116 S1213 IS: Consumer Health Insurance Protection Act of 2019
U.S. Senate
2019-04-11
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

		II
		116th CONGRESS1st Session
		S. 1213
		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.

		1.Short title
 This Act may be cited as the Consumer Health Insurance Protection Act of 2019. 2.Table of contentsThe 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.

		ILimiting insurer profits and preventing unreasonable premium increases
			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.
 102.Ensuring that consumers get value for their dollarsThe 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 generalBeginning 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 increasesIn 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 programsA 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. 103.Effective dateThe amendments made by this title shall apply to plan years beginning after December 31, 2020.
			IIMaking health insurance coverage affordable
			201.Enhancement of premium assistance credit
				(a)Use of gold level plan for benchmark
 (1)In generalClause (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 affordabilitySection 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 amendmentsSubparagraphs (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 generalSection 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 paymentsClause (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 generalSubparagraph (A) of section 36B(b)(3) of the Internal Revenue Code of 1986 is amended to read as follows:

 (A)Applicable percentageThe 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 householdincome (expressed as a percent of poverty line) within thefollowing income tier:The initialpremiumpercentage is—The finalpremiumpercentage is—

											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 amendmentsSubsections (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 generalClause (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 dateThe 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 generalSection 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 paymentFor 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 dateThe amendment made by this subsection shall apply to taxable years beginning after December 31, 2019.
 (f)Effective dateThe amendments made by this section shall apply to taxable years beginning after December 31, 2020. 202.Enhancements for reduced cost-sharing (a)Modification of amount (1)In generalSection 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 limitsThe 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 reductionThe 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)FundingSection 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)FundingOut 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..
				203.Cap on prescription drug cost-sharing
 (a)Qualified health plansSection 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)2021For 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 generalIn 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 amountIf 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 plansSection 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 dateThe amendments made by subsections (a) and (b) shall take effect with respect to plans beginning after December 31, 2020.
				204.Standardized options in the bronze, silver, and gold levels of coverage
 (a)In generalSection 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 optionIn 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)StateEach State may establish a standardized option for the bronze, silver, and gold levels of coverage.
 (ii)SecretaryThe 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)UpdatesThe Secretary shall annually update any standardized option established by the Secretary under clause (ii).
									(C)Deductible-exempt services
 (i)In generalExcept 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 coverageThe 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)DisplayEach Exchange operated by a State shall preferentially display the standardized options offered in such State on the website of the Exchange.
								.
 (b)Effective dateThe amendments made by this section shall apply to plans beginning after December 31, 2020. 205.Deductible-exempt services for group health plans and group health insurance coverage (a)In generalSection 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 generalSubject 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)RegulationsThe 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 dateThe amendments made by this section shall apply to plans beginning after December 31, 2020. 206.Clarification regarding determination of affordability of employer-sponsored minimum essential coverage (a)Special rule for employer-Sponsored minimum essential coverageClause (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 generalExcept 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 employeeIn 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 membersIn 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 dateThe amendments made by this section shall apply to taxable years beginning after December 31, 2020. IIIEnsuring access to care 301.Network adequacy requirements (a)In generalSection 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 generalA 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)EstablishmentThe 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 organizationsThe 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)JustificationA 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)ReviewThe 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 generalIn 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)ReviewA 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 generalA 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-sharingA 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 dateThe amendments made by subsection (a) shall apply to plans beginning after December 31, 2020. (c)Grants for State network adequacy reviews (1)In generalThe 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 appropriationsThere 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 generalNot 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 recommendationsThe 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.
						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 generalSection 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 generalA 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 describedAn 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)NotificationThe 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)WaiverThe 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)DefinitionsIn this paragraph: (i)Applicable areaThe 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)ExchangeThe 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 marketThe term group market has the meaning given such term in section 1304 of the Patient Protection and Affordable Care Act. (iv)Health insurance coverageThe term health insurance coverage has the meaning given the term in section 2791(b) of the Public Health Service Act.
 (v)Individual marketThe term individual market has the meaning given such term in section 1304 of the Patient Protection and Affordable Care Act. (vi)Qualified health planThe term qualified health plan has the meaning given that term in section 1301(a) of the Patient Protection and Affordable Care Act..
 (2)Effective dateThe 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 generalSection 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 dateThe amendments made by this subsection shall apply to contracts entered into or renewed after December 31, 2020.
					303.Enrollment in Exchanges
 (a)Open enrollment and special enrollment periodsSection 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-EnrollmentPart 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:

						1314.Consumer protections regarding automatic re-enrollment
							(a)Consent To avoid automatic re-Enrollment for individuals losing eligibility for premium assistance
 creditsThe 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 plansIn 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-EnrollmentAny 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 generalThe 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 coverageIn 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 dateThe amendments made by this section shall apply to plan years beginning after the date of enactment of this Act.
 (d)StudyThe 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.
 304.Marketing and outreach for Exchanges operated by the SecretaryPart 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:

