,,ii #aagth ,,congress #ast ,session ,s4 #ajjb ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #be1 #bjba ,mr4 ,casey 7for himself1 ,ms4 ,baldwin1 and ,ms4 ,stabenow7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to prohibit false or misleading advertising for health insurance coverage1 require warnings and reporting with respect to noncomprehensive health plans1 encourage enrollment in health plans1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,junk ,plan ,accountability and ,disclosure ,act of #bjba4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,,title ,i--,prohibition of false or misleading online advertising for health insurance coverage ,sec4 #aja4 ,definitions4 ,sec4 #ajb4 ,,ftc oversight of online health insurance advertisements4 ,,title ,,ii--,warnings and reporting requirements for noncomprehensive health plans ,sec4 #bja4 ,definitions4 ,sec4 #bjb4 ,requirements for notice regarding benefits4 ,sec4 #bjc4 ,reporting requirements4 ,sec4 #bjd4 ,enforcement4 ,sec4 #bje4 ,regulations4 ,,title ,,iii--,encouraging enrollment in health plans ,sec4 #cja4 ,sense of ,congress4 ,sec4 #cjb4 ,requiring ,marketplace outreach1 educational activities1 and annual enrollment targets4 ,sec4 #cjc4 ,report on effects of website maintenance during open enrollment4 ,sec4 #cjd4 ,promoting consumer outreach and education4 ,sec4 #cje4 ,improving transparency and accountability in the ,marketplace4 ,sec4 #cjf4 ,improving awareness of health coverage options4 ,sec4 #cjg4 ,promoting ,state innovations to expand coverage4 ,i ,prohibition of false or misleading online advertising for health insurance coverage #aja4 ,definitions ,in this title3 7#a7 ,commission ,the term ,commission means the ,federal ,trade ,commission4 7#b7 ,health insurance coverage ,the term health insurance coverage means benefits consisting of medical care 7provided directly1 through insurance or reimbursement1 or otherwise and including items and services paid for as medical care1 but excluding any group health plan7 that are offered to individuals1 including-- 7,a7 a plan offered through an association2 7,b7 short-term limited duration insurance2 7,c7 a policy for such benefits that is not offered by a health insurance issuer 7as such term is defined in section #bgia7;b77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia7;b77#b772 and 7,d7 other health care arrangements that are not health plans4 7#c7 ,non-,,aca compliant health insurance coverage ,the term non-,,aca compliant health insurance coverage has the meaning given such term in paragraph 7#c7 of section #acba7;c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjda7;c77 7as added by section #cjb74 7#d7 ,online platform ,the term online platform means any public-facing website1 web application1 or digital application1 including a search engine or social network4 7#e7 ,qualified health plan ,the term qualified health plan has the meaning given such term in section #acja7;a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjba7;a774 #ajb4 ,,ftc oversight of online health insurance advertisements 7a7 ,prohibitions for online private health insurance advertisement 7#a7 ,in general ,subject to paragraph 7#c71 a person may not post1 publish1 or otherwise display on the internet a deceptive advertisement for health insurance coverage4 7#b7 ,deceptive ,an online advertisement for health insurance coverage shall be considered deceptive if it-- 7,a7 is likely to mislead1 or has the effect of misleading1 a reasonable individual to believe that such advertisement is made by1 through1 or on behalf of-- 7i7 ,healthcare4gov2 7ii7 a ,state or ,federal ,american ,health ,benefit ,exchange described in sections #acaa and #acba of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca1 #ahjda72 or 7iii7 any other ,federal1 ,state1 or local government entity2 7,b7 is likely to mislead1 or has the effect of misleading1 a reasonable individual about-- 7i7 the relative cost of enrolling in non-,,aca compliant health insurance coverage as compared to the cost of enrolling in a qualified health plan2 7ii7 the relative actuarial value of non-,,aca compliant health insurance coverage as compared to a qualified health plan2 or 7iii7 the relative scope of benefits of non-,,aca compliant health insurance coverage as compared to a qualified health plan2 7,c7 is likely to mislead1 or has the effect of misleading1 a reasonable individual to believe that the health insurance coverage advertised-- 7i7 complies with the requirements for qualified health plans under the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 although the health insurance coverage does not meet such requirements2 or 7ii7 provides coverage for benefits that are not covered by such health insurance coverage2 or 7,d7 is likely to mislead1 or has the effect of misleading1 a reasonable individual regarding the scope1 cost1 or duration of coverage of the health insurance coverage being advertised4 7#c7 ,liability of online platforms ,if a person who is unrelated to the operator of an online platform pays or arranges to post1 publish1 or otherwise display an advertisement that violates paragraph 7#a7 on the online platform-- 7,a7 such person shall be deemed to have committed the violation of such paragraph2 and 7,b7 the operator of the online platform shall not be liable for a violation of such paragraph4 7b7 ,enforcement by the ,commission 7#a7 ,unfair or deceptive acts or practice ,a violation of this section or a regulation promulgated under this section shall be treated as a violation of a rule defining an unfair or deceptive act or practice under section #ah7;a77#a77;,b7 of the ,federal ,trade ,commission ,act 7#ae ,u4,s4,c4 #eg;a7a77#a77;,b774 7#b7 ,powers of the ,federal ,trade ,commission 7,a7 ,in general ,except as provided in subparagraph 7,c71 the ,commission shall enforce this section in the same manner1 by the same means1 and with the same jurisdiction1 powers1 and duties as though all applicable terms and provisions of the ,federal ,trade ,commission ,act 7#ae ,u4,s4,c4 #da et seq47 were incorporated