Calendar No. 160

106th CONGRESS

1st Session

S. 326

[Report No. 106-82]

A BILL

To improve the access and choice of patients to quality, affordable health care.


June 17, 1999

Reported with an amendment

S 326 RS

Calendar No. 160

106th CONGRESS

1st Session

S. 326

[Report No. 106-82]

To improve the access and choice of patients to quality, affordable health care.

IN THE SENATE OF THE UNITED STATES

January 28, 1999

Mr. JEFFORDS (for himself, Mr. FRIST, Mr. DEWINE, Mr. ENZI, Mr. HUTCHINSON, Ms. COLLINS, Mr. BROWNBACK, Mr. HAGEL, Mr. SESSIONS, Mr. BURNS, and Mr. GREGG) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

June 17, 1999

[Strike out all after the enacting clause and insert the part printed in italic]


A BILL

To improve the access and choice of patients to quality, affordable health care.

[Struck out->] SECTION 1. SHORT TITLE; TABLE OF CONTENTS. [<-Struck out]

[Struck out->] TITLE I--PATIENTS' BILL OF RIGHTS [<-Struck out]

[Struck out->] Subtitle A--Right to Advice and Care [<-Struck out]

[Struck out->] `SUBPART C--PATIENT RIGHT TO MEDICAL ADVICE AND CARE [<-Struck out]

[Struck out->] `Sec. 721. Patient access to emergency medical care. [<-Struck out]

[Struck out->] `Sec. 722. Offering of choice of coverage options. [<-Struck out]

[Struck out->] `Sec. 723. Patient access to obstetric and gynecological care. [<-Struck out]

[Struck out->] `Sec. 724. Patient access to pediatric care. [<-Struck out]

[Struck out->] `Sec. 725. Continuity of care. [<-Struck out]

[Struck out->] `Sec. 726. Protection of patient-provider communications. [<-Struck out]

[Struck out->] `Sec. 727. Generally applicable provision.' [<-Struck out]

[Struck out->] Subtitle B--Right to Information About Plans and Providers [<-Struck out]

[Struck out->] Subtitle C--Right to Hold Health Plans Accountable [<-Struck out]

[Struck out->] TITLE II--INDIVIDUAL RIGHTS WITH RESPECT TO PERSONAL MEDICAL INFORMATION [<-Struck out]

[Struck out->] Subtitle A--Access to Medical Records [<-Struck out]

[Struck out->] Subtitle B--Establishment of Safeguards [<-Struck out]

[Struck out->] Subtitle C--Enforcement; Definitions [<-Struck out]

[Struck out->] TITLE III--GENETIC INFORMATION AND SERVICES [<-Struck out]

[Struck out->] TITLE IV--HEALTHCARE RESEARCH AND QUALITY [<-Struck out]

[Struck out->] `TITLE IX--AGENCY FOR HEALTHCARE RESEARCH AND QUALITY [<-Struck out]

[Struck out->] `Part A--Establishment and General Duties [<-Struck out]

[Struck out->] `Sec. 901. Mission and duties. [<-Struck out]

[Struck out->] `Sec. 902. General authorities. [<-Struck out]

[Struck out->] `Part B--Healthcare Improvement Research [<-Struck out]

[Struck out->] `Sec. 911. Healthcare outcome improvement research. [<-Struck out]

[Struck out->] `Sec. 912. Private-public partnerships to improve organization and delivery. [<-Struck out]

[Struck out->] `Sec. 913. Information on quality and cost of care. [<-Struck out]

[Struck out->] `Sec. 914. Information systems for healthcare improvement. [<-Struck out]

[Struck out->] `Sec. 915. Research supporting primary care and access in underserved areas. [<-Struck out]

[Struck out->] `Sec. 916. Clinical practice and technology innovation. [<-Struck out]

[Struck out->] `Sec. 917. Coordination of Federal Government quality improvement efforts. [<-Struck out]

[Struck out->] `Part C--General Provisions [<-Struck out]

