Home > 106th Congressional Bills > S. 1344 (pcs) 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. [Placed on Calendar Senate] %%Filename:...

S. 1344 (pcs) 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. [Placed on Calendar Senate] %%Filename:...


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106th CONGRESS
  1st Session
                                S. 1344

_______________________________________________________________________

                                 AN ACT


 
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.

    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 ``Patients' Bill of 
Rights Plus Act''.
    (b) Table Of Contents.--The table of contents for 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. 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. Timely 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. Coverage for individuals participating in approved 
                            cancer clinical trials.
        ``Sec. 730A. Prohibiting discrimination against providers.
        ``Sec. 730B. Generally applicable provision.''.
Sec. 102``subchapter c--patient right to medical advice and care986.
        ``Sec. 9821. Patient access to emergency medical care.
        ``Sec. 9822. Offering of choice of coverage options.
        ``Sec. 9823. Patient access to obstetric and gynecological 
                            care.
        ``Sec. 9824. Patient access to pediatric care.
        ``Sec. 9825. Timely access to specialists.
        ``Sec. 9826. Continuity of care.
        ``Sec. 9827. Protection of patient-provider communications.
        ``Sec. 9828. Patient's right to prescription drugs.
        ``Sec. 9829. Self-payment for behavioral health care services.
        ``Sec. 9830. Coverage for individuals participating in approved 
                            cancer clinical trials.
        ``Sec. 9830A. Prohibiting discrimination against providers.
        ``Sec. 9830B. Generally applicable provision.''.
Sec. 103. Effective date and related rules.
       Subtitle B--Right to Information About Plans and Providers

Sec. 111. Information about plans.
Sec. 112. Information about providers.
           Subtitle C--Right to Hold Health Plans Accountable

Sec. 121. Amendment to Employee Retirement Income Security Act of 1974.
               TITLE II--WOMEN'S HEALTH AND CANCER RIGHTS

Sec. 201. Women's health and cancer rights.
              TITLE III--GENETIC INFORMATION AND SERVICES

Sec. 301. Short title.
Sec. 302. Amendments to Employee Retirement Income Security Act of 
                            1974.
Sec. 303. Amendments to the Public Health Service Act.
Sec. 304. Amendments to the Internal Revenue Code of 1986.
               TITLE IV--HEALTHCARE RESEARCH AND QUALITY

Sec. 401. Short title.
Sec. 402. 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.
        ``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.''.
Sec. 403. References.
         TITLE V--ENHANCED ACCESS TO HEALTH INSURANCE COVERAGE

Sec. 501. Full deduction of health insurance costs for self-employed 
                            individuals.
Sec. 502. Full availability of medical savings accounts.
Sec. 503. Permitting contribution towards medical savings account 
                            through Federal employees health benefits 
                            program (FEHBP).
Sec. 504. Carryover of unused benefits from cafeteria plans, flexible 
                            spending arrangements, and health flexible 
                            spending accounts.
       TITLE VI--PROVISIONS RELATING TO LONG-TERM CARE INSURANCE

Sec. 601. Inclusion of qualified long-term care insurance contracts in 
                            cafeteria plans, flexible spending 
                            arrangements, and health flexible spending 
                            accounts.
Sec. 602. Deduction for premiums for long-term care insurance.
Sec. 603. Study of long-term care needs in the 21st century.
                 TITLE VII--INDIVIDUAL RETIREMENT PLANS

Sec. 701. Modification of income limits on contributions and rollovers 
                            to Roth IRAs.
                     TITLE VIII--REVENUE PROVISIONS

Sec. 801. Modification to foreign tax credit carryback and carryover 
                            periods.
Sec. 802. Limitation on use of non-accrual experience method of 
                            accounting.
Sec. 803. Returns relating to cancellations of indebtedness by 
                            organizations lending money.
Sec. 804. Extension of Internal Revenue Service user fees.
Sec. 805. Property subject to a liability treated in same manner as 
                            assumption of liability.
Sec. 806. Charitable split-dollar life insurance, annuity, and 
                            endowment contracts.
Sec. 807. Transfer of excess defined benefit plan assets for retiree 
                            health benefits.
Sec. 808. Limitations on welfare benefit funds of 10 or more employer 
                            plans.
Sec. 809. Modification of installment method and repeal of installment 
                            method for accrual method taxpayers.
Sec. 810. Inclusion of certain vaccines against streptococcus 
                            pneumoniae to list of taxable vaccines.
                   TITLE IX--MISCELLANEOUS PROVISIONS

Sec. 901. Medicare competitive pricing demonstration project.

