the extent the amount is received is 
                paid into a Medicare Advantage MSA of such beneficiary 
                not later than the 60th day after the day on which the 
                beneficiary receives the payment or distribution.
                    ``(B) Limitation.--This paragraph shall not apply 
                to any amount described in subparagraph (A) received by 
                an individual from a health savings account if, at any 
                time during the 1-year period ending on the day of such 
                receipt, such individual received any other amount 
                described in subparagraph (A) from a health savings 
                account which was not includible in the individual's 
                gross income because of the application of section 
                223(f)(5)(A).''.
    (c) Conforming Amendment.--Subparagraph (A) of section 223(f)(5) of 
such Code is amended by inserting ``or Medicare Advantage MSA'' after 
``into a health savings account''.
    (d) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2011.

SEC. 205. REPEAL OF ADDITIONAL TAX ON DISTRIBUTIONS NOT USED FOR 
              QUALIFIED MEDICAL EXPENSES.

    (a) In General.--Subsection (f) of section 223 of the Internal 
Revenue Code of 1986 is amended by striking paragraph (4) and 
redesignating paragraphs (5), (6), and (7) and paragraphs (4), (5), and 
(6), respectively.
    (b) Conforming Amendments.--
            (1) Paragraph (2) of section 25(b) of such Code is amended 
        by striking subparagraph (U) and by redesignating subparagraphs 
        (V), (W), and (X) as subparagraphs (U), (V), and (W).
            (2) Subparagraph (C) of section 106(e)(4) of such Code is 
        amended by striking ``223(f)(5)'' and inserting ``223(f)(4)''.
            (3) Paragraph (6) of section 877A(g) of such Code is 
        amended by striking ``223(f)(4),''.
            (4) Paragraph (1) of section 4973(g) of such Code is 
        amended by striking ``223(f)(5)'' and inserting ``223(f)(4)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2011.

                Subtitle B--Other Health Care Tax Reform

SEC. 206. ELIMINATION OF 7.5-PERCENT FLOOR ON MEDICAL EXPENSE 
              DEDUCTIONS.

    (a) In General.--Subsection (a) of section 213 of the Internal 
Revenue Code of 1986 is amended by striking ``, to the extent that such 
expenses exceed 7.5 percent of adjusted gross income''.
    (b) Conforming Amendment.--Paragraph (1) of section 56(b) of such 
Code is amended by striking subparagraph (B).
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2011.

SEC. 207. REPEAL OF PRESCRIBED DRUG LIMITATION ON CERTAIN TAX BENEFITS 
              FOR MEDICAL EXPENSES.

    (a) Deduction for Medical Expenses.--
            (1) In general.--Section 213 of the Internal Revenue Code 
        of 1986 is amended by striking subsection (b).
            (2) Conforming amendment.--Subsection (d) of section 213 of 
        such Code is amended by striking paragraph (3).
    (b) Treatment of Reimbursements Under Accident or Health Plans.--
Section 106 of such Code is amended by striking subsection (f).
    (c) Health Savings Accounts.--Subparagraph (A) of section 223(d)(2) 
of such Code is amended by striking the last sentence thereof.
    (d) Archer MSAs.--Subparagraph (A) of section 220(d)(2) of such 
Code is amended by striking the last sentence thereof.
    (e) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2011.

SEC. 208. REPEAL OF 2-PERCENT MISCELLANEOUS ITEMIZED DEDUCTION FLOOR 
              FOR MEDICAL EXPENSE DEDUCTIONS.

    (a) In General.--Subsection (b) of section 67 of the Internal 
Revenue Code of 1986 is amended by striking paragraph (5).
    (b) Effective Date.--The amendment made by this section shall apply 
to taxable years beginning after the December 31, 2011.

SEC. 209. CHARITY CARE CREDIT.

    (a) In General.--Subpart A of part IV of subchapter A of chapter 1 
of the Internal Revenue Code of 1986 (relating to nonrefundable 
personal credits) is amended by inserting after section 25D the 
following new section:

``SEC. 25E. CHARITY CARE CREDIT.

    ``(a) Allowance of Credit.--In the case of a physician, there shall 
be allowed as a credit against the tax imposed by this chapter for a 
taxable year the amount determined in accordance with the following 
table:

``If the physician has provided     The amount of the credit is:
 during such taxable year:.
  At least 25 but less than 30      $2,000.
   qualified hours of charity care.
  At least 30 but less than 35      $2,400.
   qualified hours of charity care.
  At least 35 but less than 40      $2,800.
   qualified hours of charity care.
  At least 40 but less than 45      $3,200.
   qualified hours of charity care.
  At least 45 but less than 50      $3,600.
   qualified hours of charity care.
  At least 50 but less than 55      $4,000.
   qualified hours of charity care.
  At least 55 but less than 60      $4,400.
   qualified hours of charity care.
  At least 60 but less than 65      $4,800.
   qualified hours of charity care.
  At least 65 but less than 70      $5,200.
   qualified hours of charity care.
  At least 70 but less than 75      $5,600.
   qualified hours of charity care.
  At least 75 but less than 80      $6,000.
   qualified hours of charity care.
  At least 80 but less than 85      $6,400.
   qualified hours of charity care.
  At least 85 but less than 90      $6,800.
   qualified hours of charity care.
  At least 90 but less than 95      $7,200.
   qualified hours of charity care.
  At least 95 but less than 100     $7,600.
   qualified hours of charity care.
  At least 100 hours of charity     $8,000.
   care.
 