					1315.Marketing and outreach for Exchanges operated by the Secretary
 (a)In generalOut 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 2020There 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 yearsTo 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)AvailabilityThe amounts appropriated under paragraphs (1) and (2) shall remain available until expended.. 305.Navigator programSection 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)PreferenceAn 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..
					IVStrengthening consumer health insurance protections
			401.Prohibiting discriminatory premiums based on tobacco use
 (a)In generalSection 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 dateThe amendments made by this section shall apply to plan years beginning after December 31, 2020.
				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. 403.Patient protections (a)In generalSection 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)ReimbursementA 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 generalA 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-sharingA 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 generalA 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-sharingA 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)CircumstanceA 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 careA 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)DefinitionsFor purposes of this subsection: (A)Active course of treatmentThe 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 providerThe 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 generalA 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 constructionNothing 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 dateThe amendments made by this section shall apply to plan years beginning after December 31, 2020. 404.Limitation on balance billing for emergency services (a)In generalA 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)EnforcementThe 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)DefinitionsIn this section: (1)Cost-sharingThe 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 serviceThe 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 coverageThe 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)SecretaryThe term Secretary means the Secretary of Health and Human Services. (d)Effective dateThis section shall apply to plan years beginning after December 31, 2020.
 405.Notification of provider terminationsSubpart 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:

					2730.Notification of provider terminations
 (a)In generalBeginning 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)IndividualsThe 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.
						.
			406.Short-term limited duration health insurance coverage
 (a)In generalSection 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 dateThe amendment made by this section shall apply to plan years beginning after December 31, 2020. 407.Protecting essential health benefits and coverage of pediatric services (a)Protecting essential health benefitsSection 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 servicesThe 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.
				408.Association health plans
				(a)Treatment of association health plans
 (1)Association health plan definedFor 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 coverageFor 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 marketFor 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)PreemptionAn 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 dateThis 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.


110 HR 1503 : Avra/Black Wash Reclamation and

U.S. House of Representatives
2007-07-24
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

		IIB
		110th CONGRESS
		1st Session
		H. R. 1503
		IN THE SENATE OF THE UNITED
		  STATES

			July 24, 2007
			 Received; read twice and referred to the
			 Committee on Energy and Natural
			 Resources

		AN ACT
		To amend the Reclamation Wastewater and
		  Groundwater Study and Facilities Act to authorize the Secretary of the Interior
		  to participate in the Avra/Black Wash Reclamation and Riparian Restoration
		  Project.

		1.Short titleThis Act may be cited as the
			 Avra/Black Wash Reclamation and
			 Riparian Restoration Project.
		2.Project
			 authorization
			(a)In
			 generalThe Reclamation Wastewater and Groundwater Study and
			 Facilities Act (Public Law 102–575, title XVI;
			 43 U.S.C. 390h et
			 seq.) is amended by adding at the end the following:

					16__.AVRA/BLACK WASH
				RECLAMATION AND RIPARIAN RESTORATION PROJECT, PIMA COUNTY, ARIZONA
						(a)AuthorizationThe
				Secretary, in cooperation with Pima County, Arizona, may participate in the
				planning, design, and construction of water recycling facilities and to enhance
				and restore riparian habitat in the Black Wash Sonoran Desert ecosystem in Avra
				Valley west of the metropolitan Pima County area.
						(b)Cost
				sharingThe Federal share of the cost of the project described in
				subsection (a) shall not exceed 25 percent of the cost of the project.
						(c)LimitationFederal
				funds provided under this section shall not be used for operation or
				maintenance of the project described in subsection (a).
						(d)Authorization of
				appropriationsThere is authorized to be appropriated to carry
				out this section $14,000,000.
						(e)Use of
				fundsFederal funds provided
				under this section shall only be used for the design, planning and construction
				of water-related
				infrastructure.
						.
			(b)Clerical
			 amendmentThe table of sections for
			 Public Law
			 102–575 is amended by inserting after the last item relating to
			 title XVI the following:

						Sec. 16__. Avra/Black Wash Reclamation and
				Riparian Restoration Project, Pima County,
				Arizona.

					.

			Passed the House of
			 Representatives July 23, 2007.
			Lorraine C. Miller,
			Clerk.Deborah M. Spriggs,
			Deputy Clerk.


		III
		111th CONGRESS
		2d Session
		S. CON. RES. 70
		IN THE SENATE OF THE UNITED STATES

			August 5, 2010
			Ms. Collins (for
			 herself, Mr. Lautenberg,
			 Mr. Burr, Mr.
			 Lieberman, Mr. Akaka, and
			 Mr. Inouye) submitted the following
			 concurrent resolution; which was referred to the
			 Committee on Foreign
			 Relations

		CONCURRENT RESOLUTION
		Supporting the observance of Spirit
		  of ’45 Day.

