```

[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2430 Introduced in Senate (IS)]

113th CONGRESS
  2d Session
                                S. 2430

To establish the Office of the Special Inspector General for Monitoring 
            the Affordable Care Act, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              June 4, 2014

  Mr. Roberts introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

 
To establish the Office of the Special Inspector General for Monitoring 
            the Affordable Care Act, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Special Inspector General for 
Monitoring the ACA Act of 2014'' or the ``SIGMA Act of 2014''.

SEC. 2. SPECIAL INSPECTOR GENERAL FOR MONITORING THE AFFORDABLE CARE 
              ACT.

    (a) Office of Special Inspector General.--There is hereby 
established the Office of the Special Inspector General for Monitoring 
the Affordable Care Act (in this section, referred to as the 
``Office'') to carry out the duties described under subsection (e).
    (b) Appointment of Inspector General; Removal.--
            (1) Appointment.--The head of the Office is the Special 
        Inspector General for Monitoring the Affordable Care Act (in 
        this section referred to as the ``Special Inspector General''), 
        who shall be appointed by the President, by and with the advice 
        and consent of the Senate.
            (2) Qualifications.--The appointment of the Special 
        Inspector General shall be made solely on the basis of 
        integrity and demonstrated ability in accounting, auditing, 
        financial analysis, law, management analysis, healthcare 
        expertise and financing, public administration, or 
        investigations.
            (3) Deadline for appointment.--The appointment of an 
        individual as the Special Inspector General shall be made not 
        later than 30 days after the date of the enactment of this Act.
            (4) Compensation.--The annual rate of basic pay of the 
        Special Inspector General shall be the annual rate of basic pay 
        provided for positions at level IV of the Executive Schedule 
        under section 5315 of title 5, United States Code.
            (5) Prohibition on political activities.--For purposes of 
        section 7324 of title 5, United States Code, the Special 
        Inspector General shall not be considered an employee who 
        determines policies to be pursued by the United States in the 
        nationwide administration of Federal law.
            (6) Removal.--The Special Inspector General shall be 
        removable from office in accordance with the provisions of 
        section 3(b) of the Inspector General Act of 1978 (5 U.S.C. 
        App.).
    (c) Assistant Inspectors General.--The Special Inspector General 
shall, in accordance with applicable laws and regulations governing the 
civil service--
            (1) appoint an Assistant Inspector General for Auditing who 
        shall have the responsibility for supervising the performance 
        of auditing activities relating to the duties described under 
        subsection (e); and
            (2) appoint an Assistant Inspector General for 
        Investigations who shall have the responsibility for 
        supervising the performance of investigative activities 
        relating to such duties.
    (d) Supervision.--
            (1) In general.--Except as provided under paragraph (2), 
        the Special Inspector General shall report directly to, and be 
        under the general supervision of, the Secretary of Health and 
        Human Services.
            (2) Independence to conduct investigations and audits.--No 
        employee or officer of any of the following entities shall 
        prevent or prohibit the Special Inspector General from 
        initiating, carrying out, or completing any audit or 
        investigation related to the duties described under subsection 
        (e) or from issuing any subpoena during the course of any such 
        audit or investigation:
                    (A) The Executive Office of the President and the 
                Office of Personnel Management.
                    (B) The Department of Health and Human Services.
                    (C) The Department of the Treasury.
                    (D) The Social Security Administration, the 
                Department of Homeland Security, the Department of 
                Veterans Affairs, the Department of Defense, the 
                Department of Labor, and the Peace Corps.
                    (E) Any other Federal agency involved in 
                implementing or administering the Affordable Care Act.
    (e) Duties.--
            (1) Oversight of the implementation and administration of 
        the affordable care act.--It shall be the duty of the Special 
        Inspector General to conduct, supervise, and coordinate audits 
        and investigations of the implementation and administration of 
        programs and activities established under, and payment system 
        changes made by, the Affordable Care Act, including by 
        collecting and summarizing the following:
                    (A) A description of the individual mandate 
                requirement for applicable individuals to maintain 
                minimum essential coverage or pay a penalty under 
                section 5000A of the Internal Revenue Code of 1986, 
                including a description of the number of individuals 
                maintaining such coverage and the number of individuals 
                paying such penalties.
