,,ii #aafth ,,congress #ast ,session ,s4 #abfa ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #a1 #bjai ,mr4 ,merkley 7for himself1 ,mr4 ,murphy1 ,mrs4 ,feinstein1 ,ms4 ,harris1 ,mr4 ,blumenthal1 ,mr4 ,schatz1 ,ms4 ,baldwin1 ,mr4 ,durbin1 ,mr4 ,reed1 ,ms4 ,smith1 ,mrs4 ,shaheen1 ,ms4 ,duckworth1 ,mr4 ,booker1 ,mrs4 ,gillibrand1 and ,mr4 ,heinrich7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to provide for the establishment of ,medicare part ,e public health plans1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,choose ,medicare ,act4 #b4 ,public health plan ,the ,social ,security ,act is amended by adding at the end the following3 #bbja4 ,title ,,xxii--,medicare part ,e public health plans ,public health plans4-- 7a7 ,establishment ,the ,secretary shall establish public health plans 7to be known as ,medicare part ,e plans7 that are available in the individual market1 small group market1 and large group market4 7b7 ,benefits 7#a7 ,in general ,each ,medicare part ,e plan1 regardless of whether the plan is offered in the individual market1 small group market1 or large group market1 shall be a qualified health plan within the meaning of section #acja7;a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjba7;a77 that-- 7,a7 meets all requirements applicable to qualified health plans under subtitle ,d of title ,i of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjba et seq47 7other than the requirement under section #acja7;a77#a77;,c77ii7 of such ,act7 and title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq472 7,b7 provides coverage of-- 7i7 the essential health benefits described in section #acjb7;b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b772 and 7ii7 all items and services for which benefits are available under title ,,xviii2 7,c7 provides gold-level coverage described in section #acjb7;d77#a77;,c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;d77#a77;,c772 and 7,d7 provides coverage of abortions and all other reproductive services4 7#b7 ,preemption ,notwithstanding section #acjc7;a77#a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbc7;a77#a77-- 7,a7 a ,state may not prohibit a ,medicare part ,e plan from offering the coverage described in paragraph 7#a77;,d72 and 7,b7 no ,state law that would prohibit such a plan from offering such coverage shall apply to such plan4 7c7 ,eligibility2 enrollment 7#a7 ,availability on the ,exchanges ,the ,medicare part ,e plans offered in the individual and small group markets shall be offered through the ,federal and ,state ,exchanges1 including the ,small ,business ,health ,options ,program ,exchanges 7commonly referred to as the ,,shop ,exchanges74 7#b7 ,eligibility 7,a7 ,in general ,any individual who is a resident of the ,united ,states1 as determined by the ,secretary under subparagraph 7,c71 and who is not an individual described in subparagraph 7,b71 is eligible to enroll in a ,medicare part ,e plan4 7,b7 ,exclusions ,an individual described in this subparagraph is any individual who is-- 7i7 entitled to1 or enrolled for1 benefits under title ,,xviii2 7ii7 eligible for medical assistance under a ,state plan under title ,,xix2 or 7iii7 enrolled for child health assistance or pregnancy-related assistance under a ,state plan under title ,,xxi4 7,c7 ,regulations ,the ,secretary shall promulgate a rule for determining residency for purposes of subparagraph 7,a74 7#c7 ,employer-sponsored plans 7,a7 ,employer enrollment ,effective with respect to the first plan year that begins #a year after the date of enactment of the ,choose ,medicare ,act and each plan year thereafter1 the ,secretary shall provide options for ,medicare part ,e plans in the small group market and large group market that are voluntary1 and available to all employers4 7,b7 ,group health plans ,the ,secretary1 acting through the ,administrator for the ,centers for ,medicare ,medicaid ,services1 at the request of a plan sponsor1 shall serve as a third-party administrator of a group health plan that is a ,medicare part ,e plan offered by such sponsor4 7,c7 ,portability for employer-sponsored plans ,the ,secretary shall develop a process for allowing individuals enrolled in a ,medicare part ,e plan offered in the small group market or large group market to maintain health insurance coverage through a ,medicare part ,e plan if the individual subsequently loses eligibility for enrollment in such a plan based on termination of the employment relationship4 ,the ability to maintain such coverage shall exist