    ``(b) Qualified Hours of Charity Care.--For purposes of this 
section--
            ``(1) Qualified hours of charity care.--The term `qualified 
        hours of charity care' means the hours that a physician 
        provides medical care (as defined in section 213(d)(1)(A)) on a 
        volunteer or pro bono basis.
            ``(2) Physician.--The term `physician' has the meaning 
        given to such term in section 1861(r) of the Social Security 
        Act (42 U.S.C. 1395x(r)).''.
    (b) Conforming Amendment.--The table of sections for subpart A of 
part IV of subchapter A of chapter 1 of such Code is amended by 
inserting after the item relating to section 25D the following new 
item:

``Sec. 25E. Charity care credit.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2011.

SEC. 210. COBRA CONTINUATION COVERAGE EXTENDED.

    (a) Under IRC.--Subparagraph (B) of section 4980B(f)(2) of the 
Internal Revenue Code of 1986 is amended by striking clauses (i) and 
(v) and by redesignating clauses (ii), (iii), and (iv) as clauses (i), 
(ii), and (iii), respectively.
    (b) Under ERISA.--Paragraph (2) of section 602 of the Employee 
Retirement Income Security Act of 2009 (29 U.S.C. 1162) is amended by 
striking subparagraphs (A) and (E) and by redesignating subparagraphs 
(B), (C), and (D) as subparagraphs (A), (B), and (C), respectively.
    (c) Under PHSA.--Paragraph (2) of section 2202(2) of the Public 
Health Service Act (42 U.S.C. 300bb-2(2)) is amended by striking 
subparagraphs (A) and (E) and by redesignating subparagraphs (B), (C), 
and (D) as subparagraphs (A), (B), and (C), respectively.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to group health plans, and health insurance coverage 
offered in connection with group health plans, for plan years beginning 
after the date of the enactment of this Act.

SEC. 211. HSA CHARITABLE CONTRIBUTIONS.

    (a) In General.--Subsection (f) of section 223 of the Internal 
Revenue Code of 1986 is amended by adding at the end the following new 
paragraph:
            ``(9) Distributions for charitable purposes.--For purposes 
        of this subsection--
                    ``(A) In general.--Paragraph (2) shall not apply to 
                any qualified charitable distributions with respect to 
                a taxpayer made during any taxable year.
                    ``(B) Qualified charitable distribution.--For 
                purposes of this paragraph, the term `qualified 
                charitable distribution' means any distribution from a 
                health savings account which is made directly by the 
                trustee to an organization described in section 
                170(b)(1)(A) (other than any organization described in 
                section 509(a)(3) or any fund or account described in 
                section 4966(d)(2)). A distribution shall be treated as 
                a qualified charitable distribution only to the extent 
                that the distribution would be includible in gross 
                income without regard to subparagraph (A).
                    ``(C) Contributions must be otherwise deductible.--
                For purposes of this paragraph, a distribution to an 
                organization described in subparagraph (B) shall be 
                treated as a qualified charitable distribution only if 
                a deduction for the entire distribution would be 
                allowable under section 170 (determined without regard 
                to subsection (b) thereof and this paragraph).
                    ``(D) Denial of deduction.--Qualified charitable 
                distributions which are not includible in gross income 
                pursuant to subparagraph (A) shall not be taken into 
                account in determining the deduction under section 
                170.''.
    (b) Effective Date.--The amendment made by this section shall apply 
to taxable years beginning after December 31, 2011.

             TITLE III--MEDICARE PREMIUM ASSISTANCE PROGRAM

SEC. 301. REPLACEMENT OF MEDICARE PART A ENTITLEMENT WITH MEDICARE 
              REFORM PREMIUM ASSISTANCE PROGRAM.

