II 113th CONGRESS 2d Session S. 2430 IN THE SENATE OF THE UNITED STATES June 4, 2014 Mr. Roberts introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To establish the Office of the Special Inspector General for Monitoring the Affordable Care Act, and for other purposes.

1. Short title This Act may be cited as the Special Inspector General for Monitoring the ACA Act of 2014 or the SIGMA Act of 2014 . 2. Special Inspector General for Monitoring the Affordable Care Act (a) Office of Special Inspector General There is hereby established the Office of the Special Inspector General for Monitoring the Affordable Care Act (in this section, referred to as the Office ) to carry out the duties described under subsection (e). (b) Appointment of Inspector General; removal (1) Appointment The head of the Office is the Special Inspector General for Monitoring the Affordable Care Act (in this section referred to as the Special Inspector General ), who shall be appointed by the President, by and with the advice and consent of the Senate. (2) Qualifications The appointment of the Special Inspector General shall be made solely on the basis of integrity and demonstrated ability in accounting, auditing, financial analysis, law, management analysis, healthcare expertise and financing, public administration, or investigations. (3) Deadline for appointment The appointment of an individual as the Special Inspector General shall be made not later than 30 days after the date of the enactment of this Act. (4) Compensation The annual rate of basic pay of the Special Inspector General shall be the annual rate of basic pay provided for positions at level IV of the Executive Schedule under section 5315 of title 5, United States Code. (5) Prohibition on political activities For purposes of section 7324 of title 5, United States Code, the Special Inspector General shall not be considered an employee who determines policies to be pursued by the United States in the nationwide administration of Federal law. (6) Removal The Special Inspector General shall be removable from office in accordance with the provisions of section 3(b) of the Inspector General Act of 1978 (5 U.S.C. App.). (c) Assistant Inspectors General The Special Inspector General shall, in accordance with applicable laws and regulations governing the civil service— (1) appoint an Assistant Inspector General for Auditing who shall have the responsibility for supervising the performance of auditing activities relating to the duties described under subsection (e); and (2) appoint an Assistant Inspector General for Investigations who shall have the responsibility for supervising the performance of investigative activities relating to such duties. (d) Supervision (1) In general Except as provided under paragraph (2), the Special Inspector General shall report directly to, and be under the general supervision of, the Secretary of Health and Human Services. (2) Independence to conduct investigations and audits No employee or officer of any of the following entities shall prevent or prohibit the Special Inspector General from initiating, carrying out, or completing any audit or investigation related to the duties described under subsection (e) or from issuing any subpoena during the course of any such audit or investigation: (A) The Executive Office of the President and the Office of Personnel Management. (B) The Department of Health and Human Services. (C) The Department of the Treasury. (D) The Social Security Administration, the Department of Homeland Security, the Department of Veterans Affairs, the Department of Defense, the Department of Labor, and the Peace Corps. (E) Any other Federal agency involved in implementing or administering the Affordable Care Act. (e) Duties (1) Oversight of the implementation and administration of the affordable care act It shall be the duty of the Special Inspector General to conduct, supervise, and coordinate audits and investigations of the implementation and administration of programs and activities established under, and payment system changes made by, the Affordable Care Act, including by collecting and summarizing the following: (A) A description of the individual mandate requirement for applicable individuals to maintain minimum essential coverage or pay a penalty under section 5000A of the Internal Revenue Code of 1986, including a description of the number of individuals maintaining such coverage and the number of individuals paying such penalties. (B) A description of any increases or decreases in— (i) premiums for qualified health plans (as defined in section 1301 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18021 )); (ii) deductibles under qualified health plans; and (iii) cost-sharing under qualified health plans, including by co-payments and co-insurance, affecting individuals enrolling in coverage under such plans through an Exchange established under title I of the Patient Protection and Affordable Care Act (including a State-run Exchange, a federally administered Exchange, and a Small Business Health Options Program). (C) A description of any increases or decreases in the maximum out-of-pocket costs affecting individuals enrolling in qualified health plans through such a State-run Exchange, a federally administered Exchange, and a Small