[Struck out->] `Sec. 921. Advisory Council for Healthcare Research and Quality. [<-Struck out]

[Struck out->] `Sec. 922. Peer review with respect to grants and contracts. [<-Struck out]

[Struck out->] `Sec. 923. Certain provisions with respect to development, collection, and dissemination of data. [<-Struck out]

[Struck out->] `Sec. 924. Dissemination of information. [<-Struck out]

[Struck out->] `Sec. 925. Additional provisions with respect to grants and contracts. [<-Struck out]

[Struck out->] `Sec. 926. Certain administrative authorities. [<-Struck out]

[Struck out->] `Sec. 927. Funding. [<-Struck out]

[Struck out->] `Sec. 928. Definitions.' [<-Struck out]

[Struck out->] TITLE V--MISCELLANEOUS PROVISIONS [<-Struck out]

[Struck out->] TITLE I--PATIENTS' BILL OF RIGHTS [<-Struck out]

[Struck out->] Subtitle A--Right to Advice and Care [<-Struck out]

[Struck out->] SEC. 101. PATIENT RIGHT TO MEDICAL ADVICE AND CARE. [<-Struck out]

[Struck out->] `Subpart C--Patient Right to Medical Advice and Care [<-Struck out]

[Struck out->] `SEC. 721. PATIENT ACCESS TO EMERGENCY MEDICAL CARE. [<-Struck out]

[Struck out->] emergency medical care (as defined in subsection (c)), except for items or services specifically excluded-- [<-Struck out]

[Struck out->] `SEC. 722. OFFERING OF CHOICE OF COVERAGE OPTIONS. [<-Struck out]

[Struck out->] this paragraph, the provisions of subparagraph (C) of section 712(c)(1) shall apply in determining employer size. [<-Struck out]

[Struck out->] `SEC. 723. PATIENT ACCESS TO OBSTETRIC AND GYNECOLOGICAL CARE. [<-Struck out]

[Struck out->] `SEC. 724. PATIENT ACCESS TO PEDIATRIC CARE. [<-Struck out]

[Struck out->] `SEC. 725. CONTINUITY OF CARE. [<-Struck out]

[Struck out->] `SEC. 726. PROTECTION OF PATIENT-PROVIDER COMMUNICATIONS. [<-Struck out]

[Struck out->] (other than a fully insured group health plan) to provide specific benefits under the terms of such plan. [<-Struck out]

[Struck out->] `SEC. 727. GENERALLY APPLICABLE PROVISION. [<-Struck out]

[Struck out->] `SUBPART C--PATIENT RIGHT TO MEDICAL ADVICE AND CARE [<-Struck out]

[Struck out->] SEC. 102. EFFECTIVE DATE AND RELATED RULES. [<-Struck out]

[Struck out->] Subtitle B--Right to Information About Plans and Providers [<-Struck out]

[Struck out->] SEC. 111. INFORMATION ABOUT PLANS. [<-Struck out]

[Struck out->] `SEC. 714. HEALTH PLAN COMPARATIVE INFORMATION. [<-Struck out]

[Struck out->] health services (including telephone numbers and mailing addresses), including referrals for specialty care. [<-Struck out]

[Struck out->] or health insurance issuer in connection with group health insurance coverage, from distributing any other additional information determined by the plan or issuer to be important or necessary in assisting participants and beneficiaries enrollees or upon request potential participants in the selection of a health plan or from providing information under subsection (b)(13) as part of the required information. [<-Struck out]

[Struck out->] `Sec. 714. Health plan comparative information.'. [<-Struck out]

[Struck out->] SEC. 112. INFORMATION ABOUT PROVIDERS. [<-Struck out]

[Struck out->] Subtitle C--Right to Hold Health Plans Accountable [<-Struck out]

[Struck out->] SEC. 121. AMENDMENT TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974. [<-Struck out]

[Struck out->] `SEC. 503. CLAIMS PROCEDURE, COVERAGE DETERMINATION, GRIEVANCES AND APPEALS. [<-Struck out]