into and made a part of this section4 7,b7 ,privileges and immunities ,any person who violates this section or a regulation promulgated under this section shall be subject to the penalties and entitled to the privileges and immunities provided in the ,federal ,trade ,commission ,act 7#ae ,u4,s4,c4 #da et seq474 7,c7 ,nonprofit organizations and insurance ,notwithstanding section #d or #f of the ,federal ,trade ,commission ,act 7#ae ,u4,s4,c4 #dd1 #df71 section #b of ,mc,carran-,ferguson ,act 7#ae ,u4,s4,c4 #ajab71 or any other jurisdictional limitation of the ,commission1 the ,commission shall also enforce this section and the regulations promulgated under this section1 in the same manner provided in subparagraphs 7,a7 and 7,b7 of this paragraph1 with respect to-- 7i7 organizations not organized to carry on business for their own profit or that of their members2 and 7ii7 the business of insurance1 and persons engaged in such business4 7,d7 ,continued applicability of ,state law 7i7 ,in general ,this section shall only supersede a ,state law to the extent that this section is inconsistent with otherwise applicable ,state law4 7ii7 ,clarification ,a ,state law that provides additional protections to consumers than those protections provided in this ,act shall not be considered inconsistent with this ,act for purposes of clause 7i74 7#c7 ,rulemaking ,the ,commission shall promulgate in accordance with section #eec of title #e1 ,united ,states ,code1 such rules as may be necessary to carry out this ,act4 7#d7 ,authority preserved ,nothing in this ,act shall be construed to limit the authority of the ,commission under any other provision of law4 7c7 ,,gao study and report 7#a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study on the effectiveness of the ,commission's oversight of online advertisements for health insurance coverage pursuant to this section during the period which begins on the date of enactment of this ,act and ends #c years thereafter4 ,such study shall include the following3 7,a7 ,the number of enforcement actions during such period taken by the ,commission related to the oversight of online advertisements for health insurance coverage under this section4 7,b7 ,a description of the outcome of any such enforcement action4 7,c7 ,a description of any barrier to the ,commission's enforcement authority under this section in relation to such advertisements4 7,d7 ,a description of how the ,commission's oversight of online advertisements for health insurance coverage has protected consumers1 including through means other than enforcement actions4 7#b7 ,report ,not later than #d years after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 ,,ii ,warnings and reporting requirements for noncomprehensive health plans #bja4 ,definitions ,in this title3 7#a7 ,applicable health plan ,the term applicable health plan-- 7,a7 means 7except as provided in subparagraph 7,b77-- 7i7 health insurance coverage in the individual market providing excepted benefits1 excluding-- 7,i7 automobile liability insurance described in paragraph 7#a77;,c7 of section #bgia7;c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia7;c772 7,,ii7 automobile medical payment insurance described in paragraph 7#a77;,e7 of such section2 7,,iii7 limited scope dental or vision benefits described in paragraph 7#b77;,a7 of such section2 7,,iv7 workers' compensation1 or similar insurance1 described in paragraph 7#a77;,d7 of such section2 7,v7 coverage for on-site medical clinics described in paragraph 7#a77;,g7 of such section2 or 7,,vi7 medicare supplemental health insurance 7as defined under section #ahhb7;g77#a7 of the ,social ,security ,act7 or coverage supplemental to the coverage provided under chapter #ee of title #aj1 ,united ,states ,code2 7ii7 student health insurance coverage1 as defined in section #adg4ade7;a7 of title #de1 ,code of ,federal ,regulations 7or a successor regulation72 7iii7 short-term limited duration insurance1 as defined in section #add4ajc of title #de1 ,code of ,federal ,regulations 7or a successor regulation72 7iv7 any health care arrangement for benefits or payments for medical care offered to individuals through an association2 and 7v7 any other health care arrangement for benefits or payments for medical care 7other than under a ,federal health care program7 that is not health insurance coverage1 or a group health plan1 for purposes of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq471 part #g of subtitle ,b of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaha et seq471 or chapter #ajj of the ,internal ,revenue ,code of #aihf1 including such an arrangement offered by a ,state farm bureau or a health care sharing ministry2 and 7,b7 does not include-- 7i7 any group health plan2 7ii7 any grandfathered health plan2 and 7iii7 any health insurance coverage to which the transitional policy1 described in the letter issued on ,november #ad1 #bjac1 by the ,centers for ,medicare ,medicaid ,services to insurance commissioners1 or an extension of such policy1 applies4 7#b7 ,applicable ,state authority2 excepted benefits2 ,exchange ,the terms applicable ,state authority1 excepted benefits1 and ,exchange have the meanings given such terms in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia74 7#c7 ,federal health care program ,the term ,federal health care program has the meaning given such term under section #aabh;,b7f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f771 except that such term includes the health insurance program under chapter #hi of title #e1 ,united ,states ,code4 7#d7 ,grandfathered health plan ,the term grandfathered health plan has the meaning given such term in section #abea7;e7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjaa7;e774 7#e7 ,group health plan ,the term group health plan has the meaning given such term in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia74 7#f7 ,health care sharing ministry ,the term health care sharing ministry has the meaning given such term in section #ejjj;,a7d77#b77;,b77ii7 of the ,internal ,revenue ,code of #aihf4 