Clerk session vote number: 210
Description: 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.
Bill summary: Patients' Bill of Rights Plus 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 define "fully insured group health plan" as one under which 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 issuer under a contract or policy of insurance. Requires a group health plan (for purposes of benefits and
protections discussed in this subtitle, one other than a fully insured 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.
Requires a plan to cover additional emergency medical care to stabilize an emergency medical condition following an emergency screening examination.
Requires a plan (other than certain small employer plans) 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 coverage options.
Prohibits a plan that covers routine obstetrical, gynecological, or pediatric care from requiring a referral for that care and requires a plan to treat certain referrals by an obstetrician, gynecologist, or pediatrician as a referral by a primary provider.
Requires a plan to ensure that participants and beneficiaries have access to covered specialty care.
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 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 postpartum care), and terminal illness.
Directs: (1) the Medicare Payment Advisory Commission to conduct a study of cost, quality, and coordination of coverage for the terminally ill; (2) the Agency for Health Care to conduct studies of the possible thresholds for major conditions causing serious and complex illnesses; and (3) the Health Care Financing Administration to conduct studies of the merits of applying similar thresholds in Medicare + Choice programs. Obligates funds for such studies.
Prohibits a plan from restricting a health care professional from advising a patient about the patient's health status, medical care, or treatment, regardless of whether such care or treatment is covered.
Requires a plan that covers prescription drugs only if included in a formulary to ensure the participation of physicians and pharmacists in developing and reviewing the formulary and to provide for exceptions to the formulary when medically necessary and appropriate.
Prohibits a plan from: (1) discouraging a participant or beneficiary from self-paying for behavioral health services once the plan has denied coverage; or (2) terminating a provider because the provider permits participants or beneficiaries to self-pay for non- covered behavioral services.
Applies most of the above requirements of this Act separately to each coverage option with regard to a plan that has more than one coverage option.
(Sec. 102) Mandates a study and report to a specified Senate committee of patient access to clinical trials and the coverage of routine patient care costs by private health plans and insurers.
Directs the Secretary to provide for necessary funding.
Subtitle B: Right to Information about Plans and Providers
- Requires plans and group health insurance issuers to disclose specified plan information to participants, beneficiaries, and (upon request) potential enrollees.
Amends the Internal Revenue Code to require plans to disclose specified plan information to participants, beneficiaries, and (upon request) potential enrollees.
(Sec. 112) Mandates a study and report to 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
- Amends ERISA to revise requirements for denied claim appeal procedures.
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 or issuer and a participant or beneficiary; (3) an internal procedure for coverage determination appeals; and (4) an external review procedure for participant or beneficiary 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.
Title II: Women's Health and Cancer Rights
- Women's Health and Cancer Rights Act of 1999 - Amends the ERISA, as amended by the Omnibus Consolidated and Emergency Supplemental Appropriations Act, 1999, and the Public Health Service Act, as amended by the Omnibus Consolidated and Emergency Supplemental Appropriations Act, 1999, to require certain group health plans, and health insurance issuers providing coverage under a group plan, to ensure specified minimum coverage regarding: (1) breast cancer mastectomies, lumpectomies, and lymph node dissections; and (2) secondary consultations by specialists. Prohibits: (1) changing coverage terms and conditions based on a participant's or beneficiary's decision to request less than the minimum coverage; and (2) certain penalties or incentives to providers or specialists. Amends: (1) the Public Health Service Act to apply the same requirements to health insurance issuers in the individual market; and (2) the Internal Revenue Code to apply those requirements to group health plans.
Title III: Genetic Information and Services
- Genetic Information Nondiscrimination in Health Insurance Act of 1999 - Amends ERISA and the Public Health Service Act to prohibit a plan or issuer from: (1) basing enrollment eligibility on information about a request for or receipt of genetic services; (2) adjusting premium or contribution amounts for a group based on predictive genetic information concerning any individual, including information about a request for or receipt of genetic services; or (3) except as needed for diagnosis, treatment, or payment, requesting or requiring predictive genetic information concerning any individual. Mandates notice of a plan's or issuer's confidentiality practices regarding predictive genetic information. Requires development and dissemination of model notices. Requires a plan or issuer to maintain safeguards to protect the confidentiality, security, accuracy, and integrity of predictive genetic information.
(Sec. 203) Amends the Public Health Service Act to apply the requirements of this title to issuers offering coverage in the individual market.
(Sec. 204) Amends the Internal Revenue Code to apply the requirements of this title to group health plans.
Title IV: Healthcare Research and Quality
- Healthcare Research and Quality Act of 1999 - Amends the Public Health Service Act to establish in the Public Health Service an Agency for Healthcare Research and Quality to replace the current Agency for Health Care Policy and Research.
Authorizes: (1) training grants in health services research including pre- and post-doctoral fellowships and training programs and young investigator awards; and (2) financial assistance to establish and operate centers for multidisciplinary health services research, demonstration projects, evaluations, training, and policy analysis.
Directs the Agency to identify and disseminate methods or systems used to assess health care research results, particularly to rate the strength of the scientific evidence behind health care practice, recommendations in research literature, and technology assessments.
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.
Authorizes the Agency to provide specified scientific and technical support for private and public efforts to improve health care quality, including activities of accrediting organizations.
Directs the Secretary of Health and Human Services (Secretary), acting through the Agency Director, to establish a demonstration program of grants for one or more centers to conduct: (1) state-of-the-art clinical, laboratory, or health services 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).
Mandates conducting and supporting research and building private-public partnerships to: (1) identify the causes of preventable healthcare errors; (2) develop, demonstrate, and evaluate strategies for reducing errors and improving patient safety; and (3) promote implementation of effective strategies.
