I 

114TH CONGRESS 

2D SESSION H. R. 6011 

To require that the Centers for Medicare & Medicaid Services has in place 

adequate verification procedures to ensure that advance payments under 

the Patient Protection and Affordable Care Act are made for only enrollees under qualified health plans who have paid their premiums. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 13, 2016 

Mr. BILIRAKIS introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, 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 require that the Centers for Medicare & Medicaid Services 

has in place adequate verification procedures to ensure 

that advance payments under the Patient Protection and 

Affordable Care Act are made for only enrollees under 

qualified health plans who have paid their premiums. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘ACA Premium Pay5 ment Verification Act’’. 


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•HR 6011 IH

1 SEC. 2. REQUIRING ADEQUATE CMS VERIFICATION PROCE2 DURES TO ENSURE ADVANCE PAYMENTS 

3 UNDER THE AFFORDABLE CARE ACT ARE 

4 MADE FOR ONLY ENROLLEES UNDER QUALI5 FIED HEALTH PLANS WHO HAVE PAID THEIR 

6 PREMIUMS. 

7 (a) IN GENERAL.—Notwithstanding any other provi8 sion of law, no advance payment under section 1412 of 

9 the Patient Protection and Affordable Care Act (42 

10 U.S.C. 18082) may be made before such date that the 

11 Secretary of Health and Human Services certifies to Con12 gress that the Centers for Medicare & Medicaid Services 

13 has in place an adequate process, in accordance with sub14 section (b), to independently verify if an individual is en15 rolled under a qualified health plan and has paid the pre16 mium under such plan. 

17 (b) ADEQUATE PROCEDURES.—For purposes of sub18 section (a), a process, with respect to the verifications de19 scribed in such subsection, shall not be treated as an ade20 quate process— 

21 (1) unless such process— 

22 (A) is an automated process under which 

23 such verifications are made on a policy basis 

24 and not on an aggregate basis; 

25 (B) has been tested by the Inspector Gen26 eral of the Department of Health and Human 


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1 Services and determined by the Inspector Gen2 eral pursuant to such test as being effective; 

3 and 

4 (C) includes the provision by the Adminis5 trator of the Centers for Medicare & Medicaid 

6 Services to the Secretary of the Treasury of 

7 such payment information as needed by the 

8 Secretary for verification of eligibility of individ9 uals for purposes of advance payments under 

10 section 1412 of the Patient Protection and Af11 fordable Care Act (42 U.S.C. 18082); and 

12 (2) to the extent such process includes any pro13 cedures that rely on assurances or attestations made 

14 by the issuer of the qualified health plan involved. 

15 (c) REPORT ON COST-SHARING SUBSIDIES ALLOWED

16 FOR CERTAIN INDIVIDUALS ENROLLING IN QUALIFIED

17 HEALTH PLANS.—Not later than one year after the date 

18 of the enactment of this Act, the Secretary of Health and 

19 Human Services shall submit to Congress a report on the 

20 extent to which adequate procedures are in place with re21 spect to cost-sharing reductions allowed under section 

22 1402 of the Patient Protection and Affordable Care Act 

23 (42 U.S.C. 18071). 

Æ 


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