[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4035 Reported in Senate (RS)]
<DOC>
Calendar No. 499
118th CONGRESS
2d Session
S. 4035
[Report No. 118-220]
To require the Director of the Office of Personnel Management to take
certain actions with respect to the health insurance program carried
out under chapter 89 of title 5, United States Code, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 21, 2024
Mr. Scott of Florida (for himself and Mr. Carper) introduced the
following bill; which was read twice and referred to the Committee on
Homeland Security and Governmental Affairs
September 10, 2024
Reported by Mr. Peters, with an amendment
[Strike out all after the enacting clause and insert the part printed
in italic]
_______________________________________________________________________
A BILL
To require the Director of the Office of Personnel Management to take
certain actions with respect to the health insurance program carried
out under chapter 89 of title 5, United States Code, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
<DELETED>SECTION 1. SHORT TITLE.</DELETED>
<DELETED> This Act may be cited as the ``FEHB Protection
Act''.</DELETED>
<DELETED>SEC. 2. FEHB IMPROVEMENTS.</DELETED>
<DELETED> (a) Definitions.--In this section:</DELETED>
<DELETED> (1) Director.--The term ``Director'' means the
Director of the Office of Personnel Management.</DELETED>
<DELETED> (2) Employing office.--The term ``employing
office'' has the meaning given the term in section 890.101(a)
of title 5, Code of Federal Regulations, or any successor
regulation.</DELETED>
<DELETED> (3) Health benefits plan; member of family.--The
terms ``health benefits plan'' and ``member of family'' have
the meanings given those terms in section 8901 of title 5,
United States Code.</DELETED>
<DELETED> (4) Open season.--The term ``open season'' means
an open season described in section 890.301(f) of title 5, Code
of Federal Regulations, or any successor regulation.</DELETED>
<DELETED> (5) Program.--The term ``Program'' means the
health insurance program carried out under chapter 89 of title
5, United States Code, including the program carried out under
section 8903c of that title.</DELETED>
<DELETED> (6) Qualifying life event.--The term ``qualifying
life event'' has the meaning given the term in section 892.101
of title 5, Code of Federal Regulations, or any successor
regulation.</DELETED>
<DELETED> (b) Verification Requirements.--Beginning on the date that
is 180 days after the date of enactment of this Act, the Director shall
require each employing office to verify--</DELETED>
<DELETED> (1) the veracity of any qualifying life event
through which an enrollee in the Program seeks to add a member
of family with respect to the enrollee to a health benefits
plan under the Program; and</DELETED>
<DELETED> (2) that, when an enrollee in the Program seeks to
add a member of family with respect to the enrollee to the
health benefits plan of the enrollee under the Program during
any open season, the individual so added is actually a member
of family with respect to the enrollee.</DELETED>
<DELETED> (c) Fraud Risk Assessment.--In any fraud risk assessment
conducted with respect to the Program on or after the date of enactment
of this Act, the Director shall include an assessment of individuals
who are enrolled in, or covered under, a health benefits plan under the
Program even though those individuals are not eligible to be so
enrolled or covered.</DELETED>
<DELETED> (d) Family Member Eligibility Verification Audit.--
</DELETED>
<DELETED> (1) In general.--During the 5-year period
beginning on the date of enactment of this Act, the Director
shall conduct a comprehensive audit regarding members of
family--</DELETED>
<DELETED> (A) who are covered under an enrollment in
a health benefits plan under the Program; and</DELETED>
<DELETED> (B) with respect to whom the basis for the
eligibility for the coverage described in subparagraph
(A) has not been verified.</DELETED>
<DELETED> (2) Contents.--In conducting the audit required
under paragraph (1), the Director shall review marriage
certificates, birth certificates, and other appropriate
documents that are necessary to determine eligibility to enroll
in a health benefits plan under the Program.</DELETED>
<DELETED> (e) Disenrollment or Removal.--Beginning on the date of
enactment of this Act, the Director may disenroll or remove from
enrollment any individual enrolled in, or covered under, a health
benefits plan under the Program if the Director determines that such
individual is not eligible to be so enrolled or covered.</DELETED>
SECTION 1. SHORT TITLE.