[Struck out->] terms and [<-Struck out]

[Struck out->] conditions of the contract between the plan or issuer and the enrollee; [<-Struck out]

[Struck out->] would take place, or the manufacturer of any drug, device, procedure, or other therapy proposed for the enrollee whose treatment is under review; [<-Struck out]

[Struck out->] Security Act of 1974 is amended by striking the item relating to section 503 and inserting the following new item: [<-Struck out]

[Struck out->] TITLE II--INDIVIDUAL RIGHTS WITH RESPECT TO PERSONAL MEDICAL INFORMATION [<-Struck out]

[Struck out->] SEC. 201. SHORT TITLE. [<-Struck out]

[Struck out->] Subtitle A--Access to Medical Records [<-Struck out]

[Struck out->] SEC. 211. INSPECTION AND COPYING OF PROTECTED HEALTH INFORMATION. [<-Struck out]

[Struck out->] SEC. 212. AMENDMENT OF PROTECTED HEALTH INFORMATION. [<-Struck out]

[Struck out->] SEC. 213. NOTICE OF CONFIDENTIALITY PRACTICES. [<-Struck out]

[Struck out->] Subtitle B--Establishment of Safeguards [<-Struck out]

[Struck out->] SEC. 221. ESTABLISHMENT OF SAFEGUARDS. [<-Struck out]

[Struck out->] Subtitle C--Enforcement; Definitions [<-Struck out]

[Struck out->] SEC. 231. CIVIL PENALTY. [<-Struck out]

[Struck out->] SEC. 232. DEFINITIONS. [<-Struck out]

[Struck out->] SEC. 233. EFFECTIVE DATE. [<-Struck out]

[Struck out->] TITLE III--GENETIC INFORMATION AND SERVICES [<-Struck out]

[Struck out->] SEC. 301. SHORT TITLE. [<-Struck out]

[Struck out->] SEC. 302. AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974. [<-Struck out]

[Struck out->] `SEC. 714. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE BASIS OF PREDICTIVE GENETIC INFORMATION. [<-Struck out]

[Struck out->] Act of 1974 (29 U.S.C. 1182(b)) is amended by adding at the end the following: [<-Struck out]

[Struck out->] SEC. 303. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT. [<-Struck out]

[Struck out->] `SEC. 2707. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE BASIS OF PREDICTIVE GENETIC INFORMATION IN THE GROUP MARKET. [<-Struck out]

[Struck out->] `SEC. 2753. PROHIBITION OF HEALTH DISCRIMINATION ON THE BASIS OF PREDICTIVE GENETIC INFORMATION. [<-Struck out]

[Struck out->] a part of a request under subparagraph (A), the health insurance issuer shall provide to the individual or dependent a description of the procedures in place to safeguard the confidentiality, as described in sections 213 and 221 of the Patients' Bill of Rights Act, of such individually identifiable information.'. [<-Struck out]

[Struck out->] TITLE IV--HEALTHCARE RESEARCH AND QUALITY [<-Struck out]

[Struck out->] SEC. 401. SHORT TITLE. [<-Struck out]

[Struck out->] SEC. 402. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT. [<-Struck out]

[Struck out->] `TITLE IX--AGENCY FOR HEALTHCARE RESEARCH AND QUALITY [<-Struck out]

[Struck out->] `PART A--ESTABLISHMENT AND GENERAL DUTIES [<-Struck out]

[Struck out->] `SEC. 901. MISSION AND DUTIES. [<-Struck out]

[Struck out->] `SEC. 902. GENERAL AUTHORITIES. [<-Struck out]

[Struck out->] subsection (a)(2) of this section that affect the programs under titles XVIII, XIX and XXI of the Social Security Act shall be carried out consistent with section 1142 of such Act. [<-Struck out]

[Struck out->] `PART B--HEALTHCARE IMPROVEMENT RESEARCH [<-Struck out]

[Struck out->] `SEC. 911. HEALTHCARE OUTCOME IMPROVEMENT RESEARCH. [<-Struck out]

