PRIA, Government Policy, Made Personal

Summary

By July 1, 2013, the Secretary must write rules so two or more States can make "health care choice compacts." These compacts let qualified health plans be sold in all member States but usually follow the laws of the State that issued the plan. However, insurers must still follow market-conduct, unfair-trade, network-quality, and consumer-protection rules of the State where the buyer lives. Insurers must be licensed in each State they sell in or agree to that State’s authority and let regulators see their records. They must clearly tell buyers that the plan might not follow all laws of the buyer’s State. A State can join only if it passed a law after March 23, 2010 that allows it. The Secretary can approve a compact only if it gives coverage as complete as the coverage in section 18022(b) sold through Exchanges, keeps cost-sharing at least as affordable as Title I, covers at least as many residents, does not increase the Federal deficit, and does not weaken enforcement of the consumer protections above. A compact cannot start before January 1, 2016. Part (b) was repealed.

Title 42, §18053

The Public Health and Welfare, Source: USLM XML via OLRC

(a)Health care choice compacts

(1)In general

Not later than July 1, 2013, the Secretary shall, in consultation with the National Association of Insurance Commissioners, issue regulations for the creation of health care choice compacts under which 2 or more States may enter into an agreement under which—

(A)1 or more qualified health plans could be offered in the individual markets in all such States but, except as provided in subparagraph (B), only be subject to the laws and regulations of the State in which the plan was written or issued;

(B)the issuer of any qualified health plan to which the compact applies—

(i)would continue to be subject to market conduct, unfair trade practices, network adequacy, and consumer protection standards (including standards relating to rating), including addressing disputes as to the performance of the contract, of the State in which the purchaser resides;

(ii)would be required to be licensed in each State in which it offers the plan under the compact or to submit to the jurisdiction of each such State with regard to the standards described in clause (i) (including allowing access to records as if the insurer were licensed in the State); and

(iii)must clearly notify consumers that the policy may not be subject to all the laws and regulations of the State in which the purchaser resides.

(2)State authority

A State may not enter into an agreement under this subsection unless the State enacts a law after March 23, 2010, that specifically authorizes the State to enter into such agreements.

(3)Approval of compacts

The Secretary may approve interstate health care choice compacts under paragraph (1) only if the Secretary determines that such health care choice compact—

(A)will provide coverage that is at least as comprehensive as the coverage defined in section 18022(b) of this title and offered through Exchanges established under this title;

(B)will provide coverage and cost sharing protections against excessive out-of-pocket spending that are at least as affordable as the provisions of this title 1 would provide;

(C)will provide coverage to at least a comparable number of its residents as the provisions of this title 1 would provide;

(D)will not increase the Federal deficit; and

(E)will not weaken enforcement of laws and regulations described in paragraph (1)(B)(i) in any State that is included in such compact.

(4)Effective date

A health care choice compact described in paragraph (1) shall not take effect before January 1, 2016.

(b)Repealed. Pub. L. 111–148, title X, § 10104(p), Mar. 23, 2010, 124 Stat. 902

Notes & Related Subsidiaries

Editorial Notes

References in Text

This title, where footnoted in subsec. (a)(3)(A) to (C), is title I of Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 130, which enacted this chapter and enacted, amended, and transferred numerous other sections and notes in the Code. For complete classification of title I to the Code, see Tables.

Amendments

2010—Subsec. (b). Pub. L. 111–148, § 10104(p), struck out subsec. (b) which provided authority and requirements for health insurance issuers to offer nationwide qualified health plans.

§18053 Provisions Relating to Offering of Plans in More Than One State