This Act may be cited as the ``FEHB Protection Act''.
SEC. 2. FEHB IMPROVEMENTS.
(a) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Homeland Security and
Governmental Affairs of the Senate;
(B) the Committee on Appropriations of the Senate;
(C) the Committee on Oversight and Accountability
of the House of Representatives; and
(D) the Committee on Appropriations of the House of
Representatives.
(2) Director.--The term ``Director'' means the Director of
the Office of Personnel Management.
(3) Employing office.--The term ``employing office'' has
the meaning given the term in section 890.101(a) of title 5,
Code of Federal Regulations, or any successor regulation.
(4) Health benefits plan; member of family.--The terms
``health benefits plan'' and ``member of family'' have the
meanings given those terms in section 8901 of title 5, United
States Code.
(5) Open season.--The term ``open season'' means an open
season described in section 890.301(f) of title 5, Code of
Federal Regulations, or any successor regulation.
(6) Program.--The term ``Program'' means the health
insurance program carried out under chapter 89 of title 5,
United States Code, including the program carried out under
section 8903c of that title.
(7) Qualifying life event.--The term ``qualifying life
event'' has the meaning given the term in section 892.101 of
title 5, Code of Federal Regulations, or any successor
regulation.
(b) Verification Requirements.--Not later than 1 year after the
date of enactment of this Act, the Director shall issue regulations and
implement a process to require each employing office to verify--
(1) the veracity of any qualifying life event through which
an enrollee in the Program seeks to add a member of family with
respect to the enrollee to a health benefits plan under the
Program; and
(2) that, when an enrollee in the Program seeks to add a
member of family with respect to the enrollee to the health
benefits plan of the enrollee under the Program, including
during any open season, the individual so added is actually a
member of family with respect to the enrollee.
(c) Fraud Risk Assessment.--In any fraud risk assessment conducted
with respect to the Program on or after the date of enactment of this
Act, the Director shall include an assessment of individuals who are
enrolled in, or covered under, a health benefits plan under the Program
even though those individuals are not eligible to be so enrolled or
covered.
(d) Family Member Eligibility Verification Audit.--
(1) In general.--During the 3-year period beginning on the
date that is 1 year after the date of enactment of this Act,
the Director, in coordination with the head of each employing
office, shall conduct a comprehensive audit regarding members
of family who are enrolled in, or covered under, a health
benefits plan under the Program.
(2) Contents.--In conducting the audit required under
paragraph (1), the Director, in coordination with the head of
each employing office, shall review marriage certificates,
birth certificates, and other appropriate documents that are
necessary to determine eligibility to enroll in, or be covered
under, a health benefits plan under the Program.
(3) Reports.--
(A) In general.--Not later than 180 days after the
date on which the 3-year period described in paragraph
(1) begins, and once every 180 days thereafter until
the end of that 3-year period, the Director shall
submit to the appropriate committees of Congress a
report regarding the status of the audit required under
that paragraph.
(B) Contents.--Each report required under
subparagraph (A) shall include, for the period covered
by the report--
(i) the number of members of family who
were reviewed under the audit conducted under
paragraph (1), including the number of those
individuals found during the audit to be
ineligible to be enrolled in, or covered under,
a health benefits plan under the Program;
(ii) the number of members of family who
disenrolled from a health benefits plan, and
the number of members of family who reduced the
amount of coverage under a health benefits
plan, under the Program before the end of a
coverage year; and
(iii) any other information that the
Director determines to be relevant.
(e) Disenrollment or Removal.--Not later than 180 days after the
date of enactment of this Act, the Director shall develop a process
through which any individual enrolled in, or covered under, a health
benefits plan under the Program who is not eligible to be so enrolled
or covered shall be disenrolled or removed from enrollment with respect
to that health benefits plan.
Calendar No. 499
118th CONGRESS
2d Session
S. 4035
[Report No. 118-220]
_______________________________________________________________________
A BILL
To require the Director of the Office of Personnel Management to take
certain actions with respect to the health insurance program carried
out under chapter 89 of title 5, United States Code, and for other
purposes.
_______________________________________________________________________
September 10, 2024
Reported with an amendment