,i #aafth ,,congress #ast ,session ,h4 ,r4 #bjhe ,,in ,,the ,,house ,,of ,,representatives ,april #d1 #bjai,ms4 ,schakowsky 7for herself1 ,ms4 ,de,lauro1 ,mr4 ,grijalva1 ,ms4 ,matsui1 ,mr4 ,yarmuth1 ,ms4 ,norton1 ,mr4 ,schiff1 ,mr4 ,garamendi1 ,mr4 ,quigley1 ,ms4 ,moore1 and ,mr4 ,cohen7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to amend the ,public ,health ,service ,act to establish a public health insurance option1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,consumer ,health ,options and ,insurance ,competition ,enhancement ,act or the ,,choice ,act4 #b4 ,public health insurance option 7a7 ,in general ,part ,c of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia7 is amended by adding at the end the following3 #bgie4 ,public health insurance option 7a7 ,establishment 7#a7 ,in general ,for plan years beginning in #bjbj1 the ,secretary shall establish1 and provide for the offering through the ,exchanges1 of a qualified health plan 7in this ,act referred to as the public health insurance option7 that provides value1 choice1 competition1 and stability of affordable1 high-quality coverage throughout the ,united ,states in accordance with this section4 7#b7 ,primary responsibility ,in designing the public health insurance option1 the primary responsibility of the ,secretary shall be to create an affordable health plan without compromising quality or access to care4 7b7 ,administrating the public health insurance option 7#a7 ,offered through ,exchanges 7,a7 ,exclusive to ,exchanges ,the public health insurance option shall be made available through the ,exchanges4 7,b7 ,ensuring a level playing field ,consistent with this section1 the public health insurance option shall-- 7i7 comply with requirements under title ,i of the ,patient ,protection and ,affordable ,care ,act1 and the amendments made by that title1 that are applicable to health plans offered through the ,exchanges1 including provider networks1 notices1 consumer protections1 and cost-sharing2 and 7ii7 provide a benefit package that is comprehensive and meets the health care needs of patients1 including benefits described in section #acjb7;b7 of the ,patient ,protection and ,affordable ,care ,act4 7,c7 ,preemption ,notwithstanding section #acjc7;a77#a7 of the ,patient ,protection and ,affordable ,care ,act1 a ,state law that prohibits the public health insurance option from offering the coverage described in subparagraph 7,b7 shall be preempted4 7,d7 ,provision of benefit levels ,the public health insurance option shall offer silver and gold plans and may offer bronze plans4 7#b7 ,administrative contracting 7,a7 ,authorities ,the ,secretary may enter into contracts for the purpose of performing administrative functions 7including functions described in subsection 7a77#d7 of section #ahgd;,a of the ,social ,security ,act7 with respect to the public health insurance option in the same manner as the ,secretary may enter into contracts under subsection 7a77#a7 of such section4 ,the ,secretary shall have the same authority with respect to the public health insurance option as the ,secretary has under such subsection 7a77#a7 and subsection 7b7 of section #ahgd;,a of the ,social ,security ,act with respect to title ,,xviii of such ,act4 7,b7 ,transfer of insurance risk ,any contract under this paragraph shall not involve the transfer of insurance risk from the ,secretary to the entity entering into such contract with the ,secretary4 7#c7 ,state ,advisory ,council 7,a7 ,establishment ,a ,state may establish a public or nonprofit entity to serve as the ,state ,advisory ,council to provide recommendations to the ,secretary on the operations and policies of the public health insurance option offered through the ,exchange operating in the ,state4 7,b7 ,recommendations ,a ,state ,advisory ,council established under subparagraph 7,a7 shall provide recommendations on at least the following3 7i7 ,policies and procedures to integrate quality improvement and cost containment mechanisms into the health care delivery system4 7ii7 ,mechanisms to facilitate public awareness of the availability of the public health insurance option4 7iii7 ,alternative payment models and value-based insurance design under the public health insurance option that encourage quality improvement and cost control4 7,c7 ,members ,the members of any ,state ,advisory ,council shall be representatives of the public and include health care consumers and health care providers4 7,d7 ,applicability of recommendations ,the ,secretary may apply the recommendations of a ,state ,advisory ,council to the public health insurance option in that ,state1 in any other ,state1 or in all ,states4 7#d7 ,data collection ,the ,secretary shall collect such data as may be required-- 7,a7 to establish rates for premiums and health care provider reimbursement under subsection 7c72 and 7,b7 for other purposes under this section1 including to improve quality1 and reduce racial1 ethnic1 socioeconomic1 and other disparities1 in health and health care4 7c7 ,financing the public health insurance option 7#a7 ,premiums 7,a7 ,establishment ,the ,secretary shall establish geographically adjusted premium rates for the public health insurance option-- 7i7 in a manner that complies with the requirement for premium rates under subparagraph 7,c7 and considers the data collected under subsection 7b77#d72 and 7ii7 at a level sufficient to fully finance-- 7,i7 the costs of health benefits provided by