		Whereas, on August 14, 1945, the people of the United
			 States received word of the end of World War II;
		Whereas on that day, people in the United States and
			 around the world greeted the news of the Allies’ noble victory with joyous
			 celebration, humility, and spiritual reflection;
		Whereas the victory marked the culmination of an
			 unprecedented national effort that defeated the forces of aggression, brought
			 freedom to subjugated nations, and ended the horrors of the Holocaust;
		Whereas these historic accomplishments were achieved
			 through the collective service and personal sacrifice of the people of the
			 United States, both those who served in uniform and those who supported them on
			 the home front;
		Whereas more than 400,000 Americans gave their lives in
			 service to their country during World War II;
		Whereas August 14, 1945, marked not only the end of the
			 war, but also the beginning of an unprecedented era of rebuilding in which the
			 United States led the effort to restore the shattered nations of the Allies and
			 their enemies alike and to create institutions to work towards a more peaceful
			 global community;
		Whereas the men and women of the World War II generation
			 created an array of organizations and institutions during the postwar era which
			 helped to strengthen American democracy by promoting civic engagement,
			 volunteerism, and service to community and country;
		Whereas the courage, dedication, self-sacrifice, and
			 compassion of the World War II generation have inspired subsequent generations
			 in the United States Armed Forces, including the men and women currently in
			 service in Iraq, Afghanistan, and around the world;
		Whereas the entire World War II generation, military and
			 civilian alike, has provided a model of unity and community that serves as a
			 source of inspiration for current and future generations of Americans to come
			 together to work for the continued betterment of the United States and the
			 world; and
		Whereas the second Sunday in August has been proposed as
			 Spirit of ’45 Day to commemorate the anniversary of the end of
			 World War II on August 14, 1945: Now, therefore, be it

		That Congress supports the observance
			 of Spirit of ’45 Day.


117 S163 IS: Telecommunications Skilled Workforce Act
U.S. Senate
2021-02-02
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

II117th CONGRESS1st SessionS. 163IN THE SENATE OF THE UNITED STATESFebruary 2, 2021Mr. Thune (for himself, Mr. Tester, Mr. Peters, Mr. Wicker, and Mr. Moran) introduced the following bill; which was read twice and referred to the Committee on Commerce, Science, and TransportationA BILLTo address the workforce needs of the telecommunications industry.1.Short titleThis Act may be cited as the Telecommunications Skilled Workforce Act.2.Telecommunications interagency working group(a)In generalPart I of title III of the Communications Act of 1934 (47 U.S.C. 301 et seq.) is amended by adding at the end the following:344.Telecommunications interagency working group(a)DefinitionsIn this section:(1)5GThe term 5G, with respect to wireless infrastructure and wireless technology, means fifth-generation wireless infrastructure and wireless technology. (2)Rural areaThe term rural area means any area other than—(A)a city, town, or incorporated area that has a population of more than 20,000 inhabitants; or(B)an urbanized area adjacent to a city or town that has a population of more than 50,000 inhabitants.(3)Telecommunications interagency working groupThe term telecommunications interagency working group means the interagency working group established under subsection (b).(b)EstablishmentNot later than 60 days after the date of enactment of this section, the Chairman of the Commission, in consultation with the Secretary of Labor, shall establish within the Commission an interagency working group to develop recommendations to address the workforce needs of the telecommunications industry.(c)DutiesIn developing recommendations under subsection (b), the telecommunications interagency working group shall—(1)determine whether, and if so how, any Federal laws (including regulations), guidance, policies, or practices, or any budgetary constraints, inhibit institutions of higher education (as defined in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001)) or for-profit businesses from establishing, adopting, or expanding programs intended to address the workforce needs of the telecommunications industry, including the workforce needed to build and maintain the 5G wireless infrastructure necessary to support 5G wireless technology;(2)identify potential policies and programs that could encourage and improve coordination among Federal agencies, between Federal agencies and States, and among States, on telecommunications workforce needs;(3)identify ways in which existing Federal programs, including programs that help facilitate the employment of veterans and military personnel transitioning into civilian life, could be leveraged to help address the workforce needs of the telecommunications industry;(4)identify ways to encourage individuals and for-profit businesses to participate in qualified industry-led workforce development programs, including the Telecommunications Industry Registered Apprenticeship Program;(5)identify ways to improve recruitment in qualified industry-led workforce development programs, including the Telecommunications Industry Registered Apprenticeship Program and other industry-recognized apprenticeship programs; and(6)identify Federal incentives that could be provided to institutions of higher education, for-profit businesses, State workforce development boards established under section 101 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3111), or other relevant stakeholders to establish or adopt programs, or expand current programs, to address the workforce needs of the telecommunications industry, including such needs in rural areas.(d)MembersThe telecommunications interagency working group shall be composed of representatives of such Federal agencies and relevant non-Federal industry stakeholder organizations as the Chairman of the Commission, in consultation with the Secretary of Labor, considers appropriate, including—(1) a representative of the Department of Education, appointed by the Secretary of Education;(2)a representative of the National Telecommunications and Information Administration, appointed by the Assistant Secretary of Commerce for Communications and Information;(3)a representative of the Department of Commerce, appointed by the Secretary of Commerce;(4)a representative of the Commission, appointed by the Chairman of the Commission;(5)a representative of the Telecommunications Industry Registered Apprenticeship Program, appointed by the Secretary of Labor;(6)a representative of a telecommunications industry association, appointed by the Chairman of the Commission;(7)a representative of an Indian Tribe or Tribal organization, appointed by the Secretary of Labor;(8)a representative of a rural telecommunications carrier, appointed by the Chairman of the Commission;(9)a representative of a telecommunications contractor firm, appointed by the Chairman of the Commission;(10)a representative of a minority institution (as defined in section 365 of the Higher Education Act of 1965 (20 U.S.C. 1067k)), appointed by the Secretary of Education; and(11)a representative of a labor organization, appointed by the Secretary of Labor.(e)No compensationA member of the telecommunications interagency working group shall serve without compensation.(f)Report to CongressNot later than 180 days after the date on which the telecommunications interagency working group is established, the working group shall submit a report containing recommendations to address the workforce needs of the telecommunications industry to—(1)the Committee on Commerce, Science, and Transportation of the Senate;(2)the Committee on Health, Education, Labor, and Pensions of the Senate;(3)the Committee on Energy and Commerce of the House of Representatives; and(4)the Committee on Education and Labor of the House of Representatives.(g)Nonapplicability of FACAThe Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the telecommunications interagency working group..(b)SunsetSection 344 of the Communications Act of 1934, as added by subsection (a), shall be repealed on the day after the date on which the interagency working group established under subsection (b) of that section submits the report to Congress under subsection (f) of that section.3.Telecommunications workforce guidance Not later than 270 days after the date of enactment of this Act, the Chairman of the Federal Communications Commission, in consultation with the Secretary of Labor, shall establish and issue guidance on how States can address the workforce needs of the telecommunications industry, including guidance on how a State workforce development board established under section 101 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3111) can— (1)utilize Federal resources available to States to meet the workforce needs of the telecommunications industry; and(2)promote and improve recruitment in qualified industry-led workforce development programs, including the Telecommunications Industry Registered Apprenticeship Program.4.GAO assessment of workforce needs of the telecommunications industry(a)DefinitionsIn this section:(1)5GThe term 5G, with respect to wireless infrastructure and wireless technology, means fifth-generation wireless infrastructure and wireless technology. (2)Appropriate congressional committeesThe term appropriate congressional committees means—(A)the Committee on Commerce, Science, and Transportation of the Senate;(B)the Committee on Health, Education, Labor, and Pensions of the Senate;(C)the Committee on Energy and Commerce of the House of Representatives; and(D)the Committee on Education and Labor of the House of Representatives.(3)Broadband infrastructureThe term broadband infrastructure means any buried, underground, or aerial facility, and any wireless or wireline connection, that enables users to send and receive voice, video, data, graphics, or any combination thereof.(b)ReportNot later than 180 days after the date of enactment of this Act, the Comptroller General of the United States shall submit to the appropriate congressional committees a report that estimates the number of skilled telecommunications workers that will be required to build and maintain—(1)broadband infrastructure in rural areas; and(2)the 5G wireless infrastructure needed to support 5G wireless technology.


