Title: Consumer Health Insurance Protection Act of 2019
Policy area: Health

Summary:
Consumer Health Insurance Protection Act of 2019  This bill makes various changes to the health insurance marketplace, including (1) providing authority for the Department of Health and Human Services, or states, to prohibit health insurers from implementing unreasonable premium increases; (2) revising certain limits on cost sharing; and (3) modifying certain consumer protections.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1213 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                S. 1213

      To provide health insurance reform, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 11, 2019

Ms. Warren (for herself, Mrs. Gillibrand, Ms. Harris, Ms. Baldwin, Ms. 
  Klobuchar, Mr. Booker, and Mr. Blumenthal) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
      To provide health insurance reform, 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 ``Consumer Health Insurance Protection 
Act of 2019''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
 TITLE I--LIMITING INSURER PROFITS AND PREVENTING UNREASONABLE PREMIUM 
                               INCREASES

Sec. 101. Medical loss ratio.
Sec. 102. Ensuring that consumers get value for their dollars.
Sec. 103. Effective date.
         TITLE II--MAKING HEALTH INSURANCE COVERAGE AFFORDABLE

Sec. 201. Enhancement of premium assistance credit.
Sec. 202. Enhancements for reduced cost-sharing.
Sec. 203. Cap on prescription drug cost-sharing.
Sec. 204. Standardized options in the bronze, silver, and gold levels 
                            of coverage.
Sec. 205. Deductible-exempt services for group health plans and group 
                            health insurance coverage.
Sec. 206. Clarification regarding determination of affordability of 
                            employer-sponsored minimum essential 
                            coverage.
                   TITLE III--ENSURING ACCESS TO CARE

Sec. 301. Network adequacy requirements.
Sec. 302. Ensuring adequate coverage in areas with fewer than 3 health 
                            insurance issuers offering qualified health 
                            plans on the State Exchange.
Sec. 303. Enrollment in Exchanges.
Sec. 304. Marketing and outreach for Exchanges operated by the 
                            Secretary.
Sec. 305. Navigator program.
     TITLE IV--STRENGTHENING CONSUMER HEALTH INSURANCE PROTECTIONS

Sec. 401. Prohibiting discriminatory premiums based on tobacco use.
Sec. 402. Health insurance consumer information.
Sec. 403. Patient protections.
Sec. 404. Limitation on balance billing for emergency services.
Sec. 405. Notification of provider terminations.
Sec. 406. Short-term limited duration health insurance coverage.
Sec. 407. Protecting essential health benefits and coverage of 
                            pediatric services.
Sec. 408. Association health plans.

 TITLE I--LIMITING INSURER PROFITS AND PREVENTING UNREASONABLE PREMIUM 
                               INCREASES

SEC. 101. MEDICAL LOSS RATIO.

    Section 2718(b)(1)(A)(ii) of the Public Health Service Act (42 
U.S.C. 300gg-18(b)(1)(A)(ii)) is amended by striking ``80'' each place 
it appears and inserting ``85''.

SEC. 102. ENSURING THAT CONSUMERS GET VALUE FOR THEIR DOLLARS.

    The first section 2794 of the Public Health Service Act (42 U.S.C. 
300gg-94), added by section 1003 of the Patient Protection and 
Affordable Care Act (Public Law 111-148), is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by striking ``subsection 
                (b)(2)(A)'' and inserting ``subsections (b)(2)(A) and 
                (b)(3)''; and
                    (B) in paragraph (2), by adding at the end the 
                following: ``Notwithstanding any other provision of 
                law, a health insurance issuer may not exclude from 
                such disclosure information that is a trade secret or 
                commercial or financial information described in 
                section 552(b)(4) of title 5, United States Code.'';
            (2) in subsection (b)--
                    (A) in paragraph (2)(A), by inserting ``and 
                paragraph (3)'' after ``subsection (a)(2)''; and
                    (B) by adding at the end the following:
            ``(3) Prohibiting unreasonable premium increases.--
                    ``(A) In general.--Beginning with plan years 
                beginning in 2021, the Secretary, or a State pursuant 
                to an effective rate review program meeting the 
                requirements under paragraph (4)--
                            ``(i) shall, consistent with subsection 
                        (a)(2) and paragraph (2), review increases in 
                        premiums for health insurance coverage that are 
                        subject to review pursuant to section 154.200 
                        of title 45, Code of Federal Regulations (or 
                        any successor regulation), and determine 
                        whether such increases are unreasonable; and
                            ``(ii) may prohibit a health insurance 
                        issuer from implementing such an increase that 
                        is unreasonable.
                    ``(B) Unreasonable increases.--In determining 
                whether an increase in premiums for health insurance 
                coverage is unreasonable under subparagraph (A)(i)--
                            ``(i) the Secretary shall consider whether 
                        the increase is excessive, unjustified, 
                        discriminatory, or inadequate; and
                            ``(ii) the State, pursuant to an effective 
                        rate review program meeting the requirements 
                        under paragraph (4), shall apply applicable 
                        State law for making such determination.
            ``(4) State effective rate review programs.--A State 
        effective rate review program meets the requirements under this 
        paragraph if--
                    ``(A) the program carries out the reviews described 
                in paragraph (3)(A)(i) and ensures that such reviews 
                are meaningful, effective, and timely reviews of the 
                data and documentation (including any contracts or 
                documents described in subparagraph (E)) submitted by 
                health insurance issuers in support of proposed 
                increases in premiums for health insurance coverage;
                    ``(B) such reviews include an examination of--
                            ``(i) the affordability of proposed 
                        increases in premiums for health insurance 
                        coverage;
                            ``(ii) the quality improvement activities 
                        carried out by health insurance issuers 
                        proposing the increases;
                            ``(iii) the cost containment activities of 
                        health insurance issuers proposing the 
                        increases; and
                            ``(iv) the solvency of the health insurance 
                        coverage;
                    ``(C) the program establishes a mechanism for 
                receiving public comments on proposed increases in 
                premiums for health insurance coverage reviewed by the 
                State;
                    ``(D) such reviews include a review of all public 
                comments received under subparagraph (C);
                    ``(E) the program requires each health insurance 
                issuer proposing an increase in premiums for health 
                insurance coverage to submit to the State any provider 
                contracts that may be affected, including any documents 
                incorporated by reference into such contracts; and
                    ``(F) the program requires the State to provide the 
                Secretary its determination of whether each increase 
                reviewed is unreasonable, in a form and manner 
                prescribed by the Secretary.''; and
            (3) in subsection (c)--
                    (A) in paragraph (1)--
                            (i) in the heading, by striking ``2010 
                        through 2014'' and inserting ``2021 through 
                        2025''; and
                            (ii) in the matter preceding subparagraph 
                        (A), by striking ``2010'' and inserting 
                        ``2021''; and
                    (B) in paragraph (2)(B), by striking ``2014'' and 
                inserting ``2025''.

SEC. 103. EFFECTIVE DATE.

    The amendments made by this title shall apply to plan years 
beginning after December 31, 2020.

         TITLE II--MAKING HEALTH INSURANCE COVERAGE AFFORDABLE

SEC. 201. ENHANCEMENT OF PREMIUM ASSISTANCE CREDIT.