                    (B) A description of any increases or decreases 
                in--
                            (i) premiums for qualified health plans (as 
                        defined in section 1301 of the Patient 
                        Protection and Affordable Care Act (42 U.S.C. 
                        18021));
                            (ii) deductibles under qualified health 
                        plans; and
                            (iii) cost-sharing under qualified health 
                        plans, including by co-payments and co-
                        insurance,
                affecting individuals enrolling in coverage under such 
                plans through an Exchange established under title I of 
                the Patient Protection and Affordable Care Act 
                (including a State-run Exchange, a federally 
                administered Exchange, and a Small Business Health 
                Options Program).
                    (C) A description of any increases or decreases in 
                the maximum out-of-pocket costs affecting individuals 
                enrolling in qualified health plans through such a 
                State-run Exchange, a federally administered Exchange, 
                and a Small Business Health Options Program.
                    (D) A description of any increases or decreases in 
                the size of physician and other health care provider 
                networks affecting individuals enrolling in qualified 
                health plans through such a State-run Exchange, a 
                federally administered Exchange, and a Small Business 
                Health Options Program.
                    (E) A description of any type of health insurance 
                coverage lost because of the treatment under title I of 
                the Patient Protection and Affordable Care Act of 
                grandfathered health plans (as defined in section 
                1251(e) of such Act (42 U.S.C. 18011(e))).
                    (F) A description of any credits under section 36B 
                of the Internal Revenue Code of 1986 (and the amount 
                (if any) of the advance payment of the credit under 
                section 1412 of the Patient Protection and Affordable 
                Care Act (42 U.S.C. 18082)) and any cost-sharing 
                reduction under section 1402 of the Patient Protection 
                and Affordable Care Act (42 U.S.C. 18071) (and the 
                amount (if any) of the advance payment of the reduction 
                under section 1412 of such Act (42 U.S.C. 18082)) 
                provided to individuals enrolling under qualified 
                health plans through an Exchange established under 
                title I of the Patient Protection and Affordable Care 
                Act.
                    (G) A description of any projections, estimates, 
                analysis, goals, or targets made by any employee of the 
                Federal Government or any contractor of the Federal 
                Government in carrying out duties associated with the 
                Patient Protection and Affordable Care Act with respect 
                to the enrollment of individuals in a qualified health 
                plan through an Exchange established under title I of 
                the Patient Protection and Affordable Care Act.
                    (H) A description of the employer mandate 
                requirement that applicable large employers provide 
                eligible employees with minimum essential coverage or 
                pay a fine under section 4980H of the Internal Revenue 
                Code of 1986, including a description of the type and 
                number of employers providing such coverage and the 
                type and number of employers paying such fines.
                    (I) A description of any projections, estimates, 
                analysis, goals, or targets made by any employee of the 
                Federal Government or any contractor of the Federal 
                Government in carrying out duties associated with the 
                Patient Protection and Affordable Care Act with respect 
                to employers providing minimum essential coverage to 
                applicable employees.
                    (J) A description of any reports, meetings, 
                discussions, or materials of any employee of the 
                Federal Government or any contractor of the Federal 
                Government in carrying out duties associated with the 
                Patient Protection and Affordable Care Act relating to 
                any employers converting full-time employees to part-
                time employees or hiring new part-time employees 
                instead of full-time employees for the purposes of 
                avoiding the fines provided for under the employer 
                mandate requirement described in subparagraph (H).
                    (K) A description of any reports, meetings, 
                discussions, or materials of any employee of the 
                Federal Government or any contractor of the Federal 
                Government in carrying out duties associated with the 
                Patient Protection and Affordable Care Act relating to 
                any employers hiring no more than 50 employees for the 
                purposes of avoiding the requirement to provide minimum 
                essential coverage or pay a fine under the employer 
                mandate requirement described in subparagraph (H).