    (a) In General.--Section 226 of the Social Security Act (42 U.S.C. 
426) is amended by adding at the end the following new subsections:
    ``(k) Replacement of Entitlement With Premium Assistance Program.--
            ``(1) In general.--Notwithstanding the previous provisions 
        of this section, beginning the first January 1 after the date 
        of the enactment of the Offering Patients True Individualized 
        Options Act of 2011, the Secretary shall establish procedures 
        under which--
                    ``(A) in the case of an individual who, but for the 
                application of this paragraph, would otherwise become 
                entitled under subsection (a) on or after such January 
                1 to benefits under part A of title XVIII, subject to 
                paragraph (4), the individual shall in lieu of such 
                entitlement be automatically enrolled in the Medicare 
                Reform Premium Assistance Program established under 
                subsection (l); and
                    ``(B) in the case of an individual who before such 
                January 1 is entitled under subsection (a) to benefits 
                under part A of title XVIII, the individual may in lieu 
                of such entitlement elect on or after such January 1 to 
                enroll in the Medicare Reform Premium Assistance 
                Program established under subsection (l).
            ``(2) Treatment under the internal revenue code of 1986.--
        An individual who is enrolled under the Medicare Reform Premium 
        Assistance Program under paragraph (1) shall not be treated as 
        entitled to benefits under title XVIII for purposes of section 
        223(b)(7) of the Internal Revenue Code of 1986.
            ``(3) Ineligibility for part b or d benefits.--An 
        individual shall not be eligible for benefits under part B or D 
        of title XVIII once the individual is enrolled in the Medicare 
        Reform Premium Assistance Program under paragraph (1).
            ``(4) Opt out.--
                    ``(A) In general.--Any individual who is otherwise 
                eligible for automatic enrollment in the Medicare 
                Reform Premium Assistance Program under paragraph 
                (1)(A) may elect (in such form and manner as may be 
                specified by the Secretary of Health and Human 
                Services) to not be so enrolled.
                    ``(B) Individuals electing to opt out not treated 
                as entitled to medicare benefits.--In the case of an 
                individual who makes an election under subparagraph 
                (A)--
                            ``(i) such individual shall not be eligible 
                        for benefits under part A of title XVIII; and
                            ``(ii) the provisions of paragraphs (2) and 
                        (3) shall apply to such individual in the same 
                        manner as such paragraphs apply to an 
                        individual enrolled under the Medicare Reform 
                        Premium Assistance Program under paragraph (1).
    ``(l) Medicare Reform Premium Assistance.--
            ``(1) Establishment of premium assistance program.--The 
        Secretary shall establish a program to be known as the Medicare 
        Reform Premium Assistance Program (in this subsection referred 
        to as the `premium assistance program') consistent with this 
        subsection.
            ``(2) Automatic enrollment.--An individual otherwise 
        entitled under subsection (a) to benefits under part A of title 
        XVIII shall, subject to subsection (k)(4), be enrolled in the 
        premium assistance program for the period during which such 
        individual would otherwise be so entitled to benefits.
            ``(3) Amount of premium assistance.--
                    ``(A) In general.--Subject to clause (ii), for each 
                year that an individual is enrolled in the premium 
                assistance program, the Secretary shall provide premium 
                assistance to such individual in an amount determined 
                by the Secretary that is based on the geographic 
                location of the individual and the cost of applicable 
                health insurance coverage and benefits in such area.
                    ``(B) Computation of premium assistance amounts.--
                The amount of premium assistance provided to an 
                individual located in a geographic area for a year 
                shall be computed at 120 percent of the sum of the 
                median premium and median deductible payment for such 
                year for all health insurance coverage offered by 
                health insurance issuers in the individual market 
                serving such area.
            ``(4) Permissible use of premium assistance.--Premium 
        assistance under paragraph (3) may be used only for the 
        following purposes:
                    ``(A) For payment of premiums, deductibles, 
                copayments, or other cost-sharing for enrollment of 
                such individual for health insurance coverage offered 
                by health insurance issuers in the individual market.
                    ``(B) As a contribution into a MSA plan established 
                by such individual, as defined in section 138(b)(2) of 
                the Internal Revenue Code of 1986.
            ``(5) MSA deposits.--The amount of the premium assistance 
        received by an individual under this subsection shall be 
        deposited, on behalf of such individual, into the MSA plan of 
        such individual.''.
    (b) Effective Date.--The amendment made by this section shall take 
effect on the first January 1 after the date of the enactment of this 
Act.

                        TITLE IV--EMTALA REFORMS

SEC. 401. EMTALA REFORMS.

    (a) Use of Qualified Emergency Department Personnel in Performing 
Initial Screening.--Subsection (a) of section 1867 of the Social 
Security Act (42 U.S.C. 1395dd) is amended--
            (1) by designating the sentence beginning with ``In the 
        case of'' as paragraph (1), with the heading ``In General.--'' 
        and appropriate indentation; and
            (2) by adding at the end the following new paragraph:
            ``(2) Permitting application of er triage.--
                    ``(A) In general.--The requirement of paragraph (1) 
                that a hospital conduct an appropriate medical 
                screening examination of an individual is deemed to be 
                satisfied if a qualified emergency screener (as defined 
                in subparagraph (B)) performs a preliminary triage-type 
                screening in which the personnel--
                            ``(i) assesses the nature and extent of the 
                        individual's illness or injury; and
                            ``(ii) determines, based on such 
                        assessment, that an emergency medical condition 
                        does not exist.
                    ``(B) Qualified emergency screener defined.--In 
                this paragraph, the term `qualified emergency screener' 
                means a physician, licensed practical nurse or 
                registered nurse, qualified emergency medical 
                technician, or other individual with basic, health care 
                education that meets standards specified by the 
                Secretary as being sufficient to perform the screening 
                described in subparagraph (A).''.
    (b) Revision of Emergency Medical Condition Definition.--Subsection 
(e)(1)(A) of such section is amended to read as follows:
                    ``(A) a medical condition manifesting itself by 
                symptoms of sufficient severity (including severe pain) 
                and with an onset or of a course such that the absence 
                of immediate medical attention could reasonably be 
                expected to pose an immediate risk to life or long-term 
                health of the individual (or, with respect to a 
                pregnant woman, the life or long-term health of the 
                woman or her unborn child); or''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on the date of the enactment of this Act and shall apply to 
individuals who come to an emergency room on or after the date that is 
30 days after the date of the enactment of this Act.

TITLE V--COOPERATIVE GOVERNING OF INDIVIDUAL AND GROUP HEALTH INSURANCE 
                                COVERAGE

SEC. 501. COOPERATIVE GOVERNING OF INDIVIDUAL AND GROUP HEALTH 
              INSURANCE COVERAGE.