117 HR 4263 IH: Patient Parity Protection Act of 2021
U.S. House of Representatives
2021-06-30
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I117th CONGRESS1st SessionH. R. 4263IN THE HOUSE OF REPRESENTATIVESJune 30, 2021Mr. Gottheimer (for himself and Mr. Pascrell) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concernedA BILLTo amend title XVIII of the Social Security Act to provide for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program for certain departments of a provider if such provider was forced to relocate its campus.1.Short titleThis Act may be cited as the Patient Parity Protection Act of 2021.2.Providing for an exception to the definition of an off-campus outpatient department of a provider under the Medicare program to account for forced campus relocations of providersSection 1833(t)(21)(B) of the Social Security Act (42 U.S.C. 1395l(t)(21)(B)) is amended by adding at the end the following new clause:(ix)Exception for on-campus departments converted to off-campus departmentsFor purposes of paragraph (1)(B)(v) and this paragraph and with respect to applicable items and services furnished during 2020 or a subsequent year, the term off-campus outpatient department of a provider also shall not include a department of a provider (as so defined) that is not described in clause (ii) if—(I)the Secretary receives from the provider an attestation (pursuant to section 413.65(b)(3) of title 42, Code of Federal Regulations) not later than 60 days after the date of the enactment of this clause that such department met the requirements of a department of a provider located on the campus (as defined in such section 413.65(a)(2)) of such provider or within the distance (described in such definition of campus) from a remote location of a hospital facility (as defined in such section 413.65(a)(2)) specified in such section 413.65 as of November 1, 2015;(II)such provider was forced to relocate its campus (as so defined) from the location of such campus as of November 1, 2015, due to such campus’ inability to meet the health care needs of such provider’s patient population, as demonstrated by a certificate of need or equivalent approval document issued by the State agency licensing such provider at such location; and(III)the department continues to furnish applicable items and services at the same address at which such items and services were furnished as of November 1, 2015..


I
One Hundred Twelfth Congress of the United States of America At the Second SessionBegun and held at the City of Washington on Tuesday, the third day of January, two thousand and twelve
H. R. 4849

AN ACT
To direct the Secretary of the Interior to issue commercial use authorizations to commercial stock operators for operations in designated wilderness within the Sequoia and Kings Canyon National Parks, and for other purposes.

