I 
114TH CONGRESS 
2D SESSION 
H. R. 6011 
To require that the Centers for Medicare & Medicaid Services has in place 
adequate verification procedures to ensure that advance payments under 
the Patient Protection and Affordable Care Act are made for only enroll-
ees under qualified health plans who have paid their premiums. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 13, 2016 
Mr. BILIRAKIS introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To require that the Centers for Medicare & Medicaid Services 
has in place adequate verification procedures to ensure 
that advance payments under the Patient Protection and 
Affordable Care Act are made for only enrollees under 
qualified health plans who have paid their premiums. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘ACA Premium Pay-
ment Verification Act’’. 
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SEC. 2. REQUIRING ADEQUATE CMS VERIFICATION PROCE-
DURES TO ENSURE ADVANCE PAYMENTS 
UNDER THE AFFORDABLE CARE ACT ARE 
MADE FOR ONLY ENROLLEES UNDER QUALI-
FIED HEALTH PLANS WHO HAVE PAID THEIR 
PREMIUMS. 
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, no advance payment under section 1412 of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 18082) may be made before such date that the 
Secretary of Health and Human Services certifies to Con-
gress that the Centers for Medicare & Medicaid Services 
has in place an adequate process, in accordance with sub-
section (b), to independently verify if an individual is en-
rolled under a qualified health plan and has paid the pre-
mium under such plan. 
(b) ADEQUATE PROCEDURES.—For purposes of sub-
section (a), a process, with respect to the verifications de-
scribed in such subsection, shall not be treated as an ade-
quate process— 
(1) unless such process— 
(A) is an automated process under which 
such verifications are made on a policy basis 
and not on an aggregate basis; 
(B) has been tested by the Inspector Gen-
eral of the Department of Health and Human 
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Services and determined by the Inspector Gen-
eral pursuant to such test as being effective; 
and 
(C) includes the provision by the Adminis-
trator of the Centers for Medicare & Medicaid 
Services to the Secretary of the Treasury of 
such payment information as needed by the 
Secretary for verification of eligibility of individ-
uals for purposes of advance payments under 
section 1412 of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18082); and 
(2) to the extent such process includes any pro-
cedures that rely on assurances or attestations made 
by the issuer of the qualified health plan involved. 
(c) REPORT ON COST-SHARING SUBSIDIES ALLOWED 
FOR CERTAIN INDIVIDUALS ENROLLING IN QUALIFIED 
HEALTH PLANS.—Not later than one year after the date 
of the enactment of this Act, the Secretary of Health and 
Human Services shall submit to Congress a report on the 
extent to which adequate procedures are in place with re-
spect to cost-sharing reductions allowed under section 
1402 of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18071). 
Æ 
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