[Struck out->] `SEC. 912. PRIVATE-PUBLIC PARTNERSHIPS TO IMPROVE ORGANIZATION AND DELIVERY. [<-Struck out]

[Struck out->] `SEC. 913. INFORMATION ON QUALITY AND COST OF CARE. [<-Struck out]

[Struck out->] `SEC. 914. INFORMATION SYSTEMS FOR HEALTHCARE IMPROVEMENT. [<-Struck out]

[Struck out->] `SEC. 915. RESEARCH SUPPORTING PRIMARY CARE AND ACCESS IN UNDERSERVED AREAS. [<-Struck out]

[Struck out->] `SEC. 916. CLINICAL PRACTICE AND TECHNOLOGY INNOVATION. [<-Struck out]

[Struck out->] `SEC. 917. COORDINATION OF FEDERAL GOVERNMENT QUALITY IMPROVEMENT EFFORTS. [<-Struck out]

[Struck out->] with private sector accreditation and other quality measurement organizations; [<-Struck out]

[Struck out->] `PART C--GENERAL PROVISIONS [<-Struck out]

[Struck out->] `SEC. 921. ADVISORY COUNCIL FOR HEALTHCARE RESEARCH AND QUALITY. [<-Struck out]

[Struck out->] States. The Secretary shall ensure that the appointed members of the Council, as a group, are representative of professions and entities concerned with, or affected by, activities under this title and under section 1142 of the Social Security Act. Of such members-- [<-Struck out]

[Struck out->] `SEC. 922. PEER REVIEW WITH RESPECT TO GRANTS AND CONTRACTS. [<-Struck out]

[Struck out->] practice-oriented or provider-based research, and for such other purposes as the Director may determine to be appropriate. [<-Struck out]

[Struck out->] `SEC. 923. CERTAIN PROVISIONS WITH RESPECT TO DEVELOPMENT, COLLECTION, AND DISSEMINATION OF DATA. [<-Struck out]

[Struck out->] `SEC. 924. DISSEMINATION OF INFORMATION. [<-Struck out]

[Struck out->] `SEC. 925. ADDITIONAL PROVISIONS WITH RESPECT TO GRANTS AND CONTRACTS. [<-Struck out]

[Struck out->] `SEC. 926. CERTAIN ADMINISTRATIVE AUTHORITIES. [<-Struck out]

[Struck out->] to utilize the physical resources of such Department, and provide technical assistance and advice. [<-Struck out]

[Struck out->] `SEC. 927. FUNDING. [<-Struck out]

[Struck out->] `SEC. 929. DEFINITIONS. [<-Struck out]

[Struck out->] SEC. 403. REFERENCES. [<-Struck out]

[Struck out->] SEC. 404. STUDY. [<-Struck out]

[Struck out->] TITLE V--MISCELLANEOUS PROVISIONS [<-Struck out]

[Struck out->] SEC. 501. SENSE OF THE COMMITTEE. [<-Struck out]

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

TITLE I--PATIENTS' BILL OF RIGHTS

Subtitle A--Right to Advice and Care

`SUBPART C--PATIENT RIGHT TO MEDICAL ADVICE AND CARE

`Sec. 721. Patient access to emergency medical care.

`Sec. 722. Offering of choice of coverage options.

`Sec. 723. Patient access to obstetric and gynecological care.

`Sec. 724. Patient access to pediatric care.

`Sec. 725. Access to specialists.

`Sec. 726. Continuity of care.

`Sec. 727. Protection of patient-provider communications.

`Sec. 728. Patient's right to prescription drugs.

`Sec. 729. Self-payment for behavioral health care services.

`Sec. 730. Generally applicable provision.

Subtitle B--Right to Information About Plans and Providers

Subtitle C--Right to Hold Health Plans Accountable

TITLE II--GENETIC INFORMATION AND SERVICES

TITLE III--HEALTHCARE RESEARCH AND QUALITY

`TITLE IX--AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

`Part A--Establishment and General Duties

`Sec. 901. Mission and duties.