regardless of whether the individual has the option to enroll in other health insurance coverage1 including coverage offered in the individual market or through a subsequent employer4 7d7 ,premiums ,the ,secretary shall establish premium rates for the ,medicare part ,e plans that-- 7#a7 are adjusted based on-- 7,a7 whether the plan is offered in the individual market1 small group market1 or large group market2 and 7,b7 the applicable rating area2 7#b7 are at a level sufficient to fully finance-- 7,a7 the costs of health benefits provided by such plans2 and 7,b7 administrative costs related to operating the plans2 and 7#c7 comply with the requirements under section #bgja of the ,public ,health ,service ,act1 including for such plans that are offered in the large group market4 7e7 ,providers and reimbursement rates 7#a7 ,in general ,the ,secretary shall establish a rate schedule for reimbursing types of health care providers furnishing items and services under the ,medicare part ,e plans at rates that are consistent with the negotiations described in paragraph 7#b7 and are necessary to maintain network adequacy4 7#b7 ,manner of negotiation ,the ,secretary shall negotiate the rates described in paragraph 7#a7 in a manner that results in payment rates that are not lower1 in the aggregate1 than rates under title ,,xviii1 and not higher1 in the aggregate1 than the average rates paid by other health insurance issuers offering health insurance coverage through an ,exchange4 7#c7 ,participating providers 7,a7 ,in general ,a health care provider that is a participating provider of services or supplier under the ,medicare program under title ,,xviii on the date of enactment of ,choose ,medicare ,act shall be a participating provider for ,medicare part ,e plans4 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 for ,medicare part ,e plans4 7#d7 ,limitations on balance billing ,the limitations on balance billing pursuant to the provisions of section #ahff7;a77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77;,a77 shall apply to participating providers for ,medicare part ,e plans in the same manner as such provisions apply to participating providers under the ,medicare program4 7f7 ,encouraging use of alternative payment models ,the ,secretary shall1 as applicable1 utilize alternative payment models1 including those described in section #ahcc7z77#c77;,c71 as added by section #aja7;e77#b7 of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae 7,public ,law #aad-aj71 in making payments for items and services 7including prescription drugs7 furnished under ,medicare part ,e plans4 ,the payment rates under such alternative payment models shall comply with the requirement for negotiated rates under subsection 7e77#b74 7g7 ,prescription drugs ,the ,secretary shall apply the provisions of section #ahfj;,d-#aa7;i7 to prescription drugs under ,medicare part ,e plans in the same manner as such provisions apply with respect to applicable covered part ,d drugs under such section4 7h7 ,appropriations 7#a7 ,start up funding ,for purposes of establishing the ,medicare part ,e plans1 there is appropriated to the ,secretary1 out of any funds in the ,treasury not otherwise obligated1 #b1jjj1jjj1jjj1 for fiscal year #bjbj4 7#b7 ,initial reserves ,there is appropriated to the ,secretary1 out of any funds in the ,treasury not otherwise obligated1 such sums as may be necessary1 based on projected enrollment in the ,medicare part ,e plans in the first plan year in which such plans are offered1 to provide reserves for the purpose of paying claims filed during the initial #ij-;day period of such plan year4 7#c7 ,clarification ,any provision of law restricting the use of ,federal funds with respect to any reproductive health service shall not apply to funds appropriated under paragraph 7#a7 or 7#b74 7i7 ,health insurance issuer ,with respect to any ,medicare part ,e plan1 the ,secretary shall be considered a health insurance issuer1 within the meaning of section #bgia7;b7 of the ,public ,health ,service ,act4 4 #c4 ,notice and navigator referral for employees under the ,fair ,labor ,standards ,act of #aich 7a7 ,in general ,section #ah;,b of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bah;b7 is amended-- 7#a7 in the heading1 by striking to and inserting and navigator referral for2 7#b7 by redesignating subsection 7b7 as subsection 7c72 7#c7 by inserting after subsection 7a7 the following3 7b7 ,navigator referral 7#a7 ,in general ,an employer described in paragraph 7#c7 shall refer