    (a) Use of Gold Level Plan for Benchmark.--
            (1) In general.--Clause (i) of section 36B(b)(2)(B) of the 
        Internal Revenue Code of 1986 is amended by striking 
        ``applicable second lowest cost silver plan'' and inserting 
        ``applicable second lowest cost gold plan''.
            (2) Conforming amendment related to affordability.--Section 
        36B(c)(4)(C)(i)(I) of such Code is amended by striking ``second 
        lowest cost silver plan'' and inserting ``second lowest cost 
        gold plan''.
            (3) Other conforming amendments.--Subparagraphs (B) and (C) 
        of section 36B(b)(3) of such Code are each amended by striking 
        ``silver plan'' each place it appears in the text and the 
        heading and inserting ``gold plan''.
    (b) Expansion of Eligibility for Refundable Credits for Coverage 
Under Qualified Health Plans.--
            (1) In general.--Section 36B(c)(1)(A) of the Internal 
        Revenue Code of 1986 is amended by striking ``but does not 
        exceed 400 percent''.
            (2) Conforming amendments relating to recapture of excess 
        advanced payments.--Clause (i) of section 36B(f)(2)(B) of such 
        Code is amended--
                    (A) by striking ``In the case of'' and all that 
                follows through ``the amount of'' and inserting ``The 
                amount of'', and
                    (B) by striking ``but less than 400%'' in the table 
                therein.
    (c) Determination of Applicable Percentage.--
            (1) In general.--Subparagraph (A) of section 36B(b)(3) of 
        the Internal Revenue Code of 1986 is amended to read as 
        follows:
                    ``(A) Applicable percentage.--The applicable 
                percentage for any taxable year shall be the percentage 
                such that the applicable percentage for any taxpayer 
                whose household income is within an income tier 
                specified in the following table shall increase, on a 
                sliding scale in a linear manner, from the initial 
                premium percentage to the final premium percentage 
                specified in such table for such income tier:

 
 ``In the case of household
   income (expressed as a
  percent of poverty line)     The initial premium    The final premium
 within the following income     percentage is--       percentage is--
            tier:
 
100% through 133%...........                   0%                  1.0%
133% through 150%...........                 1.0%                  2.0%
150% through 200%...........                 2.0%                  4.0%
200% through 250%...........                 4.0%                  6.0%
250% through 300%...........                 6.0%                  7.0%
300% through 400%...........                 7.0%                  8.5%
Over 400%...................                 8.5%               8.5%''.
 

            (2) Conforming amendments.--Subsections (c)(2)(C)(iv) and 
        (c)(4)(F) of section 36B of the Internal Revenue Code of 1986 
        are each amended by inserting ``(as in effect before the date 
        of the enactment of the Consumer Health Insurance Protection 
        Act of 2019)'' after ``subsection (b)(3)(A)(ii)''.
    (d) Reconciliation of Premium Assistance Credit and Advance Credit 
for Single-Parent Households.--
            (1) In general.--Clause (i) of section 36B(f)(2)(B) of the 
        Internal Revenue Code of 1986 is amended by striking ``section 
        1(c)'' and inserting ``subsection (b) or (c) of section 1''.
            (2) Effective date.--The amendment made by this subsection 
        shall apply to taxable years beginning after December 31, 2019.
    (e) Determination of Premium Assistance Credit for Disabled 
Workers.--
            (1) In general.--Section 36B(d)(2) of the Internal Revenue 
        Code of 1986 is amended by inserting at the end the following 
        new subparagraph:
                    ``(C) Exclusion of certain amounts received as 
                lump-sum payment.--For purposes of subparagraph (B), 
                such amount shall not include any portion of a lump-sum 
                payment of disability insurance benefits under section 
                223 of the Social Security Act (42 U.S.C. 423) which 
                is--
                            ``(i) received during the taxable year, and
                            ``(ii) attributable to prior taxable 
                        years.''.
            (2) Effective date.--The amendment made by this subsection 
        shall apply to taxable years beginning after December 31, 2019.
    (f) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2020.

SEC. 202. ENHANCEMENTS FOR REDUCED COST-SHARING.

    (a) Modification of Amount.--
            (1) In general.--Section 1402 of the Patient Protection and 
        Affordable Care Act (42 U.S.C. 18071) is amended--
                    (A) in subsection (b)(1), by striking ``silver'' 
                and inserting ``gold'';
                    (B) by amending subsection (c)(1)(B) to read as 
                follows:
                    ``(B) Coordination with actuarial limits.--The 
                Secretary shall ensure the reduction under this 
                paragraph shall not result in the plan's share of the 
                total allowed costs of benefits provided under the plan 
                becoming less than--
                            ``(i) 95 percent in the case of an eligible 
                        insured described in paragraph (2)(A);
                            ``(ii) 90 percent in the case of an 
                        eligible insured described in paragraph (2)(B); 
                        and
                            ``(iii) 85 percent in the case of an 
                        eligible insured described in paragraph 
                        (2)(C).''; and
                    (C) by amending subsection (c)(2) to read as 
                follows:
            ``(2) Additional reduction.--The Secretary shall establish 
        procedures under which the issuer of a qualified health plan to 
        which this section applies shall further reduce cost-sharing 
        under the plan in a manner sufficient to--
                    ``(A) in the case of an eligible insured whose 
                household income is not less than 100 percent but not 
                more than 200 percent of the poverty line for a family 
                of the size involved, increase the plan's share of the 
                total allowed costs of benefits provided under the plan 
                to 95 percent of such costs;
                    ``(B) in the case of an eligible insured whose 
                household income is more than 200 percent but not more 
                than 300 percent of the poverty line for a family of 
                the size involved, increase the plan's share of the 
                total allowed costs of benefits provided under the plan 
                to 90 percent of such costs; and
                    ``(C) in the case of an eligible insured whose 
                household income is more than 300 percent but not more 
                than 400 percent of the poverty line for a family of 
                the size involved, increase the plan's share of the 
                total allowed costs of benefits provided under the plan 
                to 85 percent of such costs.''.
            (2) Effective date.--The amendments made by this subsection 
        shall apply to plan years beginning after December 31, 2020.
    (b) Funding.--Section 1402 of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18071) is amended by adding at the end the 
following new subsection:
    ``(g) Funding.--Out of any funds in the Treasury not otherwise 
appropriated, there are appropriated to the Secretary such sums as may 
be necessary for payments under this section.''.

SEC. 203. CAP ON PRESCRIPTION DRUG COST-SHARING.

    (a) Qualified Health Plans.--Section 1302(c) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18022(c)) is amended--
            (1) in paragraph (3)(A)(i), by inserting ``, including 
        cost-sharing with respect to prescription drugs covered by the 
        plan'' after ``charges''; and
            (2) by adding at the end the following:
            ``(5) Prescription drug cost-sharing.--
                    ``(A) 2021.--For plan years beginning in 2021, the 
                cost-sharing incurred under a health plan with respect 
                to prescription drugs covered by the plan shall not 
                exceed $250 per month for each enrolled individual, or 
                $500 for each family.
                    ``(B) 2022 and later.--
                            ``(i) In general.--In the case of any plan 
                        year beginning in a calendar year after 2021, 
                        the limitation under this paragraph shall be 
                        equal to the applicable dollar amount under 
                        subparagraph (A) for plan years beginning in 
                        2021, increased by an amount equal to the 
                        product of that amount and the medical care 
                        component of the consumer price index for all 
                        urban consumers (as published by the Bureau of 
                        Labor Statistics) for that year.
                            ``(ii) Adjustment to amount.--If the amount 
                        of any increase under clause (i) is not a 
                        multiple of $5, such increase shall be rounded 
                        to the next lowest multiple of $5.''.
    (b) Group Health Plans.--Section 2707(b) of the Public Health 
Service Act (42 U.S.C. 300gg-6(b)) is amended--
            (1) by striking ``annual''; and
            (2) by striking ``paragraph (1) of section 1302(c)'' and 
        inserting ``paragraphs (1) and (5) of section 1302(c) of the 
        Patient Protection and Affordable Care Act''.
    (c) Effective Date.--The amendments made by subsections (a) and (b) 
shall take effect with respect to plans beginning after December 31, 
2020.

