[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 1796 Introduced in Senate (IS)]

103d CONGRESS
  2d Session
                                S. 1796

 To ensure that health coverage is portable and renewable, to enhance 
  the ability of small businesses to purchase health care, to enhance 
 efficiency through paperwork reduction, to provide antitrust reforms, 
                        and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            January 25, 1994

  Mr. Gramm (for himself, Mr. McCain, Mr. Coats, Mr. Coverdell, Mrs. 
Hutchison, Mr. Helms, Mr. Lott, Mr. Faircloth, Mr. Wallop, Mr. Bennett, 
and Mr. Brown) introduced the following bill; which was read twice and 
         referred to the Committee on Labor and Human Resources

_______________________________________________________________________

                                 A BILL


 
 To ensure that health coverage is portable and renewable, to enhance 
  the ability of small businesses to purchase health care, to enhance 
 efficiency through paperwork reduction, to provide antitrust reforms, 
                        and for other purposes.

    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 ``Consensus Interim 
Health Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
        TITLE I--PORTABLE AND PERMANENT PRIVATE HEALTH INSURANCE

                        Subtitle A--Portability

Sec. 101. Amendments to COBRA
Sec. 102. Penalty-free withdrawals from qualified retirement plans for 
                            COBRA coverage.
                         Subtitle B--Permanence

Sec. 111. General renewability requirements.
Sec. 112. Individual health insurance plans.
Sec. 113. Group health plans.
Sec. 114. Definitions.
Sec. 115. Failure of health plans to meet portability and permanence 
                            requirements.
            TITLE II--SMALL BUSINESS HEALTH INSURANCE POOLS

Sec. 201. Prohibition of restrictions on groups purchasing health 
                            insurance.
Sec. 202. Prohibition of State benefit mandates for group health plans.
Sec. 203. Prohibition of restrictions on managed care.
Sec. 204. Definitions.
       TITLE III--ENHANCED EFFICIENCY THROUGH PAPERWORK REDUCTION

Sec. 301. Federal paperwork reduction and efficiency requirements.
Sec. 302. State paperwork reduction and efficiency requirements.
Sec. 303. Standardized Forms Commission.
                      TITLE IV--ANTITRUST REFORMS

Sec. 401. Establishment of limited exemption program for health care 
                            joint ventures.
Sec. 402. Issuance of health care certificates of public advantage.
Sec. 403. Interagency Advisory Committee on Competition, Antitrust 
                            Policy, and Health Care.
Sec. 404. Definitions.

        TITLE I--PORTABLE AND PERMANENT PRIVATE HEALTH INSURANCE

                        Subtitle A--Portability

SEC. 101. AMENDMENTS TO COBRA

    (a) Lower Cost Coverage Options.--Subparagraph (A) of section 
4980B(f)(2) of the Internal Revenue Code of 1986 (relating to 
continuation coverage requirements of group health plans) is amended to 
read as follows:
                    ``(A) Type of benefit coverage.--The coverage must 
                consist of coverage which, as of the time the coverage 
                is being provided--
                            ``(i) is identical to the coverage provided 
                        under the plan to similarly situated 
                        beneficiaries under the plan with respect to 
                        whom a qualifying event has not occurred,
                            ``(ii) is so identical, except such 
                        coverage is offered with an annual $1,000 
                        deductible, and
                            ``(iii) is so identical, except such 
                        coverage is offered with an annual $3,000 
                        deductible.
                If coverage under the plan is modified for any group of 
                similarly situated beneficiaries, the coverage shall 
                also be modified in the same manner for all individuals 
                who are qualified beneficiaries under the plan pursuant 
                to this subsection in connection with such group.''.
    (b) Termination of COBRA Coverage After Eligible for Employer-Based 
Coverage for 90 Days.--Clause (iv) of section 4980B(f)(2)(B) of the 
Internal Revenue Code of 1986 (relating to period of coverage) is 
amended--
            (1) by striking ``or'' at the end of subclause (I),
            (2) by redesignating subclause (II) as subclause (III), and
            (3) by inserting after subclause (I) the following new 
        subclause:
                                    ``(II) eligible for such employer-
                                based coverage for more than 90 days, 
                                or''.
    (c) Effective Date.--The amendments made by this section shall 
apply to qualifying events occurring after the date of the enactment of 
this Act.