    (a) In General.--Title XXVII of the Public Health Service Act (42 
U.S.C. 300gg et seq.) is amended by adding at the end the following new 
part:

    ``PART D--COOPERATIVE GOVERNING OF INDIVIDUAL AND GROUP HEALTH 
                           INSURANCE COVERAGE

``SEC. 2795. DEFINITIONS.

    ``In this part:
            ``(1) Primary state.--The term `primary State' means, with 
        respect to individual or group health insurance coverage 
        offered by a health insurance issuer, the State designated by 
        the issuer as the State whose covered laws shall govern the 
        health insurance issuer in the sale of such coverage under this 
        part. An issuer, with respect to a particular policy, may only 
        designate one such State as its primary State with respect to 
        all such coverage it offers. Such an issuer may not change the 
        designated primary State with respect to individual or group 
        health insurance coverage once the policy is issued, except 
        that such a change may be made upon renewal of the policy. With 
        respect to such designated State, the issuer is deemed to be 
        doing business in that State.
            ``(2) Secondary state.--The term `secondary State' means, 
        with respect to individual or group health insurance coverage 
        offered by a health insurance issuer, any State that is not the 
        primary State. In the case of a health insurance issuer that is 
        selling a policy in, or to a resident of, a secondary State, 
        the issuer is deemed to be doing business in that secondary 
        State.
            ``(3) Health insurance issuer.--The term `health insurance 
        issuer' has the meaning given such term in section 2791(b)(2), 
        except that such an issuer must be licensed in the primary 
        State and be qualified to sell individual health insurance 
        coverage in that State.
            ``(4) Individual health insurance coverage.--The term 
        `individual health insurance coverage' means health insurance 
        coverage offered in the individual market, as defined in 
        section 2791(e)(1).
            ``(5) Group health insurance coverage.--The term `group 
        health insurance coverage' has the meaning given such term in 
        2791(b)(4).
            ``(6) Applicable state authority.--The term `applicable 
        State authority' means, with respect to a health insurance 
        issuer in a State, the State insurance commissioner or official 
        or officials designated by the State to enforce the 
        requirements of this title for the State with respect to the 
        issuer.
            ``(7) Hazardous financial condition.--The term `hazardous 
        financial condition' means that, based on its present or 
        reasonably anticipated financial condition, a health insurance 
        issuer is unlikely to be able--
                    ``(A) to meet obligations to policyholders with 
                respect to known claims and reasonably anticipated 
                claims; or
                    ``(B) to pay other obligations in the normal course 
                of business.
            ``(8) Covered laws.--
                    ``(A) In general.--The term `covered laws' means 
                the laws, rules, regulations, agreements, and orders 
                governing the insurance business pertaining to--
                            ``(i) individual or group health insurance 
                        coverage issued by a health insurance issuer;
                            ``(ii) the offer, sale, rating (including 
                        medical underwriting), renewal, and issuance of 
                        individual or group health insurance coverage 
                        to an individual;
                            ``(iii) the provision to an individual in 
                        relation to individual or group health 
                        insurance coverage of health care and insurance 
                        related services;
                            ``(iv) the provision to an individual in 
                        relation to individual or group health 
                        insurance coverage of management, operations, 
                        and investment activities of a health insurance 
                        issuer; and
                            ``(v) the provision to an individual in 
                        relation to individual or group health 
                        insurance coverage of loss control and claims 
                        administration for a health insurance issuer 
                        with respect to liability for which the issuer 
                        provides insurance.
                    ``(B) Exception.--Such term does not include any 
                law, rule, regulation, agreement, or order governing 
                the use of care or cost management techniques, 
                including any requirement related to provider 
                contracting, network access or adequacy, health care 
                data collection, or quality assurance.
            ``(9) State.--The term `State' means the 50 States and 
        includes the District of Columbia, Puerto Rico, the Virgin 
        Islands, Guam, American Samoa, and the Northern Mariana 
        Islands.
            ``(10) Unfair claims settlement practices.--The term 
        `unfair claims settlement practices' means only the following 
        practices:
                    ``(A) Knowingly misrepresenting to claimants and 
                insured individuals relevant facts or policy provisions 
                relating to coverage at issue.
                    ``(B) Failing to acknowledge with reasonable 
                promptness pertinent communications with respect to 
                claims arising under policies.
                    ``(C) Failing to adopt and implement reasonable 
                standards for the prompt investigation and settlement 
                of claims arising under policies.
                    ``(D) Failing to effectuate prompt, fair, and 
                equitable settlement of claims submitted in which 
                liability has become reasonably clear.
                    ``(E) Refusing to pay claims without conducting a 
                reasonable investigation.
                    ``(F) Failing to affirm or deny coverage of claims 
                within a reasonable period of time after having 
                completed an investigation related to those claims.
                    ``(G) A pattern or practice of compelling insured 
                individuals or their beneficiaries to institute suits 
                to recover amounts due under its policies by offering 
                substantially less than the amounts ultimately 
                recovered in suits brought by them.
                    ``(H) A pattern or practice of attempting to settle 
                or settling claims for less than the amount that a 
                reasonable person would believe the insured individual 
                or his or her beneficiary was entitled by reference to 
                written or printed advertising material accompanying or 
                made part of an application.
                    ``(I) Attempting to settle or settling claims on 
                the basis of an application that was materially altered 
                without notice to, or knowledge or consent of, the 
                insured.
                    ``(J) Failing to provide forms necessary to present 
                claims within 15 calendar days of a requests with 
                reasonable explanations regarding their use.
                    ``(K) Attempting to cancel a policy in less time 
                than that prescribed in the policy or by the law of the 
                primary State.
            ``(11) Fraud and abuse.--The term `fraud and abuse' means 
        an act or omission committed by a person who, knowingly and 
        with intent to defraud, commits, or conceals any material 
        information concerning, one or more of the following:
                    ``(A) Presenting, causing to be presented or 
                preparing with knowledge or belief that it will be 
                presented to or by an insurer, a reinsurer, broker or 
                its agent, false information as part of, in support of 
                or concerning a fact material to one or more of the 
                following:
                            ``(i) An application for the issuance or 
                        renewal of an insurance policy or reinsurance 
                        contract.
                            ``(ii) The rating of an insurance policy or 
                        reinsurance contract.
                            ``(iii) A claim for payment or benefit 
                        pursuant to an insurance policy or reinsurance 
                        contract.
                            ``(iv) Premiums paid on an insurance policy 
                        or reinsurance contract.
                            ``(v) Payments made in accordance with the 
                        terms of an insurance policy or reinsurance 
                        contract.
                            ``(vi) A document filed with the 
                        commissioner or the chief insurance regulatory 
                        official of another jurisdiction.
                            ``(vii) The financial condition of an 
                        insurer or reinsurer.
                            ``(viii) The formation, acquisition, 
                        merger, reconsolidation, dissolution or 
                        withdrawal from one or more lines of insurance 
                        or reinsurance in all or part of a State by an 
                        insurer or reinsurer.
                            ``(ix) The issuance of written evidence of 
                        insurance.
                            ``(x) The reinstatement of an insurance 
                        policy.
                    ``(B) Solicitation or acceptance of new or renewal 
                insurance risks on behalf of an insurer reinsurer or 
                other person engaged in the business of insurance by a 
                person who knows or should know that the insurer or 
                other person responsible for the risk is insolvent at 
                the time of the transaction.
                    ``(C) Transaction of the business of insurance in 
                violation of laws requiring a license, certificate of 
                authority or other legal authority for the transaction 
                of the business of insurance.
                    ``(D) Attempt to commit, aiding or abetting in the 
                commission of, or conspiracy to commit the acts or 
                omissions specified in this paragraph.