SEC. 204. STANDARDIZED OPTIONS IN THE BRONZE, SILVER, AND GOLD LEVELS 
              OF COVERAGE.

    (a) In General.--Section 1301(a) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18021(a)) is amended--
            (1) in paragraph (1)(C)--
                    (A) in clause (iii), by striking ``; and'' and 
                inserting ``;'';
                    (B) by redesignating clause (iv) as clause (v); and
                    (C) by inserting after clause (iii) the following:
                            ``(iv)(I) agrees to offer the applicable 
                        standardized option under paragraph (5) for 
                        each level of coverage offered by the issuer 
                        that is the bronze, silver, or gold level of 
                        coverage; and
                            ``(II) with respect to offering coverage 
                        that is the bronze, silver, or gold level of 
                        coverage through an Exchange that is operated 
                        by the Secretary, agrees to offer only the 
                        applicable standardized option under paragraph 
                        (5) and not any other plan for such levels of 
                        coverage; and''; and
            (2) by adding at the end the following:
            ``(5) Standardized options.--
                    ``(A) Definition of standardized option.--In this 
                section, the term `standardized option' means a 
                qualified health plan--
                            ``(i) with a standardized cost-sharing 
                        structure established by the applicable State, 
                        or the Secretary, in accordance with this 
                        paragraph; and
                            ``(ii) that is offered through an Exchange.
                    ``(B) Establishment.--
                            ``(i) State.--Each State may establish a 
                        standardized option for the bronze, silver, and 
                        gold levels of coverage.
                            ``(ii) Secretary.--The Secretary shall 
                        establish a standardized option in a State for 
                        any level of coverage described in clause (i) 
                        for which the State has not established a 
                        standardized option.
                            ``(iii) Updates.--The Secretary shall 
                        annually update any standardized option 
                        established by the Secretary under clause (ii).
                    ``(C) Deductible-exempt services.--
                            ``(i) In general.--Except as provided in 
                        clause (ii), each standardized option 
                        established by the Secretary under subparagraph 
                        (B)(ii) shall provide coverage for and waive 
                        the application of a deductible for--
                                    ``(I) all primary care visits and 
                                specialist visits;
                                    ``(II) all mental health and 
                                substance use disorder outpatient 
                                services;
                                    ``(III) all drugs approved under 
                                section 505(j) of the Federal Food, 
                                Drug, and Cosmetic Act and biological 
                                products licensed under section 351(k) 
                                of the Public Health Service Act; and
                                    ``(IV) all urgent care services.
                            ``(ii) Bronze and silver levels of 
                        coverage.--The Secretary may alter the services 
                        that shall be covered as deductible-exempt 
                        services under clause (i) for standardized 
                        options in the bronze and silver levels of 
                        coverage.
                    ``(D) Display.--Each Exchange operated by a State 
                shall preferentially display the standardized options 
                offered in such State on the website of the 
                Exchange.''.
    (b) Effective Date.--The amendments made by this section shall 
apply to plans beginning after December 31, 2020.

SEC. 205. DEDUCTIBLE-EXEMPT SERVICES FOR GROUP HEALTH PLANS AND GROUP 
              HEALTH INSURANCE COVERAGE.

    (a) In General.--Section 2713 of the Public Health Service Act (42 
U.S.C. 300gg-13) is amended by adding at the end the following:
    ``(d) Deductible-Exempt Services for Group Health Plans and Group 
Health Insurance Coverage.--
            ``(1) In general.--Subject to paragraph (2), a group health 
        plan and a health insurance issuer offering group health 
        insurance coverage shall, in addition to the requirement under 
        subsection (a), at a minimum provide coverage for and waive the 
        application of a deductible for--
                    ``(A) all primary care visits and specialist 
                visits;
                    ``(B) all mental health and substance use disorder 
                outpatient services;
                    ``(C) all drugs approved under section 505(j) of 
                the Federal Food, Drug, and Cosmetic Act and biological 
                products licensed under section 351(k) of the Public 
                Health Service Act; and
                    ``(D) all urgent care services.
            ``(2) Regulations.--The Secretary may issue regulations 
        to--
                    ``(A) assist group health plans and health 
                insurance issuers offering group health insurance 
                coverage in complying with paragraph (1); and
                    ``(B) alter the services that shall be covered as 
                deductible-exempt services under paragraph (1) for 
                group health plans and group health insurance coverage 
                with levels of coverage that are designed to provide 
                benefits that are actuarially equivalent to 60 or 70 
                percent of the full actuarial value of the benefits 
                provided under the plan or coverage.''.
    (b) Effective Date.--The amendments made by this section shall 
apply to plans beginning after December 31, 2020.

SEC. 206. CLARIFICATION REGARDING DETERMINATION OF AFFORDABILITY OF 
              EMPLOYER-SPONSORED MINIMUM ESSENTIAL COVERAGE.

    (a) Special Rule for Employer-Sponsored Minimum Essential 
Coverage.--Clause (i) of section 36B(c)(2)(C) of the Internal Revenue 
Code of 1986 is amended to read as follows:
                            ``(i) Coverage must be affordable.--
                                    ``(I) In general.--Except as 
                                provided in clause (iii), an individual 
                                shall not be treated as eligible for 
                                minimum essential coverage if such 
                                coverage consists of an eligible 
                                employer-sponsored plan (as defined in 
                                section 5000A(f)(2)) and the required 
                                contribution with respect to the plan 
                                exceeds 8.5 percent of the applicable 
                                taxpayer's household income.
                                    ``(II) Required contribution with 
                                respect to employee.--In the case of 
                                the employee eligible to enroll in the 
                                plan, the required contribution for 
                                purposes of subclause (I) is the 
                                employee's required contribution 
                                (within the meaning of section 
                                5000A(e)(1)(B)(i)) with respect to the 
                                plan.
                                    ``(III) Required contribution with 
                                respect to family members.--In the case 
                                of an individual who is eligible to 
                                enroll in the plan by reason of a 
                                relationship the individual bears to 
                                the employee, the required contribution 
                                for purposes of subclause (I) is the 
                                employee's required contribution 
                                (within the meaning of section 
                                5000A(e)(1)(B)(i), determined by 
                                substituting `family' for `self-only') 
                                with respect to the plan.''.
    (b) Conforming Amendments.--
            (1) Clause (ii) of section 36B(c)(2)(C) of the Internal 
        Revenue Code of 1986 is amended by adding at the end the 
        following: ``This clause shall also apply to an individual who 
        is eligible to enroll in the plan by reason of a relationship 
        the individual bears to the employee.''.
            (2) Clause (iii) of section 36B(c)(2)(C) of such Code is 
        amended by striking ``the last sentence of clause (i)'' and 
        inserting ``clause (i)(III)''.
            (3) Clause (iv) of section 36B(c)(2)(C) of such Code is 
        amended by striking ``clause (i)(II)'' and inserting ``clause 
        (i)(I)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2020.

