,i #aaith ,,congress #ast ,session ,h4 ,r4 #aggf ,,in ,,the ,,house ,,of ,,representatives ,march #c1 #bjbe,mr4 ,palmer introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means1 and ,education and ,workforce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend the ,patient ,protection and ,affordable ,care ,act to establish a reinsurance program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,new ,health ,options ,act of #bjbe4 #b4 ,creation of a reinsurance program for a new health insurance risk pool 7a7 ,in general ,part ,v of subtitle ,b of title ,i of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjfa et seq47 is amended by adding at the end the following new section3 #acdd4 ,reinsurance program for certain off-,exchange plans 7a7 ,in general ,there is established a ,reinsurance ,program1 to be administered by the ,secretary of ,health and ,human ,services1 to provide payments to health insurance issuers with respect to claims for eligible individuals for the purpose of lowering premiums for such individuals4 7b7 ,funding 7#a7 ,appropriation ,for the purpose of providing funding for the ,reinsurance ,program1 for each year during the period beginning on ,january #a1 #bjbf1 and ending on ,december #ca1 #bjcj1 there is appropriated out of any monies in the ,treasury not otherwise obligated an amount equal to the product of #ej and the aggregate number of member months for all eligible individuals enrolled in a covered plan during such year4 7#b7 ,limitation on appropriation ,in no year shall the appropriation for the ,reinsurance ,program authorized in paragraph 7#a7 exceed #f1jjj1jjj1jjj4 7#c7 ,use of unexpended funds ,appropriated amounts remaining unexpended at the end of any year may be used to make payments under the ,reinsurance ,program in any future year4 7#d7 ,limitation on use of funds ,no funds received under the ,reinsurance ,program may be used to pay for services described in section #acjc7;b77#a77;,b77i7 7as in effect on the date of the enactment of this section74 7c7 ,operation of program 7#a7 ,in general ,the ,secretary shall establish parameters for the operation of the ,reinsurance ,program consistent with this section4 7#b7 ,deadline for initial operation ,not later than #abj days after the date of the enactment1 the ,secretary shall establish sufficient parameters to specify how the ,program will operate for #bjbf4 7#c7 ,definitions ,in this section3 7,a7 ,covered plan ,the term covered plan means individual health insurance coverage 7as such term is defined in section #bgia of the ,public ,health ,service ,act7-- 7i7 with respect to which the issuer of such coverage has made the election described in section #acab7;c77#a77;,a72 and 7ii7 that does not provide coverage for services described in section #acjc7;b77#a77;,b77i7 7as in effect on the date of the enactment of this section74 7,b7 ,eligible individual ,the term eligible individual means an individual enrolled in a covered plan4 7d7 ,attachment dollar amount and payment proportion 7#a7 ,in general ,the ,secretary shall annually establish an attachment point1 payment proportion1 and reinsurance cap with respect to claims for eligible individuals for payments under the ,reinsurance ,program1 consistent with the following3 7,a7 ,the attachment point for the period beginning ,january #a1 #bjbf1 and ending ,december #ca1 #bjbf1 shall be #aaj1jjj4 7,b7 ,the payment proportion for the period beginning ,january #a1 #bjbf1 and ending ,december #ca1 #bjbf1 shall be #ij percent4 7,c7 ,the reinsurance cap for the period beginning ,january #a1 #bjbf and ending ,december #ca1 #bjbf1 shall be #cjj1jjj4 7#b7 ,adjustment authority ,the ,secretary may adjust any amounts described in paragraph 7#a7 as necessary to ensure the ,reinsurance ,program does not make payment for a year in excess of the amount available for such year under subsection 7b74 4 7b7 ,election ,to opt out of single risk pool 7#a7 ,in general ,section #acab7;c77#a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjcb7;c77#a77 is amended-- 7,a7 by striking ,a health insurance issuer and inserting the following3 7,a7 ,in general ,a health insurance issuer 2 7,b7 in subparagraph 7,a71 as inserted by paragraph 7#a71 by inserting and other than any health plan with respect to which such issuer has elected for this subparagraph not to apply after grandfathered health plans2 and 7,c7 by adding at the end the following new subparagraph3 7,b7 ,treatment of plans opting out of single risk pool ,a health insurance issuer shall consider all enrollees in all health plans offered by such issuer in the individual market with respect to which such issuer has made the election described in subparagraph 7,a7 to be members of a single risk pool4 4 7#b7 ,prohibiting single risk pool opt out for qualified health plans ,section #acja7;a77#a77;,c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjba7;a77#a77 is amended-- 7,a7 in clause 7iii71 by striking and at the end2 7,b7 in clause 7iv71 by striking the period and inserting 2 and2 and 7,c7 by adding at the end the following new clause3 7v7 has not made the election described in section #acab7;c77#a77;,a7 with respect to such plan4 4 7#c7 ,effective date ,the amendments made by this subsection shall apply with respect to plan years beginning on or after ,january #a1 #bjbf4 7c7 ,removing age premium variation limitation for certain plans 7#a7 ,in general 7,a7 ,removal of limitation for certain plans ,section #bgja7;a77#a77;,a77iii7 of the ,public ,health ,service ,act 7#db ,u4,s4,c #cjj;gg7a77#a77;,a77iii77 is amended by inserting or1 in the case of such coverage with respect to which the issuer of such coverage has made the election described in