``SEC. 2796. APPLICATION OF LAW.

    ``(a) In General.--The covered laws of the primary State shall 
apply to individual and group health insurance coverage offered by a 
health insurance issuer in the primary State and in any secondary 
State, but only if the coverage and issuer comply with the conditions 
of this section with respect to the offering of coverage in any 
secondary State.
    ``(b) Exemptions From Covered Laws in a Secondary State.--Except as 
provided in this section, a health insurance issuer with respect to its 
offer, sale, rating (including medical underwriting), renewal, and 
issuance of individual or group health insurance coverage in any 
secondary State is exempt from any covered laws of the secondary State 
(and any rules, regulations, agreements, or orders sought or issued by 
such State under or related to such covered laws) to the extent that 
such laws would--
            ``(1) make unlawful, or regulate, directly or indirectly, 
        the operation of the health insurance issuer operating in the 
        secondary State, except that any secondary State may require 
        such an issuer--
                    ``(A) to pay, on a nondiscriminatory basis, 
                applicable premium and other taxes (including high risk 
                pool assessments) which are levied on insurers and 
                surplus lines insurers, brokers, or policyholders under 
                the laws of the State;
                    ``(B) to register with and designate the State 
                insurance commissioner as its agent solely for the 
                purpose of receiving service of legal documents or 
                process;
                    ``(C) to submit to an examination of its financial 
                condition by the State insurance commissioner in any 
                State in which the issuer is doing business to 
                determine the issuer's financial condition, if--
                            ``(i) the State insurance commissioner of 
                        the primary State has not done an examination 
                        within the period recommended by the National 
                        Association of Insurance Commissioners; and
                            ``(ii) any such examination is conducted in 
                        accordance with the examiners' handbook of the 
                        National Association of Insurance Commissioners 
                        and is coordinated to avoid unjustified 
                        duplication and unjustified repetition;
                    ``(D) to comply with a lawful order issued--
                            ``(i) in a delinquency proceeding commenced 
                        by the State insurance commissioner if there 
                        has been a finding of financial impairment 
                        under subparagraph (C); or
                            ``(ii) in a voluntary dissolution 
                        proceeding;
                    ``(E) to comply with an injunction issued by a 
                court of competent jurisdiction, upon a petition by the 
                State insurance commissioner alleging that the issuer 
                is in hazardous financial condition;
                    ``(F) to participate, on a nondiscriminatory basis, 
                in any insurance insolvency guaranty association or 
                similar association to which a health insurance issuer 
                in the State is required to belong;
                    ``(G) to comply with any State law regarding fraud 
                and abuse (as defined in section 2795(10)), except that 
                if the State seeks an injunction regarding the conduct 
                described in this subparagraph, such injunction must be 
                obtained from a court of competent jurisdiction;
                    ``(H) to comply with any State law regarding unfair 
                claims settlement practices (as defined in section 
                2795(9)); or
                    ``(I) to comply with the applicable requirements 
                for independent review under section 2798 with respect 
                to coverage offered in the State;
            ``(2) require any individual or group health insurance 
        coverage issued by the issuer to be countersigned by an 
        insurance agent or broker residing in that Secondary State; or
            ``(3) otherwise discriminate against the issuer issuing 
        insurance in both the primary State and in any secondary State.
    ``(c) Clear and Conspicuous Disclosure.--A health insurance issuer 
shall provide the following notice, in 12-point bold type, in any 
insurance coverage offered in a secondary State under this part by such 
a health insurance issuer and at renewal of the policy, with the 5 
blank spaces therein being appropriately filled with the name of the 
health insurance issuer, the name of primary State, the name of the 
secondary State, the name of the secondary State, and the name of the 
secondary State, respectively, for the coverage concerned: `Notice: 
This policy is issued by ____ and is governed by the laws and 
regulations of the State of ____, and it has met all the laws of that 
State as determined by that State's Department of Insurance. This 
policy may be less expensive than others because it is not subject to 
all of the insurance laws and regulations of the State of _____, 
including coverage of some services or benefits mandated by the law of 
the State of _____. Additionally, this policy is not subject to all of 
the consumer protection laws or restrictions on rate changes of the 
State of _____. As with all insurance products, before purchasing this 
policy, you should carefully review the policy and determine what 
health care services the policy covers and what benefits it provides, 
including any exclusions, limitations, or conditions for such services 
or benefits.'
    ``(d) Prohibition on Certain Reclassifications and Premium 
Increases.--
            ``(1) In general.--For purposes of this section, a health 
        insurance issuer that provides individual or group health 
        insurance coverage to an individual under this part in a 
        primary or secondary State may not upon renewal--
                    ``(A) move or reclassify the individual insured 
                under the health insurance coverage from the class such 
                individual is in at the time of issue of the contract 
                based on the health status-related factors of the 
                individual; or
                    ``(B) increase the premiums assessed the individual 
