I 

114TH CONGRESS 

2D SESSION H. R. 5589 

To amend title I of the Patient Protection and Affordable Care Act to 

require verification for eligibility for enrollment during special enrollment 

periods in PPACA insurance plans, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 28, 2016 

Mrs. BLACKBURN introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend title I of the Patient Protection and Affordable 

Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. 

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 ‘‘Plan Verification and 

5 Fairness Act of 2016’’. 


SSpencer on DSK4SPTVN1PROD with BILLS
2 

•HR 5589 IH

1 SEC. 2. REQUIRING VERIFICATION FOR ELIGIBILITY FOR 

2 ENROLLMENT DURING SPECIAL ENROLL3 MENT PERIODS IN PPACA INSURANCE PLANS. 

4 (a) IN GENERAL.—Section 1311(c) of the Patient 

5 Protection and Affordable Care Act (42 U.S.C. 18031(c)) 

6 is amended by adding at the end the following new para7 graph: 

8 ‘‘(7) VERIFICATION REQUIREMENT FOR SPE9 CIAL ENROLLMENT PERIODS.— 

10 ‘‘(A) IN GENERAL.—The Secretary shall 

11 provide that, in the case of a special enrollment 

12 period provided for under paragraph (6)(C) 

13 that is with respect to a plan year that begins 

14 on or after January 1, 2017, qualified health 

15 plans offered through an Exchange may not 

16 make coverage effective with respect to an indi17 vidual enrolling during such period until the 

18 Exchange verifies, through an approved verifi19 cation process described in subparagraph (B), 

20 that the individual, with respect to such Ex21 change, is a qualified individual who is eligible 

22 to enroll during such period. 

23 ‘‘(B) APPROVED VERIFICATION PROCESS

24 DESCRIBED.—For purposes of subparagraph 

25 (A), an approved verification process described 

26 in this subparagraph is a process specified by 


SSpencer on DSK4SPTVN1PROD with BILLS
3 

•HR 5589 IH

1 the Secretary through interim final rulemaking 

2 that requires an individual described in sub3 paragraph (A) seeking to enroll in a qualified 

4 health plan described in such subparagraph to 

5 submit to the Exchange such documents as the 

6 Secretary determines are necessary in order for 

7 the Exchange to verify that the individual, with 

8 respect to such Exchange, is a qualified indi9 vidual who is eligible to enroll during a period 

10 described in such subparagraph. To the extent 

11 practicable, such process shall be similar to the 

12 review and assessment process pertaining to 

13 special enrollment periods described at 81 Fed. 

14 Reg. 12274 in the final rule entitled ‘Patient 

15 Protection and Affordable Care Act; HHS No16 tice of Benefit and Payment Parameters for 

17 2017’, published at 81 Fed. Reg. 12203 (March 

18 8, 2016).’’. 

19 (b) STUDY AND REPORT.— 

20 (1) STUDY.—The Inspector General of the De21 partment of Health and Human Services shall con22 duct a study on enrollment by individuals in quali23 fied health plans (as defined in section 1301(a) of 

24 the Patient Protection and Affordable Care Act (42 

25 U.S.C. 18021(a))) during special enrollment periods 


SSpencer on DSK4SPTVN1PROD with BILLS
4 

•HR 5589 IH

1 provided for under section 1311(c)(6)(C) of such Act 

2 (42 U.S.C. 18031(c)(6)(C)) that are with respect to 

3 plan year 2015. Such study shall include, with re4 spect to each such period, an identification of each 

5 of the following: 

6 (A) The number of individuals who sought 

7 to enroll in such a plan through an Exchange 

8 established under such Act during such period 

9 but who were not allowed to so enroll during 

10 such period. 

11 (B) The number of such individuals who 

12 were not allowed to so enroll through such an 

13 Exchange during such period on account of 

14 each of the following: 

15 (i) The individual did not provide to 

16 the Exchange documentation to dem17 onstrate that the individual was, with re18 spect to the Exchange, a qualified indi19 vidual (as defined in section 1312(f)(1) of 

20 such Act (42 U.S.C. 18032(f)(1))) who 

21 was eligible to enroll during such period. 

22 (ii) Such documentation provided to 

23 the Exchange by the individual was invalid. 

24 (2) REPORT.—Not later than June 1, 2017, 

25 such Inspector General shall submit to Congress a 


SSpencer on DSK4SPTVN1PROD with BILLS
5 

•HR 5589 IH

1 report on the findings of the study conducted under 

2 paragraph (1). 

Æ 


SSpencer on DSK4SPTVN1PROD with BILLS