Business Health Options Program. (D) A description of any increases or decreases in the size of physician and other health care provider networks affecting individuals enrolling in qualified health plans through such a State-run Exchange, a federally administered Exchange, and a Small Business Health Options Program. (E) A description of any type of health insurance coverage lost because of the treatment under title I of the Patient Protection and Affordable Care Act of grandfathered health plans (as defined in section 1251(e) of such Act ( 42 U.S.C. 18011(e) )). (F) A description of any credits under section 36B of the Internal Revenue Code of 1986 (and the amount (if any) of the advance payment of the credit under section 1412 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18082 )) and any cost-sharing reduction under section 1402 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18071 ) (and the amount (if any) of the advance payment of the reduction under section 1412 of such Act (42 U.S.C. 18082)) provided to individuals enrolling under qualified health plans through an Exchange established under title I of the Patient Protection and Affordable Care Act. (G) A description of any projections, estimates, analysis, goals, or targets made by any employee of the Federal Government or any contractor of the Federal Government in carrying out duties associated with the Patient Protection and Affordable Care Act with respect to the enrollment of individuals in a qualified health plan through an Exchange established under title I of the Patient Protection and Affordable Care Act. (H) A description of the employer mandate requirement that applicable large employers provide eligible employees with minimum essential coverage or pay a fine under section 4980H of the Internal Revenue Code of 1986, including a description of the type and number of employers providing such coverage and the type and number of employers paying such fines. (I) A description of any projections, estimates, analysis, goals, or targets made by any employee of the Federal Government or any contractor of the Federal Government in carrying out duties associated with the Patient Protection and Affordable Care Act with respect to employers providing minimum essential coverage to applicable employees. (J) A description of any reports, meetings, discussions, or materials of any employee of the Federal Government or any contractor of the Federal Government in carrying out duties associated with the Patient Protection and Affordable Care Act relating to any employers converting full-time employees to part-time employees or hiring new part-time employees instead of full-time employees for the purposes of avoiding the fines provided for under the employer mandate requirement described in subparagraph (H). (K) A description of any reports, meetings, discussions, or materials of any employee of the Federal Government or any contractor of the Federal Government in carrying out duties associated with the Patient Protection and Affordable Care Act relating to any employers hiring no more than 50 employees for the purposes of avoiding the requirement to provide minimum essential coverage or pay a fine under the employer mandate requirement described in subparagraph (H). (L) A description of any reports, meetings, discussions, or materials of any employee of the Federal Government or any contractor of the Federal Government in carrying out duties associated with the Patient Protection and Affordable Care Act relating to any employers dropping the health insurance coverage offered to their employees, or employees’ spouses or dependents, for the purposes of avoiding the requirement to provide minimum essential coverage or pay a fine under the employer mandate requirement described in subparagraph (H). (M) A description of the transitional reinsurance program established under section 1341 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18061 ), including a description of reinsurance contributions collected or required to be collected under such program, a description of any reinsurance payments made or required to be made to health insurance issuers under such program, a description of the health insurance coverage and related costs for high-cost individuals for plans related to such program, an explanation of the impact of such reinsurance program on adverse selection in the marketplace, and an explanation of any premium-stabilizing effects of such program. (N) A description of the temporary risk corridors for qualified health plans established under section 1342 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18062 ), including a description of participating plans and the allowable costs and target amounts of such plans, a description of risk corridor ratios of such plans, and a description of payment adjustments made under such program. (O) A description of the permanent risk adjustment program established under section 1343 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18063 ), including a description of any plans participating in such program, a description of any risk adjustment payments made or required to be made under such program, a description of the health insurance coverage and related costs for high-cost individuals for plans related to