[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4158 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 4158
To establish the Office of the Special Inspector General for Monitoring
the Affordable Care Act, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 6, 2014
Mr. Roskam (for himself, Mr. Jordan, Mr. Hensarling, Mr. Mulvaney, Mr.
Meadows, Mr. Rice of South Carolina, Mr. Stutzman, Mr. Yoho, Mrs.
Bachmann, Mr. Fleming, Mr. Graves of Georgia, Mr. Gowdy, Mrs. Lummis,
Mrs. Black, Mrs. Blackburn, Mr. Chaffetz, Mr. Kelly of Pennsylvania,
Mr. Lamborn, Mr. Lance, Mr. Murphy of Pennsylvania, Mr. McHenry, Mrs.
Noem, Mr. Ribble, Mr. Roe of Tennessee, Mr. Rooney, Mr. Tiberi, Mr.
Walberg, Mr. Webster of Florida, Mr. Southerland, Ms. Ros-Lehtinen, Mr.
Harris, Ms. Herrera Beutler, Mr. Messer, Mr. Duncan of South Carolina,
Mr. Rodney Davis of Illinois, Mr. Byrne, and Ms. Jenkins) introduced
the following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committees on Natural Resources,
Education and the Workforce, Ways and Means, Oversight and Government
Reform, House Administration, the Judiciary, Rules, and Appropriations,
for a period to be subsequently determined by the Speaker, in each case
for consideration of such provisions as fall within the jurisdiction of
the committee concerned
_______________________________________________________________________
A BILL
To establish the Office of the Special Inspector General for Monitoring
the Affordable Care Act, and for other purposes.
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 ``Special Inspector General for
Monitoring the ACA Act of 2014'' or the ``SIGMA Act of 2014''.
SEC. 2. SPECIAL INSPECTOR GENERAL FOR MONITORING THE AFFORDABLE CARE
ACT.
(a) Office of Special Inspector General.--There is hereby
established the Office of the Special Inspector General for Monitoring
the Affordable Care Act (in this section, referred to as the
``Office'') to carry out the duties described under subsection (e).
(b) Appointment of Inspector General; Removal.--
(1) Appointment.--The head of the Office is the Special
Inspector General for Monitoring the Affordable Care Act (in
this section referred to as the ``Special Inspector General''),
who shall be appointed by the President, by and with the advice
and consent of the Senate.
(2) Qualifications.--The appointment of the Special
Inspector General shall be made solely on the basis of
integrity and demonstrated ability in accounting, auditing,
financial analysis, law, management analysis, healthcare
expertise and financing, public administration, or
investigations.
(3) Deadline for appointment.--The appointment of an
individual as the Special Inspector General shall be made not
later than 30 days after the date of the enactment of this Act.
(4) Compensation.--The annual rate of basic pay of the
Special Inspector General shall be the annual rate of basic pay
provided for positions at level IV of the Executive Schedule
under section 5315 of title 5, United States Code.
(5) Prohibition on political activities.--For purposes of
section 7324 of title 5, United States Code, the Special
Inspector General shall not be considered an employee who
determines policies to be pursued by the United States in the
nationwide administration of Federal law.
(6) Removal.--The Special Inspector General shall be
removable from office in accordance with the provisions of
section 3(b) of the Inspector General Act of 1978 (5 U.S.C.
App.).
(c) Assistant Inspectors General.--The Special Inspector General
shall, in accordance with applicable laws and regulations governing the
civil service--
(1) appoint an Assistant Inspector General for Auditing who
shall have the responsibility for supervising the performance
of auditing activities relating to the duties described under
subsection (e); and
(2) appoint an Assistant Inspector General for
Investigations who shall have the responsibility for
supervising the performance of investigative activities
relating to such duties.
(d) Supervision.--
(1) In general.--Except as provided under paragraph (2),
the Special Inspector General shall report directly to, and be
under the general supervision of, the Secretary of Health and
Human Services.
(2) Independence to conduct investigations and audits.--No
employee or officer of any of the following entities shall
prevent or prohibit the Special Inspector General from
initiating, carrying out, or completing any audit or
investigation related to the duties described under subsection
(e) or from issuing any subpoena during the course of any such
audit or investigation:
(A) The Executive Office of the President and the
Office of Personnel Management.
(B) The Department of Health and Human Services.
(C) The Department of the Treasury.
(D) The Social Security Administration, the
Department of Homeland Security, the Department of
Veterans Affairs, the Department of Defense, the
Department of Labor, and the Peace Corps.
