,,ii  #aai? ,,congress  #a/ ,session    
,s4 #igf  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #ab1 #bjbe,mr4    
,wyd5 7= himself1 ,ms4 ,duckwor?1 ,ms4  
,hirono1 ,ms4 ,klobu*>1 ,mrs4 ,murray1  
,mr4 ,s*atz1 ,mrs4 ,%ahe51 ,ms4 ,smi?1  
,mr4 ,wel*1 & ,mr4 ,van ,holl57         
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to am5d ! ,pati5t           
,protection & ,af=dable ,c>e ,act to    
r$uce fraudul5t enrollm5ts 9 qualifi$   
heal? plans1 & = o!r purposes4  #a4     
,%ort title ,?is ,act may be cit$ z !   
,insurance ,fraud ,acc\ntability ,act4  
#b4 ,r$uction ( fraudul5t enrollm5t 9   
qualifi$ heal? plans  7a7 ,p5alties =   
ag5ts & brok]s ,section #adaa7;h77#a7 ( 
! ,pati5t ,protection & ,af=dable ,c>e  
,act 7#db ,u4,s4,c4 #ahjha7;h77#a77 is  
am5d$-- 7#a7 9 subp>agraph 7,a7-- 7,a7  
by r$esignat+ clause 7ii7 z clause 7iv72
  7,b7 9 clause 7i7-- 7i7 9 ! matt]     
prec$+ subclause 7,i71 by /rik+ ,if-- & 

all t foll[s ?r\gh ! su* p]son 9 ! matt]
 foll[+ subclause 7,,ii7 & ins]t+ !     
foll[+3 ,if any p]son 7o!r ?an an ag5t  
or brok]7 fails to provide correct      
in=mation "u subsection 7b7 & su*       
failure is attributable to neglig5ce or 
disreg>d ( any rules or regulations ( ! 
,secret>y1 su* p]son2 &  7ii7 9 ! second
 s5t5ce1 by /rik+ ,= purposes & ins]t+ !
 foll[+3  7iii7 ,def9itions ( neglig5ce1
 disreg>d ,= purposes  2  7,c7 by ins]t+
 aft] clause 7i7 ! foll[+3  7ii7 ,civil 
p5alties = c]ta9 violations by ag5ts or 
brok]s ,if any ag5t or brok] fails to   
provide correct in=mation "u subsection 
7b7 or section #acaa7;c77#h7 or o!r     
in=mation1 z specifi$ by ! ,secret>y1 & 
su* failure is attributable to neglig5ce
 or disreg>d ( any rules or regulations 
( ! ,secret>y1 su* ag5t or brok] %all be
 subject1 9 addition to any o!r p5alties
 t may be prescrib$ by law1 includ+     
subp>agraph 7,c71 to a civil p5alty ( n 
less ?an #aj1jjj & n m ?an #ej1jjj )    
respect to ea* individual :o is !       

subject ( an application = :i* su*      
incorrect in=mation is provid$4  2 &    
7,d7 9 clause 7iv7 7z s r$esignat$71 by 
ins]t+ or 7ii7 aft] clause 7i72  7#b7 9 
subp>agraph 7,b7-- 7,a7 by ins]t+       
includ+ subp>agraph 7,c71 aft] law12    
7,b7 by /rik+ ,any p]son & ins]t+ !     
foll[+3  7i7 ,9 g5]al ,any p]son  2 &   
7,c7 by add+ at ! end ! foll[+3  7ii7   
,civil p5alties = kn[+ violations by    
ag5ts or brok]s  7,i7 ,9 g5]al ,any ag5t
 or brok] :o kn[+ly provides false or   
fraudul5t in=mation "u subsection 7b7 or
 section #acaa7;c77#h71 or o!r false or 
fraudul5t in=mation z "p ( an           
application = enrollm5t 9 a qualifi$    
heal? plan (f]$ ?r\gh an ,ex*ange1 z    
specifi$ by ! ,secret>y1 %all be        
subject1 9 addition to any o!r p5alties 
t may be prescrib$ by law1 includ+      
subp>agraph 7,c71 to a civil p5alty ( n 
m ?an #bjj1jjj ) respect to ea*         
individual :o is ! subject ( an         
application = :i* su* false or fraudul5t
 in=mation is provid$4  7,,ii7 ,proc$ure

