To amend title XXVII of the Public Health Service Act to include activities to address social determinants of health in the calculation of medical loss ratios.

This bill requires health insurers to include expenditures for activities that address social determinants of health when calculating the proportion of premium revenues spent on clinical services and quality improvement (i.e., medical loss ratio).

[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3969 Introduced in House (IH)]

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117th CONGRESS
  1st Session
                                H. R. 3969

   To amend title XXVII of the Public Health Service Act to include 
activities to address social determinants of health in the calculation 
                        of medical loss ratios.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 17, 2021

  Mr. Curtis (for himself and Mr. Cardenas) introduced the following 
    bill; which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
   To amend title XXVII of the Public Health Service Act to include 
activities to address social determinants of health in the calculation 
                        of medical loss ratios.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. INCLUDING ACTIVITIES TO ADDRESS SOCIAL DETERMINANTS OF 
              HEALTH IN THE CALCULATION OF MEDICAL LOSS RATIOS.

    (a) In General.--Section 2718 of the Public Health Service Act (42 
U.S.C. 300gg-18) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (2), by striking ``and'' at the 
                end;
                    (B) by redesignating paragraph (3) as paragraph 
                (4); and
                    (C) by inserting after paragraph (2) the following 
                new paragraph:
            ``(3) for activities that address social determinants of 
        health; and'';
            (2) in subsection (b)(1)(A), in the matter preceding clause 
        (i), by striking ``paragraphs (1) and (2)'' and inserting 
        ``paragraphs (1) through (3)''; and
            (3) in subsection (c)--
                    (A) by inserting ``and, with respect to the 
                activities reported under subsection (a)(3), not later 
                December 31, 2023,'' after ``December 31, 2010,''; and
                    (B) by striking ``subsection (a)(2)'' and inserting 
                ``paragraph (2) or (3) of such subsection''.
    (b) Effective Date.--The amendments made by paragraphs (1) and (2) 
of subsection (a) shall apply with respect to plan years beginning on 
or after January 1, 2024.
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