(E) Any other Federal agency involved in
implementing or administering the Affordable Care Act.
(e) Duties.--
(1) Oversight of the implementation and administration of
the affordable care act.--It shall be the duty of the Special
Inspector General to conduct, supervise, and coordinate audits
and investigations of the implementation and administration of
programs and activities established under, and payment system
changes made by, the Affordable Care Act, including by
collecting and summarizing the following:
(A) A description of the individual mandate
requirement for applicable individuals to maintain
minimum essential coverage or pay a penalty under
section 5000A of the Internal Revenue Code of 1986,
including a description of the number of individuals
maintaining such coverage and the number of individuals
paying such penalties.
(B) A description of any increases or decreases
in--
(i) premiums for qualified health plans (as
defined in section 1301 of the Patient
Protection and Affordable Care Act (42 U.S.C.
18021));
(ii) deductibles under qualified health
plans; and
(iii) cost-sharing under qualified health
plans, including by co-payments and co-
insurance,
affecting individuals enrolling in coverage under such
plans through an Exchange established under title I of
the Patient Protection and Affordable Care Act
(including a State-run Exchange, a federally
administered Exchange, and a Small Business Health
Options Program).
(C) A description of any increases or decreases in
the maximum out-of-pocket costs affecting individuals
enrolling in qualified health plans through such a
State-run Exchange, a federally administered Exchange,
and a Small Business Health Options Program.
(D) A description of any increases or decreases in
the size of physician and other health care provider
networks affecting individuals enrolling in qualified
health plans through such a State-run Exchange, a
federally administered Exchange, and a Small Business
Health Options Program.
(E) A description of any type of health insurance
coverage lost because of the treatment under title I of
the Patient Protection and Affordable Care Act of
grandfathered health plans (as defined in section
1251(e) of such Act (42 U.S.C. 18011(e))).
(F) A description of any credits under section 36B
of the Internal Revenue Code of 1986 (and the amount
(if any) of the advance payment of the credit under
section 1412 of the Patient Protection and Affordable
Care Act (42 U.S.C. 18082)) and any cost-sharing
reduction under section 1402 of the Patient Protection
and Affordable Care Act (42 U.S.C. 18071) (and the
amount (if any) of the advance payment of the reduction
under section 1412 of such Act (42 U.S.C. 18082))
provided to individuals enrolling under qualified
health plans through an Exchange established under
title I of the Patient Protection and Affordable Care
Act.
(G) A description of any projections, estimates,
analysis, goals, or targets made by any employee of the
Federal Government or any contractor of the Federal
Government in carrying out duties associated with the
Patient Protection and Affordable Care Act with respect
to the enrollment of individuals in a qualified health
plan through an Exchange established under title I of
the Patient Protection and Affordable Care Act.
(H) A description of the employer mandate
requirement that applicable large employers provide
eligible employees with minimum essential coverage or
pay a fine under section 4980H of the Internal Revenue
Code of 1986, including a description of the type and
number of employers providing such coverage and the
type and number of employers paying such fines.
(I) A description of any projections, estimates,
analysis, goals, or targets made by any employee of the
Federal Government or any contractor of the Federal
Government in carrying out duties associated with the
Patient Protection and Affordable Care Act with respect
to employers providing minimum essential coverage to
applicable employees.
(J) A description of any reports, meetings,
discussions, or materials of any employee of the
Federal Government or any contractor of the Federal
Government in carrying out duties associated with the
Patient Protection and Affordable Care Act relating to
any employers converting full-time employees to part-
time employees or hiring new part-time employees
instead of full-time employees for the purposes of
avoiding the fines provided for under the employer
mandate requirement described in subparagraph (H).
(K) A description of any reports, meetings,
discussions, or materials of any employee of the
Federal Government or any contractor of the Federal
Government in carrying out duties associated with the
Patient Protection and Affordable Care Act relating to
any employers hiring no more than 50 employees for the
purposes of avoiding the requirement to provide minimum
essential coverage or pay a fine under the employer
mandate requirement described in subparagraph (H).
(L) A description of any reports, meetings,
discussions, or materials of any employee of the
Federal Government or any contractor of the Federal
Government in carrying out duties associated with the
Patient Protection and Affordable Care Act relating to
any employers dropping the health insurance coverage
offered to their employees, or employees' spouses or
dependents, for the purposes of avoiding the
requirement to provide minimum essential coverage or
pay a fine under the employer mandate requirement
described in subparagraph (H).