                    (L) A description of any reports, meetings, 
                discussions, or materials of any employee of the 
                Federal Government or any contractor of the Federal 
                Government in carrying out duties associated with the 
                Patient Protection and Affordable Care Act relating to 
                any employers dropping the health insurance coverage 
                offered to their employees, or employees' spouses or 
                dependents, for the purposes of avoiding the 
                requirement to provide minimum essential coverage or 
                pay a fine under the employer mandate requirement 
                described in subparagraph (H).
                    (M) A description of the transitional reinsurance 
                program established under section 1341 of the Patient 
                Protection and Affordable Care Act (42 U.S.C. 18061), 
                including a description of reinsurance contributions 
                collected or required to be collected under such 
                program, a description of any reinsurance payments made 
                or required to be made to health insurance issuers 
                under such program, a description of the health 
                insurance coverage and related costs for high-cost 
                individuals for plans related to such program, an 
                explanation of the impact of such reinsurance program 
                on adverse selection in the marketplace, and an 
                explanation of any premium-stabilizing effects of such 
                program.
                    (N) A description of the temporary risk corridors 
                for qualified health plans established under section 
                1342 of the Patient Protection and Affordable Care Act 
                (42 U.S.C. 18062), including a description of 
                participating plans and the allowable costs and target 
                amounts of such plans, a description of risk corridor 
                ratios of such plans, and a description of payment 
                adjustments made under such program.
                    (O) A description of the permanent risk adjustment 
                program established under section 1343 of the Patient 
                Protection and Affordable Care Act (42 U.S.C. 18063), 
                including a description of any plans participating in 
                such program, a description of any risk adjustment 
                payments made or required to be made under such 
                program, a description of the health insurance coverage 
                and related costs for high-cost individuals for plans 
                related to such program, an explanation of the impact 
                of such program on adverse selection in the 
                marketplace, and an explanation of any premium-
                stabilizing effects of such program.
                    (P) A list of all contracts awarded under the 
                Affordable Care Act and an analysis of whether Federal 
                contracting procedures were followed when awarding any 
                contract associated with such Act.
                    (Q) A description of the development of the health 
                insurance marketplace for the Internet portal 
                established under section 1103 of the Patient 
                Protection and Affordable Care Act (42 U.S.C. 18003), 
                including a description of the design, features, and 
                security systems of such web portal and a description 
                of all costs associated with such development.
                    (R) A description of any threats, risks, problems, 
                or functionality issues identified by any employee of 
                the Federal Government or any contractor of the Federal 
                Government in carrying out duties associated with the 
                Patient Protection and Affordable Care Act prior to the 
                launch of such web portal on October 1, 2013.
                    (S) A description of any decisionmaking or 
                activities by any employee of the Federal Government or 
                any contractor of the Federal Government in carrying 
                out duties associated with the Patient Protection and 
                Affordable Care Act in response to such threats, risks, 
                problems, or functionality issues.
                    (T) A description of the systems (on the Federal 
                and State levels) in place or in development to allow 
                health insurance issuers and plans and government 
                entities to verify information is accurate for purposes 
                of enrollments in qualified health plans through 
                Exchanges established under title I of the Patient 
                Protection and Affordable Care Act, including that data 
                verification and validation can occur with respect to 
                information provided or stored by individuals, the 
                Department of Health and Human Services, the qualified 
                health plans, States, and other applicable Federal 
                agencies, including for purposes of credits under 
                section 36B of the Internal Revenue Code of 1986 (and 
                the amount (if any) of the advance payment of the 
                credit under section 1412 of the Patient Protection and 
                Affordable Care Act (42 U.S.C. 18082)) and any cost-
                sharing reduction under section 1402 of the Patient 
                Protection and Affordable Care Act (42 U.S.C. 18071) 
                (and the amount (if any) of the advance payment of the 
                reduction under section 1412 of such Act (42 U.S.C. 
                18082)).
                    (U) A description of the development of the Federal 
                Data Services Hub, including its design, features, and 
                security systems, and a description of the type of data 
                accessed through such data hub, and a description of 
                the actual storage location of such data accessed 
                through such data hub.