Requires the Agency Director to: (1) collect certain data on the cost and quality of health care; and (2) support research on and initiatives to advance the use of information systems for the study of health care quality.
Authorizes the Director to periodically convene a Preventive Services Task Force to review scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services.
Establishes within the Agency a Center for Primary Care Research to serve as the principal funding source for Department of Health and Human Services primary care 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.
Mandates the promotion of innovation in evidence-based clinical practice and health care technologies.
Requires coordination of 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 Institute of Medicine to describe and evaluate current quality improvement research and monitoring processes and recommend improvements.
Establishes an Advisory Council for Healthcare Research and Quality.
Requires that appropriate technical and scientific peer review be conducted regarding each application for a grant, cooperative agreement, or contract under this title and prohibits approving an application unless the peer review so recommended.
Mandates establishment of standard methods for developing and collecting the Agency's data.
Authorizes the Agency, on request of a public or private entity, to conduct or support research or analyses otherwise authorized under this title, with the entity paying service costs.
Authorizes appropriations through FY 2006.
Title V: Enhanced Access to Health Insurance Coverage
- Amends the Internal Revenue Code to allow a full deduction from gross income for a self-employed individual's health insurance costs.
(Sec. 502) Repeals the limitation on the availability of medical savings accounts (MSAs) to employees of small employers and the self-employed.
Repeals the limitation on the number of taxpayers having MSAs.
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.
Treats certain network-based managed care plans as high deductible health plans.
(Sec. 503) Authorizes the Office of Personnel Management to contract for catastrophic Federal employees health benefits.
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.
(Sec. 504) Allows the annual carryover of up to $500 of unused benefits from cafeteria plans, flexible spending arrangements, and health flexible spending accounts.
Title VI: Provisions Relating to Long-Term Care Insurance
- Amends the Internal Revenue Code to include qualified long-term care insurance contracts as a cafeteria plan qualified benefit.
(Sec. 602) Permits a deduction for eligible long-term health care premiums for an individual who is not eligible for an employer-subsidized long-term care health plan.
(Sec. 603) Directs the Secretary to provide for a study of long-term care needs for the 21st century.
Title VII: Individual Retirement Plans
- Amends the Internal Revenue Code to increase to $1 million the adjusted gross income a taxpayer may have and still qualify for a rollover to a Roth IRA.
Title VIII: Revenue Provisions
- Amends the Internal Revenue Code to reduce the foreign tax credit carryback by one year, and increase the carryover to seven years.
(Sec. 802) Modifies the permitted use of the special rule permitting accrual method users not to accrue payments for personal services which (on the basis of experience) will not be collected.
(Sec. 803) Requires organizations in the business or trade of lending money to report cancellations of indebtedness income to the Internal Revenue Service (IRS).
(Sec. 804) Directs the Secretary of the Treasury to establish a program of IRS user fees (and exemptions) through September 30, 2009, for ruling, determination, and opinion letters.
(Sec. 805) Provides, with respect to certain transfers of property subject to a liability, that: (1) except as provided by regulations, a recourse liability (or portion thereof) shall be treated as having been assumed if, as determined on the basis of all facts and circumstances, the transferee has agreed to satisfy such liability; and (2) a nonrecourse liability shall, with exceptions, be treated as having been assumed by the transferee of any asset subject to such liability.
(Sec. 806) Disallows any charitable contribution deduction for transfers to or for the use of a charitable remainder trust if in connection with such transfer: (1) the trust directly or indirectly pays, or has previously paid, any personal benefit contract premium with respect to the transferor (split-dollar arrangement); or (2) there is an understanding or expectation that any person will pay such premium. Defines "personal benefit contract." Exempts from treatment as indirect beneficiaries: (1) certain organizations which incur obligations under charitable gift annuity contracts; and (2) persons entitled to payments under certain charitable remainder trusts or unitrusts.
Imposes an excise tax in the amount of any premiums paid in connection with such transfers.
(Sec. 807) Extends through FY 2009 specified treatment of qualified transfers of excess pension assets to retiree health accounts. Prescribes minimum employer cost requirements for plans transferring assets during the first five-year cost maintenance period following a qualified transfer.
(Sec. 808) Revises the exemption from specified tax treatment of welfare benefit funds (prefunding limits) of any welfare benefit fund which is part of a ten or more employer plan. Limits such exemption to funds whose only benefits are medical, disability, or group term life insurance benefits which do not provide for any cash surrender value or other money that can be paid, assigned, borrowed, or pledged as loan collateral.
Revises the meaning of a disqualified benefit which would trigger a certain tax on a welfare benefit fund to set forth a special rule for a ten or more employer plan exempted from prefunding limits. Treats as a disqualified benefit subject to such tax any portio9n of a welfare benefit fund under a ten or more employer plan which is attributable to prefunding limit-exempted contributions if such portion is used for a purpose other than that for which the contributions were made.
(Sec. 809) Prohibits accrual method taxpayers from using the installment method of accounting for installment sales. Revises the special nondealer rules for pledges of installment obligations to declare that an installment payment shall be treated as directly secured by an installment obligation interest to the extent an arrangement allows the taxpayer to satisfy all or a portion of such indebtedness.
(Sec. 810) Imposes a tax on any conjugate vaccine against streptococcus pneumoniae sold by its manufacturer, producer, or importer.
Title IX: Miscellaneous Provisions
- Prohibits the Secretary from implementing the Medicare Competitive Pricing Demonstration Project under the Balanced Budget Act of 1997 in: (1) Kansas City, Missouri, or Kansas City, Kansas, or in Arizona; or (2) any area before January 1, 2001.
Directs the Secretary to study and report to Congress on the different approaches of implementing such project on a voluntary basis.
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Bill titles: 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.
Links for more info on the vote: congress.gov