SEC. 102. PENALTY-FREE WITHDRAWALS FROM QUALIFIED RETIREMENT PLANS FOR 
              COBRA COVERAGE.

    (a) In General.--Subparagraph (A) of section 72(t)(2) of the 
Internal Revenue Code of 1986 (relating to additional tax not to apply 
to certain distributions) is amended--
            (1) by striking ``or'' at the end of clauses (iv) and (v),
            (2) by striking the period at the end of clause (vi) and 
        inserting ``, or'', and
            (3) by adding at the end the following new clause:
                            ``(vii) made to an employee who is a 
                        qualified beneficiary during the period of 
                        continuation coverage under section 4980B(f).''
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to distributions made after the date of the enactment of this 
Act.

                         Subtitle B--Permanence

SEC. 111. GENERAL RENEWABILITY REQUIREMENTS.

    (a) Insurers.--
            (1) In general.--An insurer may not cancel an individual 
        health insurance plan or group health plan or deny renewal of 
        coverage under such a plan other than--
                    (A) for nonpayment of premiums,
                    (B) for fraud or other misrepresentation by the 
                insured,
                    (C) for noncompliance with plan provisions, or
                    (D) because the insurer is ceasing to provide any 
                health insurance plan in a State, or, in the case of a 
                health maintenance organization, in a geographic area.
            (2) Limitation on market reentry.--If an insurer terminates 
        the offering of health insurance plans or group health plans in 
        an area, the insurer may not offer such a plan in the area 
        until 5 years after the date of the termination.
    (b) Employers.--An employer may not cancel a self-insured group 
health plan or deny renewal of coverage under such a plan other than--
            (1) for nonpayment of premiums,
            (2) for fraud or other misrepresentation by the insured,
            (3) for noncompliance with plan provisions,
            (4) because the plan is ceasing to provide any coverage in 
        a geographic area.
    (c) Effective Date.--The provisions of this section shall apply to 
any plan on or after the date of the enactment of this Act.

SEC. 112. INDIVIDUAL HEALTH INSURANCE PLANS.

    (a) Existing Plans.--With respect to any individual health 
insurance plan in effect on the date of the enactment of this Act, the 
insurer shall offer the insured the option to purchase a new individual 
health insurance described in subsection (b).
    (b) New Plans.--With respect to any individual health insurance 
plan, the effective date of which with respect to the insured occurs 
after the date of the enactment of this Act, the insurer may not 
increase the premium for such a plan based on the health of the 
insured.

SEC. 113. GROUP HEALTH PLANS.

    (a) Existing Plans.--With respect to any group health plan (other 
than a self-insured group health plan) in effect on the date of the 
enactment of this Act, the insurer shall offer--
            (1) any insured of such plan the option to purchase upon 
        leaving the group a new individual health insurance, the 
        premium of which shall be rated based on actuarial data, may be 
        based on any preexisting condition of the insured, and may be 
        increased based on the health of such insured, and
            (2) the employer or group sponsor of such plan the option 
        to purchase a new group health plan described in subsection 
        (b).
    (b) New Plans.--With respect to any group health plan (other than a 
self-insured group health plan), the effective date of which with 
respect to the employer or group sponsor occurs after the date of the 
enactment of this Act, the insurer--
            (1) may not increase the premium for such a plan based on 
        the health of the group's insured, and
            (2) shall offer any insured of such plan the option to 
        purchase upon leaving the group a new individual health 
        insurance, the premium of which shall be rated based on 
        actuarial data, may not be based on any preexisting condition 
        of the insured, and may not be increased based on the health of 
        such insured.
    (c) Self-Insured Group Health Plans.--With respect to a self-
insured group health plan--
            (1) in effect on the date of the enactment of this Act--
                    (A) subsection (a)(1) shall apply through 1 or more 
                insurers contracted with by such plan, and
                    (B) subsection (a)(2) shall not apply, and
            (2) the effective date of which with respect to the 
        employer or group sponsor occurs after the date of the 
        enactment of this Act, subsection (b) shall apply through 1 or 
        more insurers contracted with by such plan.

