HR 2723 IH

106th CONGRESS

1st Session

H. R. 2723

To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to protect consumers in managed care plans and other health coverage.

IN THE HOUSE OF REPRESENTATIVES

August 5, 1999

Mr. NORWOOD (for himself, Mr. DINGELL, Mr. GANSKE, Mr. COOKSEY, Mr. BERRY, Mrs. CLAYTON, Mr. GRAHAM, Mr. PALLONE, Mrs. ROUKEMA, Mrs. CAPPS, Mr. SHAW, Mr. JOHN, Mr. SHAYS, Mr. TURNER, Mrs. CUBIN, Mr. BALDACCI, Mr. FOLEY, Mr. GEPHARDT, Mr. HOUGHTON, Mr. RANGEL, Mr. HORN, Mr. CLAY, Mr. GIBBONS, Mr. BROWN of Ohio, Mr. FRELINGHUYSEN, Mr. ANDREWS, Mr. GILCHREST, Mr. STARK, Mr. LEACH, Mr. WAXMAN, Mr. GILMAN, Mr. CARDIN, Mr. LATOURETTE, Mr. FORD, Mr. LOBIONDO, Mr. SANDLIN, Mr. BARR of Georgia, Mrs. THURMAN, Mr. BOEHLERT, Mr. KLINK, Mrs. MORELLA, Mr. SNYDER, Ms. ESHOO, Mr. DOYLE, Mr. MCDERMOTT, Mr. BRADY of Pennsylvania, Mr. PASCRELL, Mr. HOLT, Mr. FROST, Ms. KILPATRICK, Mr. DICKS, Ms. SCHAKOWSKY, Mr. RUSH, Mrs. MCCARTHY of New York, Mr. MURTHA, Ms. STABENOW, Mr. PHELPS, Mr. HALL of Texas, Mr. WEYGAND, Ms. BERKLEY, Mr. WYNN, Mr. TANNER, Mr. BOUCHER, Mr. BARRETT of Wisconsin, Mr. FORBES, and Mr. BONIOR) introduced the following bill; which was referred to the Committee on Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned


A BILL

To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to protect consumers in managed care plans and other health coverage.

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

TITLE I--IMPROVING MANAGED CARE

Subtitle A--Grievances and Appeals

Subtitle B--Access to Care

Subtitle C--Access to Information

Subtitle D--Protecting the Doctor-Patient Relationship

Subtitle E--Definitions

TITLE II--APPLICATION OF QUALITY STANDARDS TO GROUP HEALTH PLANS AND HEALTH INSURANCE COVERAGE UNDER THE PUBLIC HEALTH SERVICE ACT

TITLE III--AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974

TITLE IV--APPLICATION TO GROUP HEALTH PLANS UNDER THE INTERNAL REVENUE CODE OF 1986

TITLE V--EFFECTIVE DATES; COORDINATION IN IMPLEMENTATION

TITLE VI--HEALTH CARE PAPERWORK SIMPLIFICATION

TITLE I--IMPROVING MANAGED CARE

Subtitle A--Grievance and Appeals

SEC. 101. UTILIZATION REVIEW ACTIVITIES.

SEC. 102. INTERNAL APPEALS PROCEDURES.

SEC. 103. EXTERNAL APPEALS PROCEDURES.

provide for an external appeals process that meets the requirements of this section in the case of an externally appealable decision described in paragraph (2), for which a timely appeal is made either by the plan or issuer or by the participant, beneficiary, or enrollee (and any provider or other person acting on behalf of such an individual with the individual's consent or without such consent if such an individual is medically unable to provide such consent). The appropriate Secretary shall establish standards to carry out such requirements.

SEC. 104. ESTABLISHMENT OF A GRIEVANCE PROCESS.

Subtitle B--Access to Care

SEC. 111. CONSUMER CHOICE OPTION.

SEC. 112. CHOICE OF HEALTH CARE PROFESSIONAL.