each full-time employee 7as defined in section #dihj;,h of the ,internal ,revenue ,code of #aihf7 to-- 7,a7 an entity that serves as a navigator under section #acaa7;i7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;i77 for the ,exchange operating in the ,state of the employer2 or 7,b7 if the ,exchange operating in the ,state of the employer does not have an entity serving as such a navigator1 another entity that shall carry out equivalent activities as such a navigator4 7#b7 ,referral ,the referral described in paragraph 7#a7 shall occur-- 7,a7 at the time the employer hires the employee2 or 7,b7 on the effective date described in subsection 7c77#b7 with respect to an employee who is currently employed by the employer on such date4 7#c7 ,employer ,an employer described in this paragraph is any employer that-- 7,a7 does not provide an eligible employer-sponsored plan as defined in section #ejjj;,a7f77#b7 of the ,internal ,revenue ,code of #aihf2 or 7,b7 provides such an eligible employer-sponsored plan1 but the plan is determined under section #cf;,b7c77#b77;,c7 of such ,code-- 7i7 to be unaffordable to the employee2 or 7ii7 to not provide the required minimum actuarial value4 2 and 7#d7 in subsection 7c71 as so redesignated-- 7,a7 in the heading1 by striking ,effective date and inserting ,effective dates2 7,b7 by striking ,subsection 7a7 and inserting the following3 7#a7 ,notice ,subsection 7a72 2 and 7,c7 by adding at the end the following3 7#b7 ,navigator referral ,subsection 7b7 shall take effect with respect to employers in a ,state beginning on the date that is #b years after the date of enactment of the ,choose ,medicare ,act4 4 7b7 ,study ,not later than ,january #a1 #bjbd1 the ,comptroller ,general of the ,united ,states shall conduct a study on the impact of the requirements under section #ah;,b of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bah;b71 including the amendments made by subsection 7a71 on the rate of individuals without minimum essential coverage as defined in section #ejjj;,a of the ,internal ,revenue ,code of #aihf in the ,united ,states and in each ,state4 7c7 ,funding for navigator program ,section #acaa7;i77#f7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;i77#f77 is amended-- 7#a7 by striking ,grants and inserting the following3 7,a7 ,in general ,grants 2 and 7#b7 by adding at the end the following3 7,b7 ,authorization of appropriations ,there is authorized to be appropriated such sums as may be necessary to address capacity limitations of entities serving as navigators through a grant under this subsection4 4 #d4 ,protecting against high out-of-pocket expenditures for ,medicare fee-for-service benefits ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended by adding at the end the following new section3 #ahii;,c4 ,protection against high out-of-pocket expenditures 7a7 ,in general ,notwithstanding any other provision of this title1 in the case of an individual entitled to1 or enrolled for1 benefits under part ,a or enrolled in part ,b1 if the amount of the out-of-pocket cost-sharing of such individual for a year 7beginning with #bjba7 equals or exceeds the annual out-of-pocket limit under subsection 7b7 for that year1 the individual shall not be responsible for additional out-of-pocket cost-sharing incurred during that year4 7b7 ,annual out-of-,pocket limit 7#a7 ,in general ,the amount of the annual out-of-pocket limit under this subsection shall be-- 7,a7 for #bjba1 #f1gjj2 or 7,b7 for a subsequent year1 the amount specified in this subsection for the preceding year increased or decreased by the percentage change in the medical care component of the ,consumer ,price ,index for ,all ,urban ,consumers for the #ab-month period ending with ,june of such preceding year4 7#b7 ,rounding ,if any amount determined under paragraph 7#a77;,b7 is not a multiple of #e1 such amount shall be rounded to the nearest multiple of #e4 7c7 ,out-of-,pocket cost-,sharing defined 7#a7 ,in general ,subject to paragraphs 7#b7 and 7#c71 in this section1 the term out-of-pocket cost-sharing means1 with respect to an individual1 the amount of the expenses incurred by the individual that are attributable to-- 7,a7 deductibles1 coinsurance1 and copayments applicable under part ,a or ,b2 or 7,b7 for items and services that would have otherwise been covered under part ,a or ,b but for the exhaustion of those benefits4 7#b7 ,certain costs not included 7,a7 ,non-covered items and services ,expenses incurred for items and services which are not