H.R. 4796 — Introduced in House

I 113th CONGRESS 2d Session H. R. 4796 IN THE HOUSE OF REPRESENTATIVES June 2, 2014 Ms. Jackson Lee (for herself, Ms. Clarke of New York, Ms. Brown of Florida, Mr. Clay, Mr. Rangel, and Ms. Norton) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To direct the Secretary of Health and Human Services to conduct outreach efforts to provide certain health insurance information to individuals enrolled in qualified health plans offered through an Exchange established under title I of the Patient Protection and Affordable Care Act or State plans under the Medicaid program under title XIX of the Social Security Act, and for other purposes. 1. Short title This Act may be cited as the Keeping Well by Using Your Patient Protection and Affordable Care Act Plan. 2. Outreach to certain individuals on certain health insurance information (a) In general Beginning not later than 90 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall conduct outreach efforts to provide, using the most effective means (as determined by the Secretary), the health insurance information described in subsection (b) to— (1) individuals enrolled in qualified health plans offered through an Exchange established under title I of the Patient Protection and Affordable Care Act (Public Law 111–148); and (2) individuals enrolled in State plans (or under a waiver of such a plan) under the Medicaid program under title XIX of the Social Security Act. (b) Information described For purposes of subsection (a), the information described in this subsection is any information, the availability of which the Secretary of Health and Human Services determines will encourage the utilization of primary care or preventive services by the individuals described in such subsection, including the following: (1) Information on the extent to which the essential health benefits specified in section 1302(b)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(b)(1)) are provided by a plan described in subsection (a). (2) Information on which preventive health services are covered under such a plan without the application of any cost-sharing (such as a copayment or coinsurance), including screenings for certain conditions such as diabetes and high blood pressure, vaccinations for adults against influenza, measles, mumps, rubella, and other infectious diseases, and well-woman visits. (3) With respect to qualified health plans described in subsection (a)(1), the following information presented in a manner that allows for comparison of plans within each State: (A) Information on the rates of reimbursement recognized under each such qualified health plan with respect to items and services (as specified by the Secretary) that are furnished to individuals enrolled in such plan by health care providers participating in the network of the plan, such as rates of reimbursement applicable to emergency care services, laboratory tests, diagnostic tests, and physician services. (B) Information on any cost-sharing required under each such plan with respect to such items and services furnished to such individuals by such providers and an explanation on the extent to which such cost-sharing is based on such recognized rates of reimbursement. (C) A statement that— (i) the rates of reimbursement that are collectable by health care providers not participating in the network of such a plan for furnishing such items and services to such individuals may be more than the rates of reimbursement recognized under such plan for such items and services furnished to such individuals by health care providers participating in the network of such plan; and (ii) any cost-sharing required under such a plan with respect to such items and services furnished to such individuals by health care providers not participating in the network of such plan may be more than such cost-sharing with respect to such items and services furnished to such individuals by health care providers participating in the network of such plan. (4) An explanation of basic health insurance terms (as determined by the Secretary), including deductibles, cost-sharing, copayment, and coinsurance, and the application of such terms to an individual enrolled in a plan described in subsection (a), illustrated with examples of the application of such terms with respect to such individuals under different circumstances and in different health care settings. (c) Report on out-of-Pocket costs Not later than 180 days after the date of the enactment of this Act, with respect to the most recent plan year for which information is available, the Secretary of Health and Human Services shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report that— (1) contains information, for each State (including the District of Columbia), on the median cost-sharing responsibility, with respect to qualified health plans offered through an Exchange in such State, of health care services— (A) the number of which and types of which are determined appropriate by the Secretary to be included in the report; and (B) that have been identified by the Secretary as services— (i) for which, with respect to such plan year, payment may only be made under such a plan after satisfaction of the deductible applicable under such plan; and (ii) for which reimbursement under such plan is made most frequently during such plan year; and (2) describes the best method for making the information referred to in paragraph (1) available to the public.