                for such coverage based on a health status-related 
                factor or change of a health status-related factor or 
                the past or prospective claim experience of the insured 
                individual.
            ``(2) Construction.--Nothing in paragraph (1) shall be 
        construed to prohibit a health insurance issuer--
                    ``(A) from terminating or discontinuing coverage or 
                a class of coverage in accordance with subsections (b) 
                and (c) of section 2742;
                    ``(B) from raising premium rates for all policy 
                holders within a class based on claims experience;
                    ``(C) from changing premiums or offering discounted 
                premiums to individuals who engage in wellness 
                activities at intervals prescribed by the issuer, if 
                such premium changes or incentives--
                            ``(i) are disclosed to the consumer in the 
                        insurance contract;
                            ``(ii) are based on specific wellness 
                        activities that are not applicable to all 
                        individuals; and
                            ``(iii) are not obtainable by all 
                        individuals to whom coverage is offered;
                    ``(D) from reinstating lapsed coverage; or
                    ``(E) from retroactively adjusting the rates 
                charged an insured individual if the initial rates were 
                set based on material misrepresentation by the 
                individual at the time of issue.
    ``(e) Prior Offering of Policy in Primary State.--A health 
insurance issuer may not offer for sale individual or group health 
insurance coverage in a secondary State unless that coverage is 
currently offered for sale in the primary State.
    ``(f) Licensing of Agents or Brokers for Health Insurance 
Issuers.--Any State may require that a person acting, or offering to 
act, as an agent or broker for a health insurance issuer with respect 
to the offering of individual or group health insurance coverage obtain 
a license from that State, with commissions or other compensation 
subject to the provisions of the laws of that State, except that a 
State may not impose any qualification or requirement which 
discriminates against a nonresident agent or broker.
    ``(g) Documents for Submission to State Insurance Commissioner.--
Each health insurance issuer issuing individual or group health 
insurance coverage in both primary and secondary States shall submit--
            ``(1) to the insurance commissioner of each State in which 
        it intends to offer such coverage, before it may offer 
        individual or group health insurance coverage in such State--
                    ``(A) a copy of the plan of operation or 
                feasibility study or any similar statement of the 
                policy being offered and its coverage (which shall 
                include the name of its primary State and its principal 
                place of business);
                    ``(B) written notice of any change in its 
                designation of its primary State; and
                    ``(C) written notice from the issuer of the 
                issuer's compliance with all the laws of the primary 
                State; and
            ``(2) to the insurance commissioner of each secondary State 
        in which it offers individual or group health insurance 
        coverage, a copy of the issuer's quarterly financial statement 
        submitted to the primary State, which statement shall be 
        certified by an independent public accountant and contain a 
        statement of opinion on loss and loss adjustment expense 
        reserves made by--
                    ``(A) a member of the American Academy of 
                Actuaries; or
                    ``(B) a qualified loss reserve specialist.
    ``(h) Power of Courts To Enjoin Conduct.--Nothing in this section 
shall be construed to affect the authority of any Federal or State 
court to enjoin--
            ``(1) the solicitation or sale of individual or group 
        health insurance coverage by a health insurance issuer to any 
        person or group who is not eligible for such insurance; or
            ``(2) the solicitation or sale of individual or group 
        health insurance coverage that violates the requirements of the 
        law of a secondary State which are described in subparagraphs 
        (A) through (H) of section 2796(b)(1).
    ``(i) Power of Secondary States To Take Administrative Action.--
Nothing in this section shall be construed to affect the authority of 
any State to enjoin conduct in violation of that State's laws described 
in section 2796(b)(1).
    ``(j) State Powers To Enforce State Laws.--
            ``(1) In general.--Subject to the provisions of subsection 
        (b)(1)(G) (relating to injunctions) and paragraph (2), nothing 
        in this section shall be construed to affect the authority of 
        any State to make use of any of its powers to enforce the laws 
        of such State with respect to which a health insurance issuer 
        is not exempt under subsection (b).
            ``(2) Courts of competent jurisdiction.--If a State seeks 
        an injunction regarding the conduct described in paragraphs (1) 
        and (2) of subsection (h), such injunction must be obtained 
        from a Federal or State court of competent jurisdiction.
    ``(k) States' Authority To Sue.--Nothing in this section shall 
affect the authority of any State to bring action in any Federal or 
State court.
    ``(l) Generally Applicable Laws.--Nothing in this section shall be 
construed to affect the applicability of State laws generally 
applicable to persons or corporations.
    ``(m) Guaranteed Availability of Coverage to HIPAA Eligible 
Individuals.--To the extent that a health insurance issuer is offering 
coverage in a primary State that does not accommodate residents of 
secondary States or does not provide a working mechanism for residents 
of a secondary State, and the issuer is offering coverage under this 
part in such secondary State which has not adopted a qualified high 
risk pool as its acceptable alternative mechanism (as defined in 
section 2744(c)(2)), the issuer shall, with respect to any individual 
or group health insurance coverage offered in a secondary State under 
this part, comply with the guaranteed availability requirements for 
eligible individuals in section 2741.