covered under part ,a or ,b shall not be considered incurred expenses for purposes of determining out-of-pocket cost-sharing under paragraph 7#a74 7,b7 ,items and services not furnished on an assignment-related basis ,if an item or service is furnished to an individual under this title and is not furnished on an assignment-related basis1 any additional expenses the individual incurs above the amount the individual would have incurred if the item or service was furnished on an assignment-related basis shall not be considered incurred expenses for purposes of determining out-of-pocket cost-sharing under paragraph 7#a74 7#c7 ,source of payment ,for purposes of paragraph 7#a71 the ,secretary shall consider expenses to be incurred by the individual without regard to whether the individual or another person1 including a ,state program1 an employer1 a ,medicare supplemental policy1 or other third-party coverage1 has paid for such expenses4 7d7 ,announcement of the annual out-of-,pocket limit ,the ,secretary shall 7beginning in #bjbj7 announce 7in a manner intended to provide notice to all interested parties7 the annual out-of-pocket limit under this section that will be applicable for the succeeding year4 4 #e4 ,negotiating fair prices for ,medicare prescription drugs 7a7 ,in general ,section #ahfj;,d-#aa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aaa7 is amended by striking subsection 7i7 7relating to noninterference7 and by inserting the following3 7i7 ,negotiating fair prices with drug manufacturers 7#a7 ,in general ,notwithstanding any other provision of law1 in furtherance of the goals of providing quality care and containing costs under this part1 the ,secretary shall1 with respect to applicable covered part ,d drugs1 and may1 with respect to other covered part ,d drugs1 negotiate1 using the negotiation technique or techniques that the ,secretary determines will maximize savings and value to the government for prescription drug plans and ,,ma-,,pd plans and for plan enrollees 7in a manner that may be similar to ,federal entities and that may include1 but is not limited to1 formularies1 reference pricing1 discounts1 rebates1 other price concessions1 and coverage determinations71 with drug manufacturers the prices that may be charged to ,,pdp sponsors and ,,ma organizations for such drugs for part ,d eligible individuals who are enrolled in a prescription drug plan or in an ,,ma-,,pd plan4 ,in conducting such negotiations1 the ,secretary shall consider the drug's current price1 initial launch price1 prevalence of disease and usage1 and approved indications1 the number of similarly effective alternative treatments for each approved use of the drug1 the budgetary impact of providing coverage under this part for such drug for all individuals who would likely benefit from the drug1 evidence on the drug's effectiveness and safety compared to similar drugs1 and the quality and quantity of clinical data and rigor of the applicable process of approval of a drug under section #eje of the ,federal ,food1 ,drug1 and ,cosmetic ,act or a biological product under section #cea of the ,public ,health ,service ,act4 7#b7 ,use of lower of ,,va or big four price if negotiations fail ,if1 after attempting to negotiate for a price with respect to a covered part ,d drug under paragraph 7#a7 for a period of #a year1 the ,secretary is not successful in obtaining an appropriate price for the drug 7as determined by the ,secretary71 the ,secretary shall establish the price that may be charged to ,,pdp sponsors and ,,ma organizations for such drug for part ,d eligible individuals who are enrolled in a prescription drug plan or in an ,,ma-,,pd plan at an amount equal to the lesser of-- 7,a7 the price paid by the ,secretary of ,veterans ,affairs to procure the drug under the laws administered by the ,secretary of ,veterans ,affairs2 or 7,b7 the price paid to procure the drug under section #habf of title #ch1 ,united ,states ,code4 7#c7 ,applicable covered part ,d drug defined ,for purposes of this subsection1 the term applicable covered part ,d drug means a covered part ,d drug that the ,secretary determines to be appropriate for negotiation under paragraph 7#a7 based on one or more of the following factors as applied to such drug3 7,a7 ,spending on a per beneficiary basis4 7,b7 ,the proportion of total spending under this title4 7,c7 ,unit price increases over the preceding #e years4 7,d7 ,initial launch price4 7,e7 ,availability of less expensive1 similarly effective alternative