[Pages S7282-S7283]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

By Mr. REED.
S. 2254. A bill to provide for the establishment of an assistance
program for health insurance consumers; to the Committee on Labor and
Human Resources.

THE HEALTH CARE CONSUMER ASSISTANCE ACT

<bullet> Mr. REED. Mr. President, today I introduce the Health Care
Consumer Assistance Act. This legislation creates a consumer assistance
program that is key to patient protections in the health insurance
market.
President Clinton's Health Quality Commission stated in its recently
released Bill of Rights that consumers have the right to receive
accurate, easily understood information and get assistance in making
informed decisions about health plans and providers. Today, only a
loose patchwork of consumer assistance services exists. And, while a
number of sources provide assistance, most programs are limited. Many
consumer groups have advocated for the establishment of consumer
assistance programs to support consumers' growing need of information.
The legislation I am introducing today gives states grants to
establish nonprofit, private consumer assistance program designed to
help consumers understand and act on their health care choices, rights
and responsibilities. Under my bill, the Secretary of Health and Human
Services will make available funds for states to select an independent,
nonprofit agency to provide the following services to consumers:
provide information to consumers relating to their choices, rights and
responsibilities within the plans they select; operate 1-800 telephone
hotlines to respond to consumer information, advice and assistance
requests; produce and disseminate educational materials about patients'
rights; provide assistance and representation to people who wish to
appeal the denial, termination, or reduction of health care services,
or a refusal to pay for health services; and collect and disseminate
data about inquiries, problems and grievances handled by the consumer
assistance program.
This program has been championed by Ron Pollack of Families USA, a
member of the President's Commission on Quality, as well as numerous
other consumer advocates.
Mr. President, I have joined with many of my Democratic colleagues in
sponsoring S.1890, the Patients' Bill of Rights Act of 1998. I am
pleased that S.1890 would establish a consumer assistance program,
similar to that established by my legislation. My purpose today is to
emphasize the importance of such a consumer protection program. This
legislation is not without controversy, but I believe that American
consumers deserve protection and assistance as they attempt to navigate
the often confusing and complex world of health insurance.
Mr. President, I ask unanimous consent to have the bill printed in
the Record.<bullet>
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 2254

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Health Care Consumer
Assistance Act''.

SEC. 2. GRANTS.

(a) In General.--The Secretary of Health and Human Services
(referred to in this Act as the ``Secretary'') shall award
grants to States to enable such States to enter into
contracts for the establishment of consumer assistance
programs designed to assist consumers of health insurance in
understanding their rights, responsibilities and choices
among health insurance products.
(b) Eligibility.--To be eligible to receive a grant under
this section a State shall prepare and submit to the
Secretary an application at such time, in such manner, and
containing such information as the Secretary may require,
including a State plan that describes--
(1) the manner in which the State will solicit proposals
for, and enter into a contract with, an entity eligible under
section 3 to serve as the health insurance consumer office
for the State; and
(2) the manner in which the State will ensure that advice
and assistance services for health insurance consumers are
coordinated through the office described in paragraph (1).
(c) Amount of Grant.--
(1) In general.--From amounts appropriated under section 5
for a fiscal year, the Secretary shall award a grant to a
State in an amount that bears the same ratio to such amounts
as the number of individuals within the State covered under a
health insurance plan (as determined by the Secretary) bears
to the total number of individuals covered under a health
insurance plan in all States (as determined by the
Secretary). Any amounts provided to a State under this
section that are not used by the State shall be remitted to
the Secretary and reallocated in accordance with this
paragraph.
(2) Minimum amount.--In no case shall the amount provided
to a State under a grant under this section for a fiscal year
be less

[[Page S7283]]

than an amount equal to .5 percent of the amount appropriated
for such fiscal year under section 5.

SEC. 3. ELIGIBILITY OF STATE ENTITIES.