                    (V) A list of the duties and responsibilities 
                assigned to the Internal Revenue Service as a result of 
                the enactment of the Affordable Care Act, a description 
                of any plans of the Internal Revenue Service for how to 
                carry out such duties, and an explanation of the 
                resources and personnel required to carry out such 
                duties, including a description of any new resources or 
                personnel required to carry out such duties not already 
                available to the Internal Revenue Service.
                    (W) A description of any plans of the Internal 
                Revenue Service to verify the eligibility of 
                individuals enrolling in qualified health plans for any 
                credits under section 36B of the Internal Revenue Code 
                of 1986 (and the amount (if any) of the advance payment 
                of the credit under section 1412 of the Patient 
                Protection and Affordable Care Act (42 U.S.C. 18082)) 
                and any cost-sharing reduction under section 1402 of 
                the Patient Protection and Affordable Care Act (42 
                U.S.C. 18071) (and the amount (if any) of the advance 
                payment of the reduction under section 1412 of such Act 
                (42 U.S.C. 18082)), including a description of any such 
                verification completed and a description of any such 
                individuals determined to be ineligible.
                    (X) A description of any plans by the Internal 
                Revenue Service to calculate the amount of overpayment 
                of any such credit or reduction for which an individual 
                enrolled in a qualified health plan was determined to 
                be ineligible, including a description of any such 
                calculations completed.
                    (Y) A description of any plans by the Internal 
                Revenue Service to notify individuals determined to be 
                ineligible for such credits or reductions, including a 
                description of such notifications completed.
                    (Z) A description of any plans by the Internal 
                Revenue Service to recapture such overpayments of such 
                credits and reductions for individuals determined to be 
                ineligible, including a description of such recapturing 
                completed.
                    (AA) A description of the impact of the Affordable 
                Care Act on the right of conscience, including on--
                            (i) religious employers and institutions 
                        that were not exempted from the mandate issued 
                        by the Department of Health and Human Services 
                        requiring individual and group health plans to 
                        cover sterilization and Food and Drug 
                        Administration approved contraceptives;
                            (ii) individuals; and
                            (iii) medical professionals.
                    (BB) A description of abortion coverage offered 
                under qualified health plans purchased through State-
                run Exchanges, federally administered Exchanges, and 
                Small Business Health Options Programs, including costs 
                associated with such coverage.
                    (CC) A description of any actions by departments or 
                agencies of the Federal Government to delay the 
                programs or activities authorized by the Affordable 
                Care Act, including an explanation from the head of 
                such department or agency of the specific authority 
                used to implement such a delay.
                    (DD) A description of the Independent Payment 
                Advisory Board under section 1899A of the Social 
                Security Act (42 U.S.C. 1395kkk) and any actions taken 
                to alter or reduce the use of medical products, 
                treatments or procedures, including an explanation from 
                the Independent Payment Advisory Board of the reasons 
                for taking such actions, whether such actions could be 
                expected to result in worsened medical outcomes for 
                individuals effected by such alterations or reductions, 
                and an explanation of the medical information used to 
                determine whether such alterations or reductions could 
                be expected to result in such worsened outcomes.
                    (EE) A description of individuals enrolled in the 
                Medicaid program under title XIX of the Social Security 
                Act through an Exchange established under title I of 
                the Patient Protection and Affordable Care Act, 
                including a description of the cost of health care 
                services utilized by such individuals and a description 
                of the cost to States and the cost to the Federal 
                Government to provide health care services to such 
                individuals.
                    (FF) Any additional topic related to the 
                implementation and administration of the Affordable 
                Care Act, the inclusion of which helps to provide the 
                public a full and objective accounting of such law.
            (2) Data to be included.--In carrying out the duties 
        described under paragraph (1), the Special Inspector General 
        shall collect and summarize data described under such paragraph 
        according to each type of insurance marketplace and according 
        to the age and gender of individuals enrolling in coverage 
        under qualified health plans through an Exchange established 
        under title I of the Patient Protection and Affordable Care 
        Act.
