HR 2990 RDS

106th CONGRESS

1st Session

H. R. 2990

IN THE SENATE OF THE UNITED STATES

October 14, 1999

Recieved


AN ACT

To amend the Internal Revenue Code of 1986 to allow individuals greater access to health insurance through a health care tax deduction, a long-term care deduction, and other health-related tax incentives, to amend the Employee Retirement Income Security Act of 1974 to provide access to and choice in health care through association health plans, to amend the Public Health Service

Act to create new pooling opportunities for small employers to obtain greater access to health coverage through HealthMarts; to amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to protect consumers in managed care plans and other health coverage; and for other purposes.

SECTION 1. ORGANIZATION OF ACT INTO DIVISIONS; TABLE OF CONTENTS.

DIVISION A--QUALITY CARE FOR THE UNINSURED ACT OF 1999

TITLE I--GENERAL PROVISIONS

TITLE II--TAX-RELATED HEALTH CARE PROVISIONS

TITLE III--GREATER ACCESS AND CHOICE THROUGH ASSOCIATION HEALTH PLANS

TITLE IV--GREATER ACCESS AND CHOICE THROUGH HEALTHMARTS

TITLE V--COMMUNITY HEALTH ORGANIZATIONS

DIVISION B--BIPARTISAN CONSENSUS MANAGED CARE IMPROVEMENT ACT OF 1999

TITLE XI--IMPROVING MANAGED CARE

Subtitle A--Grievances and Appeals

Subtitle B--Access to Care

Subtitle C--Access to Information

Subtitle D--Protecting the Doctor-Patient Relationship

Subtitle E--Definitions

TITLE XII--APPLICATION OF QUALITY CARE STANDARDS TO GROUP HEALTH PLANS AND HEALTH INSURANCE COVERAGE UNDER THE PUBLIC HEALTH SERVICE ACT

TITLE XIII--AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974

TITLE XIV--APPLICATION TO GROUP HEALTH PLANS UNDER THE INTERNAL REVENUE CODE OF 1986

TITLE XV--EFFECTIVE DATES; COORDINATION IN IMPLEMENTATION

TITLE XVI--HEALTH CARE PAPERWORK SIMPLIFICATION

DIVISION A--QUALITY CARE FOR THE UNINSURED ACT OF 1999

TITLE I--GENERAL PROVISIONS

SEC. 101. SHORT TITLE OF DIVISION; TABLE OF CONTENTS OF DIVISION.

TITLE I--GENERAL PROVISIONS

TITLE II--TAX-RELATED HEALTH CARE PROVISIONS

TITLE III--GREATER ACCESS AND CHOICE THROUGH ASSOCIATION HEALTH PLANS

`Part 8--Rules Governing Association Health Plans

`Sec. 801. Association health plans.

`Sec. 802. Certification of association health plans.

`Sec. 803. Requirements relating to sponsors and boards of trustees.

`Sec. 804. Participation and coverage requirements.

`Sec. 805. Other requirements relating to plan documents, contribution rates, and benefit options.

`Sec. 806. Maintenance of reserves and provisions for solvency for plans providing health benefits in addition to health insurance coverage.

`Sec. 807. Requirements for application and related requirements.

`Sec. 808. Notice requirements for voluntary termination.

`Sec. 809. Corrective actions and mandatory termination.

`Sec. 810. Trusteeship by the Secretary of insolvent association health plans providing health benefits in addition to health insurance coverage.

`Sec. 811. State assessment authority.

`Sec. 812. Special rules for church plans.

`Sec. 813. Definitions and rules of construction.

TITLE IV--GREATER ACCESS AND CHOICE THROUGH HEALTHMARTS

`TITLE XXVIII--HEALTHMARTS

`Sec. 2801. Definition of HealthMart.

`Sec. 2802. Application of certain laws and requirements.

`Sec. 2803. Administration.

`Sec. 2804. Definitions.

TITLE V--COMMUNITY HEALTH ORGANIZATIONS

SEC. 102. CONSTITUTIONAL AUTHORITY TO ENACT THIS DIVISION.

SEC. 103. PURPOSES OF DIVISION.

SEC. 104. FINDINGS RELATING TO HEALTH CARE CHOICE.

TITLE II--TAX-RELATED HEALTH CARE PROVISIONS

SEC. 201. DEDUCTION FOR HEALTH AND LONG-TERM CARE INSURANCE COSTS OF INDIVIDUALS NOT PARTICIPATING IN EMPLOYER-SUBSIDIZED HEALTH PLANS.

`SEC. 222. HEALTH AND LONG-TERM CARE INSURANCE COSTS.

`For taxable years beginning

--The applicable

in calendar year--

--percentage is--

--25

--35

--65

--100.

`Sec. 222. Health and long-term care insurance costs.

`Sec. 223. Cross reference.'.

SEC. 202. DEDUCTION FOR 100 PERCENT OF HEALTH INSURANCE COSTS OF SELF-EMPLOYED INDIVIDUALS.