such program, an explanation of the impact of such program on adverse selection in the marketplace, and an explanation of any premium-stabilizing effects of such program. (P) A list of all contracts awarded under the Affordable Care Act and an analysis of whether Federal contracting procedures were followed when awarding any contract associated with such Act. (Q) A description of the development of the health insurance marketplace for the Internet portal established under section 1103 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18003 ), including a description of the design, features, and security systems of such web portal and a description of all costs associated with such development. (R) A description of any threats, risks, problems, or functionality issues identified by any employee of the Federal Government or any contractor of the Federal Government in carrying out duties associated with the Patient Protection and Affordable Care Act prior to the launch of such web portal on October 1, 2013. (S) A description of any decisionmaking or activities by any employee of the Federal Government or any contractor of the Federal Government in carrying out duties associated with the Patient Protection and Affordable Care Act in response to such threats, risks, problems, or functionality issues. (T) A description of the systems (on the Federal and State levels) in place or in development to allow health insurance issuers and plans and government entities to verify information is accurate for purposes of enrollments in qualified health plans through Exchanges established under title I of the Patient Protection and Affordable Care Act, including that data verification and validation can occur with respect to information provided or stored by individuals, the Department of Health and Human Services, the qualified health plans, States, and other applicable Federal agencies, including for purposes of credits under section 36B of the Internal Revenue Code of 1986 (and the amount (if any) of the advance payment of the credit under section 1412 of the Patient Protection and Affordable Care Act (42 U.S.C. 18082)) and any cost-sharing reduction under section 1402 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18071 ) (and the amount (if any) of the advance payment of the reduction under section 1412 of such Act ( 42 U.S.C. 18082 )). (U) A description of the development of the Federal Data Services Hub, including its design, features, and security systems, and a description of the type of data accessed through such data hub, and a description of the actual storage location of such data accessed through such data hub. (V) A list of the duties and responsibilities assigned to the Internal Revenue Service as a result of the enactment of the Affordable Care Act, a description of any plans of the Internal Revenue Service for how to carry out such duties, and an explanation of the resources and personnel required to carry out such duties, including a description of any new resources or personnel required to carry out such duties not already available to the Internal Revenue Service. (W) A description of any plans of the Internal Revenue Service to verify the eligibility of individuals enrolling in qualified health plans for any credits under section 36B of the Internal Revenue Code of 1986 (and the amount (if any) of the advance payment of the credit under section 1412 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18082 )) and any cost-sharing reduction under section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071) (and the amount (if any) of the advance payment of the reduction under section 1412 of such Act ( 42 U.S.C. 18082 )), including a description of any such verification completed and a description of any such individuals determined to be ineligible. (X) A description of any plans by the Internal Revenue Service to calculate the amount of overpayment of any such credit or reduction for which an individual enrolled in a qualified health plan was determined to be ineligible, including a description of any such calculations completed. (Y) A description of any plans by the Internal Revenue Service to notify individuals determined to be ineligible for such credits or reductions, including a description of such notifications completed. (Z) A description of any plans by the Internal Revenue Service to recapture such overpayments of such credits and reductions for individuals determined to be ineligible, including a description of such recapturing completed. (AA) A description of the impact of the Affordable Care Act on the right of conscience, including on— (i) religious employers and institutions that were not exempted from the mandate issued by the Department of Health and Human Services requiring individual and group health plans to cover sterilization and Food and Drug Administration approved contraceptives; (ii) individuals; and (iii) medical professionals. (BB) A description of abortion coverage offered under qualified health plans purchased through State-run Exchanges, federally administered Exchanges, and Small Business Health Options Programs, including costs associated with such coverage. (CC) A description of any actions by departments or agencies of the Federal Government to delay the programs or activities