section #acab7;c77#a77;,a7 of the ,patient ,protection and ,affordable ,care ,act1 by more than an actuarially justified amount for adults before 2 and4 7,b7 ,effective date ,the amendment made by subparagraph 7,a7 shall apply with respect to plan years beginning on or after ,january #a1 #bjbf4 7#b7 ,maintaining age premium variation limitation for qualified health plans ,section #acja7;a77#a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjba7;a77#a771 as amended by subsection 7b71 is further amended-- 7,a7 in subparagraph 7,b71 by striking and at the end2 7,b7 in subparagraph 7,c77v71 by striking the period and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,d7 with respect to the premium rate charged by such plan1 if such plan varies such rate by age1 does not vary such rate by more than #c to #a for adults 7consistent with section #bgjg7;c7 of the ,public ,health ,service ,act74 4 7d7 ,treatment of opt out plans in relation to individual health coverage reimbursement arrangements ,the ,secretaries of ,health and ,human ,services1 ,labor1 and the ,treasury shall not fail to treat any individual health insurance coverage 7as defined in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia77 as eligible for integration with an individual health care reimbursement arrangement on the basis that the health insurance issuer 7as so defined7 of such coverage has made the election described in section #acab7;c77#a77;,a7 of the ,patient ,protection and ,affordable ,care ,act 7as inserted by subsection 7b774 #c4 ,promotion of high-value care 7a7 ,in general ,subpart ,,ii of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq47 is amended by adding at the end the following new section3 #bgcj4 ,application of certain out-of-network costs to deductibles and out-of-pocket maximums 7a7 ,in general ,a group health plan1 and a health insurance issuer offering group or individual health insurance coverage1 shall1 in the case that an individual enrolled under such plan or coverage is furnished items or services by a health care provider or health care facility that does not have in effect a contractual relationship with such plan or issuer for the furnishing of such items or services and such individual incurs any out-of-pockets costs with respect to such items and services1 at the option of such individual1 apply such costs to any deductible or out-of-pocket maximum applicable to items and services furnished by health care providers or health care facilities with contracts in effect with such plan or issuer for the furnishing of such items or services1 but only if the following requirements are met3 7#a7 ,the item or service furnished by such provider or facility without a contract in effect with such plan or issuer is an item or service for which benefits are available under such plan or coverage4 7#b7 ,the amount charged by such provider or facility for such item or service is equal to or less than-- 7,a7 the lowest amount recognized by the plan or coverage as payment for such item or service out of all health care providers and health care facilities with a contract in effect with such plan or issuer to furnish such item or service in the same rating area 7as defined for purposes of section #bgja7 in which the item or service described in paragraph 7#a7 was furnished2 or 7,b7 the #beth percentile of charges for such item or service furnished in the same ,state in which the item or service described in paragraph 7#a7 was furnished4 7b7 ,disclosure of information ,a group health plan1 and a health insurance issuer offering group or individual health insurance coverage1 shall1 with respect to each item or service for which benefits are available under such plan or coverage1 make available the lowest amount described in subsection 7a77#b77;,a7 and the #beth percentile described in subsection 7a77#b77;,b7 to all individuals enrolled under such plan or coverage4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply to plan years beginning on or after ,january #a1 #bjbf4 #d4 ,disclosure of lower prices ,part ,e of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aca7 is amended by adding at the end the following new section3 #bgii;,b-#aj4 ,disclosure of lower prices 7a7 ,in general ,beginning ,january #a1 #bjbf1 each health care provider and health care facility shall disclose to patients and prospective patients enrolled in a group health plan1 group or individual health insurance coverage1 or a ,federal health care program 7as defined in section #aabh;,b but including the program established under chapter #hi of title #e1 ,united ,states ,code7 being furnished or seeking to be furnished an item or service by such provider or facility for which benefits are available under such plan1 coverage1 or program1 as applicable1 whether the amount of cost sharing 7including deductibles1 copayments1 and coinsurance7 that would be incurred by such individual for such item or service under such plan1 coverage1 or program1 as applicable1 exceeds the charge that would apply for such item or service for an individual without benefits under any such plan1 coverage1 or program for such item or service4 7b7 ,additional enforcement ,in addition to any other penalty applicable with respect to a violation of subsection 7a71 an individual who is harmed by a violation of this section by a health care provider or health care facility may bring an action against such provider or facility in an appropriate district court of the ,united ,states for-- 7#a7 appropriate injunctive relief2 and 7#b7 damages in an amount that is equal to the amount provided for such harm in a civil action under the law of the ,state in which the provider or facility is located4 4