                   TITLE I--PATIENTS' BILL OF RIGHTS

                  Subtitle A--Right to Advice and Care

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

    (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. PATIENT ACCESS TO EMERGENCY MEDICAL CARE.

    ``(a) Coverage of Emergency Care.--
            ``(1) In general.--To the extent that the group health plan 
        (other than a fully insured group health plan) provides 
        coverage for benefits consisting of emergency medical care (as 
        defined in subsection (c)) or emergency ambulance services, 
        except for items or services specifically excluded--
                    ``(A) the plan shall provide coverage for benefits, 
                without requiring preauthorization, for emergency 
                medical screening examinations or emergency ambulance 
                services, to the extent that a prudent layperson, who 
                possesses an average knowledge of health and medicine, 
                would determine such examinations or emergency 
                ambulance services to be necessary to determine whether 
                emergency medical care (as so defined) is necessary; 
                and
                    ``(B) the plan shall provide coverage for benefits, 
                without requiring preauthorization, for additional 
                emergency medical care to stabilize an emergency 
                medical condition following an emergency medical 
                screening examination (if determined necessary under 
                subparagraph (A)), pursuant to the definition of 
                stabilize under section 1867(e)(3) of the Social 
                Security Act (42 U.S.C. 1395dd(e)(3)).
            ``(2) Reimbursement for care to maintain medical 
        stability.--
                    ``(A) In general.--In the case of services provided 
                to a participant or beneficiary by a nonparticipating 
                provider in order to maintain the medical stability of 
                the participant or beneficiary, the group health plan 
                involved shall provide for reimbursement with respect 
                to such services if--
                            ``(i) coverage for services of the type 
                        furnished is available under the group health 
                        plan;
                            ``(ii) the services were provided for care 
                        related to an emergency medical condition and 
                        in an emergency department in order to maintain 
                        the medical stability of the participant or 
                        beneficiary; and
                            ``(iii) the nonparticipating provider 
                        contacted the plan regarding approval for such 
                        services.
                    ``(B) Failure to respond.--If a group health plan 
                fails to respond within 1 hours of being contacted in 
                accordance with subparagraph (A)(iii), then the plan 
                shall be liable for the cost of services provided by 
                the nonparticipating provider in order to maintain the 
                stability of the participant or beneficiary.
                    ``(C) Limitation.--The liability of a group health 
                plan to provide reimbursement under subparagraph (A) 
                shall terminate when the plan has contacted the 
                nonparticipating provider to arrange for discharge or 
                transfer.
                    ``(D) Liability of participant.--A participant or 
                beneficiary shall not be liable for the costs of 
                services to which subparagraph (A) in an amount that 
                exceeds the amount of liability that would be incurred 
                if the services were provided by a participating health 
                care provider with prior authorization by the plan.
    ``(b) In-Network Uniform Costs-Sharing and Out-of-Network Care.--
            ``(1) In-network uniform cost-sharing.--Nothing in this 
        section shall be construed as preventing a group health plan 
        (other than a fully insured group health plan) from imposing 
        any form of cost-sharing applicable to any participant or 
        beneficiary (including coinsurance, copayments, deductibles, 
        and any other charges) in relation to coverage for benefits 
        described in subsection (a), if such form of cost-sharing is 
        uniformly applied under such plan, with respect to similarly 
        situated participants and beneficiaries, to all benefits 
        consisting of emergency medical care (as defined in subsection 
        (c)) provided to such similarly situated participants and 
        beneficiaries under the plan, and such cost-sharing is 
        disclosed in accordance with section 714.
            ``(2) Out-of-network care.--If a group health plan (other 
        than a fully insured group health plan) provides any benefits 
        with respect to emergency medical care (as defined in 
        subsection (c)), the plan shall cover emergency medical care 
        under the plan in a manner so that, if such care is provided to 
        a participant or beneficiary by a nonparticipating health care 
        provider, the participant or beneficiary is not liable for 
        amounts that exceed any form of cost-sharing (including co-
        insurance, co-payments, deductibles, and any other charges) 
        that would be incurred if the services were provided by a 
        participating provider.
    ``(c) Definition of Emergency Medical Care.--In this section:
            ``(1) In general.--The term `emergency medical care' means, 
        with respect to a participant or beneficiary under a group 
        health plan (other than a fully insured group health plan), 
        covered inpatient and outpatient services that--
                    ``(A) are furnished by any provider, including a 
                nonparticipating provider, that is qualified to furnish 
                such services; and
                    ``(B) are needed to evaluate or stabilize (as such 
                term is defined in section 1867(e)(3) of the Social 
                Security Act (42 U.S.C. 1395dd)(e)(3)) an emergency 
                medical condition (as defined in paragraph (2)).
            ``(2) 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 

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