authorized by the Affordable Care Act, including an explanation from the head of such department or agency of the specific authority used to implement such a delay. (DD) A description of the Independent Payment Advisory Board under section 1899A of the Social Security Act ( 42 U.S.C. 1395kkk ) and any actions taken to alter or reduce the use of medical products, treatments or procedures, including an explanation from the Independent Payment Advisory Board of the reasons for taking such actions, whether such actions could be expected to result in worsened medical outcomes for individuals effected by such alterations or reductions, and an explanation of the medical information used to determine whether such alterations or reductions could be expected to result in such worsened outcomes. (EE) A description of individuals enrolled in the Medicaid program under title XIX of the Social Security Act through an Exchange established under title I of the Patient Protection and Affordable Care Act, including a description of the cost of health care services utilized by such individuals and a description of the cost to States and the cost to the Federal Government to provide health care services to such individuals. (FF) Any additional topic related to the implementation and administration of the Affordable Care Act, the inclusion of which helps to provide the public a full and objective accounting of such law. (2) Data to be included In carrying out the duties described under paragraph (1), the Special Inspector General shall collect and summarize data described under such paragraph according to each type of insurance marketplace and according to the age and gender of individuals enrolling in coverage under qualified health plans through an Exchange established under title I of the Patient Protection and Affordable Care Act. (3) Other duties related to oversight The Special Inspector General shall establish, maintain, and oversee such systems, procedures, and controls as the Special Inspector General considers appropriate to discharge the duties described under paragraph (1). (4) Duties and responsibilities under the Inspector General Act of 1978 In addition to the duties described under paragraphs (1) and (2), the Special Inspector General shall also have the duties and responsibilities of inspectors general under the Inspector General Act of 1978 (5 U.S.C. App.). (f) Coordination of efforts In carrying out the duties, responsibilities, and authorities of the Special Inspector General under this section, the Special Inspector General shall coordinate with, and receive the cooperation of each of the following: (1) The Inspector General of the Department of Health and Human Services. (2) The Inspector General of the Department of the Treasury. (3) The Inspectors General of the Social Security Administration, the Department of Homeland Security, the Department of Veterans Affairs, the Department of Defense, the Department of Labor, and the Peace Corps. (4) The inspector general of any other Federal entity, as determined by the Special Inspector General. (g) Powers and authorities (1) Authority to access materials, request information, compel response, and other authorities under the Inspector General Act of 1978 In carrying out the duties described under subsection (e), the Special Inspector General shall have all of the authorities provided under section 6 of the Inspector General Act of 1978 (5 U.S.C. App.). (2) Exemption from requirement for initial determination by Attorney General For purposes of section 6(e) of the Inspector General Act of 1978 (5 U.S.C. App.), the Special Inspector General shall be considered exempt from the requirement of an initial determination of eligibility by the Attorney General under paragraph (2) of such section. (3) Audit standards The Special Inspector General shall carry out the duties specified under subsection (e)(1) in accordance with section 4(b)(1) of the Inspector General Act of 1978 (5 U.S.C. App.). (h) Personnel, facilities, and other resources (1) Personnel The Special Inspector General may select, appoint, and employ such officers and employees as may be necessary for carrying out the duties of the Special Inspector General, subject to the provisions of title 5, United States Code, governing appointments in the competitive service, and the provisions of chapter 51 and subchapter III of chapter 53 of such title, relating to classification and General Schedule pay rates. (2) Employment of experts and consultants The Special Inspector General may obtain services as authorized by section 3109 of title 5, United States Code, at daily rates not to exceed the equivalent rate prescribed for grade GS–15 of the General Schedule by section 5332 of such title. (3) Contracting authority To the extent and in such amounts as may be provided in advance by appropriations Acts, the Special Inspector General may enter into contracts and other arrangements for audits, studies, analyses, and other services with public agencies and with private persons, and make such payments as may be necessary to carry out the duties of the Special Inspector General. (4) Resources The Secretary of Health and Human Services shall provide the Special Inspector General with appropriate and adequate office space at appropriate