42 USC 1395b-4 - Health insurance information, counseling, and assistance grants

U.S Code last checked for updates: Feb 21, 2025

§ 1395b–4.

Health insurance information, counseling, and assistance grants

(a)

Grants

(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) 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), 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), 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

 So in original. Probably should be preceded by “to”.

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

 So in original. Probably should be paragraph “(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

(Pub. L. 101–508, title IV, § 4360, Nov. 5, 1990, 104 Stat. 1388–138; Pub. L. 103–432, title I, § 171(i), Oct. 31, 1994, 108 Stat. 4450; Pub. L. 103–437, § 15(b), Nov. 2, 1994, 108 Stat. 4591; Pub. L. 105–362, title VI, § 602(b)(2), Nov. 10, 1998, 112 Stat. 3286.)

cite as: 42 USC 1395b-4