1.Short titleThis Act may be cited as the Sequoia and King Canyon National Parks Backcountry Access Act.
2.Commercial services authorizations in wilderness within the sequoia and kings canyon national parks
(a)Continuation of authorityUntil the date on which the Secretary of the Interior (referred to in this Act as the Secretary) completes any analysis and determination required under the Wilderness Act (16 U.S.C. 1131 et seq.), the Secretary shall continue to issue authorizations to provide commercial services for commercial stock operations (including commercial use authorizations and concession contracts) within any area designated as wilderness in the Sequoia and Kings Canyon National Parks (referred to in this section as the Parks) at use levels determined by the Secretary to be appropriate and subject to any terms and conditions that the Secretary determines to be appropriate.
(b)Wilderness Stewardship PlanNot later than 3 years after the date of enactment of this Act, the Secretary shall complete a wilderness stewardship plan with respect to the Parks.
(c)Termination of authorityThe authority of the Secretary to issue authorizations under subsection (a) shall terminate on the earlier of—
(1)the date on which the Secretary begins to issue authorizations to provide commercial services for commercial stock operations within any areas designated as wilderness in the Parks, as provided in a record of decision issued in accordance with a wilderness stewardship plan completed under subsection (b); or
(2)the date that is 4 years after the date of enactment of this Act.
 Speaker of the House of Representatives.Vice President of the United States and President of the Senate.


		II
		112th CONGRESS
		1st Session
		S. 640
		IN THE SENATE OF THE UNITED STATES

			March 17, 2011
			Mr. Akaka (for himself
			 and Mr. Carper) introduced the following
			 bill; which was read twice and referred to the
			 Committee on Foreign
			 Relations

		A BILL
		To underscore the importance of international nuclear
		  safety cooperation for operating power reactors, encouraging the efforts of the
		  Convention on Nuclear Safety, supporting progress in improving nuclear safety,
		  and enhancing the public availability of nuclear safety information.

		1.Short
			 titleThis Act may be cited as
			 the Furthering International Nuclear
			 Safety Act of 2011.
		2.PurposesThe purposes of this Act are as
			 follows:
			(1)To recognize the
			 paramount importance of international nuclear safety cooperation for operating
			 power reactors.
			(2)To further the
			 efforts of the Convention on Nuclear Safety as a vital international forum on
			 nuclear safety.
			(3)To support
			 progress in improving nuclear safety for countries that currently have or are
			 considering the development of a civilian nuclear power program.
			(4)To enhance the
			 public availability of nuclear safety information.
			3.DefinitionsIn this Act:
			(1)Appropriate
			 congressional committeesThe term appropriate congressional
			 committees means—
				(A)the Committee on
			 Foreign Relations of the Senate;
				(B)the Committee on
			 Environment and Public Works of the Senate;
				(C)the Committee on
			 Homeland Security and Governmental Affairs of the Senate;
				(D)the Committee on
			 Foreign Affairs of the House of Representatives;
				(E)the Committee on
			 Energy and Commerce of the House of Representatives; and
				(F)the Committee on
			 Oversight and Government Reform of the House of Representatives.
				(2)ConventionThe
			 term Convention means the Convention on Nuclear Safety, done at
			 Vienna September 20, 1994, and ratified by the United States April 11,
			 1999.
			(3)MeetingThe
			 term meeting means a meeting as described under Article 20, 21, or
			 23 of the Convention.
			(4)National
			 reportThe term national report means a report as
			 described under Article 5 of the Convention.
			(5)PartyThe
			 term party means a nation that has formally joined the Convention
			 through ratification or other means.
			(6)Summary
			 reportThe term summary report means a report as
			 described under Article 25 of the Convention.
			4.United States
			 efforts to further international nuclear safetyThe President shall instruct the United
			 States official serving as the delegate to the meetings of the Convention on
			 Nuclear Safety pursuant to Article 24 of the Convention to use the voice, vote,
			 and influence of the United States, while recognizing that these efforts by
			 parties are voluntary, to encourage, where appropriate—
			(1)parties to more
			 systematically assess where and how they have made progress in improving
			 safety, including where applicable through the incorporation of performance
			 metric tools;
			(2)parties to
			 increase the number of national reports they make available to the public by
			 posting them to a publicly available Internet Web site of the International
			 Atomic Energy Agency (IAEA);
			(3)parties to expand
			 public dissemination of written answers to questions raised by other parties
			 about national reports by posting the information to a publicly available
			 Internet Web site of the IAEA;
			(4)the IAEA to
			 further its support of the Convention, upon request by a party and where
			 funding is available, by—
				(A)providing
			 assistance to parties preparing national reports;
				(B)providing
			 additional assistance to help prepare for and support meetings, including
			 language translation services; and
				(C)providing
			 additional technical support to improve the safety of civilian nuclear power
			 programs; and
				(5)all countries
			 that currently have or are considering the establishment of a civilian nuclear
			 power program to formally join the Convention.
			5.Strategic
			 planNot later than 180 days
			 after the date of the enactment of this Act, the Secretary of State, in
			 cooperation with the heads of other relevant United States Government agencies,
			 shall submit to the appropriate congressional committees the United States
			 Government’s strategic plan and prioritized goals for international nuclear
			 safety cooperation for operating power reactors.
		6.Reports
			(a)Report on
			 implementation of strategic plan
				(1)In
			 generalNot later than 180
			 days after the issuance of each of the first two summary reports of the
			 Convention issued after the date of the enactment of this Act, the Secretary of
			 State, in cooperation with the heads of other relevant United States Government
			 agencies, shall submit to the appropriate congressional committees a report
			 that—
					(A)describes the
			 status of implementing the strategic plan and achieving the goals set forth in
			 section 5; and
					(B)enumerates the
			 most significant concerns of the United States Government regarding worldwide
			 nuclear safety and describes the extent to which the strategic plan addresses
			 these concerns.
					(2)FormThe
			 report required under paragraph (1) shall be submitted in unclassified form,
			 but may contain a classified annex.
				(b)Report on
			 United States efforts To further international nuclear safetyNot
			 later than 180 days after the issuance of each of the first two summary reports
			 of the Convention issued after the date of the enactment of this Act, the
			 United States official serving as the delegate to the meetings of the
			 Convention shall submit to the appropriate congressional committees a report
			 providing the status of achieving the actions set forth in section 4.