treatments4 7,f7 ,status of the drug as a follow-on to previously approved drugs4 7,g7 ,any other criteria determined by the ,secretary4 7#d7 ,,pdp sponsors and ,,ma organization may negotiate lower prices ,nothing in this subsection shall be construed as preventing the sponsor of a prescription drug plan1 or an organization offering an ,,ma-,,pd plan1 from obtaining a discount or reduction of the price for a covered part ,d drug below the price negotiated under paragraph 7#a7 or the price established under paragraph 7#b74 7#e7 ,no effect on existing appeals process ,nothing in this subsection shall be construed to affect the appeals procedures under subsections 7g7 and 7h7 of section #ahfj;,d-#d4 4 7b7 ,effective date ,the amendments made by this section shall take effect on the date of the enactment of this ,act and shall first apply to negotiations and prices for plan years beginning on ,january #a1 #bjbj4 #f4 ,enhancement of premium assistance credit 7a7 ,use of gold level plan for benchmark 7#a7 ,in general ,clause 7i7 of section #cf;,b7b77#b77;,b7 of the ,internal ,revenue ,code of #aihf is amended by striking applicable second lowest cost silver plan and inserting applicable second lowest cost gold plan4 7#b7 ,conforming amendment related to affordability ,section #cf;,b7c77#d77;,c77i77,i7 of such ,code is amended by striking second lowest cost silver plan and inserting second lowest cost gold plan4 7#c7 ,other conforming amendments ,subparagraphs 7,b7 and 7,c7 of section #cf;,b7b77#c7 of such ,code are each amended by striking silver plan each place it appears in the text and the heading and inserting gold plan4 7b7 ,expansion of eligibility for refundable credits for coverage under qualified health plans 7#a7 ,in general ,section #cf;,b7c77#a77;,a7 of the ,internal ,revenue ,code of #aihf is amended by striking #djj percent and inserting #fjj percent4 7#b7 ,conforming amendment ,the last line of the table contained in section #cf;,b7b77#c77;,a77i7 of such ,code is amended by striking #djj and inserting #fjj4 7#c7 ,conforming amendments relating to recapture of excess advanced payments ,clause 7i7 of section #cf;,b7f77#b77;,b7 of such ,code is amended-- 7,a7 by striking #djj percent and inserting #fjj percent2 and 7,b7 by striking #djj in the table therein and inserting #fjj4 7c7 ,elimination of failsafe ,section #cf;,b7b77#c77;,a77ii7 of the ,internal ,revenue ,code of #aihf is amended by striking subclause 7,,iii74 7d7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjah4 #g4 ,enhancements for reduced cost sharing 7a7 ,definition of eligible individual ,section #adjb7;b77#a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjg7;b77#a77 is amended by striking silver level and inserting gold level4 7b7 ,modification of amount 7#a7 ,in general ,section #adjb7;c77#b7 of the ,patient ,protection and ,affordable ,care ,act is amended to read as follows3 7#b7 ,additional reduction ,the ,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-- 7,a7 in the case of an eligible insured whose household income is not less than #ajj percent but not more than #acc percent of the poverty line for a family of the size involved1 increase the plan's share of the total allowed costs of benefits provided under the plan to #id percent of such costs2 7,b7 in the case of an eligible insured whose household income is more than #acc percent but not more than #aej percent of the poverty line for a family of the size involved1 increase the plan's share of the total allowed costs of benefits provided under the plan to #ib percent of such costs2 7,c7 in the case of an eligible insured whose household income is more than #aej percent but not more than #bjj percent of the poverty line for a family of the size involved1 increase the plan's share of the total allowed costs of benefits provided under the plan to #ij percent of such costs2 7,d7 in the case of an eligible insured whose household income is more than #bjj percent but not more than #cjj percent of the poverty line for a family of the size involved1 increase the plan's share of the total allowed costs of benefits provided under the plan to #he percent of such costs2 and 7,e7 in the case of an eligible insured whose household income is more than #cjj percent but not more than #djj percent of the poverty line for a family of the size involved1 increase the plan's share of the total allowed costs of benefits provided under the plan to #hj percent of such costs4 4 7#b7 ,conforming amendment ,clause 7i7 of section #adjb7;c77#a77;,b7 