,,ii #aacth ,,congress #b;d ,session ,s4 #bdcj ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #d1 #bjad ,mr4 ,roberts introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to establish the ,office of the ,special ,inspector ,general for ,monitoring the ,affordable ,care ,act1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,special ,inspector ,general for ,monitoring the ,,aca ,act of #bjad or the ,,sigma ,act of #bjad4 #b4 ,special ,inspector ,general for ,monitoring the ,affordable ,care ,act 7a7 ,office of ,special ,inspector ,general ,there is hereby established the ,office of the ,special ,inspector ,general for ,monitoring the ,affordable ,care ,act 7in this section1 referred to as the ,office7 to carry out the duties described under subsection 7e74 7b7 ,appointment of ,inspector ,general2 removal 7#a7 ,appointment ,the head of the ,office is the ,special ,inspector ,general for ,monitoring the ,affordable ,care ,act 7in this section referred to as the ,special ,inspector ,general71 who shall be appointed by the ,president1 by and with the advice and consent of the ,senate4 7#b7 ,qualifications ,the appointment of the ,special ,inspector ,general shall be made solely on the basis of integrity and demonstrated ability in accounting1 auditing1 financial analysis1 law1 management analysis1 healthcare expertise and financing1 public administration1 or investigations4 7#c7 ,deadline for appointment ,the appointment of an individual as the ,special ,inspector ,general shall be made not later than #cj days after the date of the enactment of this ,act4 7#d7 ,compensation ,the annual rate of basic pay of the ,special ,inspector ,general shall be the annual rate of basic pay provided for positions at level ,,iv of the ,executive ,schedule under section #ecae of title #e1 ,united ,states ,code4 7#e7 ,prohibition on political activities ,for purposes of section #gcbd of title #e1 ,united ,states ,code1 the ,special ,inspector ,general shall not be considered an employee who determines policies to be pursued by the ,united ,states in the nationwide administration of ,federal law4 7#f7 ,removal ,the ,special ,inspector ,general shall be removable from office in accordance with the provisions of section #c7;b7 of the ,inspector ,general ,act of #aigh 7#e ,u4,s4,c4 ,app474 7c7 ,assistant ,inspectors ,general ,the ,special ,inspector ,general shall1 in accordance with applicable laws and regulations governing the civil service-- 7#a7 appoint an ,assistant ,inspector ,general for ,auditing who shall have the responsibility for supervising the performance of auditing activities relating to the duties described under subsection 7e72 and 7#b7 appoint an ,assistant ,inspector ,general for ,investigations who shall have the responsibility for supervising the performance of investigative activities relating to such duties4 7d7 ,supervision 7#a7 ,in general ,except as provided under paragraph 7#b71 the ,special ,inspector ,general shall report directly to1 and be under the general supervision of1 the ,secretary of ,health and ,human ,services4 7#b7 ,independence to conduct investigations and audits ,no employee or officer of any of the following entities shall prevent or prohibit the ,special ,inspector ,general from initiating1 carrying out1 or completing any audit or investigation related to the duties described under subsection 7e7 or from issuing any subpoena during the course of any such audit or investigation3 7,a7 ,the ,executive ,office of the ,president and the ,office of ,personnel ,management4 7,b7 ,the ,department of ,health and ,human ,services4 7,c7 ,the ,department of the ,treasury4 7,d7 ,the ,social ,security ,administration1 the ,department of ,homeland ,security1 the ,department of ,veterans ,affairs1 the ,department of ,defense1 the ,department of ,labor1 and the ,peace ,corps4 7,e7 ,any other ,federal agency involved in implementing or administering the ,affordable ,care ,act4 7e7 ,duties 7#a7 ,oversight of the implementation and administration of the affordable care act ,it shall be the duty of the ,special ,inspector ,general to conduct1 supervise1 and coordinate audits and investigations of the implementation and administration of programs and activities established under1 and payment system changes made by1 the ,affordable ,care ,act1 including by collecting and summarizing the following3 7,a7 ,a description of the individual mandate requirement for applicable individuals to maintain minimum essential coverage or pay a penalty under section #ejjj;,a of the ,internal ,revenue ,code of #aihf1 including a description of the number of individuals maintaining such coverage and the number of individuals paying such penalties4 7,b7 ,a description of any increases or decreases in-- 7i7 premiums for qualified health plans 7as defined in section #acja of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjba772 7ii7 deductibles under qualified health plans2 and 7iii7 cost-sharing under qualified health plans1 including by co-payments and co-insurance1 affecting individuals enrolling in coverage under such plans through an ,exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act 7including a ,state-run ,exchange1 a federally administered ,exchange1 and a ,small ,business ,health ,options ,program74 7,c7 ,a description of any increases or decreases in the maximum out-of-pocket costs affecting individuals enrolling in qualified health plans through such a ,state-run ,exchange1 a federally administered ,exchange1 and a ,small ,business ,health ,options ,program4 7,d7 ,a description of any increases or decreases in the size of physician and other health care provider networks affecting individuals enrolling in qualified health plans through such a ,state-run ,exchange1 a federally administered ,exchange1 and a ,small ,business ,health ,options ,program4 7,e7 ,a description of any type of health insurance coverage lost because of the treatment under title ,i of the ,patient ,protection and ,affordable ,care ,act of grandfathered health plans 7as defined in section #abea7;e7 of such ,act 7#db ,u4,s4,c4 #ahjaa7;e7774 7,f7 ,a description of any credits under section #cf;,b of the ,internal ,revenue ,code of #aihf 7and the amount 7if any7 of the advance payment of the credit under section #adab of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhb77 and any cost-sharing reduction under section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7 7and the amount 7if any7 of the advance payment of the reduction under section #adab of such ,act 7#db ,u4,s4,c4 #ahjhb77 provided to individuals enrolling under qualified health plans through an ,exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act4 7,g7 ,a description of any projections1 estimates1 analysis1 goals1 or targets made by any employee of the ,federal ,government or any contractor of the ,federal ,government in carrying out duties associated with the ,patient ,protection and ,affordable ,care ,act with respect to the enrollment of individuals in a qualified health plan through an ,exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act4 7,h7 ,a description of the employer mandate requirement that applicable large employers provide eligible employees with minimum essential coverage or pay a fine under section #dihj;,h of the ,internal ,revenue ,code of #aihf1 including a description of the type and number of employers providing such coverage and the type and number of employers paying such fines4 7,i7 ,a description of any projections1 estimates1 analysis1 goals1 or targets made by any employee of the ,federal ,government or any contractor of the ,federal ,government in carrying out duties associated with the ,patient ,protection and ,affordable ,care ,act with respect to employers providing minimum essential coverage to applicable employees4 7,j7 ,a description of any reports1 meetings1 discussions1 or materials of any employee of the ,federal ,government or any contractor of the ,federal ,government in carrying out duties associated with the ,patient ,protection and ,affordable ,care ,act relating to any employers converting full-time employees to part-time employees or hiring new part-time employees instead of full-time employees for the purposes of avoiding the fines provided for under the employer mandate requirement described in subparagraph 7,h74 7,k7 ,a description of any reports1 meetings1 discussions1 or materials of any employee of the ,federal ,government or any contractor of the ,federal ,government in carrying out duties associated with the ,patient ,protection and ,affordable ,care ,act relating to any employers hiring no more than #ej employees for the purposes of avoiding the requirement to provide minimum essential coverage or pay a fine under the employer mandate requirement described in subparagraph 7,h74 7,l7 ,a description of any reports1 meetings1 discussions1 or materials of any employee of the ,federal ,government or any contractor of the ,federal ,government in carrying out duties associated with the ,patient ,protection and ,affordable ,care ,act relating to any employers dropping the health insurance coverage offered to their employees1 or employees' spouses or dependents1 for the purposes of avoiding the requirement to provide minimum essential coverage or pay a fine under the employer mandate requirement described in subparagraph 7,h74 7,m7 ,a description of the transitional reinsurance program established under section #acda of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjfa71 including a description of reinsurance contributions collected or required to be collected under such program1 a description of any reinsurance payments made or required to be made to health insurance issuers under such program1 a description of the health insurance coverage and related costs for high-cost individuals for plans related to such program1 an explanation of the impact of such reinsurance program on adverse selection in the marketplace1 and an explanation of any premium-stabilizing effects of such program4 7,n7 ,a description of the temporary risk corridors for qualified health plans established under section #acdb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjfb71 including a description of participating plans and the allowable costs and target amounts of such plans1 a description of risk corridor ratios of such plans1 and a description of payment adjustments made under such program4 7,o7 ,a description of the permanent risk adjustment program established under section #acdc of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjfc71 including a description of any plans participating in such program1 a description of any risk adjustment payments made or required to be made under such program1 a description of the health insurance coverage and related costs for high-cost individuals for plans related to such program1 an explanation of the impact of such program