SEC. 114. DEFINITIONS.

    For purposes of this subtitle:
            (1) Group health plan.--The term ``group health plan'' has 
        the meaning given such term by section 5000(b)(1) of the 
        Internal Revenue Code of 1986, but does not include any type of 
        coverage excluded from the definition of a health insurance 
        plan under paragraph (2).
            (2) Health insurance plan.--
                    (A) In general.--Except as provided in subparagraph 
                (B), the term ``health insurance plan'' means any 
                hospital or medical service policy or certificate, 
                hospital or medical service plan contract, or health 
                maintenance organization group contract offered by an 
                insurer.
                    (B) Exception.--Such term does not include any of 
                the following--
                            (i) coverage only for accident, dental, 
                        vision, disability income, or long-term care 
                        insurance, or any combination thereof,
                            (ii) medicare supplemental health 
                        insurance,
                            (iii) coverage issued as a supplement to 
                        liability insurance,
                            (iv) worker's compensation or similar 
                        insurance, or
                            (v) automobile medical-payment insurance,
                or any combination thereof.
            (3) Health maintenance organization.--The term ``health 
        maintenance organization'' includes a health insurance plan 
        that offers to provide health services on a prepaid, at-risk 
        basis primarily through a defined set of providers.
            (4) Insurer.--The term ``insurer'' means a licensed 
        insurance company, a prepaid hospital or medical service plan, 
        and a health maintenance organization offering such a plan to 
        an employer, and includes a similar organization regulated 
        under State law for solvency.

SEC. 115. FAILURE OF HEALTH PLANS TO MEET PORTABILITY AND PERMANENCE 
              REQUIREMENTS.

    (a) Deduction for Individual Health Insurance Plans.--Paragraph (1) 
of section 213(d) of the Internal Revenue Code of 1986 (defining 
medical care) is amended--
            (1) by striking ``or'' at the end of subparagraph (B), and
            (2) by striking subparagraph (C) and inserting the 
        following new subparagraphs:
                    ``(C) for insurance--
                            ``(i) meeting the requirements of section 
                        112 of the Consensus Interim Health Act, and
                            ``(ii) covering medical care referred to in 
                        subparagraphs (A) and (B), or
                    ``(D) as premiums under part B of title XVIII of 
                the Social Security Act, relating to supplementary 
                medical insurance for the aged.''.
    (b) Tax Exclusions for Employer-Provided Health Insurance.--Section 
106 of the Internal Revenue Code of 1986 (relating to contributions by 
employer to accident and health plans) is amended by striking ``an 
accident or health plan'' and inserting ``an accident or health plan 
meeting the requirements of section 113 of the Consensus Interim Health 
Act''.
    (c) Business Expense Deduction for Health Insurance.--Section 162 
of the Internal Revenue Code of 1986 (relating to trade or business 
expenses) is amended by redesignating subsection (o) as subsection (p) 
and by inserting after subsection (n) the following new subsection:
    ``(o) Group Health Plans.--The expenses paid or incurred by an 
employer for a group health plan shall not be allowed as a deduction 
under this section unless such plan meets the requirements of section 
113 of the Consensus Interim Health Act.''.
    (d) Payroll Tax Exclusion for Employer-Provided Health Insurance.--
Section 209(a)(2) of the Social Security Act (42 U.S.C. 409(a)(2)) is 
amended by inserting ``or group health insurance'' after ``group-term 
life insurance''.
    (e) Effective Date.--The amendments made by this section shall take 
effect on the date of the enactment of this Act.

            TITLE II--SMALL BUSINESS HEALTH INSURANCE POOLS

SEC. 201. PROHIBITION OF RESTRICTIONS ON GROUPS PURCHASING HEALTH 
              INSURANCE.

    No provision of State or local law shall apply that prohibits 2 or 
more employers or groups from obtaining coverage under a multiple 
employer health plan.