            (3) Other duties related to oversight.--The Special 
        Inspector General shall establish, maintain, and oversee such 
        systems, procedures, and controls as the Special Inspector 
        General considers appropriate to discharge the duties described 
        under paragraph (1).
            (4) Duties and responsibilities under the inspector general 
        act of 1978.--In addition to the duties described under 
        paragraphs (1) and (2), the Special Inspector General shall 
        also have the duties and responsibilities of inspectors general 
        under the Inspector General Act of 1978 (5 U.S.C. App.).
    (f) Coordination of Efforts.--In carrying out the duties, 
responsibilities, and authorities of the Special Inspector General 
under this section, the Special Inspector General shall coordinate 
with, and receive the cooperation of each of the following:
            (1) The Inspector General of the Department of Health and 
        Human Services.
            (2) The Inspector General of the Department of the 
        Treasury.
            (3) The Inspectors General of the Social Security 
        Administration, the Department of Homeland Security, the 
        Department of Veterans Affairs, the Department of Defense, the 
        Department of Labor, and the Peace Corps.
            (4) The inspector general of any other Federal entity, as 
        determined by the Special Inspector General.
    (g) Powers and Authorities.--
            (1) Authority to access materials, request information, 
        compel response, and other authorities under the inspector 
        general act of 1978.--In carrying out the duties described 
        under subsection (e), the Special Inspector General shall have 
        all of the authorities provided under section 6 of the 
        Inspector General Act of 1978 (5 U.S.C. App.).
            (2) Exemption from requirement for initial determination by 
        attorney general.--For purposes of section 6(e) of the 
        Inspector General Act of 1978 (5 U.S.C. App.), the Special 
        Inspector General shall be considered exempt from the 
        requirement of an initial determination of eligibility by the 
        Attorney General under paragraph (2) of such section.
            (3) Audit standards.--The Special Inspector General shall 
        carry out the duties specified under subsection (e)(1) in 
        accordance with section 4(b)(1) of the Inspector General Act of 
        1978 (5 U.S.C. App.).
    (h) Personnel, Facilities, and Other Resources.--
            (1) Personnel.--The Special Inspector General may select, 
        appoint, and employ such officers and employees as may be 
        necessary for carrying out the duties of the Special Inspector 
        General, subject to the provisions of title 5, United States 
        Code, governing appointments in the competitive service, and 
        the provisions of chapter 51 and subchapter III of chapter 53 
        of such title, relating to classification and General Schedule 
        pay rates.
            (2) Employment of experts and consultants.--The Special 
        Inspector General may obtain services as authorized by section 
        3109 of title 5, United States Code, at daily rates not to 
        exceed the equivalent rate prescribed for grade GS-15 of the 
        General Schedule by section 5332 of such title.
            (3) Contracting authority.--To the extent and in such 
        amounts as may be provided in advance by appropriations Acts, 
        the Special Inspector General may enter into contracts and 
        other arrangements for audits, studies, analyses, and other 
        services with public agencies and with private persons, and 
        make such payments as may be necessary to carry out the duties 
        of the Special Inspector General.
            (4) Resources.--The Secretary of Health and Human Services 
        shall provide the Special Inspector General with appropriate 
        and adequate office space at appropriate locations of the 
        Department of Health and Human Services together with such 
        equipment, office supplies, and communications facilities and 
        services as may be necessary for the operation of such offices, 
        and shall provide necessary maintenance services for such 
        offices and the equipment and facilities located therein.
            (5) Assistance from federal agencies.--
                    (A) In general.--Upon request of the Special 
                Inspector General for information or assistance from 
                any department, agency, or other entity of the Federal 
                Government (including any entity listed under 
                subsection (d)(2)), the head of such entity shall, 
                insofar as is practicable and not in contravention of 
                any existing law, furnish such information or 
                assistance to the Special Inspector General, or an 
                authorized designee.