                   TITLE III--ENSURING ACCESS TO CARE

SEC. 301. NETWORK ADEQUACY REQUIREMENTS.

    (a) In General.--Section 1311(c) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18031(c)) is amended--
            (1) in paragraph (1)(B), by inserting ``and paragraph (7) 
        and in accordance with paragraph (8)'' after ``Public Health 
        Service Act''; and
            (2) by adding at the end the following:
            ``(7) Network adequacy requirements.--
                    ``(A) In general.--A qualified health plan shall, 
                to be certified under this subsection, meet the network 
                adequacy standards established by the Secretary under 
                subparagraph (B), except as provided in subparagraphs 
                (B)(ii) and (C).
                    ``(B) Federal standards and review.--
                            ``(i) Standard.--
                                    ``(I) Establishment.--The Secretary 
                                shall, in consultation with 
                                stakeholders including pediatric-
                                specific stakeholders, establish a 
                                network adequacy standard based on 
                                access to in-network providers for 
                                qualified health plans, except for 
                                those plans described in subparagraph 
                                (C). Such standard shall--
                                            ``(aa) include requirements 
                                        for the minimum number and type 
                                        of in-network providers 
                                        available, the geographical 
                                        location of such providers, the 
                                        average distance and travel 
                                        time required for patients to 
                                        visit such providers, and the 
                                        average appointment wait times 
                                        for services covered by the 
                                        plan; and
                                            ``(bb) account for 
                                        differences in the needs of 
                                        children and adults.
                                    ``(II) Medicare advantage 
                                organizations.--The network adequacy 
                                standard established under subclause 
                                (I) shall, at a minimum, be equivalent 
                                to the requirements for access to 
                                services applicable to Medicare 
                                Advantage organizations offering 
                                Medicare Advantage plans under part C 
                                of title XVIII of the Social Security 
                                Act.
                            ``(ii) Justification.--A qualified health 
                        plan that fails to meet the standard 
                        established under clause (i) may satisfy the 
                        requirement under subparagraph (A) by providing 
                        the Secretary with a reasonable justification 
                        for the variance from such standard, based on 
                        factors such as the availability of providers 
                        and variables reflected in local patterns of 
                        health care.
                            ``(iii) Review.--The Secretary shall 
                        establish a process for reviewing the network 
                        adequacy of qualified health plans, except for 
                        those plans reviewed by the State in accordance 
                        with subparagraph (C)(ii).
                    ``(C) State standard.--
                            ``(i) In general.--In the case of a 
                        qualified health plan offered in a State that 
                        has implemented a quantifiable network adequacy 
                        metric that the Secretary determines is an 
                        acceptable metric commonly used in the health 
                        insurance industry to measure network adequacy, 
                        such qualified health plan may, to be certified 
                        under this subsection, satisfy the requirement 
                        under subparagraph (A) by meeting the network 
                        adequacy standards of such State based on such 
                        metric.
                            ``(ii) Review.--A State with an acceptable 
                        metric described in clause (i) may review the 
                        network adequacy of qualified health plans 
                        offered in such State in a process established 
                        by the State.
            ``(8) Coverage of out-of-network essential health 
        benefits.--
                    ``(A) In general.--A qualified health plan shall, 
                to be certified under this subsection, provide to 
                individuals enrolled in such plan coverage of any 
                service provided by an out-of-network provider if--
                            ``(i) coverage of such service would 
                        otherwise be provided by the plan if the 
                        service was provided by an in-network provider;
                            ``(ii) the service is included in the 
                        essential health benefits package described in 
                        section 1302(a); and
                            ``(iii) the service cannot be provided to 
                        the individual by an in-network provider within 
                        a reasonable timeframe or within a reasonable 
                        distance and travel time.
                    ``(B) Cost-sharing.--A qualified health plan that 
                provides coverage of a service provided by an out-of-
                network provider under subparagraph (A) shall provide 
                such coverage with the same cost-sharing requirements 
                as if the service was provided by an in-network 
                provider.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to plans beginning after December 31, 2020.
    (c) Grants for State Network Adequacy Reviews.--
            (1) In general.--The Secretary of Health and Human Services 
        shall carry out a program to award grants to States during the 
        5-year period beginning with fiscal year 2021 to assist such 
        States in developing a metric to measure network adequacy as 
        described in subparagraph (C)(i) of section 1311(c)(7) of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 
        18031(c)(7)) and to carry out the reviews described in 
        subparagraph (C)(ii) of such section.
            (2) Authorization of appropriations.--There are authorized 
        to be appropriated for each of fiscal years 2021 through 2025 
        such sums as may be necessary to carry out the grant program 
        under this subsection.
    (d) Report.--
            (1) In general.--Not later than December 31, 2022, the 
        Secretary shall prepare, and submit to Congress, a report 
        containing the analysis and recommendations described in 
        paragraph (2).
            (2) Analysis and recommendations.--The report under this 
        subsection shall--
                    (A) analyze how network adequacy and access to care 
                has changed since the implementation of this section, 
                including the amendments made by this section, 
                including for children;
                    (B) include information on the availability of 
                providers that are essential community providers as 
                described in section 1311(c)(1)(C) of the Patient 
                Protection and Affordable Care Act (42 U.S.C. 
                18031(c)(1)(C)); and
                    (C) provide recommendations for such legislation 
                and administrative actions as the Secretary considers 
                appropriate to improve network adequacy, including with 
                respect to access to pediatric services and essential 
                community providers.

SEC. 302. ENSURING ADEQUATE COVERAGE IN AREAS WITH FEWER THAN 3 HEALTH 
              INSURANCE ISSUERS OFFERING QUALIFIED HEALTH PLANS ON THE 
              STATE EXCHANGE.