`Sec. 902. General authorities.

`Part B--Healthcare Improvement Research

`Sec. 911. Healthcare outcome improvement research.

`Sec. 912. Private-public partnerships to improve organization and delivery.

`Sec. 913. Information on quality and cost of care.

`Sec. 914. Information systems for healthcare improvement.

`Sec. 915. Research supporting primary care and access in underserved areas.

`Sec. 916. Clinical practice and technology innovation.

`Sec. 917. Coordination of Federal Government quality improvement efforts.

`Part C--General Provisions

`Sec. 921. Advisory Council for Healthcare Research and Quality.

`Sec. 922. Peer review with respect to grants and contracts.

`Sec. 923. Certain provisions with respect to development, collection, and dissemination of data.

`Sec. 924. Dissemination of information.

`Sec. 925. Additional provisions with respect to grants and contracts.

`Sec. 926. Certain administrative authorities.

`Sec. 927. Funding.

`Sec. 928. Definitions.

TITLE IV--MISCELLANEOUS PROVISIONS

TITLE I--PATIENTS' BILL OF RIGHTS

Subtitle A--Right to Advice and Care

SEC. 101. PATIENT RIGHT TO MEDICAL ADVICE AND CARE.

`Subpart C--Patient Right to Medical Advice and Care

`SEC. 721. PATIENT ACCESS TO EMERGENCY MEDICAL CARE.

`SEC. 722. OFFERING OF CHOICE OF COVERAGE OPTIONS.

this paragraph, the provisions of subparagraph (C) of section 712(c)(1) shall apply in determining employer size.

`SEC. 723. PATIENT ACCESS TO OBSTETRIC AND GYNECOLOGICAL CARE.

`SEC. 724. PATIENT ACCESS TO PEDIATRIC CARE.

`SEC. 725. ACCESS TO SPECIALISTS.

`SEC. 726. CONTINUITY OF CARE.

`SEC. 727. PROTECTION OF PATIENT-PROVIDER COMMUNICATIONS.

(other than a fully insured group health plan) to provide specific benefits under the terms of such plan.

`SEC. 728. PATIENT'S RIGHT TO PRESCRIPTION DRUGS.

`SEC. 729. SELF-PAYMENT FOR BEHAVIORAL HEALTH CARE SERVICES.

`SEC. 730. GENERALLY APPLICABLE PROVISION.

`SUBPART C--PATIENT RIGHT TO MEDICAL ADVICE AND CARE

SEC. 102. COMPREHENSIVE INDEPENDENT STUDY OF PATIENT ACCESS TO CLINICAL TRIALS AND COVERAGE OF ASSOCIATED ROUTINE COSTS.

SEC. 103. EFFECTIVE DATE AND RELATED RULES.

Subtitle B--Right to Information About Plans and Providers

SEC. 111. INFORMATION ABOUT PLANS.

`SEC. 714. HEALTH PLAN COMPARATIVE INFORMATION.

for each package option available under a group health plan the following:

under subsection (b)(15) as part of the required information.

`Sec. 714. Health plan comparative information.'.

`Sec. 9813. Health plan comparative information.'; and

`SEC. 9813. HEALTH PLAN COMPARATIVE INFORMATION.

SEC. 112. INFORMATION ABOUT PROVIDERS.

Subtitle C--Right to Hold Health Plans Accountable

SEC. 121. AMENDMENT TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.

`SEC. 503. CLAIMS PROCEDURE, COVERAGE DETERMINATION, GRIEVANCES AND APPEALS.

than 30 working days after the date on which a request for such appeal is received.

would take place, or the manufacturer of any drug, device, procedure, or other therapy proposed for the participant or beneficiary whose treatment is under review;

scope of his or her State licensure or certification for the delivery of health care services and who is primarily responsible for delivering those services to the participant or beneficiary.

Security Act of 1974 is amended by striking the item relating to section 503 and inserting the following new item:

TITLE II--GENETIC INFORMATION AND SERVICES

SEC. 201. SHORT TITLE.

