Health Insurance Consumer Protection Act

To amend the Patient Protection and Affordable Care Act to require Exchanges to establish network adequacy standards for qualified health plans and 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 Consumer Protection Act I No More Narrow Networks 101. Short title This title may be cited as the No More Narrow Networks Act of 2021 102. Requiring Exchanges to establish network adequacy standards for qualified health plans (a) In general Section 1311(d) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18031(d) (8) Network adequacy standards (A) Certain Exchanges In the case of an Exchange operated by the Secretary pursuant section 1321(c)(1) or an Exchange described in section 155.200(f) of title 42, Code of Federal Regulations (or a successor regulation), the Exchange shall require each qualified health plan offered through such Exchange to meet such quantitative network adequacy standards as the Secretary may prescribe for purposes of this subparagraph. (B) State Exchanges In the case of an Exchange not described in subparagraph (A), the Exchange shall establish quantitative network adequacy standards with respect to qualified health plans offered through such Exchange and require such plans to meet such standards. . (b) Effective date The amendment made by this section shall apply with respect to plan years beginning on or after January 1, 2023. II Protecting Consumers from Unreasonable Rates 201. Short title This title may be cited as the Protecting Consumers from Unreasonable Rates Act 202. 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 (1) in section 2723 ( 42 U.S.C. 300gg–22 (A) in subsection (a)— (i) in paragraph (1), by inserting , section 2794, this part (ii) in paragraph (2), by inserting , section 2794, this part (B) in subsection (b)— (i) in paragraph (1), by inserting , section 2794, this part (ii) in paragraph (2)— (I) in subparagraph (A), by inserting , section 2794, this part (II) in subparagraph (C)(ii), by inserting , 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, 2023.

Summary: Health Insurance Consumer Protection Act This bill requires health insurance exchanges to establish network adequacy standards for health insurance plans to meet. It also expands the review process for potentially unreasonable health insurance rates, including premiums. The review process, which currently covers only premium increases, is expanded to include the annual review of potentially excessive, unjustified, or unfairly discriminatory rates for health care coverage. If a rate is determined to be unreasonable, the Department of Health and Human Services (HHS), or the relevant state agency, must take corrective action before, or as soon as possible after, the rate takes effect. Corrective actions may include denying or modifying a rate or requiring the insurer to issue a rebate to consumers. HHS may apply civil monetary penalties to health insurers that fail to comply with a corrective action. Additionally, HHS may decertify the plan as a qualified health plan (i.e., a plan that is certified for sale on a health insurance exchange, is eligible for premium subsidies, and meets the requirements for minimum essential coverage).