Health Insurance Rate Review Act

To amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates. 1. Short title This Act may be cited as the Health Insurance Rate Review Act 2. Protection of consumers from excessive, unjustified, or unfairly discriminatory rates (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 under section 2723 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 (c) Conforming amendments 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 Act, 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, 2017.

Summary: Health Insurance Rate Review Act This bill amends the Public Health Service Act to declare that federal requirements that the Department of Health and Human Services (HHS) review unreasonable premium increases in health care coverage do not prohibit a state from imposing additional rate requirements on health insurance issuers that are more protective of consumers. The review is expanded to include all rate increases, not only premium increases. HHS or the relevant state insurance commissioner or state regulator must 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. HHS may apply civil monetary penalties to health insurance issuers that fail to comply with a corrective action taken by HHS and may make the plan involved ineligible for classification as a qualified health plan. HHS must determine whether HHS or the state insurance commissioner or regulator will undertake such corrective actions based on whether the state can adequately undertake the actions. This Act applies to health plans grandfathered under the Patient Protection and Affordable Care Act.