Consumer Protection and Rate Review Act of 2013

To provide improved consumer protection and rate review for health insurance coverage in the individual market, and for other purposes. 1. Short title This Act may be cited as the Consumer Protection and Rate Review Act of 2013 2. Requiring State insurance commissioners to investigate instances of inadequate notices of cancellation or conversion of individual health insurance policies (a) In general Each State insurance commissioner shall investigate and take appropriate administrative or other actions (such as the imposition of a fine) on cases of inadequate notices of cancellations or conversions of health insurance coverage in the individual market that take effect on or after January 1, 2014. (b) Inadequate notice In this section, a notice of the cancellation or conversion of individual health insurance coverage shall be treated as inadequate if the notice— (1) fails to contain information— (A) on obtaining health insurance coverage through an Exchange under the Patient Protection and Affordable Care Act; (B) on the possible availability of assistance under such Act towards payment of the premiums and cost-sharing for such coverage; and (C) on the improved benefits for coverage through an Exchange, compared to health insurance coverage not offered through an Exchange; (2) fails to be transparent by inappropriately steering individuals to more expensive plans provided by the cancelling issuer; or (3) fails to otherwise comply with requirements of law. (c) Reports (1) State commissioners to HHS Not later than March 31, 2014, each State insurance commissioner shall submit to the Secretary of Health and Human Services a report on the investigations and actions described in subsection (a). (2) HHS report to Congress Not later than April 30, 2014, the Secretary shall submit to Congress a report on such investigations and actions. (d) Definitions of State, health insurance coverage, and individual market In this section, the terms State health insurance coverage individual market 3. Protection of consumers from excessive, unjustified, or unfairly discriminatory rates from H.R. 1019 (a) Protection from excessive, unjustified, or unfairly discriminatory rates The first section 2794 of the Public Health Service Act ( 42 U.S.C. 300gg–94 Public Law 111–148 (e) Protection from excessive, unjustified, or unfairly discriminatory rates (1) Authority of States Nothing in this section shall be construed to prohibit a State from imposing requirements (including requirements relating to rate review standards and procedures and information reporting) on health insurance issuers with respect to rates that are in addition to the requirements of this section and are more protective of consumers than such requirements. (2) Consultation in rate review process In carrying out this section, the Secretary shall consult with the National Association of Insurance Commissioners and consumer groups. (3) Determination of who conducts reviews for each State The Secretary shall determine, after the date of enactment of this section and periodically thereafter, the following: (A) In which markets in each State the State insurance commissioner or relevant State regulator shall undertake the corrective actions under paragraph (4) (B) In which markets in each State the Secretary shall undertake the corrective actions under paragraph (4) (4) Corrective action for excessive, unjustified, or unfairly discriminatory rates In accordance with the process established under this section, the Secretary or the relevant State insurance commissioner or State regulator shall take corrective actions to ensure that any excessive, unjustified, or unfairly discriminatory rates are corrected prior to implementation, or as soon as possible thereafter, through mechanisms such as— (A) denying rates; (B) modifying rates; or (C) requiring rebates to consumers. (5) Noncompliance Failure to comply with any corrective action taken by the Secretary under this subsection may result in the application of civil monetary penalties and, if the Secretary determines appropriate, make the plan involved ineligible for classification as a Qualified Health Plan. . (b) Clarification of Regulatory Authority Such section is further amended— (1) in subsection (a)— (A) in the heading, by striking premium rate (B) in paragraph (1), by striking unreasonable increases in premiums potentially excessive, unjustified, or unfairly discriminatory rates, including premiums, (C) in paragraph (2)— (i) by striking an unreasonable premium increase a potentially excessive, unjustified, or unfairly discriminatory rate (ii) by striking the increase the rate (iii) by striking such increases such rates (2) in subsection (b)— (A) by striking premium increases rates (B) in paragraph (2)(B), by striking premium rate (3) in subsection (c)(1)— (A) in the heading, by striking Premium Rate (B) by inserting that satisfy the condition under subsection (e)(3)(A) award grants to States (C) in subparagraph (A), by striking premium increases rates (c) Conforming amendment Title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg et seq. (1) in section 2723 ( 42 U.S.C. 300gg–22 (A) in subsection (a)— (i) in paragraph (1), by inserting and section 2794 this part (ii) in paragraph (2), by inserting or section 2794 this part (B) in subsection (b)— (i) in paragraph (1), by inserting and section 2794 this part (ii) in paragraph (2)— (I) in subparagraph (A), by inserting or section 2794 that is this part (II) in subparagraph (C)(ii), by inserting or section 2794 this part (2) in section 2761 ( 42 U.S.C. 300gg–61 (A) in subsection (a)— (i) in paragraph (1), by inserting and section 2794 this part (ii) in paragraph (2)— (I) by inserting or section 2794 set forth in this part (II) by inserting and section 2794 the requirements of this part (B) in subsection (b)— (i) by inserting and section 2794 this part (ii) by inserting and section 2794 part A (d) Applicability to grandfathered plans Section 1251(a)(4)(A) of the Patient Protection and Affordable Care Act ( Public Law 111–148 Public Law 111–152 (v) Section 2794 (relating to reasonableness of rates with respect to health insurance coverage). . (e) Authorization of appropriations There are authorized to be appropriated to carry out this section, such sums as may be necessary. (f) Effective date The amendments made by this section shall take effect on the date of enactment of this Act and shall be implemented with respect to health plans beginning not later than January 1, 2014.

Summary: Consumer Protection and Rate Review Act of 2013 - Requires each state insurance commissioner to investigate and take appropriate actions on cases of inadequate notices of cancellations or conversions of health insurance coverage in the individual market that take effect on or after January 1, 2014. Requires that such a notice be treated as inadequate if it fails to: (1) contain information on obtaining health insurance coverage through an American Health Benefit Exchange under the Patient Protection and Affordable Care Act (PPACA), on the possible availability of assistance under PPACA towards payment of the premiums and cost-sharing for such coverage, and on the improved benefits for coverage through an Exchange, compared to coverage not offered through an Exchange; (2) be transparent by inappropriately steering individuals to more expensive plans provided by the cancelling issuer; or (3) otherwise comply with requirements of law. Amends the Public Health Service Act to declare that federal requirements that the Secretary of Health and Human Services (HHS) review unreasonable premium increases in health care coverage shall not be construed to prohibit a state from imposing additional rate requirements on health insurance issuers that are more protective of consumers. Expands such review to include all rate increases, not only premium increases. Directs the Secretary or the relevant state insurance commissioner (or state regulator) to take corrective actions to ensure that any excessive, unjustified, or unfairly discriminatory rates are corrected before, or as soon as possible after, implementation, including through mechanisms such as denying rates, modifying rates, or requiring rebates to consumers. Authorizes civil monetary penalties and ineligibility as a qualified health plan for failing to comply with any corrective action taken by the Secretary. Requires the Secretary to determine whether the state insurance commissioner or regulator or the Secretary will undertake such corrective actions based on whether the state can adequately undertake such actions. Applies this Act to health plans grandfathered under PPACA.