		I
		111th CONGRESS
		1st Session
		H. R. 392
		IN THE HOUSE OF REPRESENTATIVES

			January 9, 2009
			Mr. Blunt (for
			 himself, Mr. Kirk,
			 Mr. Hensarling,
			 Mr. McHenry,
			 Mr. Conaway,
			 Mr. Franks of Arizona,
			 Mr. Akin, Mr. Upton, Mr.
			 Sensenbrenner, Mr. Petri,
			 Mr. Jones,
			 Mr. Manzullo,
			 Mr. Marchant,
			 Mr. Whitfield,
			 Ms. Fallin,
			 Mr. Kline of Minnesota,
			 Mr. Roskam,
			 Mr. Linder,
			 Mr. Herger,
			 Mr. Cole, and
			 Mr. Rehberg) introduced the following
			 bill; which was referred to the Committee
			 on Energy and Commerce

		A BILL
		To amend the Clean Air Act to provide for a reduction in
		  the number of boutique fuels, and for other purposes.

		1.Short titleThis Act may be cited as the
			 Boutique Fuel Reduction Act of
			 2009.
		2.Temporary
			 waiversSection
			 211(c)(4)(C)(ii)(II) of the Clean Air Act (42 U.S.C. 7545(c)(4)(C)(ii)(II)) is
			 amended by inserting after equipment failure the following:
			 , unexpected problems with distribution or delivery equipment that is
			 necessary for transportation and delivery of fuel or fuel
			 additives.
		3.Reduction in
			 number of boutique fuelsSection 211(c)(4)(C) of the Clean Air Act
			 (42 U.S.C. 7545(c)(4)(C)) is amended as follows:
			(1)By redesignating the clause (v) added by
			 section 1541(b) of the Energy Policy Act of 2005 (Public Law 109–58; 119 Stat.
			 1106) as clause (vi).
			(2)In
			 clause (vi) (as so redesignated)—
				(A)in subclause (I)
			 by striking approved under this paragraph as of September 1, 2004, in
			 all State implementation plans and by inserting in lieu there of
			 set forth on the list published under subclause (II) (or on the revised
			 list referred to in subclause (III) if the list has been revised)
			 ;
				(B)by amending
			 subclause (III) to read as follows:

						(III)The Administrator shall, after notice and
				opportunity for comment, remove a fuel from the list published under subclause
				(II) if the Administrator determines that such fuel has ceased to be included
				in any State implementation plan or is identical to a Federal fuel control or
				prohibition promulgated and implemented by the Administrator. The Administrator
				shall publish a revised list reflecting the reduction in the number of
				fuels.
						;
				(C)in subclause (IV)
			 by striking Subclause (I) and inserting Neither subclause
			 (I) nor subclause (V) and by striking not and by
			 striking if such new fuel; and
				(D)by amending
			 subclause (IV) to read as follows:

						(IV)Subclause (I) shall not limit the
				Administrator's authority to approve a control or prohibition respecting any
				new fuel under this paragraph in a State implementation plan or revision to a
				State implementation plan if such new fuel completely replaces a fuel on the
				list published under subclause (II) (or the revised list referred to in
				subclause (III) if the list has been revised) and if the Administrator, after
				consultation with the Secretary of Energy, publishes in the Federal Register
				after notice and comment a finding that, in the Administrator's judgment, such
				control or prohibition respecting such new fuel will not cause fuel supply or
				distribution interruptions or have a significant adverse impact on fuel
				producibility in the affected area or contiguous
				areas.
						.


		II
		112th CONGRESS
		1st Session
		S. 458
		IN THE SENATE OF THE UNITED STATES

			March 2, 2011
			Mrs. Gillibrand
			 introduced the following bill; which was read twice and referred to the
			 Committee on Health, Education, Labor,
			 and Pensions

		A BILL
		To amend the Federal Food, Drug, and Cosmetic Act to
		  establish and enforce a maximum somatic cell count requirement for fluid
		  milk.

		1.Short titleThis Act may be cited as the
			 Milk Quality Standards Act of
			 2011.
		2.Maximum somatic
			 cell countChapter IV of the
			 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 341 et seq.) is amended by
			 adding at the end the following:

