,,ii #aaith ,,congress #ast ,session ,s4 #igf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #ab1 #bjbe,mr4 ,wyden 7for himself1 ,ms4 ,duckworth1 ,ms4 ,hirono1 ,ms4 ,klobuchar1 ,mrs4 ,murray1 ,mr4 ,schatz1 ,mrs4 ,shaheen1 ,ms4 ,smith1 ,mr4 ,welch1 and ,mr4 ,van ,hollen7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend the ,patient ,protection and ,affordable ,care ,act to reduce fraudulent enrollments in qualified health plans1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,insurance ,fraud ,accountability ,act4 #b4 ,reduction of fraudulent enrollment in qualified health plans 7a7 ,penalties for agents and brokers ,section #adaa7;h77#a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjha7;h77#a77 is amended-- 7#a7 in subparagraph 7,a7-- 7,a7 by redesignating clause 7ii7 as clause 7iv72 7,b7 in clause 7i7-- 7i7 in the matter preceding subclause 7,i71 by striking ,if-- and all that follows through the such person in the matter following subclause 7,,ii7 and inserting the following3 ,if any person 7other than an agent or broker7 fails to provide correct information under subsection 7b7 and such failure is attributable to negligence or disregard of any rules or regulations of the ,secretary1 such person2 and 7ii7 in the second sentence1 by striking ,for purposes and inserting the following3 7iii7 ,definitions of negligence1 disregard ,for purposes 2 7,c7 by inserting after clause 7i7 the following3 7ii7 ,civil penalties for certain violations by agents or brokers ,if any agent or broker fails to provide correct information under subsection 7b7 or section #acaa7;c77#h7 or other information1 as specified by the ,secretary1 and such failure is attributable to negligence or disregard of any rules or regulations of the ,secretary1 such agent or broker shall be subject1 in addition to any other penalties that may be prescribed by law1 including subparagraph 7,c71 to a civil penalty of not less than #aj1jjj and not more than #ej1jjj with respect to each individual who is the subject of an application for which such incorrect information is provided4 2 and 7,d7 in clause 7iv7 7as so redesignated71 by inserting or 7ii7 after clause 7i72 7#b7 in subparagraph 7,b7-- 7,a7 by inserting including subparagraph 7,c71 after law12 7,b7 by striking ,any person and inserting the following3 7i7 ,in general ,any person 2 and 7,c7 by adding at the end the following3 7ii7 ,civil penalties for knowing violations by agents or brokers 7,i7 ,in general ,any agent or broker who knowingly provides false or fraudulent information under subsection 7b7 or section #acaa7;c77#h71 or other false or fraudulent information as part of an application for enrollment in a qualified health plan offered through an ,exchange1 as specified by the ,secretary1 shall be subject1 in addition to any other penalties that may be prescribed by law1 including subparagraph 7,c71 to a civil penalty of not more than #bjj1jjj with respect to each individual who is the subject of an application for which such false or fraudulent information is provided4 7,,ii7 ,procedure ,the provisions of section #aabh;,a of the ,social ,security ,act 7other than subsections 7a7 and 7b7 of such section7 shall apply to a civil monetary penalty under subclause 7,i7 in the same manner as such provisions apply to a penalty or proceeding under section #aabh;,a of the ,social ,security ,act4 2 and 7#c7 by adding at the end the following3 7,c7 ,criminal penalties ,any agent or broker who knowingly and willfully provides false or fraudulent information under subsection 7b7 or section #acaa7;c77#h71 or other false or fraudulent information as part of an application for enrollment in a qualified health plan offered through an ,exchange1 as specified by the ,secretary1 shall be fined under title #ah1 ,united ,states ,code1 imprisoned for not more than #aj years1 or both4 4 7b7 ,consumer protections 7#a7 ,in general ,section #acaa7;c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77 is amended by adding at the end the following3 7#h7 ,agent- or broker-assisted enrollment in qualified health plans in certain exchanges 7,a7 ,in general ,for plan years beginning on or after such date specified by the ,secretary1 but not later than ,january #a1 #bjbi1 in the case of an ,exchange that the ,secretary operates pursuant to section #acba7;c77#a71 the ,secretary shall establish a verification process for new enrollments of individuals in1 and changes in coverage for individuals under1 a qualified health plan offered through such ,exchange1 which are submitted by an agent or broker in accordance with section #acab7;e7 and for which the agent or broker is eligible to receive a commission4 7,b7 ,requirements ,the enrollment verification process under subparagraph 7,a7 shall include-- 7i7 a