II 

110TH CONGRESS 

2D SESSION S. 3402 

To provide information and education to consumers concerning health care 

services and health insurance coverage. 

IN THE SENATE OF THE UNITED STATES 

JULY 31, 2008 

Mr. SALAZAR introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To provide information and education to consumers concerning health care services and health insurance coverage. 

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 ‘‘Consumer Health Edu5 cation and Transparency Act of 2008’’. 

6 SEC. 2. OFFICE OF CONSUMER HEALTH EDUCATION AND 

7 INFORMATION. 

8 (a) ESTABLISHMENT.—The Secretary of Health and 

9 Human Services (referred to in this Act as the ‘‘Sec10 retary’’) shall establish within the Department of Health 


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1 and Human Services an office to be known as the ‘‘Office 

2 of Consumer Health Education and Information’’ (re3 ferred to in this Act as the ‘‘Office’’) to provide consumers 

4 of health care services and health insurance with informa5 tion, through education and outreach, concerning personal 

6 health and wellness and health insurance coverage. 

7 (b) DIRECTOR.—The Office shall be headed by a Di8 rector who shall be appointed by the Secretary, 

9 (c) DUTIES.—The Office shall— 

10 (1) collect and organize personal health and 

11 wellness information from private and public sources 

12 and disseminate such information to members of the 

13 general public to improve personal health awareness 

14 and behaviors; 

15 (2) collect and organize information on avail16 able health insurance options and consumer health 

17 insurance protections in each of the 50 States and 

18 United States territories and disseminate such infor19 mation to the general public through the Internet 

20 website established under paragraph (8) and the 

21 Federal Citizen Information Center hotline estab22 lished under paragraph (5); 

23 (3) coordinate the public health education and 

24 outreach efforts of organizations and offices within 

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1 cluding the Centers for Medicare & Medicaid Serv2 ices, the Health Resources and Services Administra3 tion, the National Institutes of Health, the Centers 

4 for Disease Control and Prevention, and the Admin5 istration on Aging, to increase the effectiveness of 

6 such efforts; 

7 (4) enter into interagency agreements with the 

8 Federal Trade Commission, the Department of 

9 Labor, and other Federal agencies determined ap10 propriate by the Secretary to facilitate the coordina11 tion of personal health and wellness or health insur12 ance information provided to consumers; 

13 (5) enter into an interagency agreement with 

14 the General Services Administration to operate di15 rectly or indirectly, through grant or contract, a 24- 

16 hour, toll-free telephone hotline at the Federal Cit17 izen Information Center to provide consumer infor18 mation regarding health insurance and personal 

19 health and wellness behaviors as well as direct con20 sumers to geographically appropriate resources; 

21 (6) identify and develop methods to increase the 

22 quality and amount of information available to con23 sumers regarding the cost, quality, and availability 

24 of health care services and health insurance plans; 


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1 (7) develop partnership agreements with public 

2 and private organizations to improve the education 

3 of the general public regarding personal health and 

4 wellness and health insurance; 

5 (8) develop and maintain a consumer education 

6 Internet website to provide information concerning 

7 personal health and wellness and health insurance; 

8 and 

9 (9) develop and disseminate relevant informa10 tion for employers purchasing health insurance cov11 erage for employees and their families. 

12 (d) ANNUAL REPORT.—Not later than 1 year after 

13 the date of enactment of this Act, and annually thereafter, 

14 the Secretary shall submit to Congress a report that in15 cludes— 

16 (1) a detailed review of the Office’s activities, 

17 operations, and achievements during the year for 

18 which the report is being prepared; 

19 (2) a description of the Office’s goals for the 

20 year following the year for which the report is being 

21 prepared and a strategic plan for the operation and 

22 activities of the Office to achieve such goals; and 

23 (3) a detailed request for additional appropria24 tions needed for the implementation of such plan, as 

25 appropriate. 


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1 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

2 authorized to be appropriated, such sums as may be nec3 essary to carry out this section. 

4 SEC. 3. DEVELOPMENT AND UTILIZATION OF UNIFORM 

5 SUMMARY OF BENEFITS EXPLANATION. 

6 (a) IN GENERAL.—The Secretary shall request the 

7 National Association of Insurance Commissioners (re8 ferred to as the ‘‘NAIC’’) to develop, and submit to the 

9 Secretary not later than 12 months after the date of en10 actment of this Act, standards for use by health insurance 

11 issuers in compiling and providing to enrollees a summary 

12 of benefits explanation that accurately represents the ben13 efits and coverage provided by the issuer under the appli14 cable health insurance plan. In developing such standards, 

15 the NAIC shall consult with a working group composed 

16 of representatives of health insurance-related consumer 

17 advocacy organizations, issuers of health insurance plans, 

18 and other qualified individuals. 

19 (b) REQUIREMENTS.—The standards for the sum20 mary of benefits explanation developed under subsection 

21 (a) shall provide for the following: 

22 (1) APPEARANCE.—The standards shall ensure 

23 that the summary is presented in a uniform format 

24 that does not exceed 4 pages in length and does not 

25 include print smaller than 12-point font. 