    (a) Requirements for Medicare Advantage Organizations.--
            (1) In general.--Section 1857(e) of the Social Security Act 
        (42 U.S.C. 1395w-27(e)) is amended by adding at the end the 
        following new paragraph:
            ``(6) Requirement for certain medicare advantage 
        organizations that offer an ma plan in an applicable area to 
        also offer qualified health plans in the applicable area.--
                    ``(A) In general.--A contract under this section 
                with an MA organization described in subparagraph (B) 
                shall require the organization to, in each applicable 
                area in which the organization offers an MA plan, also 
                offer, through the individual market in the Exchange 
                operating in the State, at least one qualified health 
                plan in the silver level of coverage and at least one 
                qualified health plan in the gold level of coverage, as 
                described in section 1302(d) of the Patient Protection 
                and Affordable Care Act.
                    ``(B) MA organizations described.--An MA 
                organization described in this subparagraph is an MA 
                organization that, in addition to offering an MA plan 
                in an applicable area, offers health insurance coverage 
                in the group market or individual market in the State 
                but does not offer such coverage through the Exchange 
                operating in the State.
                    ``(C) Notification.--The Secretary, or the State in 
                the case of an MA organization offering an MA plan in 
                an applicable area in a State with an Exchange operated 
                by the State, shall notify each MA organization that is 
                required to offer a qualified health plan under 
                subparagraph (A) for a plan year of such requirement. 
                Such notification shall be provided each year--
                            ``(i) beginning with respect to the 
                        requirement for plan years beginning after 
                        December 31, 2020; and
                            ``(ii) not less than 1 year prior to the 
                        rate filing deadline for the plan year for the 
                        Exchange operating in the State in which the MA 
                        organization will be required to offer such 
                        plan.
                    ``(D) Waiver.--The Secretary, or the State in the 
                case of an MA organization offering an MA plan in an 
                applicable area in a State with an Exchange operated by 
                the State, may waive the requirement under subparagraph 
                (A) if--
                            ``(i) by the first day of the plan year 
                        following the determination, the number of 
                        health insurance issuers offering a qualified 
                        health plan through the individual market in 
                        the Exchange has increased such that the 
                        applicable area no longer has fewer than 3 
                        health insurance issuers offering a qualified 
                        health plan through the individual market in 
                        the Exchange operating in the State; or
                            ``(ii) the Secretary, or the State in such 
                        a case, determines that the requirement under 
                        subparagraph (A) would cause the MA 
                        organization to become insolvent.
                    ``(E) Definitions.--In this paragraph:
                            ``(i) Applicable area.--The term 
                        `applicable area' means an area in which, at 
                        the time the Secretary or the State sends the 
                        notification under subparagraph (C), fewer than 
                        3 health insurance issuers offer a qualified 
                        health plan through the individual market in 
                        the Exchange operating in the State.
                            ``(ii) Exchange.--The term `Exchange' means 
                        an American Health Benefit Exchange established 
                        under section 1311 or section 1321 of the 
                        Patient Protection and Affordable Care Act.
                            ``(iii) Group market.--The term `group 
                        market' has the meaning given such term in 
                        section 1304 of the Patient Protection and 
                        Affordable Care Act.
                            ``(iv) Health insurance coverage.--The term 
                        `health insurance coverage' has the meaning 
                        given the term in section 2791(b) of the Public 
                        Health Service Act.
                            ``(v) Individual market.--The term 
                        `individual market' has the meaning given such 
                        term in section 1304 of the Patient Protection 
                        and Affordable Care Act.
                            ``(vi) Qualified health plan.--The term 
                        `qualified health plan' has the meaning given 
                        that term in section 1301(a) of the Patient 
                        Protection and Affordable Care Act.''.
            (2) Effective date.--The amendment made by this subsection 
        shall apply to contracts entered into or renewed after December 
        31, 2020.
    (b) Requirements for Medicaid Managed Care Organizations.--
            (1) In general.--Section 1903(m)(2)(A) of the Social 
        Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended--
                    (A) in clause (xii), by striking ``; and'' and 
                inserting a semicolon;
                    (B) by realigning the left margin of clause (xiii) 
                to align with the left margin of clause (xii);
                    (C) in clause (xiii), by striking the period at the 
                end and inserting ``; and''; and
                    (D) by inserting after clause (xiii) the following:
                    ``(xiv) such contract requires that the entity 
                meets the requirements described in section 1857(e)(6) 
                in the same manner as such requirements apply to an MA 
                organization.''.
            (2) Effective date.--The amendments made by this subsection 
        shall apply to contracts entered into or renewed after December 
        31, 2020.

SEC. 303. ENROLLMENT IN EXCHANGES.

    (a) Open Enrollment and Special Enrollment Periods.--Section 
1311(c)(6) of the Patient Protection and Affordable Care Act (42 U.S.C. 
18031(c)(6)) is amended--
            (1) in subparagraph (B), by inserting ``that are not less 
        than 8 weeks'' after ``open enrollment periods'';
            (2) in subparagraph (C), by striking ``; and'' and 
        inserting ``;'';
            (3) in subparagraph (D), by striking the period and 
        inserting ``;''; and
            (4) by adding at the end the following:
                    ``(E) a special enrollment period for qualified 
                individuals enrolled in a plan that makes significant 
                provider terminations during the plan year, as 
                determined in accordance with regulations promulgated 
                by the Secretary; and
                    ``(F) a special enrollment period--
                            ``(i) for each qualified individual who--
                                    ``(I) is determined by the Exchange 
                                to be eligible for a premium assistance 
                                credit under section 36B of the 
                                Internal Revenue Code of 1986; and
                                    ``(II) has a household income not 
                                in excess of 300 percent of the poverty 
                                line for the size of the family 
                                involved; and
                            ``(ii) which shall begin on the date on 
                        which the individual is determined by the 
                        Exchange to be eligible for a premium 
                        assistance credit under such section 36B.''.
    (b) Consumer Protections Regarding Automatic Re-Enrollment.--Part 2 
of subtitle D of title I of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18031 et seq.) is amended by adding at the end the 
following:

``SEC. 1314. CONSUMER PROTECTIONS REGARDING AUTOMATIC RE-ENROLLMENT.

    ``(a) Consent To Avoid Automatic Re-Enrollment for Individuals 
Losing Eligibility for Premium Assistance Credits.--The Secretary shall 
establish a process to allow an individual, who is enrolling in a 
qualified health plan through an Exchange and whom the Exchange 
estimates is eligible to receive a premium assistance credit under 
section 36B of the Internal Revenue Code of 1986, to provide consent to 
the Exchange to not automatically re-enroll the individual in such 
qualified health plan (or a comparable qualified health plan in a case 
described in subsection (b)) for the following plan year if during the 
plan year the Exchange estimates that the individual has become no 
longer eligible to receive such credit.
    ``(b) Notice Regarding Discontinued Plans.--In the case of an 
individual who is enrolled in a qualified health plan through an 
Exchange for a plan year that will not be offered through such Exchange 
for the following plan year, the Exchange through which such plan is 
offered shall, prior to the open enrollment period for the following 
plan year, send the individual a notice stating--
            ``(1) that the qualified health plan in which the 
        individual is enrolled will not be offered through such 
        Exchange for the following plan year;
            ``(2) that unless the individual takes action, the 
        individual will be enrolled in a comparable qualified health 
        plan for the following plan year;
            ``(3) the estimated amount of premiums for such comparable 
        qualified health plan; and
            ``(4) clear information on the eligibility of the 
        individual for a special enrollment period.
    ``(c) Notice Regarding Automatic Re-Enrollment.--Any notice 
regarding automatic re-enrollment sent by an Exchange to an individual 
enrolled in a qualified health plan shall be provided to the individual 
in the language that the individual has indicated to the Exchange as 
the preferred language of the individual.
    ``(d) Retroactive Termination.--
            ``(1) In general.--The Secretary shall establish a process 
        to allow an individual who is automatically re-enrolled in a 
        qualified health plan for a plan year and who has enrolled in 
        other creditable coverage for that plan year to retroactively 
        terminate such qualified health plan for such plan year.
            ``(2) Creditable coverage.--In this subsection, the term 
        `creditable coverage' has the meaning given the term in section 
        2704(c)(1) of the Public Health Service Act.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to plan years beginning after the date of enactment of this Act.
    (d) Study.--The Secretary shall conduct a study that examines the 
practices used by the Exchanges for notifying consumers of automatic 
re-enrollment in qualified health plans and identifies strategies for--
            (1) improving automatic re-enrollment and renewal 
        notifications;
            (2) improving the ability to reach consumers in providing 
        such notices;
            (3) increasing consumer comprehension of such notices; and
            (4) encouraging consumers to--
                    (A) update information that will affect eligibility 
                for premium assistance credits under section 36B of the 
                Internal Revenue Code of 1986 and the amount of such 
                credits; and
                    (B) shop for qualified health plans that will best 
                meet their needs through the Exchange operating in 
                their State.