 ,! provisions ( section #aabh;,a ( !   
,social ,security ,act 7o!r ?an         
subsections 7a7 & 7b7 ( su* section7    
%all apply to a civil monet>y p5alty "u 
subclause 7,i7 9 ! same mann] z su*     
provisions apply to a p5alty or proce$+ 
"u section #aabh;,a ( ! ,social         
,security ,act4  2 &  7#c7 by add+ at ! 
end ! foll[+3  7,c7 ,crim9al p5alties   
,any ag5t or brok] :o kn[+ly & willfully
 provides false or fraudul5t in=mation  
"u subsection 7b7 or section            
#acaa7;c77#h71 or o!r false or fraudul5t
 in=mation z "p ( an application =      
enrollm5t 9 a qualifi$ heal? plan (f]$  
?r\gh an ,ex*ange1 z specifi$ by !      
,secret>y1 %all be f9$ "u title #ah1    
,unit$ ,/ates ,code1 imprison$ = n m ?an
 #aj ye>s1 or bo?4  4  7b7 ,consum]     
protections  7#a7 ,9 g5]al ,section     
#acaa7;c7 ( ! ,pati5t ,protection &     
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjca7;c77 is am5d$ by add+ at ! end ! 
foll[+3  7#h7 ,ag5t- or brok]-assi/$    
enrollm5t 9 qualifi$ heal? plans 9 c]ta9

 ex*anges  7,a7 ,9 g5]al ,= plan ye>s   
beg9n+ on or aft] su* date specifi$ by !
 ,secret>y1 b n lat] ?an ,janu>y #a1    
#bjbi1 9 ! case ( an ,ex*ange t !       
,secret>y op]ates pursuant to section   
#acba7;c77#a71 ! ,secret>y %all e/abli% 
a v]ification process = new enrollm5ts (
 individuals 91 & *anges 9 cov]age =    
individuals "u1 a qualifi$ heal? plan   
(f]$ ?r\gh su* ,ex*ange1 :i* are        
submitt$ by an ag5t or brok] 9          
accordance ) section #acab7;e7 & = :i* !
 ag5t or brok] is eligible to receive a 
commission4  7,b7 ,requirem5ts ,!       
enrollm5t v]ification process "u        
subp>agraph 7,a7 %all include-- 7i7 a   
requirem5t t ! ag5t or brok] provide ) !
 new enrollm5t or cov]age *ange su*     
docum5tation or evid5ce 7su* z a /&>diz$
 cons5t =m7 or o!r s\rces z ! ,secret>y 
det]m9es necess>y to e/abli% t ! ag5t or
 brok] has ! cons5t ( ! individual = !  
new enrollm5t or cov]age *ange2  7ii7 a 
requirem5t t any commissions due to a   
brok] or ag5t = su* new enrollm5t or    

cov]age *ange are paid aft] ! enrollee  
has resolv$ all inconsi/5cies 9         
accordance ) p>agraphs 7#c7 & 7#d7 (    
section #adaa7;e72  7iii7 a requirem5t t
 ! in=mation requir$ "u clause 7i7 &1 z 
applicable1 ! date on :i* inconsi/5cies 
are resolv$ z describ$ 9 clause 7ii71 is
 accessible to ! applicable qualifi$    
heal? plan ?r\gh a database or o!r      
res\rce1 z det]m9$ by ! ,secret>y1 s t  
any commissions due to a brok] or ag5t =
 su* enrollm5t c be effectuat$ at !     
appropriate "t2  7iv7 a requirem5t t    
individuals are notifi$ ( any *anges to 
enrollm5t1 cov]age1 ! ag5t ( record1 or 
premium tax cr$its 9 a timely mann] & t 
su* notice provides pla9 language       
in/ructions on h[ individuals c cancel  
unau?oriz$ activity2  7v7 a requirem5t t
 individuals be able to access _! acc\nt
 in=mation on a website or o!r te*nology
 plat=m1 z def9$ by ! ,secret>y1 :5 us$ 
to submit an enrollm5t or plan *ange1 9 
lieu ( ! ,ex*ange website describ$ 9    
subsection 7d77#d77;,c71 includ+        

in=mation on ! ag5t ( record1 ! qualifi$
 heal? plan1 & :5 any *anges are made to
 ! ag5t ( record or ! qualifi$ heal?    
plan1 on a consum]-fac+ website or ?r\gh
 a toll-free telephone hotl9e2 &  7vi7 a
 requirem5t t ! ag5t or brok] report to 
! ,secret>y any ?ird-p>ty m>ket+        
organization or field m>ket+            
organization 7z su* t]ms are def9$ 9    
section #acab7;e77 involv$ 9 ! *a9 (    
enrollm5t 7z s def9$7 ) respect to su*  
new enrollm5t or cov]age *ange4  7,c7   
,consum] protection ,! ,secret>y %all   
ensure t ! enrollm5t v]ification process
 "u subp>agraph 7,a7 prioritizes        
cont9uity ( cov]age & c>e = individuals1
 includ+ by n dis5roll+ individuals f a 
qualifi$ heal? plan )\t ! cons5t ( !    
individual1 reg>dless ( :e!r ! brok]1   
ag5t1 or qualifi$ heal? plan is 9       
violation ( any requirem5t "u ?is       
p>agraph4  4  7#b7 ,requir$ report+     
,section #acaa7;c77#a7 ( ! ,pati5t      
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjca7;c77#a77 is am5d$--    