To be eligible to enter into a contract with a State and
operate as the health insurance consumer office for the State
under this Act, an entity shall--
(1) be an independent, nonprofit entity with demonstrated
experience in serving the needs of health care consumers
(particularly low income and other consumers who are most in
need of consumer assistance);
(2) prepare and submit to the State a proposal containing
such information as the State may require;
(3) demonstrate that the entity has the technical,
organizational, and professional capacity to operate the
health insurance consumer office within the State;
(4) provide assurances that the entity has no real or
perceived conflict of interest in providing advice and
assistance to consumers regarding health insurance and that
the entity is independent of health insurance plans,
companies, providers, payers, and regulators of care; and
(5) demonstrate that, using assistance provided by the
State, the entity has the capacity to provide assistance and
advice throughout the State to public and private health
insurance consumers regardless of the source of coverage.

SEC. 4. USE OF FUNDS.

(a) By State.--A State shall use amounts received under a
grant under this Act to enter into a contract described in
section 2(a) to provide funds for the establishment and
operation of a health insurance consumer office.
(b) By Entity.--
(1) In general.--An entity that enters into a contract with
a State under this Act shall use amounts received under the
contract to establish and operate a health insurance consumer
office.
(2) Noncompliance.--If the State fails to enter into a
contract under subsection (a), the Secretary shall withhold
amounts to be provided to the State under this Act and use
such amounts to enter into the contract described in
paragraph (1) for the State.
(c) Activities of Office.--A health insurance consumer
office established under this Act shall--
(1) provide information to health insurance consumers
within the State relating to choice of health insurance
products and the rights and responsibilities of consumers and
insurers under such products;
(2) operate toll-free telephone hotlines to respond to
requests for information, advice or assistance concerning
health insurance in a timely and efficient manner;
(3) produce and disseminate educational materials
concerning health insurance consumer and patient rights;
(4) provide assistance and representation (in nonlitigative
settings) to individuals who desire to appeal the denial,
termination, or reduction of health care services, or the
refusal to pay for such services, under a health insurance
plan;
(5) make referrals to appropriate private and public
individuals or entities so that inquiries, problems, and
grievances with respect to health insurance can be handled
promptly and efficiently; and
(6) collect data concerning inquiries, problems, and
grievances handled by the office and disseminate a
compilation of such information to employers, health plans,
health insurers, regulatory agencies, and the general public.
(d) Availability of Services.--The office shall not
discriminate in the provision of services regardless of the
source of the individual's health insurance coverage or
prospective coverage, including individuals covered under
employer-provided insurance, self-funded plans, the medicare
or medicaid programs under title XVIII or XIX of the Social
Security Act (42 U.S.C. 1395 and 1396 et seq.), or under any
other Federal or State health care program.
(e) Subcontracts.--An office established under this section
may carry out activities and provide services through
contracts entered into with 1 or more nonprofit entities so
long as the office can demonstrate that all of the
requirements of this Act are met by the office.
(f) Training.--
(1) In general.--An office established under this section
shall ensure that personnel employed by the office possess
the skills, expertise, and information necessary to provide
the services described in subsection (c).
(2) Contracts.--To meet the requirement of paragraph (1),
an office may enter into contracts with 1 or more nonprofit
entities for the training (both through technical and
educational assistance) of personnel and volunteers. To be
eligible to receive a contract under this paragraph, an
entity shall be independent of health insurance plans,
companies, providers, payers, and regulators of care.
(3) Limitation.--Not to exceed 7 percent of the amount
awarded to an entity under a contract under subsection (a)
for a fiscal year may be used for the provision of training
under this section.
(g) Administrative Costs.--Not to exceed 1 percent of the
amount of a block grant awarded to the State under subsection
(a) for a fiscal year may be used for administrative expenses
by the State.
(h) Term.--A contract entered into under subsection (a)
shall be for a term of 3 years.

SEC. 5. AUTHORIZATION OF APPROPRIATIONS.

There are authorized to be appropriated such sums as may be
necessary to carry out this Act.<bullet>
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