| Home > 106th Congressional Bills > H.R. 5629 (ih) To permit the Asphalt Commander to be placed under a foreign registry. [Introduced in House] ...
H.R. 5629 (ih) To permit the Asphalt Commander to be placed under a foreign registry. [Introduced in House] ...
106th CONGRESS 2d Session H. R. 5628 To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to provide for a patients' bill of rights, patient access to information, and accountability of health plans, and to expand access to health care coverage through tax incentives. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES November 3, 2000 Mr. Shadegg (for himself, Mr. Coburn, Mr. Salmon, and Mr. Aderholt) 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 the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to provide for a patients' bill of rights, patient access to information, and accountability of health plans, and to expand access to health care coverage through tax incentives. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE; TABLE OF CONTENTS. (a) Short Title.--This Act may be cited as the ``Common Sense Patients' Bill of Rights Act''. (b) Table of Contents.--The table of contents of this Act is as follows: Sec. 1. Short title; table of contents. TITLE I--PATIENTS' BILL OF RIGHTS Subtitle A--Right to Advice and Care Sec. 101.``subpart c--patient right to medical advice and care. ``Sec. 721. Access to emergency care. ``Sec. 722. Offering of choice of coverage options. ``Sec. 723. Patient access to obstetric and gynecological care. ``Sec. 724. Access to pediatric care. ``Sec. 725. Timely access to specialists. ``Sec. 726. Continuity of care. ``Sec. 727. Prohibition of interference with certain medical communications. ``Sec. 728. Patient's right to prescription drugs. ``Sec. 729. Self-payment for behavioral health care services. ``Sec. 730. Coverage for individuals participating in approved cancer clinical trials. ``Sec. 730A. Prohibition of discrimination against providers based on licensure. ``Sec. 730B. Prohibition against improper incentive arrangements. ``Sec. 730C. Payment of clean claims. ``Sec. 730D. Generally applicable provision. ``Sec. 730E. Exclusion from access to managed care provisions for fee-for-service coverage. ``Sec. 730F. Additional definitions. Sec. 102. Conforming amendments to the Public Health Service Act. Sec. 103. Conforming amendments to the Internal Revenue Code of 1986. Subtitle B--Right to Information About Plans and Providers Sec. 111. Information about plans and coverage under ERISA. ``Sec. 714. Patient access to information. Sec. 112. Conforming amendments to Public Health Service Act. Sec. 113. Conforming amendments to the Internal Revenue Code of 1986. Subtitle C--Right to Hold Health Plans Accountable Sec. 121. Amendments to Employee Retirement Income Security Act of 1974. ``Sec. 503A. Utilization review activities. ``Sec. 503B. Procedures for initial claims for benefits and prior authorization determinations. ``Sec. 503C. Internal appeals of claims denials. ``Sec. 503D. Independent external appeals procedures. Sec. 122. Conforming amendments to Public Health Service Act. Sec. 123. Conforming amendments to the Internal Revenue Code of 1986. Subtitle D--State Flexibility in Applying Requirements to Health Insurance Issuers Sec. 141. State flexibility in applying requirements to health insurance issuers under ERISA; plan satisfaction of certain requirements. Sec. 142. State flexibility in applying requirements to health insurance issuers under the Public Health Service Act. Subtitle E--Effective Dates; Coordination in Implementation; Miscellaneous Provisions Sec. 151. Effective dates. Sec. 152. Regulations; coordination. Sec. 153. No benefit requirements. Sec. 154. Severability. TITLE II--REMEDIES Sec. 201. Availability of court remedies. Sec. 202. Severability. TITLE III--HEALTH CARE COVERAGE ACCESS TAX INCENTIVES Sec. 301. Expanded availability of medical savings accounts. Sec. 302. Deduction for 100 percent of health insurance costs of self- employed individuals. TITLE IV--HEALTH CARE PAPERWORK Sec. 401. Health care paperwork simplification. TITLE I--PATIENTS' BILL OF RIGHTS Subtitle A--Right to Advice and Care SEC. 101. PATIENT RIGHT TO MEDICAL ADVICE AND CARE UNDER ERISA. (a) In General.--Part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181 et seq.) is amended-- (1) by redesignating subpart C as subpart D; and (2) by inserting after subpart B the following: ``Subpart C--Patient Right to Medical Advice and Care ``SEC. 721. ACCESS TO EMERGENCY CARE. ``(a) Coverage of Emergency Services.-- ``(1) In general.--If a group health plan, or health insurance coverage offered by a health insurance issuer in connection with such a plan, provides or covers any benefits with respect to services in an emergency department of a hospital, the plan or issuer shall cover emergency services (as defined in paragraph (2)(B))-- ``(A) without the need for any prior authorization determination; ``(B) whether the health care provider furnishing such services is a participating provider with respect to such services; ``(C) in a manner so that, if such services are provided to a participant or beneficiary-- ``(i) by a nonparticipating health care provider with or without prior authorization, or ``(ii) by a participating health care provider without prior authorization, the participant or beneficiary is not liable for amounts that exceed the amounts of liability that would be incurred if the services were provided by a participating health care provider with prior authorization; and ``(D) without regard to any other term or condition of such coverage (other than exclusion or coordination of benefits, or an affiliation or waiting period, permitted under section 2701 of the Public Health Service Act, section 701, or section 9801 of the Internal Revenue Code of 1986, and other than applicable cost-sharing). ``(2) Definitions.--In this section: ``(A) Emergency medical condition.