				424.Maximum
				somatic cell count
					(a)Maximum somatic
				cell count
						(1)In
				generalThe maximum somatic cell count for all dairy products
				sold, transported, or offered for sale or transport, in interstate commerce
				shall be 400,000 cells per milliliter of fluid milk, or equivalent, as
				determined by the Secretary.
						(2)AdjustmentThe
				Secretary, after consideration of any recommendations submitted by the National
				Conference on Interstate Milk Shipments, may lower the maximum somatic cell
				count established under paragraph (1).
						(b)CalculationThe
				Secretary shall promulgate regulations to require that the calculation of a
				herd average somatic cell count under this section shall be made using a
				geometric, rather than an arithmetic, mean.
					(c)RevisionThe
				Secretary, in consultation with the National Conference on Interstate Milk
				Shipments, shall revise the Pasteurized Milk Ordinance to take into account the
				requirement under subsection (a) and any regulations promulgated under
				subsection (b).
					(d)Enforcement
						(1)In
				generalBeginning on the date that is 18 months after the date of
				enactment of this section, any person that sells, transports, or offers for
				sale or transport, in interstate commerce any dairy product in violation of
				subsection (a) shall be subject to a civil penalty in an amount determined in
				accordance with the regulations promulgated under paragraph (2).
						(2)RegulationsNot
				later than 18 months after the date of enactment of this section, the Secretary
				shall promulgate regulations establishing a schedule of civil penalties for
				violations of subsection
				(a).
						.


