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.
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.
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