on adverse selection in the marketplace1 and an explanation of any premium-stabilizing effects of such program4 7,p7 ,a list of all contracts awarded under the ,affordable ,care ,act and an analysis of whether ,federal contracting procedures were followed when awarding any contract associated with such ,act4 7,q7 ,a description of the development of the health insurance marketplace for the ,internet portal established under section #aajc of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjjc71 including a description of the design1 features1 and security systems of such web portal and a description of all costs associated with such development4 7,r7 ,a description of any threats1 risks1 problems1 or functionality issues identified by any employee of the ,federal ,government or any contractor of the ,federal ,government in carrying out duties associated with the ,patient ,protection and ,affordable ,care ,act prior to the launch of such web portal on ,october #a1 #bjac4 7,s7 ,a description of any decisionmaking or activities by any employee of the ,federal ,government or any contractor of the ,federal ,government in carrying out duties associated with the ,patient ,protection and ,affordable ,care ,act in response to such threats1 risks1 problems1 or functionality issues4 7,t7 ,a description of the systems 7on the ,federal and ,state levels7 in place or in development to allow health insurance issuers and plans and government entities to verify information is accurate for purposes of enrollments in qualified health plans through ,exchanges established under title ,i of the ,patient ,protection and ,affordable ,care ,act1 including that data verification and validation can occur with respect to information provided or stored by individuals1 the ,department of ,health and ,human ,services1 the qualified health plans1 ,states1 and other applicable ,federal agencies1 including for purposes of credits under section #cf;,b of the ,internal ,revenue ,code of #aihf 7and the amount 7if any7 of the advance payment of the credit under section #adab of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhb77 and any cost-sharing reduction under section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7 7and the amount 7if any7 of the advance payment of the reduction under section #adab of such ,act 7#db ,u4,s4,c4 #ahjhb774 7,u7 ,a description of the development of the ,federal ,data ,services ,hub1 including its design1 features1 and security systems1 and a description of the type of data accessed through such data hub1 and a description of the actual storage location of such data accessed through such data hub4 7,v7 ,a list of the duties and responsibilities assigned to the ,internal ,revenue ,service as a result of the enactment of the ,affordable ,care ,act1 a description of any plans of the ,internal ,revenue ,service for how to carry out such duties1 and an explanation of the resources and personnel required to carry out such duties1 including a description of any new resources or personnel required to carry out such duties not already available to the ,internal ,revenue ,service4 7,w7 ,a description of any plans of the ,internal ,revenue ,service to verify the eligibility of individuals enrolling in qualified health plans for any credits under section #cf;,b of the ,internal ,revenue ,code of #aihf 7and the amount 7if any7 of the advance payment of the credit under section #adab of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhb77 and any cost-sharing reduction under section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7 7and the amount 7if any7 of the advance payment of the reduction under section #adab of such ,act 7#db ,u4,s4,c4 #ahjhb771 including a description of any such verification completed and a description of any such individuals determined to be ineligible4 7,x7 ,a description of any plans by the ,internal ,revenue ,service to calculate the amount of overpayment of any such credit or reduction for which an individual enrolled in a qualified health plan was determined to be ineligible1 including a description of any such calculations completed4 7,y7 ,a description of any plans by the ,internal ,revenue ,service to notify individuals determined to be ineligible for such credits or reductions1 including a description of such notifications completed4 7,z7 ,a description of any plans by the ,internal ,revenue ,service to recapture such overpayments of such credits and reductions for individuals determined to be ineligible1 including a description of such recapturing completed4 7,,aa7 ,a description of the impact of the ,affordable ,care ,act on the right of conscience1 including on-- 7i7 religious employers and institutions that were not exempted from the mandate issued by the ,department of ,health and ,human ,services requiring individual and group health plans to cover sterilization and ,food and ,drug ,administration approved contraceptives2 7ii7 individuals2 and 7iii7 medical professionals4 7,,bb7 ,a description of abortion coverage offered under qualified health plans purchased through ,state-run ,exchanges1 federally administered ,exchanges1 and ,small ,business ,health ,options ,programs1 including costs associated with such coverage4 7,,cc7 ,a description of any actions by departments or agencies of the ,federal ,government to delay the programs or activities authorized by the ,affordable ,care ,act1 including an explanation from the head of such