7#g7 ,health insurance coverage2 health insurance issuer2 individual market ,the terms health insurance coverage1 health insurance issuer1 and individual market have the meanings given such terms in section #bgia of the ,public ,health ,service ,act4 7#h7 ,non-,,aca compliant health insurance coverage ,the term non-,,aca compliant health insurance coverage has the meaning given such term in paragraph 7#c7 of section #acba7;c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjda7;c77 7as added by section #cjb71 except that such term shall not include any ,federal health care program4 7#i7 ,plain language ,the term plain language has the meaning given the term plain writing in section #c of the ,plain ,writing ,act of #bjaj 7#e ,u4,s4,c4 #cja note74 7#aj7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 #bjb4 ,requirements for notice regarding benefits 7a7 ,in general ,each applicable health plan shall offer to consumers1 prior to enrollment1 enrollment material that includes-- 7#a7 a plain language explanation of the benefits included in such plan1 including through forms that are culturally and linguistically appropriate for such consumers2 and 7#b7 a warning page regarding such benefits in accordance with subsection 7b74 7b7 ,warning page 7#a7 ,in general ,the warning page required under subsection 7a77#b7 shall include-- 7,a7 a clear statement indicating that the applicable health plan is not a comprehensive health plan because it is not required to comply with certain requirements under the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 and title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq472 7,b7 a statement encouraging the consumer to review the plan documents carefully to ensure the individual is aware of-- 7i7 any exclusions or limitations regarding coverage of preexisting conditions or health benefits 7such as hospitalization1 emergency services1 maternity care1 preventive care1 prescription drugs1 and mental health and substance use disorder services72 and 7ii7 any lifetime or annual dollar limits on health benefits2 7,c7 a statement notifying the consumer that1 if the plan expires or the individual loses eligibility for the plan1 the individual may have to wait until the beginning of an open enrollment period to enroll in another plan2 7,d7 a statement notifying the consumer of the option to enroll in a qualified health plan1 which is generally a more comprehensive health plan1 through the ,exchange operating in the ,state1 including-- 7i7 a statement that most consumers who enroll in a qualified health plan receive help paying for their monthly premiums2 7ii7 a statement that special enrollment periods are available through the ,exchange2 7iii7 a link to ,healthcare4gov 7or a successor website7 or another website for the ,exchange operating in the ,state2 and 7iv7 the phone number for the ,exchange operating in the ,state2 and 7,e7 a line for the signature of the consumer to acknowledge that the consumer has read and understands the provisions in the warning page1 and for the date on which such signature is provided4 7#b7 ,accessibility 7,a7 ,in general ,the warning page required under subsection 7a77#b7 shall be-- 7i7 located at the beginning of the enrollment material1 7ii7 accessible to people with disabilities1 including a physical1 cognitive1 or sensory disability1 including accessibility to such people through the use of computers and other technology for receiving consumer information2 and 7iii7 written in plain language that is easily understood by individuals with an intellectual or other cognitive or processing disability4 7,b7 ,multiple languages ,an applicable health plan shall make the warning page required under subsection 7a77#b7 available in the top #ae languages spoken by individuals with limited ,english proficiency in the ,state in which the plan is offered4 7,c7 ,restriction on promoting enrollment in non-,,aca compliant health insurance coverage ,the warning page required under subsection 7a77#b7 shall not include any provision-- 7i7 promoting enrollment in any non-,,aca compliant health insurance coverage2 or 7ii7 directing consumers to a source that could enroll the consumer in any non-,,aca compliant health insurance coverage4 7#c7 ,additional ,state requirements ,a ,state may require applicable health plans to include information1 in addition to the information required under this section1 in the warning page required under subsection 7a77#b71 except that any such additional information shall not-- 7,a7 replace the information required under this section2 7,b7 promote enrollment in any non-,,aca compliant health insurance coverage2 7,c7 direct consumers to a source that could enroll the consumer in any non-,,aca compliant health insurance coverage2 or 7,d7 otherwise conflict with a requirement under this section4 7c7 ,records of signatures 7#a7 ,in general ,an administrator of an applicable health plan shall maintain a record of the signature of a consumer obtained under subsection 7b77#a77;,e7 while the consumer is enrolled in the plan and for1 at a minimum1 #b years after the consumer is no longer enrolled in such plan4 ,the ,secretary may1 through regulations under section #bje1 require an applicable health plan to maintain such record for a period longer than #b years after the consumer is no longer enrolled in the plan4 7#b7 ,reimbursement 7,a7 ,in general ,in the case that a consumer claims1 within the period and in accordance with the procedures described in subparagraph 7,c71 that an applicable health plan did not cover a health benefit while the consumer was enrolled in such plan and the administrator of such plan is not able to provide proof of the record required under paragraph 7#a7 with respect to that consumer1 the plan shall reimburse the consumer1 in an amount determined under subparagraph 7,b71 for such benefit4 7,b7 ,amount 7i7 ,in general ,except as provided under clause 7ii71 such reimbursement shall be equal to 7the greater of7-- 7,i7 the amount the applicable second lowest cost silver plan 7as defined in section #cf;,b7b77#c77;,b7 of the ,internal ,revenue ,code of #aihf71 available in the ,exchange operating in the ,state in which the consumer resided at the time of enrollment1 would have paid for the health benefit if the consumer were enrolled in such plan and the health benefit was provided in-network2 or 7,,ii7 if applicable1 an amount determined by the ,state in which the consumer resides at the time of enrollment4 7ii7 ,coverage required by plan documents ,in the case described in subparagraph 7,a71 if the ,secretary or applicable ,state authority determines that the applicable health plan was required to provide coverage of the health benefit claimed by the consumer based on statements included in the plan documents1 the applicable health plan shall reimburse the consumer in an amount determined in accordance with such plan documents4 7,c7 ,claims ,the ,secretary shall1 through regulations under section #bje1 establish procedures for the filing of claims under subparagraph 7,a71 including by setting the period during which a claim under such subparagraph shall be filed4 ,such period shall be not less than #b years after the consumer is no longer enrolled in the plan4 7#c7 ,liability under other applicable laws ,the ability of an applicable health plan to produce proof of a record required under paragraph 7#a7 shall not shield the plan1 including any administrator1 insurance broker1 or operator of the plan1 from liability under other applicable ,state or ,federal law for any deceptive practice that the plan1 including any such administrator1 insurance broker1 or operator1 engaged in while enrolling a consumer in the plan4 #bjc4 ,reporting requirements 7a7 ,in general ,not later than ,november #a of the first calendar year following the date of enactment of this ,act1 and ,november #a of each year thereafter1 an applicable health plan shall submit to the ,secretary a report containing each of the following 7with respect to the plan year covered by the reporting period73 7#a7 ,the total enrollment in the applicable health plan4 7#b7 7,a7 ,a statement of whether the applicable health plan used an insurance broker4 7,b7 ,if such plan used an insurance broker1 an indication of the number of consumers who were enrolled in the plan through an insurance broker4 7#c7 ,the total amount of claims submitted for payment to the applicable health plan4 7#d7 ,the total amount of claims denied by the applicable health plan4 7#e7 ,information on any marketing materials the applicable health plan used to enroll consumers in the plan1 including-- 7,a7 an indication of whether the plan used any online advertisements2 and 7,b7 a copy of any marketing material used1 including any online advertisement4 7#f7 ,any other information regarding enrollment1 coverage1 or advertising the ,secretary determines appropriate through regulations issued under section #bje4 7b7 ,exemptions ,an applicable health plan shall be exempt from the requirement under subsection 7a7 if-- 7#a7 the plan is required under the law of each ,state in which the plan is offered to submit all information required under subsection 7a7 to the applicable ,state authority in each such ,state2 and 7#b7 the applicable ,state authority in each such ,state reviews such information and has a process for addressing any such information that is misleading or incorrect4 7c7 ,transmittal to ,states ,not later than #b months after receiving a report under subsection 7a7 from an applicable health plan1 the ,secretary shall transmit the report to the applicable ,state authority of each ,state in which the plan is offered4 7d7 ,public availability 7#a7 ,in general ,the ,secretary shall make all information submitted under subsection 7a7 available to the public through a publicly accessible website4 7#b7 ,publicizing website ,the ,secretary shall publicize the website under paragraph 7#a71 including through agreements with applicable ,state authorities and national and ,state organizations representing consumers4 #bjd4 ,enforcement ,the ,secretary shall have the authority to enforce the requirements under section #bjb 7except the additional ,state requirements under subsection 7b77#c7 of such section7 and section #bjc against an applicable health plan in the same manner as the ,secretary may under section #bgbc7;b7 7without regard to the limitation under paragraph 7#a77;,a7 of such section7 enforce a requirement under parts ,a and ,d of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 against a health insurance issuer that violates a provision of such part1 including through civil money penalties and procedures for administrative and judicial review under section #bgbc7;b77#b7 of such ,act 7#db ,u4,s4,c4 #cjj;gg-#bb7;b77#b774 #bje4 ,regulations 7a7 ,in general ,the ,secretary may issue regulations to carry out this title1 including-- 7#a7 regulations to establish enforcement procedures authorized under section #bjd2 and 7#b7 subject to subsection 7b71 regulations for establishing requirements for the warning page required under section #bjb7;a77#b7 that are in addition to the requirements provided under section #bjb4 7b7 ,limitation on requirements for warning page ,a requirement in a regulation described in subsection 7a77#b7 shall not-- 7#a7 use any language to promote enrollment in any non-,,aca compliant health insurance coverage2 7#b7 direct consumers to a source that could enroll the consumer in any non-,,aca compliant health insurance coverage2 or 7#c7 otherwise conflict with a requirement under this title4 ,,iii ,encouraging enrollment in health plans #cja4 ,sense of ,congress ,it is the sense of ,congress that-- 7#a7 when individuals search for phrases related to health insurance1 internet search engines1 including ,google1 ,bing1 and ,yahoo1 should display an answer box that directs individuals to-- 7,a7 ,healthcare4gov and the associated toll free number1 #a-hjj-cah-beif1 with respect to searches originating in ,states in which a ,federal ,exchange is operating2 and 7,b7 a link and phone number for the appropriate ,state-based ,exchange1 with respect to