| Committee/Subcommittee: | Activity: | |
| Senate Finance | Referral | |
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TABLE OF CONTENTS:
Patients' Bill of Rights Act - Title I: Patients' Bill of Rights - Subtitle A: Right to Advice and Care - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to require a group health plan covering emergency medical care to provide coverage, without requiring preauthorization, for appropriate emergency medical screening examinations to the extent that a prudent layperson, possessing an average knowledge of health and medicine, would determine such examinations to be necessary to determine whether emergency medical care is necessary.
(Sec. 101) Requires a plan to cover additional emergency medical services to stabilize an emergency medical condition following such an examination to the extent that a prudent emergency medical professional would determine such services to be necessary to avoid specified serious consequences.
Requires a plan (other than a fully insured group health plan) providing benefit coverage only through a defined set of participating health care professionals to offer the option of point-of-service coverage (of the same benefits provided by a nonparticipating health care professional), unless the plan offers multiple issuer or coverage options. Exempts from this requirement any group health plan (other than a fully insured plan) of a small employer.
Requires any plan offering gynecological, obstetric, or pediatric care not to require prior authorization from a participant's primary care provider if such provider is not a gynecologist, obstetrician, or pediatrician.
Requires a plan to permit a participant or beneficiary undergoing a course of treatment to continue such treatment for a period of time even though the contract between the plan (other than a fully insured plan) and a health care provider is terminated, or the schedule of benefits or coverage is terminated by a change in the terms of the provider's participation in the plan. Specifies a 90-day continuation of coverage generally, and other transitional periods for institutionalization (until discharge), pregnancy (through post-partum care), and terminal illness (remainder of life).
Declares that a plan shall not prohibit a health care professional from advising a patient about the patient's health status, medical care, or treatment for the patient's condition or disease, regardless of whether coverage for such care or treatment is provided under the contract, if the professional is acting within the lawful scope of the practice.
Defines "fully insured group health plan" as a plan where benefits are provided pursuant to the terms of an arrangement between a group health plan and a health insurance issuer and are guaranteed by the health insurance issuer under a contract or policy of insurance.
Subtitle B: Right to Information about Plans and Providers - Amends ERISA, as amended by the Omnibus Consolidated and Emergency Supplemental Appropriations Act, 1999, to require plans and group health insurance issuers to disclose specified plan information to enrollees and (upon request) potential enrollees.
(Sec. 112) Directs the Secretary of Health and Human Services (HHS) to contract with the Institute of Medicine for a study and report to the appropriate congressional committees on: (1) health care professionals information currently available to patients, consumers, States, and professional societies, nationally and on a State-by-State basis; (2) the legal and other barriers to the sharing of information about health care professionals; and (3) recommendations for disclosure of such information on health care professionals, including their competencies and professional qualifications, to better facilitate patient choice, quality improvement, and market competition.
Subtitle C: Right to Hold Health Plans Accountable - Revises requirements for plan provision of a procedure for appealing denied claims.
(Sec. 121) Requires a plan or health insurance issuer conducting utilization review to have: (1) specified procedures in place for coverage determinations, including expedited determinations; (2) written procedures for addressing grievances between a plan and enrollees; (3) an internal procedure for coverage determination appeals; and (4) an external review procedure for enrollee appeals, involving specified entities and independent medical experts, whose determination shall be binding.
Prescribes external review standards.
Directs the General Accounting Office to study and report to the appropriate congressional committees on a statistically appropriate sample of completed external reviews.
Subtitle D: Miscellaneous Provisions - Amends the Internal Revenue Code to deem the requirements of subtitle B of this Act to be incorporated into the Code.
Title II: Individual Rights with Respect to Personal Medical Information - Personal Medical Information Access Act - Subtitle A: Access to Medical Records - Requires any health care provider, health plan, employer, health or life insurer, school, or university, except in specified circumstances, to: (1) permit an individual who is the subject of protected health information (or the individual's designee) to inspect and copy protected health information concerning the individual; (2) amend such information upon the individual's request; and (3) make reasonable efforts to inform any person to whom the unamended portion of the information was previously disclosed of any nontechnical amendment that has been made.
(Sec. 212) Prescribes procedures for: (1) an entity's denial of a request to amend such information; and (2) an individual's filing of a statement of disagreement with such denial, which shall accompany any subsequent disclosure of the disputed portion of the information.
(Sec. 213) Requires any health care provider, health plan, employer, health or life insurer, school, or university to post notice of the entity's confidentiality practices, including specified information. Requires the Secretary to develop and disseminate model notices of confidentiality practices.
Subtitle B: Establishment of Safeguards - Requires any health care provider, health plan, employer, health or life insurer, school, or university to establish and maintain appropriate administrative, technical, and physical safeguards to protect the confidentiality, security, accuracy, and integrity of protected health information the entity creates, receives, obtains, maintains, uses, transmits, or disposes of.
Subtitle C: Enforcement; Definitions - Prescribes civil money penalties for substantial and material failure to comply with this Act.
(Sec. 232) Sets forth definitions.
Title III: Genetic Information and Services - Genetic Information Nondiscrimination in Health Insurance Act of 1999 - Amends ERISA, the Public Health Service Act (PHSA) (as amended by the Omnibus Consolidated and Emergency Supplemental Appropriations Act, 1999), and the Internal Revenue Code to prohibit a health care plan or health insurance issuer from restricting enrollment or adjusting premium or contribution amounts for a group on the basis of predictive genetic information concerning an individual in the group or a family member of the individual (including information about a request for or receipt of genetic services).