SEC. 202. PROHIBITION OF STATE BENEFIT MANDATES FOR GROUP HEALTH PLANS.

    In the case of a group health plan, no provision of State or local 
law shall apply that requires the coverage of one or more specific 
benefits, services, or categories of health care, or services of any 
class or type of provider of health care.

SEC. 203. PROHIBITION OF RESTRICTIONS ON MANAGED CARE.

    (a) Preemption of State Law Provisions.--Subject to subsection (c), 
the following provisions of State law are preempted and may not be 
enforced:
            (1) Restrictions on reimbursement rates or selective 
        contracting.--Any law that restricts the ability of a group 
        health plan to negotiate reimbursement rates with providers or 
        to contract selectively with one provider or a limited number 
        of providers.
            (2) Restrictions on differential financial incentives.--Any 
        law that limits the financial incentives that a group health 
        plan may require a beneficiary to pay when a non-plan provider 
        is used on a non-emergency basis.
            (3) Restrictions on utilization review methods.--Any law 
        that--
                    (A) prohibits utilization review of any or all 
                treatments and conditions,
                    (B) requires that such review be made (i) by a 
                resident of the State in which the treatment is to be 
                offered or by an individual licensed in such State, or 
                (ii) by a physician in any particular specialty or with 
                any board certified specialty of the same medical 
                specialty as the provider whose services are being 
                reviewed,
                    (C) requires the use of specified standards of 
                health care practice in such reviews or requires the 
                disclosure of the specific criteria used in such 
                reviews,
                    (D) requires payments to providers for the expenses 
                of responding to utilization review requests, or
                    (E) imposes liability for delays in performing such 
                review.
        Nothing in subparagraph (B) shall be construed as prohibiting a 
        State from (i) requiring a licensed physician or other health 
        care professional be available at some time in the review or 
        appeal process, or (ii) requiring that any decision in an 
        appeal from such a review be made by a licensed physician.
    (b) GAO Study.--
            (1) In general.--The Comptroller General of the United 
        States shall conduct a study of the regulatory and legal 
        impediments at the Federal, State, and local levels of 
        government that restrict the ability of small businesses and 
        other organizations to group together voluntarily to allow 
        their employees or members to pool their health insurance 
        purchases.
            (2) Report.--By not later than 2 years after the date of 
        the enactment of this Act, the Comptroller General shall submit 
        a report to Congress on the study conducted under paragraph (1) 
        and shall include in the report such recommendations (including 
        whether the provisions of subsection (a) should be extended) as 
        may be appropriate.
    (c) Sunset.--Unless otherwise provided, subsection (a) shall not 
apply 5 years after the date of the enactment of this Act.

SEC. 204. DEFINITIONS.

    For purposes of this title--
            (1) Employer.--The term ``employer'' shall have the meaning 
        applicable under section 3(5) of the Employee Retirement Income 
        Security Act of 1974.
            (2) Group health plan.--The term ``group health plan'' has 
        the meaning given such term in section 114(1).
            (3) Multiple employer health plan.--The term ``multiple 
        employer health plan'' means a multiple employer welfare 
        arrangement (as defined in section 3(40) of the Employee 
        Retirement Income Security Act of 1974.
            (4) State.--The term ``State'' means each of the several 
        States of the United States, the District of Columbia, the 
        Commonwealth of Puerto Rico, the United States Virgin Islands, 
        Guam, America Samoa, and the Commonwealth of the Northern 
        Mariana Islands.

       TITLE III--ENHANCED EFFICIENCY THROUGH PAPERWORK REDUCTION

SEC. 301. FEDERAL PAPERWORK REDUCTION AND EFFICIENCY REQUIREMENTS.