of such ,act is amended to read as follows3 7i7 ,in general ,the ,secretary shall ensure the reduction under this paragraph shall not result in an increase in the plan's share of the total allowed costs of benefits provided under the plan above-- 7,i7 #id percent in the case of an eligible insured described in paragraph 7#b77;,a72 7,,ii7 #ib percent in the case of an eligible insured described in paragraph 7#b77;,b72 7,,iii7 #ij percent in the case of an eligible insured described in paragraph 7#b77;,c72 7,,iv7 #he percent in the case of an eligible insured described in paragraph 7#b77;,d72 and 7,v7 #hj percent in the case of an eligible insured described in paragraph 7#b77;,e74 4 7c7 ,effective date ,the amendments made by this section shall apply to plan years beginning after ,december #ca1 #bjai4 #h4 ,reinsurance and affordability fund ,part #e of subtitle ,d of title ,i of the ,patient ,protection and ,affordable ,care ,act is amended by inserting after section #acda 7#db ,u4,s4,c4 #ahjfa7 the following3 #acda;,a4 ,reinsurance and affordability fund for the individual market in each ,state 7a7 ,in general ,the ,secretary1 in consultation with the ,national ,association of ,insurance ,commissioners1 shall establish a program to enable each ,state1 for any plan year beginning in the #c-year period beginning ,january #a1 #bjbj1 to-- 7#a7 provide reinsurance payments to health insurance issuers with respect to individuals enrolled under individual health insurance coverage offered by such issuers2 or 7#b7 provide assistance 7other than through payments described in paragraph 7#a77 to reduce out-of-pocket costs1 such as copayments1 coinsurance1 premiums1 and deductibles1 of individuals enrolled under qualified health plans offered in the individual market through an ,exchange4 7b7 ,appropriations ,there is appropriated1 out of any money in the ,treasury not otherwise appropriated1 #cj1jjj1jjj1jjj for the period of fiscal years #bjbj through #bjbb for purposes of establishing and administering the program established under this section4 ,such amount shall remain available until expended4 4 #i4 ,expanding rating rules to large group market 7a7 ,in general ,section #bgja7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg7a77 is amended-- 7#a7 in paragraph 7#a71 by striking small2 and 7#b7 by striking paragraph 7#e74 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply to plans offered in the first plan year beginning after the date of enactment of this ,act and any plan year thereafter4 #aj4 ,protection of consumers from excessive1 unjustified1 or unfairly discriminatory rates 7a7 ,protection from excessive1 unjustified1 or unfairly discriminatory rates ,the first section #bgid of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#id71 as added by section #ajjc of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 is amended by adding at the end the following new subsection3 7e7 ,protection from excessive1 unjustified1 or unfairly discriminatory rates 7#a7 ,authority of ,states ,nothing in this section shall be construed to prohibit a ,state from imposing requirements 7including requirements relating to rate review standards and procedures and information reporting7 on health insurance issuers with respect to rates that are in addition to the requirements of this section and are more protective of consumers than such requirements4 7#b7 ,consultation in rate review process ,in carrying out this section1 the ,secretary shall consult with the ,national ,association of ,insurance ,commissioners and consumer groups4 7#c7 ,determination of who conducts reviews for each ,state ,the ,secretary shall determine1 after the date of enactment of this subsection and periodically thereafter1 the following3 7,a7 ,in which markets in each ,state the ,state insurance commissioner or relevant ,state regulator shall undertake the corrective actions under paragraph 7#d71 as a condition of the ,state receiving the grant in subsection 7c71 based on the ,secretary's determination that the ,state insurance commissioner or relevant ,state regulator is adequately undertaking and utilizing such actions in that market4 7,b7 ,in which markets in each ,state the ,secretary shall undertake the corrective actions under paragraph 7#d71 in cooperation with the relevant ,state insurance commissioner or ,state regulator1 based on the ,secretary's determination that the ,state is not adequately undertaking and utilizing such actions in that market4 7#d7 ,corrective action for