(M) A description of the transitional reinsurance
program established under section 1341 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18061),
including a description of reinsurance contributions
collected or required to be collected under such
program, a description of any reinsurance payments made
or required to be made to health insurance issuers
under such program, a description of the health
insurance coverage and related costs for high-cost
individuals for plans related to such program, an
explanation of the impact of such reinsurance program
on adverse selection in the marketplace, and an
explanation of any premium-stabilizing effects of such
program.
(N) A description of the temporary risk corridors
for qualified health plans established under section
1342 of the Patient Protection and Affordable Care Act
(42 U.S.C. 18062), including a description of
participating plans and the allowable costs and target
amounts of such plans, a description of risk corridor
ratios of such plans, and a description of payment
adjustments made under such program.
(O) A description of the permanent risk adjustment
program established under section 1343 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18063),
including a description of any plans participating in
such program, a description of any risk adjustment
payments made or required to be made under such
program, a description of the health insurance coverage
and related costs for high-cost individuals for plans
related to such program, an explanation of the impact
of such program on adverse selection in the
marketplace, and an explanation of any premium-
stabilizing effects of such program.
(P) A list of all contracts awarded under the
Affordable Care Act and an analysis of whether Federal
contracting procedures were followed when awarding any
contract associated with such Act.
(Q) A description of the development of the health
insurance marketplace for the Internet portal
established under section 1103 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18003),
including a description of the design, features, and
security systems of such web portal and a description
of all costs associated with such development.
(R) A description of any threats, risks, problems,
or functionality issues identified by any employee of
the Federal Government or any contractor of the Federal
Government in carrying out duties associated with the
Patient Protection and Affordable Care Act prior to the
launch of such web portal on October 1, 2013.
(S) A description of any decisionmaking or
activities by any employee of the Federal Government or
any contractor of the Federal Government in carrying
out duties associated with the Patient Protection and
Affordable Care Act in response to such threats, risks,
problems, or functionality issues.
(T) A description of the systems (on the Federal
and State levels) in place or in development to allow
health insurance issuers and plans and government
entities to verify information is accurate for purposes
of enrollments in qualified health plans through
Exchanges established under title I of the Patient
Protection and Affordable Care Act, including that data
verification and validation can occur with respect to
information provided or stored by individuals, the
Department of Health and Human Services, the qualified
health plans, States, and other applicable Federal
agencies, including for purposes of credits under
section 36B of the Internal Revenue Code of 1986 (and
the amount (if any) of the advance payment of the
credit under section 1412 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18082)) and any cost-
sharing reduction under section 1402 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18071)
(and the amount (if any) of the advance payment of the
reduction under section 1412 of such Act (42 U.S.C.
18082)).
(U) A description of the development of the Federal
Data Services Hub, including its design, features, and
security systems, and a description of the type of data
accessed through such data hub, and a description of
the actual storage location of such data accessed
through such data hub.
(V) A list of the duties and responsibilities
assigned to the Internal Revenue Service as a result of
the enactment of the Affordable Care Act, a description
of any plans of the Internal Revenue Service for how to
carry out such duties, and an explanation of the
resources and personnel required to carry out such
duties, including a description of any new resources or
personnel required to carry out such duties not already
available to the Internal Revenue Service.
(W) A description of any plans of the Internal
Revenue Service to verify the eligibility of
individuals enrolling in qualified health plans for any
credits under section 36B of the Internal Revenue Code
of 1986 (and the amount (if any) of the advance payment
of the credit under section 1412 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18082))
and any cost-sharing reduction under section 1402 of
the Patient Protection and Affordable Care Act (42
U.S.C. 18071) (and the amount (if any) of the advance
payment of the reduction under section 1412 of such Act
(42 U.S.C. 18082)), including a description of any such
verification completed and a description of any such
individuals determined to be ineligible.
(X) A description of any plans by the Internal
Revenue Service to calculate the amount of overpayment
of any such credit or reduction for which an individual
enrolled in a qualified health plan was determined to
be ineligible, including a description of any such
calculations completed.
(Y) A description of any plans by the Internal
Revenue Service to notify individuals determined to be
ineligible for such credits or reductions, including a
description of such notifications completed.
(Z) A description of any plans by the Internal
Revenue Service to recapture such overpayments of such
credits and reductions for individuals determined to be
ineligible, including a description of such recapturing
completed.
(AA) A description of the impact of the Affordable
Care Act on the right of conscience, including on--
(i) religious employers and institutions
that were not exempted from the mandate issued
by the Department of Health and Human Services
requiring individual and group health plans to
cover sterilization and Food and Drug
Administration approved contraceptives;
(ii) individuals; and
(iii) medical professionals.