    (a) In General.--The Secretary of Health and Human Services 
(hereafter referred to in this title as the ``Secretary'') shall, in 
consultation with the Director of the Office of Management and Budget, 
the Secretary of Veterans Affairs, the Secretary of Defense, the 
Director of Personnel Management, and other appropriate Federal 
officials, adopt standards to reduce the administrative and paperwork 
burdens of all Federal health care programs by--
            (1) 50 percent within the 2-year period following the date 
        of the enactment of this Act, and
            (2) an additional 50 percent over a subsequent 3-year 
        period,
for a total reduction of 75 percent over the 5-year period following 
the date of the enactment of this Act.
    (b) Initial Reduction.--In order to achieve a paperwork reduction 
described in subsection (a)(1), the Secretary, shall adopt standards 
for Federal health care programs relating to each of the following:
            (1) Data elements for use in paper and electronic claims 
        processing under health insurance plans, as well as for use in 
        utilization review and management of care (including data 
        fields, formats, and medical nomenclature, and including plan 
        benefit and insurance information).
            (2) Uniform claims forms (including uniform procedure and 
        bill codes for use with such forms and including information on 
        other health insurance plans that may be liable for benefits).
            (3) Uniform electronic transmission of the data elements 
        (for purposes of billing and utilization review).
Standards under paragraph (3) relating to electronic transmission of 
data elements for claims for services shall supersede (to the extent 
specified in such standards) the standards adopted under paragraph (2) 
relating to the submission of paper claims for such services. Standards 
under paragraph (3) shall include protections to assure the 
confidentiality of patient-specific information and to protect against 
the unauthorized use and disclosure of information.
    (c) Subsequent Reduction.--In order to achieve a further paperwork 
reduction described in subsection (a)(2), the Secretary shall modify by 
regulation the standards adopted under subsection (b). The modification 
of the standards may include such recommendations as reported by the 
Standardized Form Commission in section 303, or any other provisions 
necessary to meet the goals for reduction in the paperwork burden of 
Federal health care programs.
    (d) Definition.--For purposes of this section, the term ``Federal 
health care program'' means all Federal programs related to health 
care, including programs described in--
            (1) title XVIII or XIX of the Social Security Act,
            (2) the Public Health Service Act,
            (3) chapter 55 of title 10, United States Code,
            (4) chapter 17 of title 38, United States Code,
            (5) chapter 89 of title 5, United States Code, or
            (6) the Indian Health Care Improvement Act.

SEC. 302. STATE PAPERWORK REDUCTION AND EFFICIENCY REQUIREMENTS.

    (a) In General.--In order to be eligible for Federal funds in 
connection with any State-administered health care program, each State 
shall standardize the processing of paper and electronic claims to 
reduce the administrative and paperwork burdens on such programs by 75 
percent during the 5-year period following the date of the enactment of 
this Act.
    (b) Enforcement.--
            (1) Interim evaluation.--If at the end of the 4-year period 
        following the date of the enactment of this Act the Secretary 
        determines that a State has not achieved substantial progress 
        toward the reductions required under subsection (a), the 
        Secretary shall notify such State regarding the proportion of 
        required reductions achieved and the further reduction 
        necessary to achieve compliance with subsection (a).
            (2) Final compliance.--If at the end of the 5-year period 
        following the date of the enactment of this Act the Secretary 
        determines that a State has not achieved the reductions 
        required under subsection (a), the Secretary shall reduce 
        Federal payments for health care programs administered by such 
        State by 10 percent. For each year that such State fails to 
        comply with the requirements of subsection (a), Federal 
        payments for health care programs administered by the State 
        shall be reduced by an additional 10 percent.
            (3) Waivers of payment reductions.--Any State subject to a 
        reduction in Federal payments under paragraph (2) may appeal to 
        the Secretary for a 1-year waiver of such reduction. In 
        granting such a waiver, the Secretary shall make a 
        determination of the good faith effort of such State to comply 
        with the requirements of subsection (a), taking into account 
        the technical, practical, and financial capabilities of the 
        State in meeting such requirements.
    (c) Definition.--For purposes of this section, the term ``State'' 
means any of the States, territories, districts, or possessions of the 
United States.

SEC. 303. STANDARDIZED FORMS COMMISSION.