--The term `emergency medical condition' means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in a condition described in clause (i), (ii), or (iii) of section 1867(e)(1)(A) of the Social Security Act (42 U.S.C. 1395dd(e)(1)(A)). ``(B) Emergency services.--The term `emergency services' means with respect to an emergency medical condition-- ``(i) a medical screening examination (as required under section 1867 of the Social Security Act) that is within the capability of the emergency department of a hospital, including ancillary services routinely available to the emergency department to evaluate such emergency medical condition, and ``(ii) within the capabilities of the staff and facilities available at the hospital, such further medical examination and treatment as are required under section 1867 of such Act to stabilize the patient. ``(C) Stabilize.--The term `to stabilize' means, with respect to an emergency medical condition, to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility. ``(b) Reimbursement for Maintenance Care and Post-Stabilization Care.--If benefits are available under a group health plan, or under health insurance coverage offered by a health insurance issuer in connection with such a plan, with respect to maintenance care or post- stabilization care covered under the guidelines established under section 1852(d)(2) of the Social Security Act, the plan or issuer shall provide for reimbursement with respect to such services provided to a participant or beneficiary other than through a participating health care provider in a manner consistent with subsection (a)(1)(C) (and shall otherwise comply with such guidelines). ``(c) Coverage of Emergency Ambulance Services.-- ``(1) In general.--If a group health plan, or health insurance coverage provided by a health insurance issuer in connection with such a plan, provides any benefits with respect to ambulance services and emergency services, the plan or issuer shall cover emergency ambulance services (as defined in paragraph (2)) furnished under the plan or coverage under the same terms and conditions under subparagraphs (A) through (D) of subsection (a)(1) under which coverage is provided for emergency services. ``(2) Emergency ambulance services.--For purposes of this subsection, the term `emergency ambulance services' means ambulance services (as defined for purposes of section 1861(s)(7) of the Social Security Act) furnished to transport an individual who has an emergency medical condition (as defined in subsection (a)(2)(A)) to a hospital for the receipt of emergency services (as defined in subsection (a)(2)(B)) in a case in which the emergency services are covered under the plan or coverage pursuant to subsection (a)(1) and a prudent layperson, with an average knowledge of health and medicine, could reasonably expect that the absence of such transport would result in placing the health of the individual in serious jeopardy, serious impairment of bodily function, or serious dysfunction of any bodily organ or part. ``(d) Rule of Construction.--Nothing in this section shall be construed to prohibit a group health plan or a health insurance issuer from negotiating reimbursement rates with a nonparticipating provider for items or services provided under this section. ``SEC. 722. OFFERING OF CHOICE OF COVERAGE OPTIONS. ``(a) Requirement.--If a group health plan provides coverage for benefits only through a defined set of participating health care professionals, the plan shall offer each participant the option to purchase point-of-service coverage (as defined in subsection (b)) for all such benefits for which coverage is otherwise so limited. Such option shall be made available to the participant at the time of enrollment under the plan and at such other times as the plan offers the participant a choice of coverage options. ``(b) Point-of-Service Coverage Defined.--In this section, the term `point-of-service coverage' means, with respect to benefits covered under a group health plan, coverage of such benefits when provided by a nonparticipating health care professional. ``(c) Small Employer Exemption.-- ``(1) In general.--The requirement of subsection (a) shall not apply to a group health plan with respect to a small employer if the employer demonstrates that compliance with such requirement would result in an increase in overall costs to the employer. ``(2) Small employer defined.--For purposes of subparagraph (A), the term `small employer' means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of fewer than 25 employees on days during the preceding calendar year and fewer than 25 employees on the first day of the plan year. ``(3) Determination of employer size.--For purposes of this subsection, the provisions of subparagraph (C) of section 712(c)(1) shall apply in determining employer size. ``(d) Rule of Construction.--Nothing in this section shall be construed-- ``(1) as requiring coverage for benefits for a particular type of health care professional; ``(2) as requiring an increase in the level of employer contributions or as permitting an employer to comply with the requirements of this section by means of reducing the level of employer contributions attributable to coverage with respect to any participant or group of participants in relation to the level that would otherwise be maintained if such requirements did not apply; ``(3) as preventing a group health plan from imposing, on a participant who exercises the point-of-service coverage option under subsection (a), the additional cost of creation and maintenance of the option as well as any additional other costs (including additional cost-sharing) attributable to the option; or ``(4) to require that a group health plan include coverage of health care professionals that the plan excludes because of fraud, quality of care, or other similar reasons with respect to such professionals.
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