department or agency of the specific authority used to implement such a delay4 7,,dd7 ,a description of the ,independent ,payment ,advisory ,board under section #ahii;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekkk7 and any actions taken to alter or reduce the use of medical products1 treatments or procedures1 including an explanation from the ,independent ,payment ,advisory ,board of the reasons for taking such actions1 whether such actions could be expected to result in worsened medical outcomes for individuals effected by such alterations or reductions1 and an explanation of the medical information used to determine whether such alterations or reductions could be expected to result in such worsened outcomes4 7,,ee7 ,a description of individuals enrolled in the ,medicaid program under title ,,xix of the ,social ,security ,act through an ,exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act1 including a description of the cost of health care services utilized by such individuals and a description of the cost to ,states and the cost to the ,federal ,government to provide health care services to such individuals4 7,,ff7 ,any additional topic related to the implementation and administration of the ,affordable ,care ,act1 the inclusion of which helps to provide the public a full and objective accounting of such law4 7#b7 ,data to be included ,in carrying out the duties described under paragraph 7#a71 the ,special ,inspector ,general shall collect and summarize data described under such paragraph according to each type of insurance marketplace and according to the age and gender of individuals enrolling in coverage under qualified health plans through an ,exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act4 7#c7 ,other duties related to oversight ,the ,special ,inspector ,general shall establish1 maintain1 and oversee such systems1 procedures1 and controls as the ,special ,inspector ,general considers appropriate to discharge the duties described under paragraph 7#a74 7#d7 ,duties and responsibilities under the ,inspector ,general ,act of #aigh ,in addition to the duties described under paragraphs 7#a7 and 7#b71 the ,special ,inspector ,general shall also have the duties and responsibilities of inspectors general under the ,inspector ,general ,act of #aigh 7#e ,u4,s4,c4 ,app474 7f7 ,coordination of efforts ,in carrying out the duties1 responsibilities1 and authorities of the ,special ,inspector ,general under this section1 the ,special ,inspector ,general shall coordinate with1 and receive the cooperation of each of the following3 7#a7 ,the ,inspector ,general of the ,department of ,health and ,human ,services4 7#b7 ,the ,inspector ,general of the ,department of the ,treasury4 7#c7 ,the ,inspectors ,general of the ,social ,security ,administration1 the ,department of ,homeland ,security1 the ,department of ,veterans ,affairs1 the ,department of ,defense1 the ,department of ,labor1 and the ,peace ,corps4 7#d7 ,the inspector general of any other ,federal entity1 as determined by the ,special ,inspector ,general4 7g7 ,powers and authorities 7#a7 ,authority to access materials1 request information1 compel response1 and other authorities under the ,inspector ,general ,act of #aigh ,in carrying out the duties described under subsection 7e71 the ,special ,inspector ,general shall have all of the authorities provided under section #f of the ,inspector ,general ,act of #aigh 7#e ,u4,s4,c4 ,app474 7#b7 ,exemption from requirement for initial determination by ,attorney ,general ,for purposes of section #f7;e7 of the ,inspector ,general ,act of #aigh 7#e ,u4,s4,c4 ,app471 the ,special ,inspector ,general shall be considered exempt from the requirement of an initial determination of eligibility by the ,attorney ,general under paragraph 7#b7 of such section4 7#c7 ,audit standards ,the ,special ,inspector ,general shall carry out the duties specified under subsection 7e77#a7 in accordance with section #d7;b77#a7 of the ,inspector ,general ,act of #aigh 7#e ,u4,s4,c4 ,app474 7h7 ,personnel1 facilities1 and other resources 7#a7 ,personnel ,the ,special ,inspector ,general may select1 appoint1 and employ such officers and employees as may be necessary for carrying out the duties of the ,special ,inspector ,general1 subject to the provisions of title #e1 ,united ,states ,code1 governing appointments in the competitive service1 and the provisions of chapter #ea and subchapter ,,iii of chapter #ec of such title1 relating to classification and ,general ,schedule pay rates4 7#b7 ,employment of experts and consultants ,the ,special ,inspector ,general may obtain services as authorized by section #caji of title #e1 ,united ,states ,code1 at daily rates not to exceed the equivalent rate prescribed for grade ,,gs-#ae of the ,general ,schedule by section #eccb of such title4 7#c7 ,contracting authority ,to the extent and in such amounts as may be provided in advance by appropriations ,acts1 the ,special ,inspector ,general may enter into contracts and other arrangements for audits1 studies1 analyses1 and other services with public agencies and with private persons1 and make such payments as may be necessary to carry out the duties of the ,special ,inspector ,general4 7#d7 ,resources ,the ,secretary of ,health and ,human ,services shall provide the ,special ,inspector ,general with appropriate and adequate office space at appropriate locations of the ,department of ,health and ,human ,services