117 HR 4659 IH: Balancing the Rights Of Web Surfers Equally and Responsibly Act of 2021
U.S. House of Representatives
2021-07-22
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I117th CONGRESS1st SessionH. R. 4659IN THE HOUSE OF REPRESENTATIVESJuly 22, 2021Mrs. McClain (for herself, Mr. Babin, Mr. Cawthorn, Mr. Grothman, Mr. Owens, and Mr. Steube) introduced the following bill; which was referred to the Committee on Energy and CommerceA BILLTo require providers of broadband internet access service and edge services to clearly and conspicuously notify users of the privacy policies of those providers, to give users opt-in or opt-out approval rights with respect to the use of, disclosure of, and access to user information collected by those providers based on the level of sensitivity of the information, and for other purposes.1.Short titleThis Act may be cited as the Balancing the Rights Of Web Surfers Equally and Responsibly Act of 2021 or the BROWSER Act of 2021.2.DefinitionsIn this Act:(1)Broadband internet access service(A)In generalThe term broadband internet access service means a mass-market retail service by wire or radio that provides the capability to transmit data to and receive data from all or substantially all internet endpoints, including any capabilities that are incidental to and enable the operation of the communications service, but excluding dial-up internet access service.(B)Functional equivalent; evasionThe term broadband internet access service includes any service that—(i)the Commission finds to be providing a functional equivalent of the service described in subparagraph (A); or(ii)is used to evade the protections set forth in this Act.(2)CommissionThe term Commission means the Federal Trade Commission.(3)Covered serviceThe term covered service means—(A)broadband internet access service; or(B)an edge service.(4)Edge serviceThe term edge service—(A)means a service provided over the internet—(i)for which the provider requires the user to subscribe or establish an account in order to use the service;(ii)that the user purchases from the provider of the service without a subscription or account;(iii)by which a program searches for and identifies items in a database that correspond to keywords or characters specified by the user, used especially for finding particular sites on the world wide web; or(iv)by which the user divulges sensitive user information; and(B)includes a service described in subparagraph (A) that is provided through a software program, including a mobile application.(5)Emergency servicesThe term emergency services has the meaning given the term in section 222 of the Communications Act of 1934 (47 U.S.C. 222).(6)MaterialThe term material means, with respect to a change in a privacy policy of a provider of a covered service, any change in the policy that a user of the service, acting reasonably under the circumstances, would consider important to the decisions of the user regarding the privacy of the user, including any change to information required to be included in a privacy notice under section 3.(7)Mobile applicationThe term mobile application means a software program that runs on the operating system of a mobile device.(8)Non-sensitive user informationThe term non-sensitive user information means any user information that is not sensitive user information.(9)Opt-in approvalThe term opt-in approval means a method for obtaining from a user of a covered service consent to use, disclose, or permit access to sensitive user information under which the provider of the service obtains express consent allowing the requested usage of, disclosure of, or access to the sensitive user information.(10)Opt-out approvalThe term opt-out approval means a method for obtaining from a user of a covered service consent to use, disclose, or permit access to non-sensitive user information under which the user is deemed to have consented to the use of, disclosure of, or access to the non-sensitive user information if the user has failed to object to the use, disclosure, or access.(11)Public safety answering pointThe term public safety answering point has the meaning given the term in section 222 of the Communications Act of 1934 (47 U.S.C. 222).(12)Sensitive user informationThe term sensitive user information includes any of the following:(A)Financial information.(B)Health information.(C)Information pertaining to children under the age of 13.(D)Social Security number.(E)Precise geolocation information.(F)Content of communications.(G)Web browsing history, history of usage of a software program (including a mobile application), and the functional equivalents of either.(13)StateThe term State means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, American Samoa, the United States Virgin Islands, the Commonwealth of the Northern Mariana Islands, any other territory or possession of the United States, and each federally recognized Indian Tribe.(14)UserThe term user means, with respect to a covered service, a person who—(A)is a current or former—(i)subscriber to the service; or(ii)holder of an account for the service;(B)purchases the service without a subscription or account;(C)is an applicant for the service; or(D)in the case of a service described in clause (iii) or (iv) of paragraph (4)(A), uses the service.(15)User informationThe term user information means any information that—(A)a provider of a covered service acquires in connection with the provision of the service; and(B)is linked or reasonably linkable to an individual.3.Notice of privacy policies(a)In generalA provider of a covered service shall provide a user of the service with clear and conspicuous notice of the privacy policies of the provider with respect to the service.(b)Availability to prospective usersThe notice required by subsection (a) shall be made available to a prospective user of a covered service—(1)at the point of sale of, subscription to, or establishment of an account for the covered service, prior to that sale, subscription, or establishment, without regard to whether the point of sale, subscription, or establishment is in person, online, over the telephone, or through another means; or(2)if there is no such sale, subscription, or establishment, before the user uses the service.(c)Persistent availabilityThe notice required by subsection (a) shall be made persistently available.(d)Material changesA provider of a covered service shall provide a user of the service with clear and conspicuous advance notice of any material change to the privacy policies of the provider with respect to the service.4.User opt-in or opt-out approval rights based on sensitivity of information(a)Opt-In approval required for sensitive user informationExcept as provided in subsection (c), a provider of a covered service shall obtain opt-in approval from a user to use, disclose, or permit access to the sensitive user information of the user.(b)Opt-Out approval required for non-Sensitive user informationExcept as provided in subsection (c), a provider of a covered service—(1)shall obtain opt-out approval from a user to use, disclose, or permit access to any of the non-sensitive user information of the user; or(2)if the provider so chooses, may comply with the requirement of paragraph (1) by obtaining opt-in approval from the user to use, disclose, or permit access to any of the non-sensitive user information of the user.(c)Limitations and exceptionsA provider of a covered service may use, disclose, or permit access to user information without user approval for the following purposes:(1)In providing the covered service from which the information is derived, or in providing services necessary to, or used in, the provision of the service.(2)To initiate, render, bill for, and collect for the covered service.(3)To protect the rights or property of the provider, or to protect users of the covered service and other service providers from fraudulent, abusive, or unlawful use of the service.(4)To provide location information or non-sensitive user information—(A)to a public safety answering point, emergency medical service provider or emergency dispatch provider, public safety, fire service, or law enforcement official, or hospital emergency or trauma care facility, in order to respond to the request of the user for emergency services;(B)to inform the legal guardian of the user, or members of the immediate family of the user, of the location of the user in an emergency situation that involves the risk of death or serious physical harm; or(C)to providers of information or database management services solely for purposes of assisting in the delivery of emergency services in response to an emergency.(5)As otherwise required or authorized by law.(d)Mechanism for exercising user approval(1)In generalA provider of a covered service shall make available a simple, easy-to-use mechanism for a user to grant, deny, or withdraw opt-in approval or opt-out approval at any time.(2)Form and mannerThe mechanism required by paragraph (1) shall be—(A)clear and conspicuous; and(B)made available—(i)at no additional cost to the user; and(ii)in a language other than English, if the provider transacts business with the user in that other language.(3)EffectThe grant, denial, or withdrawal of opt-in approval or opt-out approval by a user shall—(A)be given effect promptly; and(B)remain in effect until the user revokes or limits the grant, denial, or withdrawal of approval.5.Service offers conditioned on waivers of privacy rightsA provider of a covered service may not—(1)condition, or effectively condition, provision of the service on agreement by a user to waive privacy rights guaranteed by law or regulation, including this Act; or(2)terminate the service or otherwise refuse to provide the service as a direct or indirect consequence of the refusal of a user to waive any privacy rights described in paragraph (1).6.Enforcement by Federal Trade Commission(a)General applicationThe requirements of this Act apply, according to their terms, to—(1)those persons, partnerships, and corporations over which the Commission has authority pursuant to section 5(a)(2) of the Federal Trade Commission Act (15 U.S.C. 45(a)(2)); and(2)providers of broadband internet access service, notwithstanding the exception in such section 5(a)(2) for common carriers subject to the Communications Act of 1934 (47 U.S.C. 151 et seq.).(b)Unfair or deceptive acts or practicesA violation of this Act shall be treated as an unfair or deceptive act or practice in or affecting commerce for purposes of section 5(a)(2) of the Federal Trade Commission Act (15 U.S.C. 45(a)(2)).(c)Powers of CommissionExcept as provided in subsection (a)(2) of this section—(1)the Commission shall enforce this Act in the same manner, by the same means, and with the same jurisdiction, powers, and duties as though all applicable terms and provisions of the Federal Trade Commission Act (15 U.S.C. 41 et seq.) were incorporated into and made a part of this Act; and(2)any person who violates this Act shall be subject to the penalties and entitled to the privileges and immunities provided in the Federal Trade Commission Act.7.Relationship to other law(a)Preemption of State lawNo State or political subdivision of a State shall, with respect to a provider of a covered service subject to this Act, adopt, maintain, enforce, or impose or continue in effect any law, rule, regulation, duty, requirement, standard, or other provision having the force and effect of law relating to or with respect to the privacy of user information.(b)Other Federal law(1)In generalExcept as provided in paragraph (2), nothing in this Act shall be construed to supersede any Federal statute or regulation relating to information privacy.(2)Communications Act of 1934Insofar as any provision of the Communications Act of 1934 (47 U.S.C. 151 et seq.) or any regulations promulgated under that Act apply to any person, partnership, or corporation subject to this Act with respect to privacy policies, terms of service, and practices covered by this Act, the provision or regulations shall have no force or effect, unless the regulations pertain to emergency services.