requirement that the agent or broker provide with the new enrollment or coverage change such documentation or evidence 7such as a standardized consent form7 or other sources as the ,secretary determines necessary to establish that the agent or broker has the consent of the individual for the new enrollment or coverage change2 7ii7 a requirement that any commissions due to a broker or agent for such new enrollment or coverage change are paid after the enrollee has resolved all inconsistencies in accordance with paragraphs 7#c7 and 7#d7 of section #adaa7;e72 7iii7 a requirement that the information required under clause 7i7 and1 as applicable1 the date on which inconsistencies are resolved as described in clause 7ii71 is accessible to the applicable qualified health plan through a database or other resource1 as determined by the ,secretary1 so that any commissions due to a broker or agent for such enrollment can be effectuated at the appropriate time2 7iv7 a requirement that individuals are notified of any changes to enrollment1 coverage1 the agent of record1 or premium tax credits in a timely manner and that such notice provides plain language instructions on how individuals can cancel unauthorized activity2 7v7 a requirement that individuals be able to access their account information on a website or other technology platform1 as defined by the ,secretary1 when used to submit an enrollment or plan change1 in lieu of the ,exchange website described in subsection 7d77#d77;,c71 including information on the agent of record1 the qualified health plan1 and when any changes are made to the agent of record or the qualified health plan1 on a consumer-facing website or through a toll-free telephone hotline2 and 7vi7 a requirement that the agent or broker report to the ,secretary any third-party marketing organization or field marketing organization 7as such terms are defined in section #acab7;e77 involved in the chain of enrollment 7as so defined7 with respect to such new enrollment or coverage change4 7,c7 ,consumer protection ,the ,secretary shall ensure that the enrollment verification process under subparagraph 7,a7 prioritizes continuity of coverage and care for individuals1 including by not disenrolling individuals from a qualified health plan without the consent of the individual1 regardless of whether the broker1 agent1 or qualified health plan is in violation of any requirement under this paragraph4 4 7#b7 ,required reporting ,section #acaa7;c77#a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#a77 is amended-- 7,a7 in subparagraph 7,h71 by striking and at the end2 7,b7 in subparagraph 7,i71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following3 7,j7 report to the ,secretary the termination 7as defined in section #acab7;e77#d77;,c77 of an issuer4 4 7c7 ,authority ,to regulate field marketing organizations and third-,party marketing organizations ,section #acab7;e7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjcb7;e77 is amended-- 7#a7 by redesignating paragraphs 7#a7 and 7#b7 as subclauses 7,i7 and 7,,ii71 respectively1 and adjusting the margins accordingly2 7#b7 in subclause 7,,ii7 7as so redesignated71 by striking the period at the end and inserting 2 and2 7#c7 by striking the subsection designation and heading and all that follows through brokers-- and inserting the following3 7e7 ,regulation of agents1 brokers1 and certain marketing organizations 7#a7 ,agents1 brokers1 and certain marketing organizations 7,a7 ,in general ,the ,secretary shall establish procedures under which a ,state may allow-- 7i7 agents or brokers-- 2 and 7#d7 by adding at the end the following3 7ii7 field marketing organizations and third-party marketing organizations to participate in the chain of enrollment for an individual with respect to qualified health plans offered through an ,exchange4 7,b7 ,criteria ,for plan years beginning on or after such date specified by the ,secretary1 but not later than ,january #a1 #bjbi1 the ,secretary1 by regulation1 shall establish criteria for ,states to use in determining whether to allow agents and brokers to enroll individuals and employers in qualified health plans as described in subclause 7,i7 of subparagraph 7,a77i7 and to assist individuals as described in subclause 7,,ii7 of such subparagraph and field marketing organizations and third-party marketing organizations to participate in the chain of enrollment as described in subparagraph 7,a77ii74 ,such criteria shall1 at a minimum1 require that-- 7i7 an agent or broker act in accordance with a standard of conduct that includes a duty of such agent or broker to act in the best interests of the enrollee2 7ii7 a field marketing organization or third-party marketing organization agree to report the termination of an agent or broker