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1 (2) LANGUAGE.—The standards shall ensure 

2 that the language used in the summary is presented 

3 in a manner determined to be understandable by the 

4 average health plan enrollee. 

5 (3) CONTENTS.—The standards shall ensure 

6 that the summary includes— 

7 (A) information determined to be essential 

8 to a consumer’s understanding of the applicable 

9 health insurance plan benefits; 

10 (B) uniform definitions of standard insur11 ance terms; 

12 (C) examples to illustrate common benefits 

13 scenarios; and 

14 (D) illustrations that enhance consumer 

15 understanding of the explanation. 

16 (c) REGULATIONS.— 

17 (1) SUBMISSION.—If, not later than 12 months 

18 after the date of enactment of this Act, the NAIC 

19 submits to the Secretary the standards provided for 

20 under subsection (a), the Secretary shall, not later 

21 than 60 days after the date on which such standards 

22 are submitted, promulgate regulations to apply such 

23 standards to entities described in subsection (c)(2). 

24 (2) FAILURE TO SUBMIT.—If the NAIC fails to 

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1 section (a) within the 12-month period provided for 

2 in paragraph (1), the Secretary shall, not later than 

3 90 days after the expiration of such 12-month pe4 riod, promulgate regulations providing for the appli5 cation of Federal standards for the summary of ben6 efit explantion to entities described in subsection 

7 (d)(2). 

8 (d) REQUIREMENT TO PROVIDE.— 

9 (1) IN GENERAL.—Not later than 24 months 

10 after the date of enactment of the Act, each entity 

11 described in paragraph (2) shall, prior to the effec12 tive date of any health insurance coverage provided 

13 by the entity to an individual, provide to such indi14 vidual a summary of benefits explanation pursuant 

15 to the standards promulgated by the Secretary 

16 under subsection (c). 

17 (2) ENTITIES.— 

18 (A) IN GENERAL.—An entity is described 

19 in this paragraph is— 

20 (i) a health insurance issuer (includ21 ing a group health plan) offering health in22 surance coverage within the United States 

23 (including carriers under the Federal Em24 ployee Health Benefits Program under 

25 chapter 89 of title 5, United States Code); 


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1 (ii) the Secretary with respect to cov2 erage under the Medicare, Medicaid, and 

3 SCHIP programs under titles XVIII, XIX, 

4 and XXI of the Social Security Act (42 

5 U.S.C. 1395, 1396, 1397aa et seq.); 

6 (iii) the Secretary of Veterans Affairs 

7 with respect to coverage provided through 

8 the Department of Veterans Affairs; and 

9 (iv) the Secretary of Defense with re10 spect to military health program coverage 

11 under chapter 55 of title 10, United States 

12 Code, including under the TRICARE pro13 gram (as defined in section 1072(7) of 

14 such title). 

15 (B) LIMITATION.—An entity described in 

16 the paragraph shall not include a self-funded 

17 group health plan to which the Employee Re18 tirement Income Security Act of 1974 applies. 

19 (e) PREEMPTION.—The standards promulgated 

20 under subsection (c) shall preempt any related State 

21 standards that require summary of benefits health plan 

22 explanations that provide less information to consumers, 

23 as determined by the Secretary. 

24 (f) FAILURE TO PROVIDE.—An entity described in 

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1 mation required under this section shall be subject to a 

2 fine of not more than $1,000 for each such failure. Such 

3 failure with respect to each enrollee shall constitute a sep4 arate offense for purposes of this subsection. 

5 SEC. 4. CONSUMER HEALTH EDUCATION AND OUTREACH 

6 INITIATIVE. 

7 (a) ESTABLISHMENT.—Not later than 12 months 

8 after the date of enactment of this Act, the Secretary, act9 ing through the Director of the Office, shall establish and 

10 implement a consumer health education and outreach ini11 tiative through the use of print, Internet, television, and 

12 radio media. 

13 (b) REQUIRED INFORMATION.—The initiative estab14 lished under subsection (a) shall provide consumers with 

15 information concerning the following: 

16 (1) The importance of adopting responsible per17 sonal health and wellness behaviors. 

18 (2) The important role of health insurance cov19 erage in maintaining personal health and wellness 

20 behaviors. 

21 (3) The impact of individuals without health in22 surance on the general health care market and costs 

23 of health care services. 

24 (4) The importance of utilizing preventive 

25 health services and how to access such services. 


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1 (5) The operation of health insurance plans. 

2 (6) Common health care terminology. 

3 (7) The information that a consumer should ob4 tain about health care services and health insurance 

5 plans prior to participating. 

6 (8) The availability of, and eligibility for, Fed7 eral health care programs and assistance. 

8 (9) The format and content of the summary of 

9 benefits explanation required under section 3. 

10 (10) The resources available through the Office 

11 and how to access those resources, including the 

12 Internet website and toll free hotline. 

13 (c) LANGUAGES.—The Secretary shall provide infor14 mation through the initiative under subsection (a) in mul15 tiple languages and in an accessible format for individuals 

16 with sight and hearing disabilities. 

