Protection of consumers from excessive, unjustified, or unfairly discriminatory rates

(a) Protection from excessive, unjustified, or unfairly discriminatory rates Section 2794 of the Public Health Service Act (42 U.S.C. 300gg–94) is amended by adding at the end the following new subsection: (e) Protection from excessive, unjustified, or unfairly discriminatory rates (1) Authority of States Nothing in this section shall be construed to prohibit a State from imposing requirements (including requirements relating to rate review standards and procedures and information reporting) on health insurance issuers with respect to rates that are in addition to the requirements of this section and are more protective of consumers than such requirements. (2) Consultation in rate review process In carrying out this section, the Secretary shall consult with the National Association of Insurance Commissioners and consumer groups. (3) Determination of who conducts reviews for each State The Secretary shall determine, after the date of enactment of this subsection and periodically thereafter, the following: (A) In which markets in each State the State insurance commissioner or relevant State regulator shall undertake the corrective actions under paragraph (4), based on the Secretary’s determination that the State insurance commissioner or relevant State regulator is adequately undertaking and utilizing such actions in that market. (B) In which markets in each State the Secretary shall undertake the corrective actions under paragraph (4), in cooperation with the relevant State insurance commissioner or State regulator, based on the Secretary’s determination that the State is not adequately undertaking and utilizing such actions in that market. (4) Corrective action for excessive, unjustified, or unfairly discriminatory rates In accordance with the process established under this section, the Secretary or the relevant State insurance commissioner or State regulator shall take corrective actions to ensure that any excessive, unjustified, or unfairly discriminatory rates are corrected prior to implementation, or as soon as possible thereafter, through mechanisms such as— (A) denying rates; (B) modifying rates; or (C) requiring rebates to consumers. (5) Noncompliance (A) In general Failure to comply with any corrective action taken by the Secretary under this subsection may result in the application of civil monetary penalties described in subparagraph (B) and, if the Secretary determines appropriate, make the plan involved ineligible for classification as a qualified health plan. (B) Civil monetary penalties (i) In general The provisions of section 1128A of the Social Security Act, other than subsection (a) and (b) and the first sentence of subsection (c)(1) of such section, shall apply to civil monetary penalties under this paragraph in the same manner as such provisions apply to a penalty or proceeding under section 1128A of the Social Security Act. (ii) Amount The provisions of subparagraph (C) of section 2723(b)(2) shall apply to civil monetary penalties under this paragraph in the same manner as such provisions apply to a penalty under such section.. (b) Clarification of Regulatory Authority Section 2794 of the Public Health Service Act (42 U.S.C. 300gg–94) is further amended— (1) in subsection (a)— (A) in the subsection heading, by striking premium and inserting rate; (B) in paragraph (1), by striking unreasonable increases in premiums and inserting potentially excessive, unjustified, or unfairly discriminatory rates, including premiums,; and (C) in paragraph (2)— (i) by striking an unreasonable premium increase and inserting a potentially excessive, unjustified, or unfairly discriminatory rate; (ii) by striking the increase and inserting the rate; and (iii) by striking such increases and inserting such rates; and (2) in subsection (b)— (A) in the subsection heading, by striking Premium and inserting Rate; (B) by striking premium increases each place it appears and inserting rates; (C) in paragraph (1)— (i) in the paragraph heading, by striking Premium Increase and inserting Rate; and (ii) in subparagraph (B), by striking excessive or unjustified and inserting excessive, unjustified, or unfairly discriminatory; and (D) in paragraph (2)— (i) in the paragraph heading, by striking Premium Increases and inserting Rates; and (ii) in subparagraph (B), by striking premium and inserting rate. (c) Conforming amendment Section 1311(e)(2) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(e)(2)) is amended by striking excessive or unjustified premium increases and inserting excessive, unjustified, or unfairly discriminatory rates. (d) Applicability to grandfathered health plans Section 1251(a)(5) of the Patient Protection and Affordable Care Act (42 U.S.C. 18011(a)(5)) is amended— (1) by striking Sections 2799A–1 and inserting the following: (A) In general Sections 2799A–1; and (2) by adding at the end the following: (B) Ensuring that consumers get value for their dollars Section 2794 of the Public Health Service Act shall apply to grandfathered health plans for plan years beginning on or after January 1, 2026.. (e) Effective date The amendments made by this section shall take effect on the date of enactment of this Act and shall be implemented with respect to health plans beginning not later than January 1, 2026.