    (a) In General.--
            (1) Establishment.--Not later than 12 months after the date 
        of the enactment of this Act, the Secretary shall establish a 
        Standardized Forms Commission (hereafter referred to in this 
        section as the ``Commission'') which shall make recommendations 
        on the standardization of paper and electronic claims 
        processing so as to reduce the paperwork burden associated 
        with, and enhance the efficiency and productivity of, such 
        claims processing.
            (2) Membership.--
                    (A) In General.--The Commission shall be composed 
                of at least 12 but not more than 20 representatives of 
                private health care providers and private insurers.
                    (B) Chair.--The Secretary shall appoint a Chair of 
                the Commission.
            (3) Report on findings and recommendations.--Not later than 
        24 months after the date of the enactment of this Act, the 
        Chair of the Commission shall report to the Secretary on the 
        findings and recommendations of the Commission.
            (4) Prohibition of compensation.--Members of the Commission 
        shall serve without pay except for reimbursement for travel 
        expenses, including per diem in lieu of subsistence, in 
        accordance with sections 5702 and 5703 of title 5, United 
        States Code.
            (5) Staff of federal agencies.--Upon request of the Chair, 
        the head of any Federal department or agency shall detail any 
        of the personnel of that department or agency to the Commission 
        to assist it in carrying out its duties under this section.
            (6) Obtaining official data.--The Commission may secure 
        directly from any department or agency of the United States 
        information necessary to enable it to carry out this section.
            (7) Administrative support services.--Upon request of the 
        Chair, the Administrator of General Services shall provide to 
        the Commission the administrative support services necessary 
        for the Commission to carry out its responsibilities under this 
        section.
    (b) Legislative Proposal.--
            (1) In general.--
                    (A) Development of implementing bill.--Not later 
                than 3 months after the Commission has submitted its 
                findings and recommendations to the Secretary, the 
                Secretary shall take such recommendations and submit 
                them to Congress in the form of an implementing bill 
                which contains the provisions necessary or appropriate 
                to implement the recommendations by either repealing or 
                amending existing laws or providing new statutory 
                authority.
                    (B) Consideration of implementing bill.--The 
                implementing bill described in subparagraph (A) shall 
                be considered by Congress under the procedures for 
                consideration described in paragraph (2).
            (2) Congressional consideration.--
                    (A) Rules of house of representatives and senate.--
                This paragraph is enacted by Congress--
                            (i) as an exercise of the rulemaking power 
                        of the House of Representatives and the Senate, 
                        respectively, and as such is deemed a part of 
                        the rules of each House, respectively, but 
                        applicable only with respect to the procedure 
                        to be followed in that House in the case of an 
                        implementing bill described in paragraph 
                        (1)(A), and supersedes other rules only to the 
                        extent that such rules are inconsistent 
                        therewith; and
                            (ii) with full recognition of the 
                        constitutional right of either House to change 
                        the rules (so far as relating to the procedure 
                        of that House) at any time, in the same manner 
                        and to the same extent as in the case of any 
                        other rule of that House.
                    (B) Introduction and referral.--On the day on which 
                the implementing bill described in paragraph (1)(A) is 
                transmitted to the House of Representatives and the 
                Senate, such bill shall be introduced (by request) in 
                the House of Representatives by the Majority Leader of 
                the House, for himself and the Minority Leader of the 
                House, or by Members of the House designated by the 
                Majority Leader and Minority Leader of the House and 
                shall be introduced (by request) in the Senate by the 
                Majority Leader of the Senate, for himself and the 
                Minority Leader of the Senate, or by Members of the 
                Senate designated by the Majority Leader and Minority 
                Leader of the Senate. If either House is not in session 
                on the day on which the implementing bill is 
                transmitted, the bill shall be introduced in the House, 
                as provided in the preceding sentence, on the first day 
                thereafter on which the House is in session. The 
                implementing bill introduced in the House of 
                Representatives and the Senate shall be referred to the 
                appropriate committees of each House.
                    (C) Amendments prohibited.--No amendment to an 
                implementing bill shall be in order in either the House 
                of Representatives or the Senate and no motion to 
                suspend the application of this paragraph shall be in 
                order in either House, nor shall it be in order in 
                either House for the Presiding Officer to entertain a 
                request to suspend the application of this paragraph by 
                unanimous consent.
                    (D) Period for committee and floor consideration.--
                            (i) In general.--Except as provided in 
                        clause (ii), if the committee or committees of 
                        either House to which an implementing bill has 
                        been referred have not reported it at the close 
                        of the 45th day after its introduction, such 
                        committee or committees shall be automatically 
                        discharged from further consideration of the 
                        implementing bill and it shall be placed on the 
                        appropriate calendar. A vote on final passage 
                        of the implementing bill shall be taken in each 