17 (d) DURATION.—The initiative under subsection (a) 

18 shall be at least 6 months in duration. 

19 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

20 authorized to be appropriated, $10,000,000 to carry out 

21 this section. 

22 SEC. 5. REPORT CONCERNING END-OF-LIFE CARE EDU23 CATION AND SPENDING. 

24 (a) STUDY.—The Secretary, in consultation with the 

25 representatives described in subsection (c), shall conduct 


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1 a comprehensive study of matters related to improved con2 sumer education on end-of-life care decisions and spend3 ing. Such study shall evaluate issues including— 

4 (1) consumer attitudes and questions regarding 

5 end-of-life care decisions; 

6 (2) effective outreach methods to increase con7 sumer understanding of end-of-life care consider8 ations and tools for making end-of-life care deci9 sions; 

10 (3) methods for empowering consumers to en11 sure that their end-of-life care instructions are prop12 erly executed; 

13 (4) the appropriate timing and venues for end14 of-life care discussions between health care con15 sumers and providers; 

16 (5) ethical and legal considerations considered 

17 by consumers when making end-of-life care deci18 sions; 

19 (6) trends in end-of-life care spending and the 

20 impact of such spending on overall health care costs; 

21 and 

22 (7) potential strategies for addressing any iden23 tified end-of-life care spending issues. 

24 (b) REPORT.—Not later than 18 months after the 

25 date of enactment of this Act, the Secretary shall submit 


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1 to Congress, a report concerning the study conducted 

2 under subsection (a) together with the recommendations 

3 of the Secretary for legislative or administrative action 

4 where appropriate. 

5 (c) REPRESENTATIVES.—The representatives de6 scribed in this subsection include representatives from the 

7 following groups, organizations, or associations: 

8 (1) A senior citizen advocacy organization. 

9 (2) A hospice organization. 

10 (3) A physician-based hospice and palliative 

11 care organization. 

12 (4) A home-health organization. 

13 (5) A long-term care advocacy organization. 

14 (6) A cancer research organization. 

15 (7) A patient advocacy organization. 

16 (8) A faith-based health care organization. 

17 (9) A nurse-based medical association. 

18 (10) A geriatrician-based medical association. 

19 (11) An academic medical institution. 

20 (12) A caregiver advocacy organization. 

21 (13) A chronic disease advocacy organization. 

22 (14) A disability rights advocacy organization. 

23 (15) A social work association. 

24 (16) A pediatric palliative care organization. 

25 (17) A veterans health care organization. 


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1 SEC. 6. ESTABLISHMENT OF DEPARTMENT OF EDUCATION 

2 GRANTS TO LOCAL EDUCATIONAL AGENCIES 

3 FOR DEVELOPMENT AND IMPLEMENTATION 

4 OF PERSONAL HEALTH AND NUTRITION PRO5 GRAMS IN GRADES K–12. 

6 (a) DEFINITIONS.—In this section: 

7 (1) LOCAL EDUCATIONAL AGENCY.—The term 

8 ‘‘local educational agency’’ has the meaning given 

9 the term in section 9101 of the Elementary and Sec10 ondary Education Act of 1965 (20 U.S.C. 7801). 

11 (2) SECRETARY.—The term ‘‘Secretary’’ means 

12 the Secretary of Education. 

13 (b) PROGRAM AUTHORIZED.—The Secretary shall es14 tablish a 5-year pilot program awarding grants, on a com15 petitive basis, to not more than 25 local educational agen16 cies to allow the local educational agencies to develop and 

17 implement a personal health and nutrition curriculum in 

18 elementary schools or secondary schools. 

19 (c) APPLICATION.—A local educational agency that 

20 desires to receive a grant under this section shall submit 

21 an application to the Secretary at such time, in such man22 ner, and accompanied by such information as the Sec23 retary may require. The application shall contain a plan 

24 for the proposed curriculum and for the use of the grant 

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1 tion of the population of children to be targeted by the 

2 program assisted under the grant. 

3 (d) AWARD BASIS.—In awarding grants under this 

4 section, the Secretary shall consider whether the cur5 riculum proposal submitted by the local educational agen6 cy in the application— 

7 (1) is age-appropriate for, and appealing to, 

8 children in the targeted population described in the 

9 application; 

10 (2) incorporates evidence-based health and nu11 trition standards as the basis for instruction; 

12 (3) integrates classroom instruction with phys13 ical activity to demonstrate the benefits of adopting 

14 good personal health and nutrition habits; 

15 (4) incorporates communication with parents 

16 and includes family learning activities outside of the 

17 classroom; and 

18 (5) promotes school staff health and wellness. 

19 (e) USE OF FUNDS.—A local educational agency re20 ceiving a grant under this section shall use such funds 

21 to develop and implement a personal health and nutrition 

22 curriculum for elementary or secondary school students. 


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1 (f) AUTHORIZATION OF APPROPRIATION.—There are 

2 authorized to be appropriated to carry out this section 

3 $500,000 for each of the fiscal years 2009 through 2014. 

Æ 


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