COBURN - SHADEGG SEC. 103. EXTERNAL APPEALS PROCEDURES. (b)(1)(C) OTHER TERMS AND CONDITIONS- The terms and conditions of this paragraph shall be consistent with the standards the appropriate Secretary shall establish to assure there is no real or apparent conflict of interest in the conduct of external appeal activities. All costs of the process (except those incurred by the participant, beneficiary, enrollee, or treating professional in support of the appeal) shall be paid by the plan or issuer, and not by the participant, beneficiary, or enrollee. The previous sentence shall not be construed as applying to the imposition of a filing fee under subsection (a)(4). (b)(2)(C) REQUIRED CONSIDERATION OF CERTAIN MATTERS- In making such determination, the external appeal entity shall consider, but not be bound by-- (i) any language in the plan or coverage document relating to the definitions of the terms medical necessity, medically necessary or appropriate, or experimental, investigational, or related terms; (d) EXTERNAL APPEAL DETERMINATION BINDING ON PLAN- (1) IN GENERAL- The determination by an external appeal entity under this section shall be binding on the plan (and issuer, if any) involved in the determination. SEC. 121. PATIENT ACCESS TO INFORMATION (b) INFORMATION PROVIDED- The information described in this subsection with respect to a group health plan or health insurance coverage offered by a health insurance issuer shall be provided to a participant, beneficiary, or enrollee free of charge at least once a year and includes the following: (1) SERVICE AREA- The service area of the plan or issuer. (2) BENEFITS- Benefits offered under the plan or coverage, including-- (A) those that are covered benefits (by reference to relevant CPT and DRG codes), limits and conditions on such benefits, and those benefits that are explicitly excluded from coverage (by reference to relevant CPT and DRG codes); SEC. 601. HEALTH CARE PAPERWORK SIMPLIFICATION. (a) ESTABLISHMENT OF PANEL- (1) ESTABLISHMENT- There is established a panel to be known as the Health Care Panel to Devise a Uniform Explanation of Benefits (in this section referred to as the `Panel'). (2) DUTIES OF PANEL- (A) IN GENERAL- The Panel shall devise a single form for use by third-party health care payers for the remittance of claims to providers. (B) DEFINITION- For purposes of this section, the term `third-party health care payer' means any entity that contractually pays health care bills for an individual. (3) MEMBERSHIP- (A) SIZE AND COMPOSITION- The Secretary of Health and Human Services, in consultation with the Majority Leader of the Senate and the Speaker of the House of Representatives, shall determine the number of members and the composition of the Panel. Such Panel shall include equal numbers of representatives of private insurance organizations, consumer groups, State insurance commissioners, State medical societies, State hospital associations, and State medical specialty societies. (B) TERMS OF APPOINTMENT- The members of the Panel shall serve for the life of the Panel. (C) VACANCIES- A vacancy in the Panel shall not affect the power of the remaining members to execute the duties of the Panel, but any such vacancy shall be filled in the same manner in which the original appointment was made. (4) PROCEDURES- (A) MEETINGS- The Panel shall meet at the call of a majority of its members. (B) FIRST MEETING- The Panel shall convene not later than 60 days after the date of the enactment of the Health Care Quality and Choice Act of 1999. (C) QUORUM- A quorum shall consist of a majority of the members of the Panel. (D) HEARINGS- For the purpose of carrying out its duties, the Panel may hold such hearings and undertake such other activities as the Panel determines to be necessary to carry out its duties. (5) ADMINISTRATION- (A) COMPENSATION- Except as provided in subparagraph (B), members of the Panel shall receive no additional pay, allowances, or benefits by reason of their service on the Panel. (B) TRAVEL EXPENSES AND PER DIEM- Each member of the Panel who is not an officer or employee of the Federal Government shall receive travel expenses and per diem in lieu of subsistence in accordance with sections 5702 and 5703 of title 5, United States Code. (C) CONTRACT AUTHORITY- The Panel may contract with and compensate government and private agencies or persons for items and services, without regard to section 3709 of the Revised Statutes (41 U.S.C. 5). (D) USE OF MAILS- The Panel may use the United States mails in the same manner 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. (E) ADMINISTRATIVE SUPPORT SERVICES- Upon the request of the Panel, the Secretary of Health and Human Services