searches originating in ,states in which a ,state ,exchange is operating2 and 7#b7 the answer box related to ,healthcare4,gov in response to a search described in paragraph 7#a7 should be placed in position zero1 above all other content1 including advertisements4 #cjb4 ,requiring ,marketplace outreach1 educational activities1 and annual enrollment targets 7a7 ,in general ,section #acba7;c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjda7;c77 is amended by adding at the end the following3 7#c7 ,outreach and educational activities 7,a7 ,in general ,in the case of an ,exchange established or operated by the ,secretary within a ,state pursuant to this subsection1 the ,secretary shall carry out outreach and educational activities for purposes of informing individuals about qualified health plans offered through the ,exchange1 including by informing such individuals of the availability of coverage under such plans and financial assistance for coverage under such plans4 ,such outreach and educational activities shall be provided in a manner that is culturally and linguistically appropriate to the needs of the populations being served by the ,exchange 7including hard-to-reach populations1 such as racial and sexual minorities1 limited ,english proficient populations1 individuals in rural areas1 veterans1 and young adults7 and shall be provided to populations residing in high health disparity areas 7as defined in subparagraph 7,e77 served by the ,exchange1 in addition to other populations served by the ,exchange4 7,b7 ,limitation on use of funds ,no funds appropriated under this paragraph shall be used for expenditures for promoting non-,,aca compliant health insurance coverage4 7,c7 ,non-,,aca compliant health insurance coverage ,for purposes of subparagraph 7,b73 7i7 ,the term non-,,aca compliant health insurance coverage means-- 7,i7 health insurance coverage1 or a group health plan1 that is not a qualified health plan2 and 7,,ii7 other health care arrangements that are not health plans4 7ii7 ,such term includes the following3 7,i7 ,an association health plan4 7,,ii7 ,short-term limited duration insurance 7as defined in section #add4ajc of title #de1 ,code of ,federal ,regulations 7or a successor regulation774 7,d7 ,funding ,out of any funds in the ,treasury not otherwise appropriated1 there are hereby appropriated for fiscal year #bjbc and each subsequent fiscal year1 #ajj1jjj1jjj to carry out this paragraph4 ,funds appropriated under this subparagraph shall remain available until expended4 7,e7 ,high health disparity area defined ,for purposes of subparagraph 7,a71 the term high health disparity area means a contiguous geographic area that-- 7i7 is located in one census tract or ,,zip code2 7ii7 has measurable and documented racial1 ethnic1 or geographic health disparities2 7iii7 has a low-income population1 as demonstrated by-- 7,i7 average income below #ach percent of the ,federal poverty line2 or 7,,ii7 a rate of participation in the special supplemental nutrition program under section #ag of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf7 that is higher than the national average rate of participation in such program2 7iv7 has poor health outcomes1 as demonstrated by-- 7,i7 lower life expectancy than the national average2 or 7,,ii7 a higher percentage of instances of low birth weight than the national average2 and 7v7 is part of a ,metropolitan ,statistical ,area identified by the ,office of ,management and ,budget4 7#d7 ,annual enrollment targets ,for plan year #bjbb and each subsequent plan year1 in the case of an ,exchange established or operated by the ,secretary within a ,state pursuant to this subsection1 the ,secretary shall establish annual enrollment targets for such ,exchange for such year4 4 7b7 ,grants for ,state ,exchanges ,section #acaa of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7 is amended by adding at the end the following3 7l7 ,open enrollment outreach grants 7#a7 ,in general ,the ,secretary shall award grants to ,states that have established an ,exchange pursuant to this section1 for purposes of assisting such ,states in conducting open enrollment outreach with respect to qualified health plans4 7#b7 ,applications ,a ,state desiring a grant under this subsection shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require1 including a plan demonstrating how the ,state will use the grant funds to carry out outreach and educational activities consistent with the requirements under section #acba7;c77#c74 7#c7 ,awards 7,a7 ,in general ,the ,secretary shall award grants under this subsection as follows3 7i7 ,the ,secretary shall award an initial round of grants to each qualifying ,state in the amount of #a1jjj1jjj4 7ii7 ,if amounts remain available under this subsection after awards are made under clause 7i71 the ,secretary shall award eligible ,states that received an award under clause 7i7 an amount determined appropriate by the ,secretary based on-- 7,i7 the ,state's total population2 7,,ii7 the percentage of the ,state's population that is uninsured2 7,,iii7 the percentage of the ,state's population that is difficult to insure2 and 7,,iv7 such other factors as the ,secretary determines appropriate4 7,b7 ,available until expended ,with respect to a ,state receiving a grant under this subsection1 the grant funds shall remain available until expended4 7,c7 ,matching requirement 7i7 ,in general ,subject to clause 7iii71 as a condition for receiving a grant under this section1 a ,state shall be required to expend non-,federal funds1 at minimum1 in an amount equal to the lesser of-- 7,i7 #be percent of the amount received under the grant for the purpose described in paragraph 7#a72 or 7,,ii7 #a1jjj1jjj4 7ii7 ,previous allocations ,a ,state may apply funding allocated to the purpose described in paragraph 7#a7 prior to receipt of the grant to satisfy the requirement of clause 7i74 7iii7 ,waiver ,the ,secretary may waive the requirement under clause 7i7 in response to-- 7,i7 a public health emergency or a disaster2 or 7,,ii7 an economic recession or other economic