text: SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
  
      (a) Short Title.--This Act may be cited as the ``Choice in Health 
  Options Insures Care for Everyone (CHOICE) Act of 2009''.
      (b) Table of Contents.--The table of contents of this Act is as 
  follows:
  
  Sec. 1. Short title; table of contents.
  Sec. 2. Establishment of American Trust Health Plan; administrative 
                              structure.
  Sec. 3. Finances.
  Sec. 4. Eligibility and enrollment.
  Sec. 5. Providers.
  Sec. 6. Benefits.
  Sec. 7. Premiums.
  
  SEC. 2. ESTABLISHMENT OF AMERICAN TRUST HEALTH PLAN; ADMINISTRATIVE 
                STRUCTURE.
  
      (a) In General.--There is established an American Trust Health Plan 
  (in this Act referred to as the ``American Trust Health Plan'' or the 
  ``Plan'') or to provide for the offering to eligible individuals of 
  health benefits coverage throughout the United States, including its 
  territories.
      (b) Compliance With Requirements.--
              (1) In general.--The American Trust Health Plan shall 
          comply with all requirements that are applicable with respect 
          to other health benefits plans to be offered through a National 
          Health Insurance Exchange (as defined in subsection (e)), 
          including (as specified in this Act) minimum benefit and cost-
          sharing requirements and premium rating requirements.
              (2) Exemption from state insurance regulations.--As a 
          Federal health program, the American Trust Health Plan is not 
          required to comply with the insurance regulations of the States 
          to the extent health benefits plans offered through the 
          National Health Insurance Exchange are exempt from such 
          regulations.
              (3) Satisfaction of individual mandate requirement.--An 
          individual's enrollment with the Plan shall be treated as 
          satisfying any requirement under Federal law for the individual 
          to demonstrate enrollment in health insurance or benefits 
          coverage.
      (c) Plan Administration.--
              (1) Administrator.--The American Trust Health Plan shall be 
          administered by an Office of American Trust Health 
          Administration (in this Act referred to as the ``Office'') 
          within the Department of Health and Human Services. The Office 
          shall be headed by an Administrator (in this Act referred to as 
          the ``Administrator'') who shall be appointed by the President, 
          by and with the advice and consent of the Senate.
              (2) Compensation.--The Administrator shall be entitled to 
          compensation at the level II of the Executive Schedule (under 
          section 5313 of title 5, United States Code).
              (3) Limitation.--The Administrator and the Office shall not 
          participate in the administration of any regulation regarding 
          the health insurance market or in the administration of the 
          National Health Insurance Exchange.
              (4) General authority.--The Administrator shall have the 
          same general authorities with respect to personnel and 
          operations of the Office as the heads of other agencies and 
          departments of the Federal Government have with respect to such 
          agencies and departments.
      (d) Advisory Board.--
              (1) In general.--The Administrator shall be advised by an 
          Advisory Board (in this Act referred to as the ``Advisory 
          Board'') composed of 7 individuals appointed by the President. 
          The President shall nominate individuals to serve on the 
          Advisory Board in a manner that provides for inclusion on the 
          Board of individuals who--
                      (A) represent the interests of patients or 
                  consumers;
                      (B) represent the interests health care providers, 
                  at least one of whom is a physician; and
                      (C) are experts in health care quality measurements 
                  and reporting.
              (2) Duties.--The Advisory Board shall advise the 
          Administrator regarding the operation of the American Trust 
          Health Plan and the Administrator shall consult with the 
          Advisory Board not less often than quarterly and before making 
          any annual changes in benefits under Plan.
              (3) Terms, compensation, chair, meetings, etc.--The 
          provisions of paragraphs (2)(D), (3), (4), (5), and (6) of 
          section 1805(c) of the Social Security Act (42 U.S.C. 1395b-
          6(c)) shall apply with respect to the Advisory Board and the 
          President under this section in the same manner as such 
          provisions apply to the Medicare Payment Advisory Commission 
          and the Comptroller General, respectively, under section 1805 
          of such Act.
              (4) Financing.--Within the budget established for the 
          operation of the Plan, the Administrator shall provide for 
          payment for the costs of operation of the Advisory Board.
      (e) National Health Insurance Exchange Defined.--In this Act, the 
  term ``National Health Insurance Exchange'' means a mechanism 
  established or recognized under Federal law for coordinating the 
  offering of health benefits coverage to individuals in the United 
  States (and includes such a mechanism that may be operated at a State 
  or regional level) through the establishment of standards for benefits 
  and cost-sharing and for premiums for such health benefits coverage.
  
  SEC. 3. FINANCES.
  
      (a) Self-Financing.--The American Trust Health Plan shall be 
  financially self-sustaining insofar as funds to operate the Plan, 
  including costs of benefits, administration, and marketing, shall be 
  derived from premiums for individuals enrolled under the Plan. The Plan 
  is eligible to accept subsidies, including subsidies for the enrollment 
  of such individuals, in the same manner and to the same extent as other 
  health benefits plans offered through a National Health Insurance 
  Exchange are eligible to accept subsidies.
      (b) Contingency Reserve.--The Administrator shall establish and 
  fund a contingency reserve for the Plan in a form similar to that of a 
  contingency reserve for health benefits plans under the Federal 
  Employees Health Benefits Program under chapter 89 of title 5, United 
  States Code.
  
  SEC. 4. ELIGIBILITY AND ENROLLMENT.
  