shall provide to the Panel on a reimbursable basis such administrative support services as the Panel may request. (6) SUBMISSION OF FORM- Not later than 2 years after the first meeting, the Panel shall submit a form to the Secretary of Health and Human Services for use by third- party health care payers. (7) TERMINATION- The Panel shall terminate on the day after submitting its the form under paragraph (6). (b) REQUIREMENT FOR USE OF FORM BY THIRD-PARTY CARE PAYERS- A third-party health care payer shall be required to use the form devised under subsection (a) for plan years beginning on or after 5 years following the date of the enactment of this Act. DINGELL - NORWOOD SEC. 103. EXTERNAL APPEALS PROCEDURES. (b)(1)(C) OTHER TERMS AND CONDITIONS- The terms and conditions of a contract under this paragraph shall be consistent with the standards the appropriate Secretary shall establish to assure there is no real or apparent conflict of interest in the conduct of external appeal activities. Such contract shall provide that all costs of the process (except those incurred by the participant, beneficiary, enrollee, or treating professional in support of the appeal) shall be paid by the plan or issuer, and not by the participant, beneficiary, or enrollee. The previous sentence shall not be construed as applying to the imposition of a filing fee under subsection (a)(4). (b)(2)(C) CONSIDERATION OF PLAN OR COVERAGE DEFINITIONS- In making such determination, the external appeal entity shall consider (but not be bound by) any language in the plan or coverage document relating to the definitions of the terms medical necessity, medically necessary or appropriate, or experimental, investigational, or related terms. (d) EXTERNAL APPEAL DETERMINATION BINDING ON PLAN- The determination by an external appeal entity under this section is binding on the plan and issuer involved in the determination. SEC. 601. HEALTH CARE PAPERWORK SIMPLIFICATION. (a) ESTABLISHMENT OF PANEL- (1) ESTABLISHMENT- There is established a panel to be known as the Health Care Panel to Devise a Uniform Explanation of Benefits (in this section referred to as the `Panel'). (2) DUTIES OF PANEL- (A) IN GENERAL- The Panel shall devise a single form for use by third-party health care payers for the remittance of claims to providers. (B) DEFINITION- For purposes of this section, the term `third-party health care payer' means any entity that contractually pays health care bills for an individual. (3) MEMBERSHIP- (A) SIZE AND COMPOSITION- The Secretary of Health and Human Services shall determine the number of members and the composition of the Panel. Such Panel shall include equal numbers of representatives of private insurance organizations, consumer groups, State insurance commissioners, State medical societies, State hospital associations, and State medical specialty societies. (B) TERMS OF APPOINTMENT- The members of the Panel shall serve for the life of the Panel. (C) VACANCIES- A vacancy in the Panel shall not affect the power of the remaining members to execute the duties of the Panel, but any such vacancy shall be filled in the same manner in which the original appointment was made. (4) PROCEDURES- (A) MEETINGS- The Panel shall meet at the call of a majority of its members. (B) FIRST MEETING- The Panel shall convene not later than 60 days after the date of the enactment of the Bipartisan Consensus Managed Care Improvement Act of 1999. (C) QUORUM- A quorum shall consist of a majority of the members of the Panel. (D) HEARINGS- For the purpose of carrying out its duties, the Panel may hold such hearings and undertake such other activities as the Panel determines to be necessary to carry out its duties. (5) ADMINISTRATION- (A) COMPENSATION- Except as provided in subparagraph (B), members of the Panel shall receive no additional pay, allowances, or benefits by reason of their service on the Panel. (B) TRAVEL EXPENSES AND PER DIEM- Each member of the Panel who is not an officer or employee of the Federal Government shall receive travel expenses and per diem in lieu of subsistence in accordance with sections 5702 and 5703 of title 5, United States Code. (C) CONTRACT AUTHORITY- The Panel may contract with and compensate government and private agencies or persons for items and services, without regard to section 3709 of the Revised Statutes (41 U.S.C. 5). (D) USE OF MAILS- The Panel may use the United States mails in the same manner 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. (E) ADMINISTRATIVE SUPPORT SERVICES- Upon the request of the Panel, the Secretary of Health and Human Services shall provide to the Panel on a reimbursable basis such administrative support services as the Panel may