``SEC. 2797. PRIMARY STATE MUST MEET FEDERAL FLOOR BEFORE ISSUER MAY 
              SELL INTO SECONDARY STATES.

    ``A health insurance issuer may not offer, sell, or issue 
individual or group health insurance coverage in a secondary State if 
the State insurance commissioner does not use a risk-based capital 
formula for the determination of capital and surplus requirements for 
all health insurance issuers.

``SEC. 2798. INDEPENDENT EXTERNAL APPEALS PROCEDURES.

    ``(a) Right to External Appeal.--A health insurance issuer may not 
offer, sell, or issue individual or group health insurance coverage in 
a secondary State under the provisions of this title unless--
            ``(1) both the secondary State and the primary State have 
        legislation or regulations in place establishing an independent 
        review process for individuals who are covered by individual 
        health insurance coverage or group health insurance offered by 
        a health insurance issuer, repsectively, or
            ``(2) in any case in which the requirements of subparagraph 
        (A) are not met with respect to the either of such States, the 
        issuer provides an independent review mechanism substantially 
        identical (as determined by the applicable State authority of 
        such State) to that prescribed in the `Health Carrier External 
        Review Model Act' of the National Association of Insurance 
        Commissioners for all individuals who purchase insurance 
        coverage under the terms of this part, except that, under such 
        mechanism, the review is conducted by an independent medical 
        reviewer, or a panel of such reviewers, with respect to whom 
        the requirements of subsection (b) are met.
    ``(b) Qualifications of Independent Medical Reviewers.--In the case 
of any independent review mechanism referred to in subsection (a)(2):
            ``(1) In general.--In referring a denial of a claim to an 
        independent medical reviewer, or to any panel of such 
        reviewers, to conduct independent medical review, the issuer 
        shall ensure that--
                    ``(A) each independent medical reviewer meets the 
                qualifications described in paragraphs (2) and (3);
                    ``(B) with respect to each review, each reviewer 
                meets the requirements of paragraph (4) and the 
                reviewer, or at least 1 reviewer on the panel, meets 
                the requirements described in paragraph (5); and
                    ``(C) compensation provided by the issuer to each 
                reviewer is consistent with paragraph (6).
            ``(2) Licensure and expertise.--Each independent medical 
        reviewer shall be a physician (allopathic or osteopathic) or 
        health care professional who--
                    ``(A) is appropriately credentialed or licensed in 
                1 or more States to deliver health care services; and
                    ``(B) typically treats the condition, makes the 
                diagnosis, or provides the type of treatment under 
                review.
            ``(3) Independence.--
                    ``(A) In general.--Subject to subparagraph (B), 
                each independent medical reviewer in a case shall--
                            ``(i) not be a related party (as defined in 
                        paragraph (7));
                            ``(ii) not have a material familial, 
                        financial, or professional relationship with 
                        such a party; and
                            ``(iii) not otherwise have a conflict of 
                        interest with such a party (as determined under 
                        regulations).
                    ``(B) Exception.--Nothing in subparagraph (A) shall 
                be construed to--
                            ``(i) prohibit an individual, solely on the 
                        basis of affiliation with the issuer, from 
                        serving as an independent medical reviewer if--
                                    ``(I) a non-affiliated individual 
                                is not reasonably available;
                                    ``(II) the affiliated individual is 
                                not involved in the provision of items 
                                or services in the case under review;
                                    ``(III) the fact of such an 
                                affiliation is disclosed to the issuer 
                                and the enrollee (or authorized 
                                representative) and neither party 
                                objects; and
                                    ``(IV) the affiliated individual is 
                                not an employee of the issuer and does 
                                not provide services exclusively or 
                                primarily to or on behalf of the 
                                issuer;
                            ``(ii) prohibit an individual who has staff 
                        privileges at the institution where the 
                        treatment involved takes place from serving as 
                        an independent medical reviewer merely on the 
                        basis of such affiliation if the affiliation is 
                        disclosed to the issuer and the enrollee (or 
                        authorized representative), and neither party 
                        objects; or
                            ``(iii) prohibit receipt of compensation by 
                        an independent medical reviewer from an entity 
                        if the compensation is provided consistent with 
                        paragraph (6).
            ``(4) Practicing health care professional in same field.--
                    ``(A) In general.--In a case involving treatment, 
                or the provision of items or services--
                            ``(i) by a physician, a reviewer shall be a 
                        practicing physician (allopathic or 
                        osteopathic) of the same or similar specialty, 
                        as a physician who, acting within the 