SEC. 202. AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.

`SEC. 715. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE BASIS OF PREDICTIVE GENETIC INFORMATION.

SEC. 203. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

`SEC. 2707. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE BASIS OF PREDICTIVE GENETIC INFORMATION IN THE GROUP MARKET.

`SEC. 2753. PROHIBITION OF HEALTH DISCRIMINATION ON THE BASIS OF PREDICTIVE GENETIC INFORMATION.

SEC. 204. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.

`SEC. 9814. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE BASIS OF PREDICTIVE GENETIC INFORMATION.

TITLE III--HEALTHCARE RESEARCH AND QUALITY

SEC. 301. SHORT TITLE.

SEC. 302. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

`TITLE IX--AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

`PART A--ESTABLISHMENT AND GENERAL DUTIES

`SEC. 901. MISSION AND DUTIES.

`SEC. 902. GENERAL AUTHORITIES.

`PART B--HEALTHCARE IMPROVEMENT RESEARCH

`SEC. 911. HEALTHCARE OUTCOME IMPROVEMENT RESEARCH.

`SEC. 912. PRIVATE-PUBLIC PARTNERSHIPS TO IMPROVE ORGANIZATION AND DELIVERY.

`SEC. 913. INFORMATION ON QUALITY AND COST OF CARE.

`SEC. 914. INFORMATION SYSTEMS FOR HEALTHCARE IMPROVEMENT.

`SEC. 915. RESEARCH SUPPORTING PRIMARY CARE AND ACCESS IN UNDERSERVED AREAS.

serve as the principal source of funding for primary care practice research in the Department of Health and Human Services. For purposes of this paragraph, primary care research focuses on 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.

`SEC. 916. CLINICAL PRACTICE AND TECHNOLOGY INNOVATION.

`SEC. 917. COORDINATION OF FEDERAL GOVERNMENT QUALITY IMPROVEMENT EFFORTS.

review of their quality oversight, quality improvement and quality research programs, the Secretary shall enter into a contract with the Institute of Medicine--

`PART C--GENERAL PROVISIONS

`SEC. 921. ADVISORY COUNCIL FOR HEALTHCARE RESEARCH AND QUALITY.

States. The Secretary shall ensure that the appointed members of the Council, as a group, are representative of professions and entities concerned with, or affected by, activities under this title and under section 1142 of the Social Security Act. Of such members--

`SEC. 922. PEER REVIEW WITH RESPECT TO GRANTS AND CONTRACTS.

practice-oriented or provider-based research, and for such other purposes as the Director may determine to be appropriate.

`SEC. 923. CERTAIN PROVISIONS WITH RESPECT TO DEVELOPMENT, COLLECTION, AND DISSEMINATION OF DATA.

`SEC. 924. DISSEMINATION OF INFORMATION.

than $10,000 for each such violation involved. Such penalty shall be imposed and collected in the same manner as civil money penalties under subsection (a) of section 1128A of the Social Security Act are imposed and collected.

`SEC. 925. ADDITIONAL PROVISIONS WITH RESPECT TO GRANTS AND CONTRACTS.

`SEC. 926. CERTAIN ADMINISTRATIVE AUTHORITIES.

to utilize the physical resources of such Department, and provide technical assistance and advice.

to complete the entire period of assignment, or 1 year, whichever is shorter, unless separated or reassigned for reasons that are beyond the control of the expert or consultant and that are acceptable to the Secretary. If the expert or consultant violates the agreement, the money spent by the United States for the expenses specified in subparagraph (A) is recoverable from the expert or consultant as a statutory obligation owed to the United States. The Secretary may waive in whole or in part a right of recovery under this subparagraph.

`SEC. 927. FUNDING.

`SEC. 928. DEFINITIONS.

SEC. 303. REFERENCES.

TITLE IV--MISCELLANEOUS PROVISIONS

SEC. 401. SENSE OF THE COMMITTEE.

END