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U.S. Code as of:
01/19/04
Section 1395b-4. Health insurance information, counseling, and assistance grants
(a) Grants
The Secretary of Health and Human Services (in this section
referred to as the "Secretary") shall make grants to States, with
approved State regulatory programs under section 1395ss of this
title, that submit applications to the Secretary that meet the
requirements of this section for the purpose of providing
information, counseling, and assistance relating to the procurement
of adequate and appropriate health insurance coverage to
individuals who are eligible to receive benefits under this
subchapter (in this section referred to as "eligible individuals").
The Secretary shall prescribe regulations to establish a minimum
level of funding for a grant issued under this section.
(b) Grant applications
(1) In submitting an application under this section, a State may
consolidate and coordinate an application that consists of parts
prepared by more than one agency or department of such State.
(2) As part of an application for a grant under this section, a
State shall submit a plan for a State-wide health insurance
information, counseling, and assistance program. Such program shall
-
(A) establish or improve upon a health insurance information,
counseling, and assistance program that provides counseling and
assistance to eligible individuals in need of health insurance
information, including -
(i) information that may assist individuals in obtaining
benefits and filing claims under this subchapter and subchapter
XIX of this chapter;
(ii) policy comparison information for medicare supplemental
policies (as described in section 1395ss(g)(1) of this title)
and information that may assist individuals in filing claims
under such medicare supplemental policies;
(iii) information regarding long-term care insurance; and
(iv) information regarding other types of health insurance
benefits that the Secretary determines to be appropriate;
(B) in conjunction with the health insurance information,
counseling, and assistance program described in subparagraph (A),
establish a system of referral to appropriate Federal or State
departments or agencies for assistance with problems related to
health insurance coverage (including legal problems), as
determined by the Secretary;
(C) provide for a sufficient number of staff positions
(including volunteer positions) necessary to provide the services
of the health insurance information, counseling, and assistance
program;
(D) provide assurances that staff members (including volunteer
staff members) of the health insurance information, counseling,
and assistance program have no conflict of interest in providing
the counseling described in subparagraph (A);
(E) provide for the collection and dissemination of timely and
accurate health care information to staff members;
(F) provide for training programs for staff members (including
volunteer staff members);
(G) provide for the coordination of the exchange of health
insurance information between the staff of departments and
agencies of the State government and the staff of the health
insurance information, counseling, and assistance program;
(H) make recommendations concerning consumer issues and
complaints related to the provision of health care to agencies
and departments of the State government and the Federal
Government responsible for providing or regulating health
insurance;
(I) establish an outreach program to provide the health
insurance information and counseling described in subparagraph
(A) and the referrals described in subparagraph (B) to eligible
individuals; and
(J) demonstrate, to the satisfaction of the Secretary, an
ability to provide the counseling and assistance required under
this section.
(c) Special grants
(1) A State that is conducting a health insurance information,
counseling, and assistance program that is substantially similar to
a program described in subsection (b)(2) of this section shall, as
a requirement for eligibility for a grant under this section,
demonstrate, to the satisfaction of the Secretary, that such State
shall maintain the activities of such program at least at the level
that such activities were conducted immediately preceding the date
of the issuance of any grant during the period of time covered by
such grant under this section.
(2) If the Secretary determines that the existing health
insurance information, counseling, and assistance program is
substantially similar to a program described in subsection (b)(2)
of this section, the Secretary may waive some or all of the
requirements described in such subsection and issue a grant to the
State for the purpose of increasing the number of services offered
by the health insurance information, counseling, and assistance
program, experimenting with new methods of outreach in conducting
such program, or expanding such program to geographic areas of the
State not previously served by the program.
(d) Criteria for issuing grants
In issuing a grant under this section, the Secretary shall
consider -
(1) the commitment of the State to carrying out the health
insurance information, counseling, and assistance program
described in subsection (b)(2) of this section, including the
level of cooperation demonstrated -
(A) by the office of the chief insurance regulator of the
State, or the equivalent State entity;
(B) other officials of the State responsible for overseeing
insurance plans issued by nonprofit hospital and medical
service associations; and
(C) departments and agencies of such State responsible for -
(i) administering funds under subchapter XIX of this
chapter, and
(ii) administering funds appropriated under the Older
Americans Act [42 U.S.C. 3001 et seq.];
(2) the population of eligible individuals in such State as a
percentage of the population of such State; and
(3) in order to ensure the needs of rural areas in such State,
the relative costs and special problems associated with
addressing the special problems of providing health care
information, counseling, and assistance eligible )1(! individuals
residing in rural areas of such State.
(e) Annual State report
A State that receives a grant under this section shall, not later
than 180 days after receiving such grant, and annually thereafter
during the period of the grant, issue a report to the Secretary
that includes information concerning -
(1) the number of individuals served by the health insurance
information, counseling and assistance program of such State;
(2) an estimate of the amount of funds saved by the State, and
by eligible individuals in the State, in the implementation of
such program; and
(3) the problems that eligible individuals in such State
encounter in procuring adequate and appropriate health care
coverage.
(f) Report to Congress
Beginning with 1992, and annually thereafter, the Secretary shall
issue a report to the Committee on Finance of the Senate, the
Special Committee on Aging of the Senate, the Committee on Ways and
Means of the House of Representatives, and the Committee on Energy
and Commerce of the House of Representatives that -
(1) summarizes the allocation of funds authorized for grants
under this section and the expenditure of such funds;
(2) outlines the problems that eligible individuals encounter
in procuring adequate and appropriate health care coverage;
(3) makes recommendations that the Secretary determines to be
appropriate to address the problems described in paragraph (3);
)2(! and
(4) in the case of the report issued 2 years after November 5,
1990, evaluates the effectiveness of counseling programs
established under this program, and makes recommendations
regarding continued authorization of funds for these purposes.
(g) Authorization of appropriations for grants
There are authorized to be appropriated, in equal parts from the
Federal Hospital Insurance Trust Fund and from the Federal
Supplementary Medical Insurance Trust Fund, $10,000,000 for each of
fiscal years 1991, 1992, 1993, 1994, 1995, and 1996, to fund the
grant programs described in this section.
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