locations of the Department of Health and Human Services together with such equipment, office supplies, and communications facilities and services as may be necessary for the operation of such offices, and shall provide necessary maintenance services for such offices and the equipment and facilities located therein. (5) Assistance from Federal agencies (A) In general Upon request of the Special Inspector General for information or assistance from any department, agency, or other entity of the Federal Government (including any entity listed under subsection (d)(2)), the head of such entity shall, insofar as is practicable and not in contravention of any existing law, furnish such information or assistance to the Special Inspector General, or an authorized designee. (B) Reporting of refused assistance (i) Reporting to Health and Human Services and Congress In accordance with clause (ii), as the case may be, whenever information or assistance requested by the Special Inspector General is, in the judgment of the Special Inspector General, unreasonably refused or not provided, the Special Inspector General shall report the circumstances to the Secretary of Health and Human Services and to the appropriate congressional committees without delay. (ii) Reporting to the public on refusal or noncooperation in transparency Whenever any information described in clause (i) is requested by the Special Inspector General and unreasonably refused or not provided, the report to the Secretary of Health and Human Services and the appropriate congressional committees shall be titled Notice of Refusal or Noncooperation in Transparency and shall be published on a publicly available website in an accessible format without delay. (6) Use of personnel, facilities, and other resources of the Office Upon the request of the Special Inspector General, an Inspector General— (A) may detail, on a reimbursable basis, any of the personnel of the Office for the purpose of carrying out this section; and (B) may provide, on a reimbursable basis, any of the facilities or other resources of the Office for the purpose of carrying out this section. (i) Reports (1) Initial report Not later than 120 days after the date of the enactment of this Act, the Special Inspector General shall submit to the appropriate congressional committees and the Secretary of Health and Human Services a report summarizing, for the period beginning on the date of the enactment of the Health Care and Education Reconciliation Act of 2010 and ending on the completion of a fiscal year quarter after the date of enactment of this Act, the activities during such period of the Special Inspector General required under subsection (e). (2) Quarterly reports Beginning with the first full fiscal year quarter after the date of the enactment of this Act, not later than 30 days after the end of each fiscal year quarter, during which the Affordable Care Act is in effect, the Special Inspector General shall submit to the appropriate congressional committees and the Secretary of Health and Human Services a report summarizing, for the period of that quarter and, to the extent possible, the period from the end of such quarter to the time of the submission of the report, the activities during such period of the Special Inspector General required under subsection (e). (3) Comments on report Not later than 30 days after receipt of a report under this subsection, the Secretary of Health and Human Services shall submit to the appropriate congressional committees any comments on the matters covered by the report. (4) Public availability The Special Inspector General shall publish on a publicly available website each report described under this subsection and any comments on the matters covered by the report submitted pursuant to paragraph (3). (5) Protected information To the extent possible, information submitted in any report required under this subsection shall be in a form that is not prohibited from disclosure under section 552a of title 5, United States Code (commonly known as the Privacy Act of 1974). (6) Aggregated information The Special Inspector General shall, to the maximum extent possible, aggregate any personally identifiable information submitted in a report required under this subsection. (j) Termination The Office of the Special Inspector General shall terminate on the date on which the final report required by subsection (h) is submitted for the last year the Affordable Care Act is in effect. (k) Definitions In this section: (1) Affordable Care Act The term Affordable Care Act means the Patient Protection and Affordable Care Act and title I and subtitle B of title II of the Health Care and Education Reconciliation Act of 2010. (2) Appropriate congressional committees The term appropriate congressional committees means— (A) the Committees on Appropriations, the Budget, Education and the Workforce, Energy and Commerce, Homeland Security, the Judiciary, Oversight and Government Reform, Small Business, and Ways and Means of the House of Representatives; and (B) the Committees on Appropriations, the Budget, Commerce, Science, and Transportation, Finance, Health, Education, Labor, and Pensions, Homeland Security and Governmental Affairs, the Judiciary, and Small Business and Entrepreneurship of the Senate.