H.R. 3590 - Sec. 1003. Ensuring That Consumers Get Value For Their Dollar lyrics

Part C of title XXVII of the Public Health Service Act (42 U.S.C. 300gg-91 et seq.), as amended by section 1002, is further amended by adding at the end the following: SEC. 2794. ENSURING THAT CONSUMERS GET VALUE FOR THEIR DOLLARS. (a) Initial Premium Review Process: (1) IN GENERAL: The Secretary, in conjunction with States, shall establish a process for the annual review, beginning with the 2010 plan year and subject to subsection (b)(2)(A), of unreasonable increases in premiums for health insurance coverage. (2) JUSTIFICATION AND DISCLOSURE: The process established under paragraph (1) shall require health insurance issuers to submit to the Secretary and the relevant State a justification for an unreasonable premium increase prior to the implementation of the increase. Such issuers shall prominently post such information on their Internet websites. The Secretary shall ensure the public disclosure of information on such increases and justifications for all health insurance issuers. (b) Continuing Premium Review Process: (1) INFORMING SECRETARY OF PREMIUM INCREASE PATTERNS: As a condition of receiving a grant under subsection (c)(1), a State, through its Commissioner of Insurance, shall: (A) provide the Secretary with information about trends in premium increases in health insurance coverage in premium rating areas in the State; and (B) make recommendations, as appropriate, to the State Exchange about whether particular health insurance issuers should be excluded from participation in the Exchange based on a pattern or practice of excessive or unjustified premium increases. (2) MONITORING BY SECRETARY OF PREMIUM INCREASES: (A) IN GENERAL: Beginning with plan years beginning in 2014, the Secretary, in conjunction with the States and consistent with the provisions of subsection (a)(2), shall monitor premium increases of health insurance coverage offered through an Exchange and outside of an Exchange. (B) CONSIDERATION IN OPENING EXCHANGE: In determining under section 1312(f)(2)(B) of the Patient Protection and Affordable Care Act whether to offer qualified health plans in the large group market through an Exchange, the State shall take into account any excess of premium growth outside of the Exchange as compared to the rate of such growth inside the Exchange. (c) Grants in Support of Process: (1) PREMIUM REVIEW GRANTS DURING 2010 THROUGH 2014: The Secretary shall carry out a program to award grants to States during the 5-year period beginning with fiscal year 2010 to a**ist such States in carrying out subsection (a), including: (A) in reviewing and, if appropriate under State law, approving premium increases for health insurance coverage; and (B) in providing information and recommendations to the Secretary under subsection (b)(1). (2) FUNDING: (A) IN GENERAL: Out of all funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary $250,000,000, to be available for expenditure for grants under paragraph (1) and subparagraph (B). (B) FURTHER AVAILABILITY FOR INSURANCE REFORM AND CONSUMER PROTECTION: If the amounts appropriated under subparagraph (A) are not fully obligated under grants under paragraph (1) by the end of fiscal year 2014, any remaining funds shall remain available to the Secretary for grants to States for planning and implementing the insurance reforms and consumer protections under part A. (C) ALLOCATION: The Secretary shall establish a formula for determining the amount of any grant to a State under this subsection. Under such formula-- (i) the Secretary shall consider the number of plans of health insurance coverage offered in each State and the population of the State; and (ii) no State qualifying for a grant under paragraph (1) shall receive less than $1,000,000, or more than $5,000,000 for a grant year.'