7,a7 9 subp>agraph 7,h71 by /rik+ & at !
 end2  7,b7 9 subp>agraph 7,i71 by /rik+
 ! p]iod at ! end & ins]t+ 2 &2 &  7,c7 
by add+ at ! end ! foll[+3  7,j7 report 
to ! ,secret>y ! t]m9ation 7z def9$ 9   
section #acab7;e77#d77;,c77 ( an issu]4 
4  7c7 ,au?ority ,to regulate field     
m>ket+ organizations & ?ird-,p>ty m>ket+
 organizations ,section #acab7;e7 ( !   
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjcb7;e77 is      
am5d$-- 7#a7 by r$esignat+ p>agraphs    
7#a7 & 7#b7 z subclauses 7,i7 & 7,,ii71 
respectively1 & adju/+ ! m>g9s          
accord+ly2  7#b7 9 subclause 7,,ii7 7z s
 r$esignat$71 by /rik+ ! p]iod at ! end 
& ins]t+ 2 &2  7#c7 by /rik+ !          
subsection designation & head+ & all t  
foll[s ?r\gh brok]s-- & ins]t+ ! foll[+3
  7e7 ,regulation ( ag5ts1 brok]s1 &    
c]ta9 m>ket+ organizations  7#a7 ,ag5ts1
 brok]s1 & c]ta9 m>ket+ organizations   
7,a7 ,9 g5]al ,! ,secret>y %all e/abli% 
proc$ures "u :i* a ,/ate may all[-- 7i7 
ag5ts or brok]s--  2 &  7#d7 by add+ at 

! end ! foll[+3  7ii7 field m>ket+      
organizations & ?ird-p>ty m>ket+        
organizations to p>ticipate 9 ! *a9 (   
enrollm5t = an individual ) respect to  
qualifi$ heal? plans (f]$ ?r\gh an      
,ex*ange4  7,b7 ,crit]ia ,= plan ye>s   
beg9n+ on or aft] su* date specifi$ by !
 ,secret>y1 b n lat] ?an ,janu>y #a1    
#bjbi1 ! ,secret>y1 by regulation1 %all 
e/abli% crit]ia = ,/ates to use 9       
det]m9+ :e!r to all[ ag5ts & brok]s to  
enroll individuals & employ]s 9 qualifi$
 heal? plans z describ$ 9 subclause 7,i7
 ( subp>agraph 7,a77i7 & to assi/       
individuals z describ$ 9 subclause      
7,,ii7 ( su* subp>agraph & field m>ket+ 
organizations & ?ird-p>ty m>ket+        
organizations to p>ticipate 9 ! *a9 (   
enrollm5t z describ$ 9 subp>agraph      
7,a77ii74 ,su* crit]ia %all1 at a       
m9imum1 require t-- 7i7 an ag5t or brok]
 act 9 accordance ) a /&>d ( conduct t  
includes a duty ( su* ag5t or brok] to  
act 9 ! be/ int]e/s ( ! enrollee2  7ii7 
a field m>ket+ organization or ?ird-p>ty

 m>ket+ organization agree to report !  
t]m9ation ( an ag5t or brok] to !       
applicable ,/ate & ! ,secret>y1 includ+ 
! reason = t]m9ation2 &  7iii7 an ag5t1 
brok]1 field m>ket+ organization1 or    
?ird-p>ty m>ket+ organization-- 7,i7    
meet su* m>ket+ requirem5ts z are       
requir$ by ! ,secret>y2  7,,ii7 meet    
m>ket+ requirem5ts 9 accordance ) o!r   
applicable ,f$]al or ,/ate law2  7,,iii7
 does n employ practices t are confus+  
or mislead+1 z det]m9$ by ! ,secret>y2  
7,,iv7 submit all m>ket+ mat]ials to !  
,secret>y =1 z det]m9$ appropriate by ! 
,secret>y1 review & approval2  7,v7 is a
 lic5s$ ag5t or brok] or meets o!r      
lic5sure requirem5ts1 z requir$ by !    
,/ate2  7,,vi7 regi/] ) ! ,secret>y2 &  
7,,vii7 does n comp5sate any individual 
or organization = ref]rals or any o!r   
s]vice relat+ to ! sale (1 m>ket+ =1 or 
enrollm5t 9 qualifi$ heal? plans unless 
su* individual or organization meets !  
crit]ia describ$ 9 subclauses 7,i7 ?r\gh
 7,,vi74  7,c7 ,def9itions ,9 ?is       