SEC. 304. MARKETING AND OUTREACH FOR EXCHANGES OPERATED BY THE 
              SECRETARY.

    Part 2 of subtitle D of title I of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18031 et seq.), as amended by section 
303(b), is further amended by adding at the end the following:

``SEC. 1315. MARKETING AND OUTREACH FOR EXCHANGES OPERATED BY THE 
              SECRETARY.

    ``(a) In General.--Out of the funds appropriated under subsection 
(b), the Secretary shall conduct a marketing and outreach program with 
respect to qualified health plans offered through Exchanges operated by 
the Secretary in order to encourage enrollment in such plans.
    ``(b) Appropriations.--
            ``(1) Encouraging enrollment for plan year 2020.--There is 
        appropriated to the Secretary, out of any moneys in the 
        Treasury not otherwise appropriated, $480,000,000 to carry out 
        the marketing and outreach program under subsection (a) with 
        respect to encouraging enrollment for qualified health plans 
        that begin in calendar year 2020.
            ``(2) Encouraging enrollment for subsequent plan years.--To 
        carry out the marketing and outreach program under subsection 
        (a) with respect to encouraging enrollment for qualified health 
        plans that begin in each of calendar years 2021 through 2025, 
        there is appropriated to the Secretary prior to each such 
        calendar year, out of any moneys in the Treasury not otherwise 
        appropriated, an amount equal to the amount appropriated under 
        this subsection for the prior calendar year increased by 4 
        percent for each such calendar year.
            ``(3) Availability.--The amounts appropriated under 
        paragraphs (1) and (2) shall remain available until 
        expended.''.

SEC. 305. NAVIGATOR PROGRAM.

    Section 1311(i) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18031(i)) is amended--
            (1) in paragraph (2)--
                    (A) in subparagraph (B), by striking ``and other 
                entities'' and inserting ``and other entities (such as 
                Indian tribes, tribal organizations, urban Indian 
                organizations, and State or local human service 
                agencies)''; and
                    (B) by adding at the end the following:
                    ``(C) Preference.--An Exchange shall ensure that, 
                each year, it awards a grant under paragraph (1) to--
                            ``(i) at least one entity described in this 
                        paragraph that is a community and consumer-
                        focused nonprofit group; and
                            ``(ii) at least one entity described in 
                        subparagraph (B), which may include another 
                        community and consumer-focused nonprofit 
                        group.'';
            (2) in paragraph (3)--
                    (A) in subparagraph (D), by striking ``; and'' and 
                inserting ``;'';
                    (B) in subparagraph (E), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following:
                    ``(F) provide targeted assistance to individuals 
                likely to qualify for a special enrollment period under 
                subparagraph (C), (D), or (E) of subsection (c)(6).''; 
                and
            (3) in paragraph (4)(A)--
                    (A) in the matter preceding clause (i), by striking 
                ``not'';
                    (B) in clause (i)--
                            (i) by inserting ``not'' before ``be''; and
                            (ii) by striking ``; or'' and inserting 
                        ``;'';
                    (C) in clause (ii)--
                            (i) by inserting ``not'' before 
                        ``receive''; and
                            (ii) by striking the period and inserting 
                        ``;''; and
                    (D) by adding at the end the following:
                            ``(iii) maintain physical presence in the 
                        State of the Exchange so as to allow in-person 
                        assistance to consumers; and
                            ``(iv) not provide compensation to an 
                        employee employed by the navigator based on the 
                        number of individuals the employee assists in 
                        enrolling in qualified health plans.''.

     TITLE IV--STRENGTHENING CONSUMER HEALTH INSURANCE PROTECTIONS

SEC. 401. PROHIBITING DISCRIMINATORY PREMIUMS BASED ON TOBACCO USE.

    (a) In General.--Section 2701(a)(1)(A) of the Public Health Service 
Act (42 U.S.C. 300gg(a)(1)(A)) is amended--
            (1) in clause (ii), by inserting ``and'' after the 
        semicolon; and
            (2) by striking clause (iv).
    (b) Effective Date.--The amendments made by this section shall 
apply to plan years beginning after December 31, 2020.

SEC. 402. HEALTH INSURANCE CONSUMER INFORMATION.

    Section 2793 of the Public Health Service Act (42 U.S.C. 300gg-93) 
is amended--
            (1) in subsection (d)--
                    (A) in the second sentence, by striking ``and shall 
                share'' and inserting ``, shall share''; and
                    (B) by striking the period at the end of second 
                sentence and inserting ``, and (not later than 2 years 
                after the date of enactment of the Consumer Health 
                Insurance Protection Act of 2019) shall make such data 
                available to the public in a searchable format on an 
                internet website established by the Secretary.''; and
            (2) in subsection (e)--
                    (A) in paragraph (1), by striking ``$30,000,000 for 
                the first fiscal year for which this section applies'' 
                and inserting ``$50,000,000 for each of fiscal years 
                2021 through 2025''; and
                    (B) in paragraph (2), by striking ``each fiscal 
                year following the fiscal year described in paragraph 
                (1)'' and inserting ``fiscal year 2026 and each fiscal 
                year thereafter''.

SEC. 403. PATIENT PROTECTIONS.