SEC. 203. EXPANSION OF AVAILABILITY OF MEDICAL SAVINGS ACCOUNTS.

SEC. 204. LONG-TERM CARE INSURANCE PERMITTED TO BE OFFERED UNDER CAFETERIA PLANS AND FLEXIBLE SPENDING ARRANGEMENTS.

SEC. 205. ADDITIONAL PERSONAL EXEMPTION FOR TAXPAYER CARING FOR ELDERLY FAMILY MEMBER IN TAXPAYER'S HOME.

SEC. 206. EXPANDED HUMAN CLINICAL TRIALS QUALIFYING FOR ORPHAN DRUG CREDIT.

SEC. 207. INCLUSION OF CERTAIN VACCINES AGAINST STREPTOCOCCUS PNEUMONIAE TO LIST OF TAXABLE VACCINES; REDUCTION IN PER DOSE TAX RATE.

SEC. 208. CREDIT FOR CLINICAL TESTING RESEARCH EXPENSES ATTRIBUTABLE TO CERTAIN QUALIFIED ACADEMIC INSTITUTIONS INCLUDING TEACHING HOSPITALS.

`SEC. 41A. CREDIT FOR MEDICAL INNOVATION EXPENSES.

`Sec. 41A. Credit for medical innovation expenses.'.

TITLE III--GREATER ACCESS AND CHOICE THROUGH ASSOCIATION HEALTH PLANS

SEC. 301. RULES.

`Part 8--Rules Governing Association Health Plans

`SEC. 801. ASSOCIATION HEALTH PLANS.

`SEC. 802. CERTIFICATION OF ASSOCIATION HEALTH PLANS.

`SEC. 803. REQUIREMENTS RELATING TO SPONSORS AND BOARDS OF TRUSTEES.

`SEC. 804. PARTICIPATION AND COVERAGE REQUIREMENTS.

`SEC. 805. OTHER REQUIREMENTS RELATING TO PLAN DOCUMENTS, CONTRIBUTION RATES, AND BENEFIT OPTIONS.

`SEC. 806. MAINTENANCE OF RESERVES AND PROVISIONS FOR SOLVENCY FOR PLANS PROVIDING HEALTH BENEFITS IN ADDITION TO HEALTH INSURANCE COVERAGE.

`SEC. 807. REQUIREMENTS FOR APPLICATION AND RELATED REQUIREMENTS.

`SEC. 808. NOTICE REQUIREMENTS FOR VOLUNTARY TERMINATION.

`SEC. 809. CORRECTIVE ACTIONS AND MANDATORY TERMINATION.

`SEC. 810. TRUSTEESHIP BY THE SECRETARY OF INSOLVENT ASSOCIATION HEALTH PLANS PROVIDING HEALTH BENEFITS IN ADDITION TO HEALTH INSURANCE COVERAGE.

`SEC. 811. STATE ASSESSMENT AUTHORITY.

`SEC. 812. SPECIAL RULES FOR CHURCH PLANS.

`SEC. 813. DEFINITIONS AND RULES OF CONSTRUCTION.

`Part 8--Rules Governing Association Health Plans

SEC. 302. CLARIFICATION OF TREATMENT OF SINGLE EMPLOYER ARRANGEMENTS.

SEC. 303. CLARIFICATION OF TREATMENT OF CERTAIN COLLECTIVELY BARGAINED ARRANGEMENTS.

SEC. 304. ENFORCEMENT PROVISIONS.

SEC. 305. COOPERATION BETWEEN FEDERAL AND STATE AUTHORITIES.

SEC. 306. EFFECTIVE DATE AND TRANSITIONAL AND OTHER RULES.

TITLE IV--GREATER ACCESS AND CHOICE THROUGH HEALTHMARTS

SEC. 401. EXPANSION OF CONSUMER CHOICE THROUGH HEALTHMARTS.

`TITLE XXVIII--HEALTHMARTS

`SEC. 2801. DEFINITION OF HEALTHMART.

`SEC. 2802. APPLICATION OF CERTAIN LAWS AND REQUIREMENTS.

`SEC. 2803. ADMINISTRATION.

`SEC. 2804. DEFINITIONS.

TITLE V--COMMUNITY HEALTH ORGANIZATIONS

SEC. 501. PROMOTION OF PROVISION OF INSURANCE BY COMMUNITY HEALTH ORGANIZATIONS.

`WAIVER OF STATE LICENSURE REQUIREMENT FOR COMMUNITY HEALTH ORGANIZATIONS IN CERTAIN CASES

DIVISION B--BIPARTISAN CONSENSUS MANAGED CARE IMPROVEMENT ACT OF 1999

SEC. 1001. SHORT TITLE OF DIVISION; TABLE OF CONTENTS OF DIVISION.