the public health insurance option2 and 7,,ii7 administrative costs related to operating the public health insurance option4 7,b7 ,contingency margin ,in establishing premium rates under subparagraph 7,a71 the ,secretary shall include an appropriate amount for a contingency margin4 7,c7 ,variations in premium rates ,the premium rate charged for the public health insurance option may not vary except as provided under section #bgja4 7#b7 ,health care provider payment rates for items and services 7,a7 ,in general 7i7 ,rates negotiated by the ,secretary ,not later than ,january #a1 #bjbj1 and except as provided in clause 7ii71 the ,secretary shall1 through a negotiated agreement with health care providers1 establish rates for reimbursing health care providers for providing the benefits covered by the public health insurance option4 7ii7 ,medicare reimbursement rates ,if the ,secretary and health care providers are unable to reach a negotiated agreement on a reimbursement rate1 the ,secretary shall reimburse providers at rates determined for equivalent items and services under the original ,medicare fee-for-service program under parts ,a and ,b of title ,,xviii of the ,social ,security ,act4 7iii7 ,for new services ,the ,secretary shall modify reimbursement rates described in clause 7ii7 in order to accommodate payments for services1 such as well-child visits1 that are not otherwise covered under the original ,medicare fee-for-service program4 7,b7 ,prescription drugs ,any payment rate under this subsection for a prescription drug shall be at a rate negotiated by the ,secretary4 ,if the ,secretary is unable to reach a negotiated agreement on such a reimbursement rate1 the ,secretary shall use rates determined for equivalent drugs paid for under the original ,medicare fee-for-service program4 ,the ,secretary shall modify such rates in order to accommodate payments for drugs that are not otherwise covered under the original ,medicare fee-for-service program4 7#c7 ,account 7,a7 ,establishment ,there is established in the ,treasury of the ,united ,states an account for the receipts and disbursements attributable to the operation of the public health insurance option1 including the startup funding under subparagraph 7,c7 and appropriations authorized under subparagraph 7,d74 7,b7 ,prohibition of ,state imposition of taxes ,section #ahed7;g7 of the ,social ,security ,act shall apply to receipts and disbursements described in subparagraph 7,a7 in the same manner as such section applies to payments or premiums described in such section4 7,c7 ,startup funding 7i7 ,authorization of funding ,there are authorized to be appropriated such sums as may be necessary to establish the public health insurance option and cover #ij days of claims reserves based on projected enrollment4 7ii7 ,amortization of startup funding ,the ,secretary shall provide for the repayment of the startup funding provided under clause 7i7 to the ,treasury in an amortized manner over the #aj-year period beginning on ,january #a1 #bjbj4 7,d7 ,additional authorization of appropriations ,to carry out paragraph 7#b7 of subsection 7b71 there are authorized to be appropriated such sums as may be necessary4 7,e7 ,limitation ,any provision of law restricting the use of ,federal funds with respect to any reproductive health service shall not apply to funds appropriated under this subsection4 7d7 ,health care provider participation 7#a7 ,provider participation 7,a7 ,in general ,the ,secretary shall establish conditions of participation for health care providers under the public health insurance option4 7,b7 ,licensure or certification ,the ,secretary shall not allow a health care provider to participate in the public health insurance option unless such provider is appropriately licensed or certified under ,state law4 7,c7 ,clarification ,notwithstanding subparagraph 7,a71 a health care provider may not be prohibited from participating in the public health insurance option for reasons other than the ability of such provider to provide covered services4 7#b7 ,establishment of a provider network 7,a7 ,medicare and ,medicaid participating providers ,a health care provider that is a participating provider of services or supplier under the ,medicare program under title ,,xviii of the ,social ,security ,act or under a ,state ,medicaid plan under title ,,xix of such ,act is a participating provider in the public health insurance option unless the health care provider opts out of participating in the public health insurance option through a process established by the ,secretary4 7,b7 ,additional providers ,the ,secretary shall establish a process to allow health care providers not described in subparagraph 7,a7 to become participating providers in the public health insurance option4 4 7b7 ,conforming amendments 7#a7 ,treatment as a qualified health plan ,section #acja7;a77#b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjba7;a77#b77 is amended-- 7,a7 in the paragraph heading1 by inserting 1 the public health insurance option1 before and2 and 7,b7 by inserting the public health insurance option under section #bgie of the ,public ,health ,service ,act1 before and a multi-,state plan4 7#b7 ,level playing field ,section #acbd7;a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjdd7;a77 is amended by inserting the public health insurance option under section #bgie of the ,public ,health ,service ,act1 before or a multi-,state qualified health plan4