(BB) A description of abortion coverage offered
under qualified health plans purchased through State-
run Exchanges, federally administered Exchanges, and
Small Business Health Options Programs, including costs
associated with such coverage.
(CC) A description of any actions by departments or
agencies of the Federal Government to delay the
programs or activities authorized by the Affordable
Care Act, including an explanation from the head of
such department or agency of the specific authority
used to implement such a delay.
(DD) A description of the Independent Payment
Advisory Board under section 1899A of the Social
Security Act (42 U.S.C. 1395kkk) and any actions taken
to alter or reduce the use of medical products,
treatments or procedures, including an explanation from
the Independent Payment Advisory Board of the reasons
for taking such actions, whether such actions could be
expected to result in worsened medical outcomes for
individuals effected by such alterations or reductions,
and an explanation of the medical information used to
determine whether such alterations or reductions could
be expected to result in such worsened outcomes.
(EE) A description of individuals enrolled in the
Medicaid program under title XIX of the Social Security
Act through an Exchange established under title I of
the Patient Protection and Affordable Care Act,
including a description of the cost of health care
services utilized by such individuals and a description
of the cost to States and the cost to the Federal
Government to provide health care services to such
individuals.
(FF) Any additional topic related to the
implementation and administration of the Affordable
Care Act, the inclusion of which helps to provide the
public a full and objective accounting of such law.
(2) Data to be included.--In carrying out the duties
described under paragraph (1), the Special Inspector General
shall collect and summarize data described under such paragraph
according to each type of insurance marketplace and according
to the age and gender of individuals enrolling in coverage
under qualified health plans through an Exchange established
under title I of the Patient Protection and Affordable Care
Act.
(3) Other duties related to oversight.--The Special
Inspector General shall establish, maintain, and oversee such
systems, procedures, and controls as the Special Inspector
General considers appropriate to discharge the duties described
under paragraph (1).
(4) Duties and responsibilities under the inspector general
act of 1978.--In addition to the duties described under
paragraphs (1) and (2), the Special Inspector General shall
also have the duties and responsibilities of inspectors general
under the Inspector General Act of 1978 (5 U.S.C. App.).
(f) Coordination of Efforts.--In carrying out the duties,
responsibilities, and authorities of the Special Inspector General
under this section, the Special Inspector General shall coordinate
with, and receive the cooperation of each of the following:
(1) The Inspector General of the Department of Health and
Human Services.
(2) The Inspector General of the Department of the
Treasury.
(3) The Inspectors General of the Social Security
Administration, the Department of Homeland Security, the
Department of Veterans Affairs, the Department of Defense, the
Department of Labor, and the Peace Corps.
(4) The inspector general of any other Federal entity, as
determined by the Special Inspector General.
(g) Powers and Authorities.--
(1) Authority to access materials, request information,
compel response, and other authorities under the inspector
general act of 1978.--In carrying out the duties described
under subsection (e), the Special Inspector General shall have
all of the authorities provided under section 6 of the
Inspector General Act of 1978 (5 U.S.C. App.).
(2) Exemption from requirement for initial determination by
attorney general.--For purposes of section 6(e) of the
Inspector General Act of 1978 (5 U.S.C. App.), the Special
Inspector General shall be considered exempt from the
requirement of an initial determination of eligibility by the
Attorney General under paragraph (2) of such section.
(3) Audit standards.--The Special Inspector General shall
carry out the duties specified under subsection (e)(1) in
accordance with section 4(b)(1) of the Inspector General Act of
1978 (5 U.S.C. App.).
(h) Personnel, Facilities, and Other Resources.--
(1) Personnel.--The Special Inspector General may select,
appoint, and employ such officers and employees as may be
necessary for carrying out the duties of the Special Inspector
General, subject to the provisions of title 5, United States
Code, governing appointments in the competitive service, and
the provisions of chapter 51 and subchapter III of chapter 53
of such title, relating to classification and General Schedule
pay rates.
(2) Employment of experts and consultants.--The Special
Inspector General may obtain services as authorized by section
3109 of title 5, United States Code, at daily rates not to
exceed the equivalent rate prescribed for grade GS-15 of the
General Schedule by section 5332 of such title.
(3) Contracting authority.--To the extent and in such
amounts as may be provided in advance by appropriations Acts,
the Special Inspector General may enter into contracts and
other arrangements for audits, studies, analyses, and other
services with public agencies and with private persons, and
make such payments as may be necessary to carry out the duties
of the Special Inspector General.
