Patients Right to Know Act of 2013

Bill: 113-hr-1205
Sponsor: full_name: Rep. Walden, Greg [R-OR-2]
Introduced: 2013-03-14
Policy area: Health
Subjects: Administrative remedies

Congressional oversight

Consumer affairs

Government studies and investigations

Health care costs and insurance

Health care coverage and access

Health promotion and preventive care

Insurance industry and regulation

Sales and excise taxes

User charges and fees

Women's health
Latest action: action_date: 2013-03-15
text: Referred to the Subcommittee on Health.

Summaries:
action_date: 2013-03-14
action_desc: Introduced in House
text: <p>Patients Right to Know Act of 2013 - Amends the Public Health Service Act to require health plans to include in their annual summary of benefits and coverage explanations: (1) the annual fee on health insurance providers under the Patient Protection and Affordable Care Act, (2) the annual fees imposed on health insurance policies, (3) required contributions by health plans to the reinsurance program, (4) user fees on health plans participating in health insurance exchanges, (5) payments by health plans whose costs are lower than the target amount (premiums collected minus administrative costs), and (6) charges assessed by states on health plans whose enrollees have a lower actuarial risk than the average actuarial risk of all enrollees in a state. Allows such costs to be calculated separately for individual, small group, or large group markets.</p> <p>Requires the Comptroller General (GAO) to study the methods of calculating the impact on average premium costs associated with: (1) guaranteed issuance of coverage and community rated premiums, (2) limitations on age rating, (3) required coverage of women's preventive services, and (4) the requirement that plans cover at least 60% of the actuarial value of essential health benefits.</p>

tv_txt: I 113th CONGRESS 1st Session H. R. 1205 IN THE HOUSE OF REPRESENTATIVES March 14, 2013 Mr. Walden introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend title XXVII of the Public Health Service Act to require health insurance issuers and group health plans to disclose information regarding how certain taxes and fees impact the amount of premiums, and for other purposes.

1. Short title This Act may be cited as the Patients Right to Know Act of 2013 . 2. Protection of certain health insurance disclosures (a) In general Section 2715 of the Public Health Service Act ( 42 U.S.C. 300gg–15 ) is amended by adding at the end the following new subsection: (h) Protection of disclosure of fee and other additional information (1) In general A health insurance issuer or sponsor of a group health plan, with respect to its annual summary of benefits and coverage explanation provided under subsection (d)— (A) shall include (effective for plan years beginning on or after January 1, 2016, and in addition to the information required to be disclosed under this section)— (i) the applicable additional information relating to fees described in paragraph (2); and (ii) the applicable additional information included under paragraph (3)(D); and (B) shall not be subject to any administrative action by the Secretary or by a State authority with respect to any disclosure made on or after the date of the enactment of this subsection of such applicable additional information if the disclosure is made based upon a good faith estimate of such information and is in accordance with such standards as the Secretary may establish to carry out this subsection. (2) Fee information The additional information described in this paragraph, with respect to a health insurance issuer issuing health insurance coverage in the individual, small, or large group market and with respect to the sponsor of a group health plan, is as follows: (A) Fee on health insurance providers The annual fee on health insurance providers under section 9010 of the Patient Protection and Affordable Care Act ( 26 U.S.C. 4001 note). (B) PCORI Tax Fees imposed under subchapter B of chapter 34 of the Internal Revenue Code of 1986 (relating to funding the Patient-Centers Outcome Research Institute). (C) Reinsurance contributions Reinsurance contributions required under section 1341(b) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18061(b) ). (D) Proposed health insurance exchange user fee Fees imposed on health plans relating to participation in an Exchange under subtitle D of title I of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18021 et seq. ). (E) Risk corridor payments Risk corridor payments required under section 1342(b)(2) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18062(b)(2) ). (F) Risk adjustment charges Risk adjustment charges imposed under section 1343(a)(1) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18063(a)(1) ). In the case of health insurance coverage, such costs may be calculated separately for such coverage in the individual market, in the small group market, and in the large group market for the health insurance issuer involved. (3) Other information (A) Study The Comptroller General of the United States shall conduct a study of methods of calculating the impact on average premium costs associated with each of the following: (i) Market impact of guaranteed issue and community rating The requirement for guaranteed issuance of coverage under section 2702 and community rated premiums under section 2701. (ii) Age rating impact The requirement of section 2701(a)(1)(A)(iii) (relating to limitations on age rating). (iii) Women’s preventive services The requirement for coverage of women’s preventive services under section 2713. (iv) Minimum essential health benefits coverage The requirement that coverage provide for at least 60 percent of the actuarial value of essential health benefits under section 1302(d) of the Patient Protection and Affordable Care Act. ( 42 U.S.C. 18022(d) ). (B) Consultation In conducting such study, the Comptroller General shall consult with health insurance issuers and State health insurance commissioners. (C) Report Not later than October 1, 2014, the Comptroller General shall submit to each House of Congress and the Secretary a report on the study conducted under subparagraph (A). (D) Inclusion of additional information After submission of such report, the Secretary may also include in the information required to be disclosed under paragraph (1)(A)(ii) information on the impact on premiums of each of the requirements described in subparagraph (A). (4) Retention of State rate setting authority Nothing in this subsection shall be construed to preempt State authority to regulate, reject, alter, or require additional information in support of rates for health insurance coverage or oversight authority of the Secretary. .