II 113th CONGRESS 2d Session S. 2749 IN THE SENATE OF THE UNITED STATES July 31, 2014 Mrs. Shaheen introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To establish a board of directors and CEO to oversee the Federal Exchange and State Exchanges, and to provide health insurance oversight.

1. Exchange oversight Subtitle D of title I of the Patient Protection and Affordable Care Act (42 U.S.C. 18021 et seq.) is amended by adding at the end the following: 6 Exchange Oversight 1351. Board of directors and CEO (a) In general There is established the Marketplace Health Insurance Corporation headed by a Chief Executive Officer and directed by a Board of Directors, to oversee management of the Federal Exchange and State Exchanges, and to provide health insurance oversight. (b) CEO (1) In general The President shall appoint a Chief Executive Officer, by and with the consent of the Senate, who shall be responsible for administering the Federal Exchange, for overseeing State Exchanges, and for health insurance oversight. (2) Authorities and duties The Chief Executive Officer shall— (A) report directly to the President; (B) be accountable for implementation of the Federal Exchange and oversight of the State Exchanges; (C) be responsible for all Federal health insurance oversight; and (D) serve the public interest of individuals seeking health insurance, serve businesses seeking access to health coverage through the Exchanges, and ensure the efficient operation and function of the Exchanges. (3) Requirement To be eligible for appointment as Chief Executive Officer, an individual shall have a background in health care issues and private-sector management experience. (c) Board of Directors (1) Establishment There is established a Board of Directors of the Marketplace Health Insurance Corporation. (2) Duties The Board of Directors shall advise the Chief Executive Officer on the operation of the Federal Exchange, implementation of the State Exchanges, and health insurance oversight, including— (A) the functionality of healthcare.gov (or any subsequent Internet site), including SHOP exchanges; (B) ensuring that enrollment information is properly transferred from healthcare.gov (or any subsequent Internet site) to State Medicaid agencies; (C) accuracy of enrollee information submitted through the Exchanges; (D) ensuring the accuracy of advanced premium tax credits; (E) ensuring the accuracy of payment to insurers; (F) enhancement of the consumer experience when comparing plans, including out-of-pocket costs, and searching for a specific provider or drug formulary; (G) overseeing the selection of plans offered on the Federal Exchange, including sufficient network adequacy and transparency requirements; (H) providing recommendations to the Secretary of the Treasury with respect to the implementation of section 4980H of the Internal Revenue Code of 1986 and potential policy changes with respect to such section and associated reporting requirements; (I) creating an automated appeals system for healthcare.gov (or any subsequent Internet site); (J) overseeing the transition from a State Exchange to the Federal Exchange; (K) enabling online enrollment in health insurance plans through the Exchanges for small businesses and employee choice for employees of small businesses; (L) overseeing the Federal contracting related to healthcare.gov (or any subsequent Internet site); (M) providing recommendations to the Office of Personal Management on the oversight and administration of the multi-State plan program; and (N) additional matters, as determined by the Secretary of Health and Human Services, the Chief Executive Officer, or President. (3) Membership The Board of Directors shall be comprised of the following: (A) The Secretary of Health and Human Services. (B) The Administrator of the Centers for Medicare & Medicaid Services. (C) The Commissioner of the Internal Revenue Service. (D) The Administrator of the Small Business Administration. (E) Three representatives of the private sector who have demonstrated knowledge in individual health care coverage, small employer health care coverage, administering a public or private health care delivery system, operating complex information system technologies, or promoting health and wellness, appointed by the Comptroller General of the United States. (4) Terms (A) Officers of the Federal Government Each member of the Board of Directors described in subparagraphs (A) through (D) of paragraph (3) shall serve for a term that is concurrent with the member’s term as an officer within the Federal department or agency. (B) Other members Each member of the board described in paragraph (3)(E) shall be appointed for a term of 3 years and may be reappointed for a term of an additional 2 years. (5) Chairperson The Secretary of Health and Human Services shall serve as Chair of the Board of Directors. (d) Technical advisory committee (1) In general To assist the Chief Executive Officer and Board of Directors in carrying out their duties, the Board of Directors shall establish a technical advisory committee. (2) Membership The technical advisory committee shall be comprised of the following: (A) One technical expert from the Centers for Medicare & Medicaid Administration. (B) One representative of the health insurance industry. (C) One representative of health care consumer groups. (D) One representative of the National Association of Insurance Commissioners. (E) One representative of the State Medicaid agencies. (F) One representative from the small business community. (G) One representative of Federal information technology contractors involved in the operation and development of healthcare.gov (or any subsequent Internet site). (H) At the discretion of the Chair of the Board of Directors, up to 2 additional members, selected by the Chair and approved by the Chief Executive Officer. (3) Chair The Chair of the Board of Directors shall appoint one member of the technical advisory committee to serve as Chair of such committee. (4) Terms Each member of the technical advisory committee shall be appointed for a term of 3 years and may be reappointed for a term of an additional 2 years. (e) Work plan and report (1) Work plan Not later than 3 months after the date of enactment of this section, the Chief Executive Officer, in cooperation with the Board of Directors, shall develop a work plan with respect to duties described in subsection (c)(2), indicating the priority and schedule the Board of Directors will take in addressing such duties. The work plan shall be displayed on healthcare.gov (or any subsequent Internet site). (2) Annual report Not later than February 1 of each year, the Chief Executive Officer, in consultation with the Board of Directors, shall submit an annual report to the President and Congress on the status of the Federal Exchange and related insurance oversight, including progress made on the duties of the Chief Executive Officer and Board of Directors under subsection (c)(2) and remaining issues to be addressed to enhance the functionality of healthcare.gov (or any subsequent Internet site). .