hardship that results in an increase in uninsured individuals4 7#d7 ,limitation on use of funds ,no funds appropriated under this subsection shall be used for expenditures for promoting non-,,aca compliant health insurance coverage 7as such term is defined in section #acba7;c77#c77;,c774 7#e7 ,application to ,medicaid and ,,chip outreach and enrollment grants ,funds received by a ,state under a grant awarded under this subsection-- 7,a7 shall not be taken into consideration by the ,secretary when determining whether to award the ,state a grant under section #baac of the ,social ,security ,act 7#db ,u4,s4,c4 #acigmm72 and 7,b7 may not be used by the ,state to satisfy the maintenance of effort requirement under subsection 7e7 of such section4 7#f7 ,funding ,to carry out this subsection1 there are appropriated1 out of amounts in the ,treasury not otherwise appropriated1 #ej1jjj1jjj for fiscal year #bjbc and each subsequent fiscal year4 4 7c7 ,study and report ,not later than #cj days after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall release to ,congress all aggregated documents relating to studies and data sets that were created on or after ,january #a1 #bjad1 and related to marketing and outreach with respect to qualified health plans offered through ,exchanges under title ,i of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjja et seq474 #cjc4 ,report on effects of website maintenance during open enrollment ,not later than #a year after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report examining whether the ,department of ,health and ,human ,services has been conducting maintenance on the website commonly referred to as ,health,care4gov during annual open enrollment periods 7as described in section #acaa7;c77#f77;,b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#f77;,b77 in such a manner so as to minimize any disruption to the use of such website resulting from such maintenance4 #cjd4 ,promoting consumer outreach and education 7a7 ,in general ,section #acaa7;i7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;i77 is amended-- 7#a7 in paragraph 7#b71 by adding at the end the following new subparagraph3 7,c7 ,selection of recipients ,in the case of an ,exchange established and operated by the ,secretary within a ,state pursuant to section #acba7;c71 in awarding grants under paragraph 7#a71 the ,exchange shall-- 7i7 select entities to receive such grants based on an entity's demonstrated capacity to carry out each of the duties specified in paragraph 7#c72 7ii7 not take into account whether or not the entity has demonstrated how the entity will provide information to individuals relating to group health plans offered by a group or association of employers described in section #beaj4c-e7;b7 of title #bi1 ,code of ,federal ,regulations 7or any successor regulation71 or short-term limited duration insurance 7as defined in section #add4ajc of title #de1 ,code of ,federal ,regulations 7or a successor regulation772 and 7iii7 ensure that1 each year1 the ,exchange awards such a grant to-- 7,i7 at least one entity described in this paragraph that is a community and consumer-focused nonprofit group2 and 7,,ii7 at least one entity described in subparagraph 7,b71 which may include another community and consumer-focused nonprofit group in addition to any such group awarded a grant pursuant to subclause 7,i74 ,in awarding such grants1 an ,exchange may consider an entity's record with respect to waste1 fraud1 and abuse for purposes of maintaining the integrity of such ,exchange4 2 7#b7 in paragraph 7#c7-- 7,a7 by amending subparagraph 7,c7 to read as follows3 7,c7 facilitate enrollment1 including with respect to individuals with limited ,english proficiency and individuals with chronic illnesses1 in qualified health plans1 ,state ,medicaid plans under title ,,xix of the ,social ,security ,act1 and ,state child health plans under title ,,xxi of such ,act2 2 7,b7 in subparagraph 7,d71 by striking and at the end2 7,c7 in subparagraph 7,e71 by striking the period at the end and inserting 2 and2 7,d7 by inserting after subparagraph 7,e7 the following new subparagraph3 7,f7 provide referrals to community-based organizations that address social needs related to health outcomes4 2 and 7,e7 by adding at the end the following flush left sentence3 ,the duties specified in the preceding sentence may be carried out by such a navigator at any time during a year4 2 7#c7 in paragraph 7#d77;,a7-- 7,a7 in the matter preceding clause 7i71 by striking not2 7,b7 in clause 7i7-- 7i7 by inserting not before be2 and 7ii7 by striking 2 or and inserting a semicolon2 7,c7 in clause 7ii7-- 7i7 by inserting not before receive2 and 7ii7 by striking the period and inserting a semicolon2 and 7,d7 by adding at the end the following3 7iii7 maintain physical presence in the ,state of the ,exchange so as to allow in-person assistance to consumers2 and 7iv7 receive opioid specific education and training that ensures the navigator can best educate individuals on qualified health plans offered through an ,exchange1 specifically coverage under such plans for opioid health care treatment4 2 and 7#d7 in paragraph 7#f7-- 7,a7 by striking ,funding4--,grants under and inserting ,funding4-- 7,a7 ,state ,exchanges ,grants under 2 and 7,b7 by adding at the end the following new subparagraph3 7,b7 ,federal ,exchanges ,for purposes of carrying out this subsection1 with respect to an ,exchange established and operated by the ,secretary within a ,state pursuant to section #acba7;c71 the ,secretary shall obligate #ajj1jjj1jjj out of amounts collected through the user fees on participating health insurance issuers pursuant to section #aef4ej of title #de1 ,code of ,federal ,regulations 7or any successor regulations71 for fiscal year #bjbb and each subsequent fiscal year4 ,such amount for a fiscal year shall remain available until expended4 4 7b7 ,effective date ,the amendments made by this section shall apply with respect to plan years beginning on or after ,january #a1 #bjbb4 #cje4 ,improving transparency and accountability in