excessive1 unjustified1 or unfairly discriminatory rates ,in accordance with the process established under this section1 the ,secretary or the relevant ,state insurance commissioner or ,state regulator shall take corrective actions to ensure that any excessive1 unjustified1 or unfairly discriminatory rates are corrected prior to implementation1 or as soon as possible thereafter1 through mechanisms such as-- 7,a7 denying rates2 7,b7 modifying rates2 or 7,c7 requiring rebates to consumers4 7#e7 ,noncompliance ,failure to comply with any corrective action taken by the ,secretary under this subsection may result in the application of civil monetary penalties and1 if the ,secretary determines appropriate1 make the plan involved ineligible for classification as a qualified health plan4 4 7b7 ,clarification of ,regulatory ,authority ,such section is further amended-- 7#a7 in subsection 7a7-- 7,a7 in the subsection heading1 by striking premium and inserting rate2 7,b7 in paragraph 7#a71 by striking unreasonable increases in premiums and inserting potentially excessive1 unjustified1 or unfairly discriminatory rates1 including premiums12 and 7,c7 in paragraph 7#b7-- 7i7 by striking an unreasonable premium increase and inserting a potentially excessive1 unjustified1 or unfairly discriminatory rate2 7ii7 by striking the increase and inserting the rate2 and 7iii7 by striking such increases and inserting such rates2 7#b7 in subsection 7b7-- 7,a7 in the subsection heading1 by striking ,premium and inserting ,rate2 7,b7 by striking premium increases each place it appears and inserting rates2 7,c7 in paragraph 7#a71 in the paragraph heading1 by striking ,premium ,increase and inserting ,rate2 and 7,d7 in paragraph 7#b7-- 7i7 in the paragraph heading1 by striking ,premium ,increases and inserting ,rates2 and 7ii7 in subparagraph 7,b71 by striking premium and inserting rate2 and 7#c7 in subsection 7c77#a7-- 7,a7 in the heading1 by striking ,premium and inserting ,rate2 7,b7 by inserting that satisfy the condition under subsection 7e77#c77;,a7 after award grants to ,states2 and 7,c7 in subparagraph 7,a71 by striking premium increases and inserting rates4 7c7 ,conforming amendments 7#a7 ,public ,health ,service ,act ,title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is amended-- 7,a7 in section #bgbc 7#db ,u4,s4,c4 #cjj;gg-#bb7-- 7i7 in subsection 7a7-- 7,i7 in paragraph 7#a71 by inserting and section #bgid 7relating to the reasonableness of rates with respect to health insurance coverage7 after this part2 and 7,,ii7 in paragraph 7#b71 by inserting or such section #bgid after this part2 and 7ii7 in subsection 7b7-- 7,i7 in paragraph 7#a71 by inserting and section #bgid 7relating to the reasonableness of rates with respect to health insurance coverage7 after this part2 and 7,,ii7 in paragraph 7#b7-- 7aa7 in subparagraph 7,a71 by inserting or such section #bgid that is after this part2 and 7bb7 in subparagraph 7,c77ii71 by inserting or such section #bgid after this part2 and 7,b7 in section #bgfa 7#db ,u4,s4,c4 #cjj;gg-#fa7-- 7i7 in subsection 7a7-- 7,i7 in paragraph 7#a71 by inserting and section #bgid 7relating to the reasonableness of rates with respect to health insurance coverage7 after this part2 and 7,,ii7 in paragraph 7#b7-- 7aa7 by inserting or such section #bgid after set forth in this part2 and 7bb7 by inserting and such section #bgid after the requirements of this part2 and 7ii7 in subsection 7b71 by inserting and such section #bgid after this part4 7#b7 ,patient ,protection and ,affordable ,care ,act ,section #acaa7;e77#b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;e77#b77 is amended by striking unjustified premium increases and inserting unjustified rates4 7d7 ,applicability to grandfathered plans ,section #abea7;a77#d77;,a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjaa7;a77#d77;,a77 is amended by adding at the end the following3 7v7 ,section #bgid 7relating to reasonableness of rates with respect to health insurance coverage74 4 7e7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act and shall be implemented with respect to health plans beginning not later than ,january #a1 #bjbj4 #aa4 ,sense of ,congress ,it is the sense of the ,congress that-- 7#a7 the ,federal ,government1 acting in its capacity as an insurer1 employer1 or health care provider1 should serve as a model for the ,nation to ensure coverage of all reproductive services2 and 7#b7 all restrictions on coverage of reproductive services in the private insurance market should end4