S 3058 PCS

Calendar No. 809

106th CONGRESS

2d Session

S. 3058

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

IN THE SENATE OF THE UNITED STATES

September 15, 2000

Mr. KENNEDY (for himself and Mr. DASCHLE) introduced the following bill; which was read the first time

September 18, 2000

Read the second time and placed on the calendar


A BILL

To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, 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--Grievance 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 CARE 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--MISCELLANEOUS PROVISIONS

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.

made in a timely basis consistent with the deadlines provided under this subtitle.

duty, function, or activity required or authorized pursuant to this section, to have violated any criminal law, or to be civilly liable under any law of the United States or of any State (or political subdivision thereof) if due care was exercised in the performance of such duty, function, or activity and there was no actual malice or gross misconduct in the performance of such duty, function, or activity.

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.

section 1867(e)(1)(A) of the Social Security Act.

SEC. 114. ACCESS TO SPECIALTY CARE.

(a)(3)(A)) with respect to the ongoing special condition.

SEC. 115. ACCESS TO OBSTETRICAL AND GYNECOLOGICAL CARE.

SEC. 116. ACCESS TO PEDIATRIC CARE.

SEC. 117. CONTINUITY OF CARE.

does not include a termination of the contract by the plan or issuer for failure to meet applicable quality standards or for fraud.

SEC. 118. ACCESS TO NEEDED PRESCRIPTION DRUGS.

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

clinical trial, nothing in paragraph (1) shall be construed as preventing a plan or issuer from requiring that a qualified individual participate in the trial through such a participating provider if the provider will accept the individual as a participant in the trial.

Subtitle C--Access to Information

SEC. 121. PATIENT ACCESS TO INFORMATION.

plan or health insurance coverage offered by a health insurance issuer includes the following:

would be) compensated in connection with the provision of health care under the plan or coverage.

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.

Subtitle E--Definitions

SEC. 151. DEFINITIONS.

SEC. 152. PREEMPTION; STATE FLEXIBILITY; CONSTRUCTION.

A law of the United States applicable only to the District of Columbia shall be treated as a State law rather than a law of the United States.

SEC. 153. EXCLUSIONS.

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.

a plan) shall comply with the requirements of title I of the Patients' Bill of Rights Act (as in effect as of the date of the enactment of such Act), and such requirements shall be deemed to be incorporated into this subsection.

1133) is amended by inserting `(a)' after `SEC. 503.' and by adding at the end the following new subsection:

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

SEC. 303. LIMITATIONS ON ACTIONS.

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--MISCELLANEOUS PROVISIONS

SEC. 601. HEALTH CARE PAPERWORK SIMPLIFICATION.

and under the same conditions as Federal agencies and shall, for purposes of the frank, be considered a commission of Congress as described in section 3215 of title 39, United States Code.

SEC. 602. NO IMPACT ON SOCIAL SECURITY TRUST FUND.

Calendar No. 809

106th CONGRESS

2d Session

S. 3058

A BILL

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


September 18, 2000

Read the second time and placed on the calendar

END