TITLE XI--IMPROVING MANAGED CARE

Subtitle A--Grievances and Appeals

Subtitle B--Access to Care

Subtitle C--Access to Information

Subtitle D--Protecting the Doctor-Patient Relationship

Subtitle E--Definitions

TITLE XII--APPLICATION OF QUALITY CARE STANDARDS TO GROUP HEALTH PLANS AND HEALTH INSURANCE COVERAGE UNDER THE PUBLIC HEALTH SERVICE ACT

TITLE XIII--AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974

TITLE XIV--APPLICATION TO GROUP HEALTH PLANS UNDER THE INTERNAL REVENUE CODE OF 1986

TITLE XV--EFFECTIVE DATES; COORDINATION IN IMPLEMENTATION

TITLE XVI--HEALTH CARE PAPERWORK SIMPLIFICATION

TITLE XI--IMPROVING MANAGED CARE

Subtitle A--Grievance and Appeals

SEC. 1101. UTILIZATION REVIEW ACTIVITIES.

SEC. 1102. INTERNAL APPEALS PROCEDURES.

SEC. 1103. EXTERNAL APPEALS PROCEDURES.

SEC. 1104. ESTABLISHMENT OF A GRIEVANCE PROCESS.

Subtitle B--Access to Care

SEC. 1111. CONSUMER CHOICE OPTION.

SEC. 1112. CHOICE OF HEALTH CARE PROFESSIONAL.

SEC. 1113. ACCESS TO EMERGENCY CARE.

SEC. 1114. ACCESS TO SPECIALTY CARE.

SEC. 1115. ACCESS TO OBSTETRICAL AND GYNECOLOGICAL CARE.

SEC. 1116. ACCESS TO PEDIATRIC CARE.

SEC. 1117. CONTINUITY OF CARE.

SEC. 1118. ACCESS TO NEEDED PRESCRIPTION DRUGS.

SEC. 1119. COVERAGE FOR INDIVIDUALS PARTICIPATING IN APPROVED CLINICAL TRIALS.

Subtitle C--Access to Information

SEC. 1121. PATIENT ACCESS TO INFORMATION.

Subtitle D--Protecting the Doctor-Patient Relationship

SEC. 1131. PROHIBITION OF INTERFERENCE WITH CERTAIN MEDICAL COMMUNICATIONS.

SEC. 1132. PROHIBITION OF DISCRIMINATION AGAINST PROVIDERS BASED ON LICENSURE.

SEC. 1133. PROHIBITION AGAINST IMPROPER INCENTIVE ARRANGEMENTS.

SEC. 1134. PAYMENT OF CLAIMS.

SEC. 1135. PROTECTION FOR PATIENT ADVOCACY.

Subtitle E--Definitions

SEC. 1151. DEFINITIONS.

SEC. 1152. PREEMPTION; STATE FLEXIBILITY; CONSTRUCTION.

SEC. 1153. EXCLUSIONS.

SEC. 1154. COVERAGE OF LIMITED SCOPE PLANS.

SEC. 1155. REGULATIONS.

TITLE XII--APPLICATION OF QUALITY CARE STANDARDS TO GROUP HEALTH PLANS AND HEALTH INSURANCE COVERAGE UNDER THE PUBLIC HEALTH SERVICE ACT

SEC. 1201. APPLICATION TO GROUP HEALTH PLANS AND GROUP HEALTH INSURANCE COVERAGE.

`SEC. 2707. PATIENT PROTECTION STANDARDS.

SEC. 1202. APPLICATION TO INDIVIDUAL HEALTH INSURANCE COVERAGE.

`SEC. 2753. PATIENT PROTECTION STANDARDS.

TITLE XIII--AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974

SEC. 1301. APPLICATION OF PATIENT PROTECTION STANDARDS TO GROUP HEALTH PLANS AND GROUP HEALTH INSURANCE COVERAGE UNDER THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.

`SEC. 714. PATIENT PROTECTION STANDARDS.

SEC. 1302. ERISA PREEMPTION NOT TO APPLY TO CERTAIN ACTIONS INVOLVING HEALTH INSURANCE POLICYHOLDERS.

SEC. 1303. LIMITATIONS ON ACTIONS.

TITLE XIV--APPLICATION TO GROUP HEALTH PLANS UNDER THE INTERNAL REVENUE CODE OF 1986

SEC. 1401. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.

`Sec. 9813. Standard relating to patient freedom of choice.';

`SEC. 9813. STANDARD RELATING TO PATIENTS' BILL OF RIGHTS.

TITLE XV--EFFECTIVE DATES; COORDINATION IN IMPLEMENTATION

SEC. 1501. EFFECTIVE DATES.

SEC. 1502. COORDINATION IN IMPLEMENTATION.

TITLE XVI--HEALTH CARE PAPERWORK SIMPLIFICATION

SEC. 1601. HEALTH CARE PAPERWORK SIMPLIFICATION.

Passed the House of Representatives October 7, 1999.

Attest:

JEFF TRANDAHL,

Clerk.

END