p>agraph3 7i7 ,*a9 ( enrollm5t ,! t]m   
*a9 ( enrollm5t1 ) respect to enrollm5t 
( an individual 9 a qualifi$ heal? plan 
(f]$ ?r\gh an ,ex*ange1 means any /eps  
tak5 f m>ket+ to su* individual1 to su* 
individual mak+ an enrollm5t decision ) 
respect to su* a plan4  7ii7 ,field     
m>ket+ organization ,! t]m field m>ket+ 
organization means an organization or   
individual t directly employs or        
contracts ) ag5ts & brok]s1 or contracts
 ) c>ri]s1 to provide functions relat+  
to enrollm5t ( individuals 9 qualifi$   
heal? plans (f]$ ?r\gh an ,ex*ange z "p 
( ! *a9 ( enrollm5t4  7iii7 ,m>ket+ ,!  
t]m m>ket+ means ! use ( m>ket+ mat]ials
 to provide in=mation to curr5t &       
prospective enrollees 9 a qualifi$ heal?
 plan (f]$ ?r\gh an ,ex*ange4  7iv7     
,m>ket+ mat]ials ,! t]m m>ket+ mat]ials 
means mat]ials relat+ to a qualifi$     
heal? plan (f]$ ?r\gh an ,ex*ange or    
b5efits (f]$ ?r\gh an ,ex*ange t-- 7,i7 
are int5d$-- 7aa7 to draw an            
individual's att5tion to su* plan or !  

premium tax cr$its or co/-%>+ r$uctions 
= su* plan or plans (f]$ ?r\gh an       
,ex*ange2  7bb7 to influ5ce an          
individual's decision-mak+ process :5   
select+ a qualifi$ heal? plan 9 :i* to  
enroll2 or  7cc7 to influ5ce an         
enrollee's decision to /ay enroll$ 9 su*
 plan2 &  7,,ii7 include or address     
cont5t reg>d+ ! b5efits1 b5efit         
/ructure1 premiums1 or co/ %>+ ( su*    
plan4  7v7 ,t]m9ation ,! t]m t]m9ation1 
) respect to a contract or bus9ess      
arrangem5t betwe5 an ag5t or brok] & a  
field m>ket+ organization1 ?ird-p>ty    
m>ket+ organization1 or heal? insurance 
issu]1 means-- 7,i7 ! end+ ( su*        
contract or bus9ess arrangem5t1 ei!r    
unilat]ally by "o ( ! p>ties or on      
mutual agreem5t2 or  7,,ii7 ! expiration
 ( su* contract or bus9ess arrangem5t t 
is n replac$ by a sub/antially simil>   
agreem5t4  7vi7 ,?ird-p>ty m>ket+       
organization ,! t]m ?ird-p>ty m>ket+    
organization means an organization or   
individual t is comp5sat$ to p]=m lead  

g5]ation1 m>ket+1 or sales relat+ to    
enrollm5t ( individuals 9 qualifi$ heal?
 plans (f]$ ?r\gh an ,ex*ange z "p ( !  
*a9 ( enrollm5t4  4  7d7 ,transp>5cy    
,section #acab7;e7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjcb7;e77 7z am5d$ by       
subsection 7c77 is am5d$ by add+ at !   
end ! foll[+3  7#b7 ,audits  7,a7 ,9    
g5]al ,= plan ye>s beg9n+ on or aft] su*
 date specifi$ by ! ,secret>y1 b n lat] 
?an ,janu>y #a1 #bjbi1 ! ,secret>y1 9   
coord9ation ) ! ,/ates & 9 consultation 
) ! ,national ,association ( ,insurance 
,commission]s1 %all implem5t a process =
 ! ov]sight & en=cem5t ( ag5t & brok]   
compliance ) ?is section & o!r          
applicable ,f$]al & ,/ate law 7includ+  
regulations7 t %all include-- 7i7       
p]iodic audits ( ag5ts & brok]s bas$    
on-- 7,i7 compla9ts fil$ ) ! ,secret>y  
by individuals enroll$ by su* an ag5t or
 brok] 9 a qualifi$ heal? plan (f]$     
?r\gh an ,ex*ange2  7,,ii7 an incid5t or
 enrollm5t patt]n t sugge/s fraud2 &    

7,,iii7 o!r factors det]m9$ by !        
,secret>y2 &  7ii7 a process "u :i* !   
,secret>y %all %>e audit results & ref] 
pot5tial cases ( fraud to ! relevant    
,/ate dep>tm5t ( insurance4  7,b7       
,effect ,no?+ 9 ?is p>agraph limits or  
re/ricts any ref]rals made "u section   
#acaa7;i77#c7 or any en=cem5t actions "u
 section #adaa7;h74  7#c7 ,li/ ,!       
,secret>y %all develop a process to     
regul>ly provide to qualifi$ heal?      
plans1 ,ex*anges1 & ,/ates a li/ (      
susp5d$ & t]m9at$ ag5ts & brok]s4  4