    (a) In General.--Section 2719A of the Public Health Service Act (42 
U.S.C. 300gg-19a) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (1), in the matter preceding 
                subparagraph (A), by striking ``paragraph (2)(B)'' and 
                inserting ``paragraph (3)(B)'';
                    (B) by redesignating paragraph (2) as paragraph 
                (3);
                    (C) by inserting after paragraph (1) the following:
            ``(2) Reimbursement.--A group health plan or health 
        insurance issuer offering group or individual health insurance 
        coverage shall reimburse an out-of-network provider providing 
        emergency services to an individual who is a participant, 
        beneficiary, or enrollee of such plan or coverage at an amount 
        equal to the greatest of--
                    ``(A) the median amount negotiated with in-network 
                providers for the emergency service;
                    ``(B) the amount for the emergency service 
                calculated using the same method the plan or issuer 
                uses to determine payments for out-of-network services 
                that are not emergency services; or
                    ``(C) the amount that would be paid to a provider 
                of services or supplier with respect to the furnishing 
                of such service under title XVIII of the Social 
                Security Act.''; and
                    (D) in paragraph (3)(B), as so redesignated--
                            (i) clause (i), by inserting ``, including 
                        ambulance services provided by ground or air 
                        transportation'' before ``, and'' at the end; 
                        and
                            (ii) in clause (ii), by striking the period 
                        at the end and inserting ``, including 
                        ambulance services provided by ground or air 
                        transportation.''; and
            (2) by adding at the end the following:
    ``(e) Coverage of Services by Out-of-Network Providers Based on 
Plan or Issuer Error.--
            ``(1) In general.--A group health plan or health insurance 
        issuer offering group or individual health insurance coverage 
        shall provide coverage of a service provided by an out-of-
        network provider to an individual who is a participant, 
        beneficiary, or enrollee of such plan or coverage if--
                    ``(A) the plan or issuer would have provided 
                coverage of the service if the service was provided by 
                an in-network provider; and
                    ``(B) in choosing such provider, the individual 
                reasonably relied on a materially inaccurate, 
                incomplete, or misleading statement of information 
                contained in a directory of in-network providers 
                compiled by the plan or issuer.
            ``(2) Cost-sharing.--A group health plan or health 
        insurance issuer that provides coverage of a service provided 
        by an out-of-network provider under paragraph (1) shall provide 
        such coverage with the same cost-sharing requirement that would 
        apply if the services were provided in-network.
    ``(f) Coverage for Enrollees in Active Course of Treatment.--
            ``(1) In general.--A group health plan or health insurance 
        issuer offering group or individual health insurance coverage 
        shall, at the request of an individual who is a participant, 
        beneficiary, or enrollee of such plan or coverage and in 
        accordance with paragraphs (4) and (5), provide to such 
        individual coverage of services for an active course of 
        treatment provided by a provider that is an out-of-network 
        provider with respect to such plan or coverage if--
                    ``(A) coverage of such services would be provided 
                under the group health plan or health insurance 
                coverage if the services were provided by an in-network 
                provider; and
                    ``(B) a circumstance described in paragraph (3) 
                applies.
            ``(2) Cost-sharing.--A group health plan or health 
        insurance issuer offering group or individual health insurance 
        coverage shall ensure that any cost-sharing requirements for 
        coverage of services for an active course of treatment provided 
        by an out-of-network provider under paragraph (1) are the same 
        requirements as if such services were provided by an in-network 
        provider.
            ``(3) Circumstance.--A circumstance described in this 
        paragraph is a circumstance in which--
                    ``(A) with respect to a health insurance issuer 
                offering group or individual health insurance 
                coverage--
                            ``(i) the individual was receiving services 
                        for the active course of treatment described in 
                        paragraph (1) from the out-of-network provider 
                        described in such paragraph during the prior 
                        plan year when--
                                    ``(I) the individual was a 
                                participant, beneficiary, or enrollee 
                                of a different health insurance 
                                coverage offered by such health 
                                insurance issuer; and
                                    ``(II) such provider was an in-
                                network provider with respect to such 
                                different health insurance coverage; 
                                and
                            ``(ii) the health insurance issuer decided 
                        to cancel or discontinue offering such 
                        different health insurance coverage for the 
                        plan year for which the individual makes the 
                        request, including a case in which such 
                        different health insurance coverage is 
                        withdrawn from the market for such plan year; 
                        and
                    ``(B) the individual was receiving services for the 
                active course of treatment described in paragraph (1) 
                from the out-of-network provider described in such 
                paragraph while the provider was an in-network provider 
                for the group health plan or health insurance coverage 
                for the plan year, and, during such plan year, the 
                provider became a terminated provider with respect to 
                such plan or coverage for the remainder of such plan 
                year.
            ``(4) Duration.--A group health plan or health insurance 
        issuer offering group or individual health insurance coverage 
        shall provide coverage of services for an active course of 
        treatment under paragraph (1) until the earlier of--
                    ``(A) the date on which the treatment is complete; 
                or
                    ``(B) the date that is 180 days following the first 
                date on which the provider described in paragraph (1) 
                is no longer an in-network provider of the plan or 
                coverage in providing such services to the individual.
            ``(5) Request for continuity of care.--A request made under 
        paragraph (1) shall be subject to any internal or external 
        grievance or appeals process of the group health plan or health 
        insurance issuer, in accordance with any applicable State or 
        Federal law.
            ``(6) Definitions.--For purposes of this subsection:
                    ``(A) Active course of treatment.--The term `active 
                course of treatment' means any of the following:
                            ``(i) An ongoing course of treatment for--
                                    ``(I) a life-threatening condition;
                                    ``(II) a serious, acute condition; 
                                or
                                    ``(III) a serious, chronic 
                                condition.
                            ``(ii) Care provided with respect to 
                        pregnancy, including until the completion of 
                        postpartum care directly related to the 
                        delivery.
                            ``(iii) An ongoing course of treatment for 
                        a child between birth and 36 months.
                            ``(iv) The performance of a surgery or 
                        other procedure that, as documented prior to 
                        the time the provider became an out-of-network 
                        provider with respect to the group health plan 
                        or health insurance coverage--
                                    ``(I) the plan or issuer offering 
                                such coverage authorized as part of a 
                                course of treatment for the individual; 
                                and
                                    ``(II) the provider recommended for 
                                such individual.
                    ``(B) Terminated provider.--The term `terminated 
                provider'--
                            ``(i) means a provider that had a contract 
                        with a group health plan or health insurance 
                        issuer offering group or individual health 
                        insurance coverage to provide services as an 
                        in-network provider with respect to such plan 
                        or coverage for a plan year, and, during such 
                        plan year, the plan or issuer terminated such 
                        contract or did not renew such contract for the 
                        remainder of the plan year; and
                            ``(ii) does not include--
                                    ``(I) any provider that voluntarily 
                                terminated or did not renew such 
                                contract for the remainder of the plan 
                                year; and
                                    ``(II) any provider whose contract 
                                with the plan or issuer terminated, or 
                                was not renewed, for the remainder of 
                                the plan year for reasons relating to a 
                                medical disciplinary cause, fraud, or 
                                other criminal activity.
    ``(g) Limitations on Changes in Coverage of Prescription Drugs.--
            ``(1) In general.--A group health plan or health insurance 
        issuer offering group or individual health insurance coverage 
        shall not, during a plan year, take any of the following 
        actions with respect to coverage for such plan year:
                    ``(A) Remove a prescription drug from a formulary 
                of prescription drugs covered by such plan or coverage, 
                except as provided in paragraph (2)(C).
                    ``(B) Increase the obligation of a participant, 
                beneficiary, or enrollee with respect to cost-sharing, 
                as defined in section 1302(c)(3) of the Patient 
                Protection and Affordable Care Act, for a prescription 
                drug covered under such plan or coverage.
            ``(2) Rule of construction.--Nothing in this subsection 
        shall prohibit a group health plan or health insurance issuer 
        offering group or individual health insurance coverage from, 
        during a plan year, taking any of the following actions with 
        respect to coverage under the plan or health insurance coverage 
        for such plan year:
                    ``(A) Changing the policy of the plan or health 
                insurance coverage to require a participant, 
                beneficiary, or enrollee to use a generic substitution 
                for a branded prescription drug.
                    ``(B) Adding a new prescription drug to a formulary 
                of prescription drugs covered by such plan or health 
                insurance coverage.
                    ``(C) Removing a prescription drug from such a 
                formulary due to patient safety concerns, or a 
                prescription drug recall, or removing a prescription 
                drug from interstate commerce as determined necessary 
                by the Secretary.''.
    (b) Effective Date.--The amendments made by this section shall 
apply to plan years beginning after December 31, 2020.

SEC. 404. LIMITATION ON BALANCE BILLING FOR EMERGENCY SERVICES.