together with such equipment1 office supplies1 and communications facilities and services as may be necessary for the operation of such offices1 and shall provide necessary maintenance services for such offices and the equipment and facilities located therein4 7#e7 ,assistance from ,federal agencies 7,a7 ,in general ,upon request of the ,special ,inspector ,general for information or assistance from any department1 agency1 or other entity of the ,federal ,government 7including any entity listed under subsection 7d77#b771 the head of such entity shall1 insofar as is practicable and not in contravention of any existing law1 furnish such information or assistance to the ,special ,inspector ,general1 or an authorized designee4 7,b7 ,reporting of refused assistance 7i7 ,reporting to ,health and ,human ,services and ,congress ,in accordance with clause 7ii71 as the case may be1 whenever information or assistance requested by the ,special ,inspector ,general is1 in the judgment of the ,special ,inspector ,general1 unreasonably refused or not provided1 the ,special ,inspector ,general shall report the circumstances to the ,secretary of ,health and ,human ,services and to the appropriate congressional committees without delay4 7ii7 ,reporting to the public on refusal or noncooperation in transparency ,whenever any information described in clause 7i7 is requested by the ,special ,inspector ,general and unreasonably refused or not provided1 the report to the ,secretary of ,health and ,human ,services and the appropriate congressional committees shall be titled ,notice of ,refusal or ,noncooperation in ,transparency and shall be published on a publicly available website in an accessible format without delay4 7#f7 ,use of personnel1 facilities1 and other resources of the ,office ,upon the request of the ,special ,inspector ,general1 an ,inspector ,general-- 7,a7 may detail1 on a reimbursable basis1 any of the personnel of the ,office for the purpose of carrying out this section2 and 7,b7 may provide1 on a reimbursable basis1 any of the facilities or other resources of the ,office for the purpose of carrying out this section4 7i7 ,reports 7#a7 ,initial report ,not later than #abj days after the date of the enactment of this ,act1 the ,special ,inspector ,general shall submit to the appropriate congressional committees and the ,secretary of ,health and ,human ,services a report summarizing1 for the period beginning on the date of the enactment of the ,health ,care and ,education ,reconciliation ,act of #bjaj and ending on the completion of a fiscal year quarter after the date of enactment of this ,act1 the activities during such period of the ,special ,inspector ,general required under subsection 7e74 7#b7 ,quarterly reports ,beginning with the first full fiscal year quarter after the date of the enactment of this ,act1 not later than #cj days after the end of each fiscal year quarter1 during which the ,affordable ,care ,act is in effect1 the ,special ,inspector ,general shall submit to the appropriate congressional committees and the ,secretary of ,health and ,human ,services a report summarizing1 for the period of that quarter and1 to the extent possible1 the period from the end of such quarter to the time of the submission of the report1 the activities during such period of the ,special ,inspector ,general required under subsection 7e74 7#c7 ,comments on report ,not later than #cj days after receipt of a report under this subsection1 the ,secretary of ,health and ,human ,services shall submit to the appropriate congressional committees any comments on the matters covered by the report4 7#d7 ,public availability ,the ,special ,inspector ,general shall publish on a publicly available website each report described under this subsection and any comments on the matters covered by the report submitted pursuant to paragraph 7#c74 7#e7 ,protected information ,to the extent possible1 information submitted in any report required under this subsection shall be in a form that is not prohibited from disclosure under section #eeb;a of title #e1 ,united ,states ,code 7commonly known as the ,privacy ,act of #aigd74 7#f7 ,aggregated information ,the ,special ,inspector ,general shall1 to the maximum extent possible1 aggregate any personally identifiable information submitted in a report required under this subsection4 7j7 ,termination ,the ,office of the ,special ,inspector ,general shall terminate on the date on which the final report required by subsection 7h7 is submitted for the last year the ,affordable ,care ,act is in effect4 7k7 ,definitions ,in this section3 7#a7 ,affordable ,care ,act ,the term ,affordable ,care ,act means the ,patient ,protection and ,affordable ,care ,act and title ,i and subtitle ,b of title ,,ii of the ,health ,care and ,education ,reconciliation ,act of #bjaj4 7#b7 ,appropriate congressional committees ,the term appropriate congressional committees means-- 7,a7 the ,committees on ,appropriations1 the ,budget1 ,education and the ,workforce1 ,energy and ,commerce1 ,homeland ,security1 the ,judiciary1 ,oversight and ,government ,reform1 ,small ,business1 and ,ways and ,means of the ,house of ,representatives2 and 7,b7 the ,committees on ,appropriations1 the ,budget1 ,commerce1 ,science1 and ,transportation1 ,finance1 ,health1 ,education1 ,labor1 and ,pensions1 ,homeland ,security and ,governmental ,affairs1 the ,judiciary1 and ,small ,business and ,entrepreneurship of the ,senate4