SEC. 113. ACCESS TO EMERGENCY CARE.

SEC. 114. ACCESS TO SPECIALTY CARE.

SEC. 115. ACCESS TO OBSTETRICAL AND GYNECOLOGICAL CARE.

SEC. 116. ACCESS TO PEDIATRIC CARE.

SEC. 117. CONTINUITY OF CARE.

subsection with respect to the surgery or transplantation shall extend beyond the period under paragraph (1) and until the date of discharge of the individual after completion of the surgery or transplantation.

SEC. 118. ACCESS TO NEEDED PRESCRIPTION DRUGS.

SEC. 119. COVERAGE FOR INDIVIDUALS PARTICIPATING IN APPROVED CLINICAL TRIALS.

Subtitle C--Access to Information

SEC. 121. PATIENT ACCESS TO INFORMATION.

Subtitle D--Protecting the Doctor-Patient Relationship

SEC. 131. PROHIBITION OF INTERFERENCE WITH CERTAIN MEDICAL COMMUNICATIONS.

SEC. 132. PROHIBITION OF DISCRIMINATION AGAINST PROVIDERS BASED ON LICENSURE.

SEC. 133. PROHIBITION AGAINST IMPROPER INCENTIVE ARRANGEMENTS.

SEC. 134. PAYMENT OF CLAIMS.

SEC. 135. PROTECTION FOR PATIENT ADVOCACY.

plan or issuer is deemed a reference to the institutional health care provider.

Subtitle E--Definitions

SEC. 151. DEFINITIONS.

SEC. 152. PREEMPTION; STATE FLEXIBILITY; CONSTRUCTION.

SEC. 153. EXCLUSIONS.

specific items and services (including abortions) under the terms of such plan or coverage, other than those provided under the terms of such plan or coverage.

SEC. 154. COVERAGE OF LIMITED SCOPE PLANS.

SEC. 155. REGULATIONS.

TITLE II--APPLICATION OF QUALITY CARE STANDARDS TO GROUP HEALTH PLANS AND HEALTH INSURANCE COVERAGE UNDER THE PUBLIC HEALTH SERVICE ACT

SEC. 201. APPLICATION TO GROUP HEALTH PLANS AND GROUP HEALTH INSURANCE COVERAGE.

`SEC. 2707. PATIENT PROTECTION STANDARDS.

SEC. 202. APPLICATION TO INDIVIDUAL HEALTH INSURANCE COVERAGE.

`SEC. 2753. PATIENT PROTECTION STANDARDS.

TITLE III--AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974

SEC. 301. APPLICATION OF PATIENT PROTECTION STANDARDS TO GROUP HEALTH PLANS AND GROUP HEALTH INSURANCE COVERAGE UNDER THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.

`SEC. 714. PATIENT PROTECTION STANDARDS.

insurance issuer, the Secretary shall determine the circumstances under which the plan is not required to provide or make available the information (and is not liable for the issuer's failure to provide or make available the information), if the issuer is obligated to provide and make available (or provides and makes available) such information.

SEC. 302. ERISA PREEMPTION NOT TO APPLY TO CERTAIN ACTIONS INVOLVING HEALTH INSURANCE POLICYHOLDERS.

or sponsor acting within the scope of employment), or

TITLE IV--APPLICATION TO GROUP HEALTH PLANS UNDER THE INTERNAL REVENUE CODE OF 1986

SEC. 401. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.

`Sec. 9813. Standard relating to patient freedom of choice.';

`SEC. 9813. STANDARD RELATING TO PATIENTS' BILL OF RIGHTS.

TITLE V--EFFECTIVE DATES; COORDINATION IN IMPLEMENTATION

SEC. 501. EFFECTIVE DATES.

SEC. 502. COORDINATION IN IMPLEMENTATION.

TITLE VI--HEALTH CARE PAPERWORK SIMPLIFICATION

SEC. 601. HEALTH CARE PAPERWORK SIMPLIFICATION.

END