the ,marketplace 7a7 ,open enrollment reports ,for plan year #bjbb and each subsequent year1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 in coordination with the ,secretary of the ,treasury and the ,secretary of ,labor1 shall issue biweekly public reports during the annual open enrollment period on the performance of the federally facilitated ,exchange operated pursuant to section #acba7;c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjda7;c774 ,each such report shall include a summary1 including information on a ,state-by-,state basis where available1 of-- 7#a7 the number of unique website visits2 7#b7 the number of individuals who create an account2 7#c7 the number of calls to the call center2 7#d7 the average wait time for callers contacting the call center2 7#e7 with respect to applications for enrollment-- 7,a7 the number of such applications submitted2 7,b7 the total number of individuals on submitted applications for enrollment2 7,c7 the number of individuals on such submitted applications who are determined eligible for enrollment in a qualified health plan2 7,d7 the number of individuals on such submitted applications who are determined or assessed eligible for the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq472 7,e7 the number of individuals on such submitted applications who are determined or assessed eligible for the ,state ,children's ,health ,insurance ,program under title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq472 7,f7 the number of individuals on such submitted applications who are determined eligible for a premium assistance credit under section #cf;,b of the ,internal ,revenue ,code of #aihf2 7,g7 ,the number of individuals on such submitted applications who are determined eligible for cost-sharing reduction under section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga72 and 7,h7 a breakdown of the data described in subparagraphs 7,a7 through 7,g7 by age1 sex1 race and preferred language1 where such information is available2 7#f7 the number of individuals who enroll in a qualified health plan2 and 7#g7 the percentage of individuals who enroll in a qualified health plan through each of-- 7,a7 the website2 7,b7 the call center2 7,c7 navigators2 7,d7 agents and brokers2 7,e7 the enrollment assistant program2 7,f7 directly from issuers or web brokers2 and 7,g7 other means4 7b7 ,open ,enrollment ,after ,action ,report ,for plan year #bjbb and each subsequent year1 the ,secretary1 in coordination with the ,secretary of the ,treasury and the ,secretary of ,labor1 shall publish an after action report not later than #c months after the completion of the annual open enrollment period regarding the performance of the ,exchange described in subsection 7a7 for the applicable plan year4 ,each such report shall include a summary1 including information on a ,state-by-,state basis where available1 of-- 7#a7 the open enrollment data reported under subsection 7a7 for the entirety of the enrollment period2 and 7#b7 activities related to patient navigators described in section #acaa7;i7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;i771 including-- 7,a7 the performance objectives established by the ,secretary for such patient navigators2 7,b7 the number of consumers enrolled by such a patient navigator2 7,c7 an assessment of how such patient navigators have met established performance metrics1 including a detailed list of all patient navigators1 funding received by patient navigators1 and whether established performance objectives of patient navigators were met2 and 7,d7 with respect to the performance objectives described in subparagraph 7,a7-- 7i7 whether such objectives assess the full scope of patient navigator responsibilities1 including general education1 plan selection1 and determination of eligibility for tax credits1 cost-sharing reductions1 or other coverage2 7ii7 how the ,secretary worked with patient navigators to establish such objectives2 and 7iii7 how the ,secretary adjusted such objectives for case complexity and other contextual factors4 7c7 ,report on advertising and consumer outreach ,not later than #c months after the completion of the annual open enrollment period for plan year #bjbb1 the ,secretary shall issue a report on advertising and outreach to consumers for the open enrollment period for plan year #bjbb4 ,such report shall include a description of-- 7#a7 the division of spending on individual advertising platforms1 including television and radio advertisements and digital media1 to raise consumer awareness of open enrollment2 7#b7 the division of spending on individual outreach platforms1 including email and text messages1 to raise consumer awareness of open enrollment2 and 7#c7 whether the ,secretary conducted targeted outreach to specific demographic groups and geographic areas4 7d7 ,promoting transparency and accountability in the administration's expenditures of exchange user fees ,for plan year #bjbb and each subsequent plan year1 not later than the date that is #c months after the end of such plan year1 the ,secretary of ,health and ,human ,services shall submit to the appropriate committees of ,congress and make available to the public an annual report on the expenditures by the ,department of ,health and ,human ,services of user fees collected pursuant to section #aef4ej of title #de1 ,code of ,federal ,regulations 7or any successor regulations74 ,each such report for a plan year shall include a detailed accounting of the amount of such user fees collected during such plan year and of the amount of such expenditures used during such plan year for the federally facilitated ,exchange operated pursuant to section #acba7;c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjda7;c77 on outreach and enrollment activities1 navigators1 maintenance of ,healthcare4gov1 and operation of call centers4 #cjf4 ,improving awareness of health coverage options 7a7 ,in general ,not later than #ij days after the date of the enactment of this ,act1 the ,secretary of ,labor1 in consultation with the ,secretary of ,health and ,human ,services1 shall update1 and make publicly available in a prominent location on the website of the ,department of ,labor1 the model ,consolidated ,omnibus ,budget ,reconciliation ,act of #aihe 7referred to in this section as ,,cobra7 continuation coverage general notice and the model ,,cobra continuation coverage election notice developed by the ,secretary of ,labor for purposes of facilitating compliance of group health plans with the notification requirements under section #fjf of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaff74 ,in updating each such notice1 the ,secretary of ,labor shall include information regarding any ,exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjja et seq47 through which a qualified beneficiary may be eligible to enroll in a qualified health plan1 including-- 7#a7 the publicly accessible ,internet website address for such ,exchange2 7#b7 the publicly accessible ,internet website address for the ,find ,local ,help directory maintained by the ,department of ,health and ,human ,services on the healthcare4gov ,internet website 7or a successor website72 7#c7 a clear explanation that-- 7,a7 an individual who is eligible for continuation coverage may also be eligible to enroll1 with financial assistance1 in a qualified health plan offered through such ,exchange1 but1 in the case that such individual elects to enroll in such continuation coverage and subsequently elects to terminate such continuation coverage before the period of such continuation coverage expires1 such individual will not be eligible to enroll in a qualified health plan offered through such ,exchange during a special enrollment period2 and 7,b7 an individual who elects to enroll in continuation coverage will remain eligible to enroll in a qualified health plan offered through such ,exchange during an open enrollment period and may be eligible for financial assistance with respect to enrolling in such a qualified health plan2 7#d7 information on consumer protections with respect to enrolling in a qualified health plan offered through such ,exchange1 including the requirement for such a qualified health plan to provide coverage for essential health benefits 7as defined in section #acjb7;b7 of such ,act 7#db ,u4,s4,c4 #ahjbb7;b77 and the requirements applicable to such a qualified health plan under parts ,a and ,d of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq472 and 7#e7 information on the availability of financial assistance with respect to enrolling in a qualified health plan1 including the maximum income limit for eligibility for a premium tax credit under section #cf;,b of the ,internal ,revenue ,code of #aihf4 7b7 ,name of notices ,in addition to updating the model ,,cobra continuation coverage general notice and the model ,,cobra continuation coverage election notice under paragraph 7#a71 the ,secretary of ,labor shall rename each such notice as the model ,,cobra continuation coverage and ,affordable ,care ,act coverage general notice and the model ,,cobra continuation coverage and ,affordable ,care ,act coverage election notice1 respectively4 7c7 ,consumer testing ,prior to making publicly available the model ,,cobra continuation coverage general notice and the model ,,cobra continuation coverage election notice updated under paragraph 7#a71 the ,secretary of ,labor shall provide an opportunity for consumer testing of each such notice1 as so updated1 to ensure that each such notice is clear and understandable to the average participant or beneficiary of a group health plan4 7d7 ,definitions ,in this subsection3 7#a7 ,continuation coverage ,the term continuation coverage1 with respect to a group health plan1 has the meaning given such term in section #fjb of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aafb74 7#b7 ,group health plan ,the term group health plan has the meaning given such term in section #fjg of such ,act 7#bi ,u4,s4,c4 #aafg74 7#c7 ,qualified beneficiary ,the term qualified beneficiary has the meaning given such term in such section #fjg4 7#d7 ,qualified health plan ,the term qualified health plan has the meaning given such term in section #acja of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjba74 #cjg4 ,promoting ,state innovations to expand coverage 7a7 ,in general ,subject to subsection 7d71 the ,secretary of ,health and ,human ,services shall award grants to eligible ,state agencies to enable such ,states to explore innovative solutions to promote greater enrollment in health insurance coverage in the individual and small group markets1 including activities described in subsection 7c74 7b7 ,eligibility ,for purposes of subsection 7a71 eligible ,state agencies are ,exchanges established by a ,state under title ,i of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjja et seq47 and ,state agencies with primary responsibility over health and human services for the ,state involved4 7c7 ,use of funds ,for purposes of subsection 7a71 the activities described in this subsection are the following3 7#a7 ,state efforts to streamline health insurance enrollment procedures in order to reduce burdens on consumers and facilitate greater enrollment in health insurance coverage in the individual and small group markets1 including automatic enrollment and reenrollment of1 or pre-populated applications for1 individuals without health insurance who are eligible for tax credits under section #cf;,b of the ,internal ,revenue ,code of #aihf1 with the ability to opt out of such enrollment4 7#b7 ,state investment in technology to improve data sharing and collection for the purposes of facilitating greater enrollment in health insurance coverage in such markets4 7#c7 ,feasibility studies to develop comprehensive and coherent ,state plan for increasing enrollment in the individual and small group market4 7d7 ,funding ,for purposes of carrying out this section1 there is hereby appropriated1 out of any funds in the ,treasury not otherwise appropriated1 #bjj1jjj1jjj for each of the fiscal years #bjbb through #bjbd4 ,such amount shall remain available until expended4