                    (B) Reporting of refused assistance.--
                            (i) Reporting to health and human services 
                        and congress.--In accordance with clause (ii), 
                        as the case may be, whenever information or 
                        assistance requested by the Special Inspector 
                        General is, in the judgment of the Special 
                        Inspector General, unreasonably refused or not 
                        provided, the Special Inspector General shall 
                        report the circumstances to the Secretary of 
                        Health and Human Services and to the 
                        appropriate congressional committees without 
                        delay.
                            (ii) Reporting to the public on refusal or 
                        noncooperation in transparency.--Whenever any 
                        information described in clause (i) is 
                        requested by the Special Inspector General and 
                        unreasonably refused or not provided, the 
                        report to the Secretary of Health and Human 
                        Services and the appropriate congressional 
                        committees shall be titled ``Notice of Refusal 
                        or Noncooperation in Transparency'' and shall 
                        be published on a publicly available website in 
                        an accessible format without delay.
            (6) Use of personnel, facilities, and other resources of 
        the office.--Upon the request of the Special Inspector General, 
        an Inspector General--
                    (A) may detail, on a reimbursable basis, any of the 
                personnel of the Office for the purpose of carrying out 
                this section; and
                    (B) may provide, on a reimbursable basis, any of 
                the facilities or other resources of the Office for the 
                purpose of carrying out this section.
    (i) Reports.--
            (1) Initial report.--Not later than 120 days after the date 
        of the enactment of this Act, the Special Inspector General 
        shall submit to the appropriate congressional committees and 
        the Secretary of Health and Human Services a report 
        summarizing, for the period beginning on the date of the 
        enactment of the Health Care and Education Reconciliation Act 
        of 2010 and ending on the completion of a fiscal year quarter 
        after the date of enactment of this Act, the activities during 
        such period of the Special Inspector General required under 
        subsection (e).
            (2) Quarterly reports.--Beginning with the first full 
        fiscal year quarter after the date of the enactment of this 
        Act, not later than 30 days after the end of each fiscal year 
        quarter, during which the Affordable Care Act is in effect, the 
        Special Inspector General shall submit to the appropriate 
        congressional committees and the Secretary of Health and Human 
        Services a report summarizing, for the period of that quarter 
        and, to the extent possible, the period from the end of such 
        quarter to the time of the submission of the report, the 
        activities during such period of the Special Inspector General 
        required under subsection (e).
            (3) Comments on report.--Not later than 30 days after 
        receipt of a report under this subsection, the Secretary of 
        Health and Human Services shall submit to the appropriate 
        congressional committees any comments on the matters covered by 
        the report.
            (4) Public availability.--The Special Inspector General 
        shall publish on a publicly available website each report 
        described under this subsection and any comments on the matters 
        covered by the report submitted pursuant to paragraph (3).
            (5) Protected information.--To the extent possible, 
        information submitted in any report required under this 
        subsection shall be in a form that is not prohibited from 
        disclosure under section 552a of title 5, United States Code 
        (commonly known as the Privacy Act of 1974).
            (6) Aggregated information.--The Special Inspector General 
        shall, to the maximum extent possible, aggregate any personally 
        identifiable information submitted in a report required under 
        this subsection.
    (j) Termination.--The Office of the Special Inspector General shall 
terminate on the date on which the final report required by subsection 
(h) is submitted for the last year the Affordable Care Act is in 
effect.
    (k) Definitions.--In this section:
            (1) Affordable care act.--The term ``Affordable Care Act'' 
        means the Patient Protection and Affordable Care Act and title 
        I and subtitle B of title II of the Health Care and Education 
        Reconciliation Act of 2010.
            (2) Appropriate congressional committees.--The term 
        ``appropriate congressional committees'' means--
                    (A) the Committees on Appropriations, the Budget, 
                Education and the Workforce, Energy and Commerce, 
                Homeland Security, the Judiciary, Oversight and 
                Government Reform, Small Business, and Ways and Means 
                of the House of Representatives; and
                    (B) the Committees on Appropriations, the Budget, 
                Commerce, Science, and Transportation, Finance, Health, 
                Education, Labor, and Pensions, Homeland Security and 
                Governmental Affairs, the Judiciary, and Small Business 
                and Entrepreneurship of the Senate.
                                 <all>
```