(4) Resources.--The Secretary of Health and Human Services
shall provide the Special Inspector General with appropriate
and adequate office space at appropriate locations of the
Department of Health and Human Services together with such
equipment, office supplies, and communications facilities and
services as may be necessary for the operation of such offices,
and shall provide necessary maintenance services for such
offices and the equipment and facilities located therein.
(5) Assistance from federal agencies.--
(A) In general.--Upon request of the Special
Inspector General for information or assistance from
any department, agency, or other entity of the Federal
Government (including any entity listed under
subsection (d)(2)), the head of such entity shall,
insofar as is practicable and not in contravention of
any existing law, furnish such information or
assistance to the Special Inspector General, or an
authorized designee.
(B) Reporting of refused assistance.--
(i) Reporting to health and human services
and congress.--In accordance with clause (ii),
as the case may be, whenever information or
assistance requested by the Special Inspector
General is, in the judgment of the Special
Inspector General, unreasonably refused or not
provided, the Special Inspector General shall
report the circumstances to the Secretary of
Health and Human Services and to the
appropriate congressional committees without
delay.
(ii) Reporting to the public on refusal or
noncooperation in transparency.--Whenever any
information described in clause (i) is
requested by the Special Inspector General and
unreasonably refused or not provided, the
report to the Secretary of Health and Human
Services and the appropriate congressional
committees shall be titled ``Notice of Refusal
or Noncooperation in Transparency'' and shall
be published on a publicly available website in
an accessible format without delay.
(6) Use of personnel, facilities, and other resources of
the office.--Upon the request of the Special Inspector General,
an Inspector General--
(A) may detail, on a reimbursable basis, any of the
personnel of the Office for the purpose of carrying out
this section; and
(B) may provide, on a reimbursable basis, any of
the facilities or other resources of the Office for the
purpose of carrying out this section.
(i) Reports.--
(1) Initial report.--Not later than 120 days after the date
of the enactment of this Act, the Special Inspector General
shall submit to the appropriate congressional committees and
the Secretary of Health and Human Services a report
summarizing, for the period beginning on the date of the
enactment of the Health Care and Education Reconciliation Act
of 2010 and ending on the completion of a fiscal year quarter
after the date of enactment of this Act, the activities during
such period of the Special Inspector General required under
subsection (e).
(2) Quarterly reports.--Beginning with the first full
fiscal year quarter after the date of the enactment of this
Act, not later than 30 days after the end of each fiscal year
quarter, during which the Affordable Care Act is in effect, the
Special Inspector General shall submit to the appropriate
congressional committees and the Secretary of Health and Human
Services a report summarizing, for the period of that quarter
and, to the extent possible, the period from the end of such
quarter to the time of the submission of the report, the
activities during such period of the Special Inspector General
required under subsection (e).
(3) Comments on report.--Not later than 30 days after
receipt of a report under this subsection, the Secretary of
Health and Human Services shall submit to the appropriate
congressional committees any comments on the matters covered by
the report.
(4) Public availability.--The Special Inspector General
shall publish on a publicly available website each report
described under this subsection and any comments on the matters
covered by the report submitted pursuant to paragraph (3).
(5) Protected information.--To the extent possible,
information submitted in any report required under this
subsection shall be in a form that is not prohibited from
disclosure under section 552a of title 5, United States Code
(commonly known as the Privacy Act of 1974).
(6) Aggregated information.--The Special Inspector General
shall, to the maximum extent possible, aggregate any personally
identifiable information submitted in a report required under
this subsection.
(j) Termination.--The Office of the Special Inspector General shall
terminate on the date on which the final report required by subsection
(h) is submitted for the last year the Affordable Care Act is in
effect.
(k) Definitions.--In this section:
(1) Affordable care act.--The term ``Affordable Care Act''
means the Patient Protection and Affordable Care Act and title
I and subtitle B of title II of the Health Care and Education
Reconciliation Act of 2010.
(2) Appropriate congressional committees.--The term
``appropriate congressional committees'' means--
(A) the Committees on Appropriations, Budget,
Education and the Workforce, Energy and Commerce,
Homeland Security, Judiciary, Oversight and Government
Reform, Small Business, and Ways and Means of the House
of Representatives; and
(B) the Committees on Appropriations, Budget,
Commerce, Science, and Transportation, Finance, Health,
Education, Labor, and Pensions, Homeland Security and
Governmental Affairs, Judiciary, and Small Business and
Entrepreneurship of the Senate.
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