                        appropriate scope of practice within the State 
                        in which the service is provided or rendered, 
                        typically treats the condition, makes the 
                        diagnosis, or provides the type of treatment 
                        under review; or
                            ``(ii) by a non-physician health care 
                        professional, the reviewer, or at least 1 
                        member of the review panel, shall be a 
                        practicing non-physician health care 
                        professional of the same or similar specialty 
                        as the non-physician health care professional 
                        who, acting within the appropriate scope of 
                        practice within the State in which the service 
                        is provided or rendered, typically treats the 
                        condition, makes the diagnosis, or provides the 
                        type of treatment under review.
                    ``(B) Practicing defined.--For purposes of this 
                paragraph, the term `practicing' means, with respect to 
                an individual who is a physician or other health care 
                professional, that the individual provides health care 
                services to individual patients on average at least 2 
                days per week.
            ``(5) Pediatric expertise.--In the case of an external 
        review relating to a child, a reviewer shall have expertise 
        under paragraph (2) in pediatrics.
            ``(6) Limitations on reviewer compensation.--Compensation 
        provided by the issuer to an independent medical reviewer in 
        connection with a review under this section shall--
                    ``(A) not exceed a reasonable level; and
                    ``(B) not be contingent on the decision rendered by 
                the reviewer.
            ``(7) Related party defined.--For purposes of this section, 
        the term `related party' means, with respect to a denial of a 
        claim under a coverage relating to an enrollee, any of the 
        following:
                    ``(A) The issuer involved, or any fiduciary, 
                officer, director, or employee of the issuer.
                    ``(B) The enrollee (or authorized representative).
                    ``(C) The health care professional that provides 
                the items or services involved in the denial.
                    ``(D) The institution at which the items or 
                services (or treatment) involved in the denial are 
                provided.
                    ``(E) The manufacturer of any drug or other item 
                that is included in the items or services involved in 
                the denial.
                    ``(F) Any other party determined under any 
                regulations to have a substantial interest in the 
                denial involved.
            ``(8) Definitions.--For purposes of this subsection:
                    ``(A) Enrollee.--The term `enrollee' means, with 
                respect to health insurance coverage offered by a 
                health insurance issuer, an individual enrolled with 
                the issuer to receive such coverage.
                    ``(B) Health care professional.--The term `health 
                care professional' means an individual who is licensed, 
                accredited, or certified under State law to provide 
                specified health care services and who is operating 
                within the scope of such licensure, accreditation, or 
                certification.

``SEC. 2799. ENFORCEMENT.

    ``(a) In General.--Subject to subsection (b), with respect to 
specific individual or group health insurance coverage the primary 
State for such coverage has sole jurisdiction to enforce the primary 
State's covered laws in the primary State and any secondary State.
    ``(b) Secondary State's Authority.--Nothing in subsection (a) shall 
be construed to affect the authority of a secondary State to enforce 
its laws as set forth in the exception specified in section 2796(b)(1).
    ``(c) Court Interpretation.--In reviewing action initiated by the 
applicable secondary State authority, the court of competent 
jurisdiction shall apply the covered laws of the primary State.
    ``(d) Notice of Compliance Failure.--In the case of individual 
health insurance coverage offered in a secondary State, or group health 
insurance coveraged offered by a health insurance issuer in a secondary 
State, that fails to comply with the covered laws of the primary State, 
the applicable State authority of the secondary State may notify the 
applicable State authority of the primary State.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to health insurance coverage offered, issued, or sold after the 
date that is one year after the date of the enactment of this Act.
    (c) GAO Ongoing Study and Reports.--
            (1) Study.--The Comptroller General of the United States 
        shall conduct an ongoing study concerning the effect of the 
        amendment made by subsection (a) on--
                    (A) the number of uninsured and under-insured;
                    (B) the availability and cost of health insurance 
                policies for individuals with pre-existing medical 
                conditions;
                    (C) the availability and cost of health insurance 
                policies generally;
                    (D) the elimination or reduction of different types 
                of benefits under health insurance policies offered in 
                different States; and
                    (E) cases of fraud or abuse relating to health 
                insurance coverage offered under such amendment and the 
                resolution of such cases.
            (2) Annual reports.--The Comptroller General shall submit 
        to Congress an annual report, after the end of each of the 5 
        years following the effective date of the amendment made by 
        subsection (a), on the ongoing study conducted under paragraph 
        (1).
                                 <all>
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