      (a) Eligibility.--
              (1) In general.--Any individual who is made eligible to 
          purchase coverage with a health benefits plan through the 
          National Health Insurance Exchange is eligible to enroll with 
          the American Health Trust Plan.
              (2) Employer enrollment.--To the extent provided by the 
          National Health Insurance Exchange with respect to health 
          benefits coverage offered through the Exchange, employers are 
          eligible to purchase coverage for, and enroll their employees 
          and dependents with, the Plan.
      (b) Annual Open Enrollment Period.--The Administrator shall 
  determine a yearly period of open enrollment for eligible individuals 
  of not less than four consecutive weeks. Such a period shall be 
  consistent with any similar annual open enrollment period established 
  by the National Health Insurance Exchange for health benefits plans 
  offered through the Exchange.
      (c) Notices of Significant Changes.--
              (1) In general.--No significant change shall be made under 
          the Plan except with public notice and on an annual basis and 
          consistent with rules established by the National Health 
          Insurance Exchange for health benefits coverage offered through 
          the Exchange.
              (2) Significant change defined.--In this subsection, the 
          term ``significant change'' includes any change in benefits, 
          copayments, deductibles, or premiums.
  
  SEC. 5. PROVIDERS.
  
      (a) Access to Medicare Provider Network.--
              (1) In general.--Except as provided in paragraph (2), any 
          health care provider that is eligible for and accepts 
          reimbursement for services under the Medicare program under 
          title XVIII of the Social Security Act (in this section 
          referred to as the ``Medicare'') shall, as a condition of 
          continuing to participate under such program, also participate 
          under the American Health Trust Plan.
              (2) Exception.--Paragraph (1) shall not be construed as 
          requiring a provider to accept new patients due to bona fide 
          capacity limitations of the provider.
      (b) Reimbursement Levels.--
              (1) In general.--The Administrator shall provide for 
          payment to health care providers for covered services at rates 
          not less, on average and in the aggregate nationally, than 105 
          percent of the payment rates recognized for such services (or 
          substantially similar services) under Medicare. In the case of 
          those services which are covered under the Plan but are not 
          covered under Medicare, the Administrator shall seek to apply 
          payment rates and methodologies similar to those described in 
          the previous sentence.
              (2) Adjustment.--The Administrator, in determining the 
          competitiveness of the Plan within different markets and 
          compared to other health benefits plans offered through the 
          National Health Insurance Exchange, may increase the payment 
          rates for health care providers above the rate otherwise 
          provided under paragraph (1).
              (3) GPCI floors.--In applying paragraph (1), the work and 
          practice expense geographic indices applied under section 
          1848(e)(1) of the Social Security Act for any locality shall 
          not be less than 1.00.
      (c) Adoption of Medicare Reforms.--The Plan may adopt Medicare 
  system delivery reforms that provide patients with a coordinated system 
  of care and make changes to the provider payment structure.
  
  SEC. 6. BENEFITS.
  
      (a) In General.--The Administrator shall specify the benefits to be 
  provided under the Plan consistent with this section and in 
  consultation with the Advisory Board.
      (b) Minimum Benefit Level.--The Plan may offer coverage with 
  differing benefit levels so long as such benefits and levels are 
  consistent with the benefits and levels of benefits required to be 
  offered by health benefits plans under the National Health Insurance 
  Exchange, and shall include the offering of at least one benefit level 
  which closely reflects the lowest benefit level that may be offered by 
  a health benefits plan through such Exchange.
  
  SEC. 7. PREMIUMS.
  
      (a) In General.--The Administrator shall specify the levels of 
  premiums for coverage under the Plan so long as they--
              (1) are based upon a system of rating that is consistent 
          with rating rules that is established for health benefits plans 
          offered through the National Health Insurance Exchange;
              (2) do not take into account health status related factors 
          for any individual enrollee; and
              (3) are designed to provide sufficient funds to meet the 
          requirement of section 3(a).
      (b) Rating Rules.--To the extent permitted for health benefits 
  plans offered through the National Health Insurance Exchange, the 
  premiums for the Plan shall vary based on geographic area and family 
  size and may vary based on tobacco usage of an enrollee or other 
  factors permitted for health benefits plans offered through the 
  Exchange.
target: Choice in Health Options Insures Care for Everyone (CHOICE) Act of 2009 - Establishes the American Trust Health Plan to offer eligible individuals health benefits coverage. Requires the Plan to comply with all requirements that are applicable with respect to other health benefit plans to be offered through a National Health Insurance Exchange. (The Exchange has not yet been established.) Exempts the Plan from state insurance regulations. Treats enrollment with the Plan as satisfying any requirement under federal law for the individual to demonstrate enrollment in health insurance or benefits coverage. Sets forth provisions regarding administration of the Plan.
  
  Requires the Plan to be financially self-sustaining insofar as funds to operate the Plan shall be derived from premiums of individuals enrolled under the Plan. Makes the Plan eligible to accept subsides to the same extent as other health benefit plans offered through an Exchange.
  
  Prohibits significant changes to the Plan without public notice.
  
  Conditions a health care provider's continued participation in the Medicare program on participation in the American Trust Health Plan. Sets payment for health care providers under the Plan at 105% of the payment rates under Medicare.
  
  Requires the Administrator of the Plan to set the benefit level and the premiums.
feat_title: To provide for the offering of an American Trust Health Plan to provide choice in health insurance options so as to ensure quality, affordable health coverage for all Americans.