request. (6) SUBMISSION OF FORM- Not later than 2 years after the first meeting, the Panel shall submit a form to the Secretary of Health and Human Services for use by third- party health care payers. (7) TERMINATION- The Panel shall terminate on the day after submitting the form under paragraph (6). (b) REQUIREMENT FOR USE OF FORM BY THIRD-PARTY CARE PAYERS- A third-party health care payer shall be required to use the form devised under subsection (a) for plan years beginning on or after 5 years following the date of the enactment of this Act. TALENT BILL - H.R. 2990 SEC. 203. EXPANSION OF AVAILABILITY OF MEDICAL SAVINGS ACCOUNTS. (a) REPEAL OF LIMITATIONS ON NUMBER OF MEDICAL SAVINGS ACCOUNTS- (1) IN GENERAL- Subsections (i) and (j) of section 220 of the Internal Revenue Code of 1986 are hereby repealed. (2) CONFORMING AMENDMENTS- (A) Paragraph (1) of section 220(c) of such Code is amended by striking subparagraph (D). (B) Section 138 of such Code is amended by striking subsection (f). (b) AVAILABILITY NOT LIMITED TO ACCOUNTS FOR EMPLOYEES OF SMALL EMPLOYERS AND SELF-EMPLOYED INDIVIDUALS- (1) IN GENERAL- Section 220(c)(1)(A) of such Code (relating to eligible individual) is amended to read as follows: `(A) IN GENERAL- The term `eligible individual' means, with respect to any month, any individual if- - `(i) such individual is covered under a high deductible health plan as of the 1st day of such month, and `(ii) such individual is not, while covered under a high deductible health plan, covered under any health plan-- `(I) which is not a high deductible health plan, and `(II) which provides coverage for any benefit which is covered under the high deductible health plan.'. (2) CONFORMING AMENDMENTS- (A) Section 220(c)(1) of such Code is amended by striking subparagraph (C). (B) Section 220(c) of such Code is amended by striking paragraph (4) (defining small employer) and by redesignating paragraph (5) as paragraph (4). (C) Section 220(b) of such Code is amended by striking paragraph (4) (relating to deduction limited by compensation) and by redesignating paragraphs (5), (6), and (7) as paragraphs (4), (5), and (6), respectively. (c) INCREASE IN AMOUNT OF DEDUCTION ALLOWED FOR CONTRIBUTIONS TO MEDICAL SAVINGS ACCOUNTS- (1) IN GENERAL- Paragraph (2) of section 220(b) of such Code is amended to read as follows: `(2) MONTHLY LIMITATION- The monthly limitation for any month is the amount equal to 1/12 of the annual deductible (as of the first day of such month) of the individual's coverage under the high deductible health plan.'. (2) CONFORMING AMENDMENT- Clause (ii) of section 220(d)(1)(A) of such Code is amended by striking `75 percent of'. (d) BOTH EMPLOYERS AND EMPLOYEES MAY CONTRIBUTE TO MEDICAL SAVINGS ACCOUNTS- Paragraph (4) of section 220(b) of such Code (as redesignated by subsection (b)(2)(C)) is amended to read as follows: `(4) COORDINATION WITH EXCLUSION FOR EMPLOYER CONTRIBUTIONS- The limitation which would (but for this paragraph) apply under this subsection to the taxpayer for any taxable year shall be reduced (but not below zero) by the amount which would (but for section 106(b)) be includible in the taxpayer's gross income for such taxable year.'. (e) REDUCTION OF PERMITTED DEDUCTIBLES UNDER HIGH DEDUCTIBLE HEALTH PLANS- (1) IN GENERAL- Subparagraph (A) of section 220(c)(2) of such Code (defining high deductible health plan) is amended-- (A) by striking `$1,500' in clause (i) and inserting `$1,000'; and (B) by striking `$3,000' in clause (ii) and inserting `$2,000'. (2) CONFORMING AMENDMENT- Subsection (g) of section 220 of such Code is amended to read as follows: `(g) COST-OF-LIVING ADJUSTMENT- `(1) IN GENERAL- In the case of any taxable year beginning in a calendar year after 1998, each dollar amount in subsection (c)(2) shall be increased by an amount equal to-- `(A) such dollar amount, multiplied by `(B) the cost-of-living adjustment determined under section 1(f)(3) for the calendar year in which such taxable year begins by substituting `calendar year 1997' for `calendar year 1992' in subparagraph (B) thereof. `(2) SPECIAL RULES- In the case of the $1,000 amount in subsection (c)(2)(A)(i) and the $2,000 amount in subsection (c)(2)(A)(ii), paragraph (1)(B) shall be applied by substituting `calendar year 1999' for `calendar year 1997'. `(3) ROUNDING- If any increase under paragraph (1) or (2) is not a multiple of $50, such increase shall be rounded to the nearest multiple of $50.'. (f) MEDICAL SAVINGS ACCOUNTS MAY BE OFFERED UNDER CAFETERIA PLANS- Subsection (f) of section 125 of such Code is amended by striking `106(b),'. (g) EFFECTIVE DATE- The amendments made by this section shall apply to taxable years beginning after December 31, 2000.