S. 4035 — Reported in Senate

II Calendar No. 499 118th CONGRESS 2d Session S. 4035 [Report No. 118–220] IN THE SENATE OF THE UNITED STATES March 21, 2024Mr. Scott of Florida (for himself and Mr. Carper) introduced the following bill; which was read twice and referred to the Committee on Homeland Security and Governmental Affairs September 10, 2024Reported by Mr. Peters, with an amendmentStrike out all after the enacting clause and insert the part printed in italic A BILL To require the Director of the Office of Personnel Management to take certain actions with respect to the health insurance program carried out under chapter 89 of title 5, United States Code, and for other purposes. 1. Short title This Act may be cited as the FEHB Protection Act. 2. FEHB improvements (a) Definitions In this section: (1) Director The term Director means the Director of the Office of Personnel Management. (2) Employing office The term employing office has the meaning given the term in section 890.101(a) of title 5, Code of Federal Regulations, or any successor regulation. (3) Health benefits plan; member of family The terms health benefits plan and member of family have the meanings given those terms in section 8901 of title 5, United States Code. (4) Open season The term open season means an open season described in section 890.301(f) of title 5, Code of Federal Regulations, or any successor regulation. (5) Program The term Program means the health insurance program carried out under chapter 89 of title 5, United States Code, including the program carried out under section 8903c of that title. (6) Qualifying life event The term qualifying life event has the meaning given the term in section 892.101 of title 5, Code of Federal Regulations, or any successor regulation. (b) Verification requirements Beginning on the date that is 180 days after the date of enactment of this Act, the Director shall require each employing office to verify— (1) the veracity of any qualifying life event through which an enrollee in the Program seeks to add a member of family with respect to the enrollee to a health benefits plan under the Program; and (2) that, when an enrollee in the Program seeks to add a member of family with respect to the enrollee to the health benefits plan of the enrollee under the Program during any open season, the individual so added is actually a member of family with respect to the enrollee. (c) Fraud risk assessment In any fraud risk assessment conducted with respect to the Program on or after the date of enactment of this Act, the Director shall include an assessment of individuals who are enrolled in, or covered under, a health benefits plan under the Program even though those individuals are not eligible to be so enrolled or covered. (d) Family member eligibility verification audit (1) In general During the 5-year period beginning on the date of enactment of this Act, the Director shall conduct a comprehensive audit regarding members of family— (A) who are covered under an enrollment in a health benefits plan under the Program; and (B) with respect to whom the basis for the eligibility for the coverage described in subparagraph (A) has not been verified. (2) Contents In conducting the audit required under paragraph (1), the Director shall review marriage certificates, birth certificates, and other appropriate documents that are necessary to determine eligibility to enroll in a health benefits plan under the Program. (e) Disenrollment or removal Beginning on the date of enactment of this Act, the Director may disenroll or remove from enrollment any individual enrolled in, or covered under, a health benefits plan under the Program if the Director determines that such individual is not eligible to be so enrolled or covered. 1. Short title This Act may be cited as the FEHB Protection Act. 2. FEHB improvements (a) Definitions In this section: (1) Appropriate committees of Congress The term appropriate committees of Congress means— (A) the Committee on Homeland Security and Governmental Affairs of the Senate; (B) the Committee on Appropriations of the Senate; (C) the Committee on Oversight and Accountability of the House of Representatives; and (D) the Committee on Appropriations of the House of Representatives. (2) Director The term Director means the Director of the Office of Personnel Management. (3) Employing office The term employing office has the meaning given the term in section 890.101(a) of title 5, Code of Federal Regulations, or any successor regulation. (4) Health benefits plan; member of family The terms health benefits plan and member of family have the meanings given those terms in section 8901 of title 5, United States Code. (5) Open season The term open season means an open season described in section 890.301(f) of title 5, Code of Federal Regulations, or any successor regulation. (6) Program The term Program means the health insurance program carried out under chapter 89 of title 5, United States Code, including the program carried out under section 8903c of that title. (7) Qualifying life event The term qualifying life event has the meaning given the term in section 892.101 of title 5, Code of Federal Regulations, or any successor regulation. (b) Verification requirements Not later than 1 year after the date of enactment of this Act, the Director shall issue regulations and implement a process to require each employing office to verify— (1) the veracity of any qualifying life event through which an enrollee in the Program seeks to add a member of family with respect to the enrollee to a health benefits plan under the Program; and (2) that, when an enrollee in the Program seeks to add a member of family with respect to the enrollee to the health benefits plan of the enrollee under the Program, including during any open season, the individual so added is actually a member of family with respect to the enrollee. (c) Fraud risk assessment In any fraud risk assessment conducted with respect to the Program on or after the date of enactment of this Act, the Director shall include an assessment of individuals who are enrolled in, or covered under, a health benefits plan under the Program even though those individuals are not eligible to be so enrolled or covered. (d) Family member eligibility verification audit (1) In general During the 3-year period beginning on the date that is 1 year after the date of enactment of this Act, the Director, in coordination with the head of each employing office, shall conduct a comprehensive audit regarding members of family who are enrolled in, or covered under, a health benefits plan under the Program. (2) Contents In conducting the audit required under paragraph (1), the Director, in coordination with the head of each employing office, shall review marriage certificates, birth certificates, and other appropriate documents that are necessary to determine eligibility to enroll in, or be covered under, a health benefits plan under the Program. (3) Reports (A) In general Not later than 180 days after the date on which the 3-year period described in paragraph (1) begins, and once every 180 days thereafter until the end of that 3-year period, the Director shall submit to the appropriate committees of Congress a report regarding the status of the audit required under that paragraph. (B) Contents Each report required under subparagraph (A) shall include, for the period covered by the report— (i) the number of members of family who were reviewed under the audit conducted under paragraph (1), including the number of those individuals found during the audit to be ineligible to be enrolled in, or covered under, a health benefits plan under the Program; (ii) the number of members of family who disenrolled from a health benefits plan, and the number of members of family who reduced the amount of coverage under a health benefits plan, under the Program before the end of a coverage year; and (iii) any other information that the Director determines to be relevant. (e) Disenrollment or removal Not later than 180 days after the date of enactment of this Act, the Director shall develop a process through which any individual enrolled in, or covered under, a health benefits plan under the Program who is not eligible to be so enrolled or covered shall be disenrolled or removed from enrollment with respect to that health benefits plan. September 10, 2024Reported with an amendment