(Sec. 302) Prohibits a plan or issuer from requesting or requiring predictive genetic information concerning an individual or a family member of the individual (including information about a request for or receipt of genetic services). Permits a plan or issuer to request, but not require, such information for diagnosis, treatment, or payment purposes only.
Title IV: Healthcare Research and Quality - Healthcare Research and Quality Act of 1999 - Amends PHSA to establish within the Public Health Service (PHS) an Agency for Healthcare Quality Research to replace the current Agency for Health Care Policy and Research.
(Sec. 402) Directs the Agency to identify and disseminate methods or systems used to assess healthcare research results, particularly to rate the strength of the scientific evidence behind healthcare practice and technology recommendations in the research.
Requires the Agency to employ research strategies and mechanisms that will link research directly with clinical practice in geographically diverse locations throughout the United States, including: (1) Healthcare Improvement Research Centers that combine demonstrated multidisciplinary expertise in outcomes or quality improvement research with linkages to relevant sites of care; (2) Provider-based Research Networks, including plan, facility, or delivery system sites of care (especially primary care), that can evaluate and promote quality improvement; and (3) other innovative mechanisms or strategies.
Directs the Agency to: (1) award grants to enable eligible entities at geographically diverse locations throughout the United States to carry out research training programs dedicated to health services research training at the doctoral, post-doctoral, and junior faculty levels; and (2) provide specified scientific and technical support for private and public efforts to improve healthcare quality, including accrediting organizations.
Directs the Secretary, acting through the Agency Director, to establish a program of grants for one or more centers to conduct: (1) state-of-the-art clinical research on drugs, biological products, and devices; (2) research on the comparative effectiveness, cost-effectiveness, and safety of drugs, biological products, and devices; and (3) other appropriate activities (excluding the review of new drugs).
Requires the Agency Director to: (1) collect certain data on the cost and quality of healthcare; (2) support research on and initiatives to advance the use of information systems for the study of healthcare quality; and (3) provide ongoing administrative, research, and technical support for the Preventive Services Task Force, which shall review scientific evidence on the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services regarding their usefulness in daily clinical practice.
Establishes within the Agency a Center for Primary Care Delivery Research to serve as the principal funding source for HHS primary care delivery research and demonstrations with respect to the first contact when illness or health concerns arise, the diagnosis, treatment or referral to specialty care, preventive care, and the relationship between the clinician and the patient in the context of the family and community.
Requires the Agency Director by specified activities to promote innovation in evidence-based clinical practice and healthcare technologies.
Requires the Secretary, acting through the Director, to coordinate all research, evaluations, and demonstrations related to health services research and quality measurement and improvement activities undertaken and supported by the Federal Government.
Requires the Secretary to contract with the Institute of Medicine to: (1) describe and evaluate current quality improvement research and monitoring processes; and (2) recommend options to improve the efficiency and effectiveness of such processes, and optimize public-private sector accreditation bodies.
Establishes an Advisory Council for Healthcare Quality Research to replace the current Advisory Council for Health Care Policy, Research, and Evaluation.
Requires the Agency Director to establish technical and scientific peer review groups to review each application for a grant, cooperative agreement, or contract under this title.
Repeals the mandates for: (1) a demonstration program regarding centers for education and research on therapeutics; and (2) the Office of the Forum for Quality and Effectiveness in Health Care.
Authorizes appropriations.
(Sec. 404) Requires the Secretary, within 30 days after enactment of any Act providing for a qualifying health care benefit, to evaluate scientifically and report to the appropriate congressional committees on: (1) the safety, efficacy, cost, benefits and value of such benefit; (2) alternative approaches in improving care compared with such benefit; and (3) the benefit's overall impact on health care as measured through research.
Title V: Enhanced Access to Health Insurance Coverage - Amends the Internal Revenue Code to allow a full deduction from gross income of the health insurance costs of self-employed individuals.
(Sec. 502) Repeals the limitation of the availability of medical savings accounts (MSAs) to employees of small employers and the self-employed.
Reduces from $1,500 to $1,000 (self-only coverage) and from $3,000 to $2,000 (family coverage) the minimum annual deductible of a high deductible health plan.
Revises the formula for the monthly limitation on the allowable deduction for MSAs to increase the contribution limit to 100 percent of the annual deductible under a high deductible health plan.
Waives the additional tax on MSA distributions not used for qualified medical expenses to the extent any payment or distribution does not reduce the fair market value of the MSA assets to an amount less than the annual deductible for the account holder's high deductible health plan.
(Sec. 503) Allows the annual carryover of up to $500 of unused benefits from cafeteria plans, flexible spending arrangements, and health flexible spending accounts.
(Sec. 504) Authorizes the Office of Personnel Management to contract for or approve catastrophic FEHBP plans, whose covered expenses exceed $500.
Amends Federal civil service law, with respect to Government contributions under the Federal Employees Health Benefits Program (FEHBP), to require an additional Government contribution, according to a certain formula, to an individual's MSA with respect to a catastrophic plan.
Deems subscription charges for MSAs to be the amount of Government contributions.