                        House on or before the close of the 45th day 
                        after the implementing bill is reported by the 
                        committees or committee of that House to which 
                        it was referred, or after such committee or 
                        committees have been discharged from further 
                        consideration of the implementing bill. If 
                        prior to the passage by 1 House of an 
                        implementing bill of that House, that House 
                        receives the same implementing bill from the 
                        other House then--
                                    (I) the procedure in that House 
                                shall be the same as if no implementing 
                                bill had been received from the other 
                                House; but
                                    (II) the vote on final passage 
                                shall be on the implementing bill of 
                                the other House.
                            (ii) Computation of days.--For purposes of 
                        clause (i), in computing a number of days in 
                        either House, there shall be excluded--
                                    (I) the days on which either House 
                                is not in session because of an 
                                adjournment of more than 3 days to a 
                                day certain, or an adjournment of the 
                                Congress sine die, and
                                    (II) any Saturday and Sunday not 
                                excluded under subclause (I) when 
                                either House is not in session.
                    (E) Floor consideration in the house of 
                representatives.--
                            (i) Motion to proceed.--A motion in the 
                        House of Representatives to proceed to the 
                        consideration of an implementing bill shall be 
                        highly privileged and not debatable. An 
                        amendment to the motion shall not be in order, 
                        nor shall it be in order to move to reconsider 
                        the vote by which the motion is agreed to or 
                        disagreed to.
                            (ii) Debate.--Debate in the House of 
                        Representatives on an implementing bill shall 
                        be limited to not more than 20 hours, which 
                        shall be divided equally between those favoring 
                        and those opposing the bill. A motion further 
                        to limit debate shall not be debatable. It 
                        shall not be in order to move to recommit an 
                        implementing bill or to move to reconsider the 
                        vote by which an implementing bill is agreed to 
                        or disagreed to.
                            (iii) Motion to postpone.--Motions to 
                        postpone, made in the House of Representatives 
                        with respect to the consideration of an 
                        implementing bill, and motions to proceed to 
                        the consideration of other business, shall be 
                        decided without debate.
                            (iv) Appeals.--All appeals from the 
                        decisions of the Chair relating to the 
                        application of the Rules of the House of 
                        Representatives to the procedure relating to an 
                        implementing bill shall be decided without 
                        debate.
                            (v) General rules apply.--Except to the 
                        extent specifically provided in the preceding 
                        provisions of this subparagraph, consideration 
                        of an implementing bill shall be governed by 
                        the Rules of the House of Representatives 
                        applicable to other bills and resolutions in 
                        similar circumstances.
                    (F) Floor consideration in the senate.--
                          (i) Motion to proceed.--A motion in the 
                        Senate to proceed to the consideration of an 
                        implementing bill shall be privileged and not 
                        debatable. An amendment to the motion shall not 
                        be in order, nor shall it be in order to move 
                        to reconsider the vote by which the motion is 
                        agreed to or disagreed to.
                            (ii) General debate.--Debate in the Senate 
                        on an implementing bill, and all debatable 
                        motions and appeals in connection therewith, 
                        shall be limited to not more than 20 hours. The 
                        time shall be equally divided between, and 
                        controlled by, the Majority Leader and the 
                        Minority Leader or their designees.
                            (iii) Debate of motions and appeals.--
                        Debate in the Senate on any debatable motion or 
                        appeal in connection with an implementing bill 
                        shall be limited to not more than 1 hour, to be 
                        equally divided between, and controlled by, the 
                        mover and the manager of the implementing bill, 
                        except that in the event the manager of the 
                        implementing bill is in favor of any such 
                        motion or appeal, the time in opposition 
                        thereto, shall be controlled by the Minority 
                        Leader or his designee. Such leaders, or either 
                        of them, may, from time under their control on 
                        the passage of an implementing bill, allot 
                        additional time to any Senator during the 
                        consideration of any debatable motion or 
                        appeal.
                            (iv) Other motions.--A motion in the Senate 
                        to further limit debate is not debatable. A 
                        motion to recommit an implementing bill is not 
                        in order.
    (c) Failure to Comply with Recommendations Enacted.--A health care 
provider or health care insurer that fails to comply with any 
recommendations of the Commission that are enacted in accordance with 
subsection (b) and that are applicable to such provider or insurer 
shall be ineligible for payments of claims submitted under any 
provision of the Social Security Act or the Public Health Service Act.