to the applicable ,state and the ,secretary1 including the reason for termination2 and 7iii7 an agent1 broker1 field marketing organization1 or third-party marketing organization-- 7,i7 meet such marketing requirements as are required by the ,secretary2 7,,ii7 meet marketing requirements in accordance with other applicable ,federal or ,state law2 7,,iii7 does not employ practices that are confusing or misleading1 as determined by the ,secretary2 7,,iv7 submit all marketing materials to the ,secretary for1 as determined appropriate by the ,secretary1 review and approval2 7,v7 is a licensed agent or broker or meets other licensure requirements1 as required by the ,state2 7,,vi7 register with the ,secretary2 and 7,,vii7 does not compensate any individual or organization for referrals or any other service relating to the sale of1 marketing for1 or enrollment in qualified health plans unless such individual or organization meets the criteria described in subclauses 7,i7 through 7,,vi74 7,c7 ,definitions ,in this paragraph3 7i7 ,chain of enrollment ,the term chain of enrollment1 with respect to enrollment of an individual in a qualified health plan offered through an ,exchange1 means any steps taken from marketing to such individual1 to such individual making an enrollment decision with respect to such a plan4 7ii7 ,field marketing organization ,the term field marketing organization means an organization or individual that directly employs or contracts with agents and brokers1 or contracts with carriers1 to provide functions relating to enrollment of individuals in qualified health plans offered through an ,exchange as part of the chain of enrollment4 7iii7 ,marketing ,the term marketing means the use of marketing materials to provide information to current and prospective enrollees in a qualified health plan offered through an ,exchange4 7iv7 ,marketing materials ,the term marketing materials means materials relating to a qualified health plan offered through an ,exchange or benefits offered through an ,exchange that-- 7,i7 are intended-- 7aa7 to draw an individual's attention to such plan or the premium tax credits or cost-sharing reductions for such plan or plans offered through an ,exchange2 7bb7 to influence an individual's decision-making process when selecting a qualified health plan in which to enroll2 or 7cc7 to influence an enrollee's decision to stay enrolled in such plan2 and 7,,ii7 include or address content regarding the benefits1 benefit structure1 premiums1 or cost sharing of such plan4 7v7 ,termination ,the term termination1 with respect to a contract or business arrangement between an agent or broker and a field marketing organization1 third-party marketing organization1 or health insurance issuer1 means-- 7,i7 the ending of such contract or business arrangement1 either unilaterally by one of the parties or on mutual agreement2 or 7,,ii7 the expiration of such contract or business arrangement that is not replaced by a substantially similar agreement4 7vi7 ,third-party marketing organization ,the term third-party marketing organization means an organization or individual that is compensated to perform lead generation1 marketing1 or sales relating to enrollment of individuals in qualified health plans offered through an ,exchange as part of the chain of enrollment4 4 7d7 ,transparency ,section #acab7;e7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjcb7;e77 7as amended by subsection 7c77 is amended by adding at the end the following3 7#b7 ,audits 7,a7 ,in general ,for plan years beginning on or after such date specified by the ,secretary1 but not later than ,january #a1 #bjbi1 the ,secretary1 in coordination with the ,states and in consultation with the ,national ,association of ,insurance ,commissioners1 shall implement a process for the oversight and enforcement of agent and broker compliance with this section and other applicable ,federal and ,state law 7including regulations7 that shall include-- 7i7 periodic audits of agents and brokers based on-- 7,i7 complaints filed with the ,secretary by individuals enrolled by such an agent or broker in a qualified health plan offered through an ,exchange2 7,,ii7 an incident or enrollment pattern that suggests fraud2 and 7,,iii7 other factors determined by the ,secretary2 and 7ii7 a process under which the ,secretary shall share audit results and refer potential cases of fraud to the relevant ,state department of insurance4 7,b7 ,effect ,nothing in this paragraph limits or restricts any referrals made under section #acaa7;i77#c7 or any enforcement actions under section #adaa7;h74 7#c7 ,list ,the ,secretary shall develop a process to regularly provide to qualified health plans1 ,exchanges1 and ,states a list of suspended and terminated agents and brokers4 4