    (a) In General.--A health care provider that provides any emergency 
service to an individual that is a participant, beneficiary, or 
enrollee of a group health plan, group health insurance coverage, or 
individual health insurance coverage and that is not an in-network 
provider of such plan or coverage shall not impose a charge on such 
individual for such emergency service, other than any cost-sharing that 
would otherwise be applicable if the health care provider was an in-
network provider of such plan or health insurance coverage.
    (b) Enforcement.--The Secretary may impose a civil monetary 
penalty, in the same manner as such penalties are authorized under 
section 1128A of the Social Security Act (42 U.S.C. 1320a-7a) for 
violations of balance billing prohibitions under part B of title XVIII 
of such Act (42 U.S.C. 1395j et seq.), on any provider that violates 
the requirement under subsection (a).
    (c) Definitions.--In this section:
            (1) Cost-sharing.--The term ``cost-sharing'' has the 
        meaning given the term in section 1302(c)(3) of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18022(c)(3)).
            (2) Emergency service.--The term ``emergency service'' has 
        the meaning given such term in paragraph (3)(B) of section 
        2719A(b) of the Public Health Service Act (42 U.S.C. 300gg-
        19a(b)), as amended by section 403(a).
            (3) Group health plan, group health insurance coverage, and 
        individual health insurance coverage.--The terms ``group health 
        plan'', ``group health insurance coverage'', and ``individual 
        health insurance coverage'' have the meanings given such terms 
        in section 2791 of the Public Health Service Act (42 U.S.C. 
        300gg-91).
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (d) Effective Date.--This section shall apply to plan years 
beginning after December 31, 2020.

SEC. 405. NOTIFICATION OF PROVIDER TERMINATIONS.

    Subpart II of part A of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg-11 et seq.) is amended by adding at the end the 
following:

``SEC. 2730. NOTIFICATION OF PROVIDER TERMINATIONS.

    ``(a) In General.--Beginning January 1, 2020, a group health plan 
or health insurance issuer offering group or individual health 
insurance coverage shall inform individuals described in subsection (b) 
of the termination of any provider as an in-network provider under the 
plan or health insurance coverage. Such notice shall be provided not 
later than 30 days prior to the termination.
    ``(b) Individuals.--The individuals described in this subsection 
are any individuals enrolled in the group health plan or health 
insurance coverage described in subsection (a) who have seen the 
provider described in such subsection on a regular basis or who have 
received primary care from such provider.''.

SEC. 406. SHORT-TERM LIMITED DURATION HEALTH INSURANCE COVERAGE.

    (a) In General.--Section 2791(b)(5) of the Public Health Service 
Act (42 U.S.C. 300gg-91(b)(5)) is amended by striking ``but does not 
include'' and inserting ``including''.
    (b) Effective Date.--The amendment made by this section shall apply 
to plan years beginning after December 31, 2020.

SEC. 407. PROTECTING ESSENTIAL HEALTH BENEFITS AND COVERAGE OF 
              PEDIATRIC SERVICES.

    (a) Protecting Essential Health Benefits.--Section 1302(b) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 18022(b)) is 
amended--
            (1) in paragraph (2)(B) and paragraph (3), by striking 
        ``(4)(H)'' each place it appears and inserting ``(4)(I)''; and
            (2) in paragraph (4)--
                    (A) in subparagraph (A)--
                            (i) by striking ``such subsection'' and 
                        inserting ``such paragraph''; and
                            (ii) by inserting ``and coverage in every 
                        category is included'' before the semicolon;
                    (B) by redesignating subparagraphs (E) through (H) 
                as subparagraphs (F) through (I), respectively; and
                    (C) by inserting after subparagraph (D) the 
                following:
                    ``(E) ensure that, to be treated as providing 
                coverage for the essential health benefits described in 
                paragraph (1), a qualified health plan--
                            ``(i) shall not substitute benefits between 
                        categories described such paragraph, as 
                        described in section 156.115(b)(2)(ii) of title 
                        45, Code of Federal Regulations, as in effect 
                        on the day before the date of enactment of the 
                        Consumer Health Insurance Protection Act of 
                        2019;
                            ``(ii) shall provide a wide variety of 
                        classes of prescription drugs on the 
                        prescription drug formulary of such plan;
                            ``(iii) shall, if a medically necessary 
                        drug is not on the prescription drug formulary 
                        of such plan, allow individuals enrolled in 
                        such plan to have access to the drug through an 
                        exceptions process established by the plan; and
                            ``(iv) shall not impose limits on coverage 
                        of habilitative services and devices that are 
                        less favorable than any such limits imposed on 
                        coverage of rehabilitative services and 
                        devices.''.
    (b) Coverage of Pediatric Services.--The Secretary of Health and 
Human Services, in consultation with pediatric service providers, shall 
promulgate a series of recommendations for group health plans and 
health insurance issuers offering group or individual health insurance 
coverage to improve coverage of pediatric services.

SEC. 408. ASSOCIATION HEALTH PLANS.

    (a) Treatment of Association Health Plans.--
            (1) Association health plan defined.--For purposes of this 
        subsection, the term ``association health plan'' means any 
        health insurance coverage that is provided to an association, 
        but not related to employment, and sold to individuals through 
        such association.
            (2) Treatment as individual health insurance coverage.--For 
        purposes of title XXVII of the Public Health Service Act (42 
        U.S.C. 300gg et seq.), part 7 of subtitle B of title I of the 
        Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181 
        et seq.), chapter 100 of the Internal Revenue Code of 1986, and 
        title I of the Patient Protection and Affordable Care Act 
        (Public Law 111-148), health insurance coverage offered through 
        an association health plan shall be treated as individual 
        health insurance coverage if--
                    (A) the coverage is offered to a member of the 
                association other than in connection with a group 
                health plan; or
                    (B) the coverage is offered to a member of the 
                association that is an employer maintaining a group 
                health plan that has fewer than 2 participants who are 
                employees on the first day of the plan year.
            (3) Treatment as health insurance coverage in the small 
        group market.--For purposes of title XXVII of the Public Health 
        Service Act (42 U.S.C. 300gg et seq.), part 7 of subtitle B of 
        title I of the Employee Retirement Income Security Act of 1974 
        (29 U.S.C. 1181 et seq.), chapter 100 of the Internal Revenue 
        Code of 1986, and title I of the Patient Protection and 
        Affordable Care Act (Public Law 111-148), health insurance 
        coverage offered through an association health plan shall, 
        subject to paragraph (2)(B), be treated as health insurance 
        coverage in the small group market if the coverage is offered 
        to a member of the association in connection with a group 
        health plan offered to employers that are small employers, as 
        defined in such applicable Act or Code.
            (4) Preemption.--An association health plan shall be 
        treated as individual health insurance coverage in accordance 
        with paragraph (2) or health insurance coverage in the small 
        group market in accordance with paragraph (3) notwithstanding 
        any applicable State law.
            (5) Effective date.--This subsection shall apply to plan 
        years beginning after December 31, 2020.
    (b) Department of Labor Rule Regarding the Definition of 
``Employer'' Under ERISA.--Beginning with respect to plan years 
beginning after December 31, 2020, the final rule of the Department of 
Labor entitled ``Definition of `Employer' Under Section 3(5) of ERISA--
Association Health Plans'' (83 Fed. Reg. 28912 (June 21, 2018)) shall 
have no force or effect.
                                 <all>