                      TITLE IV--ANTITRUST REFORMS

SEC. 401. ESTABLISHMENT OF LIMITED EXEMPTION PROGRAM FOR HEALTH CARE 
              JOINT VENTURES.

    (a) Establishment.--
            (1) In general.--Not later than 6 months after the date of 
        the enactment of this Act, the Attorney General, after 
        consultation with the Secretary of Health and Human Services 
        and the Interagency Advisory Committee on Competition, 
        Antitrust Policy, and Health Care, shall promulgate specific 
        guidelines under which a health care joint venture may submit 
        an application requesting that the Attorney General provide the 
        entities participating in the joint venture with an exemption 
        under which (notwithstanding any other provision of law)--
                    (A) monetary recovery on a claim under the 
                antitrust laws shall be limited to actual damages if 
                the claim results from conduct within the scope of the 
                joint venture that occurs while the exemption is in 
                effect; and
                    (B) the conduct of the entity in making or 
                performing a contract to carry out the joint venture 
                shall not be deemed illegal per se under the antitrust 
                laws but shall be judged on the basis of its 
                reasonableness, taking into account all relevant 
                factors affecting competition, including (but not 
                limited to) effects on competition in properly defined, 
                relevant research, development, product, process, and 
                service markets (taking into consideration worldwide 
                capacity to the extent that it may be appropriate in 
                the circumstances).
            (2) Deadline for response.--The Attorney General, after 
        consultation with the Secretary and the Advisory Committee, 
        shall approve or disapprove the application of a health care 
        joint venture for an exemption under this subsection not later 
        than 30 days after the Attorney General receives the joint 
        venture's application.
            (3) Providing reasons for disapproval.--If the Attorney 
        General disapproves the application of a health care joint 
        venture for an exemption under this subsection, the Attorney 
        General shall provide the joint venture with a statement 
        explaining the reasons for the Attorney General's disapproval.
    (b) Requirements for Approval.--For purposes of subsection (a), the 
Attorney General shall approve the application of a health care joint 
venture for an exemption under subsection (a) if an entity 
participating in the joint venture submits to the Attorney General an 
application not later than 30 days after the entity has entered into a 
written agreement to participate in the joint venture (or not later 
than 30 days after the date of the enactment of this Act in the case of 
a joint venture in effect as of such date) that contains the following 
information and assurances:
            (1) The identities of the parties to the joint venture.
            (2) The nature, objectives, and planned activities of the 
        joint venture.
            (3) Assurances that the entities participating in the joint 
        venture shall notify the Attorney General of any changes in the 
        information described in paragraphs (1) and (2) during the 
        period for which the exemption is in effect.
    (c) Revocation of Exemption.--
            (1) In general.--The Attorney General, after consultation 
        with the Secretary, may revoke an exemption provided to a 
        health care joint venture under this section if, at any time 
        during which the exemption is in effect, the Attorney General 
        finds that the joint venture no longer meets the applicable 
        requirements for approval under subsection (b), except that the 
        Attorney General may not revoke such an exemption if the 
        failure of the health care joint venture to meet such 
        requirements is merely technical in nature.
            (2) Timing.--The revocation of an exemption under paragraph 
        (1) shall apply only to conduct of the health care joint 
        venture occurring after the exemption is no longer in effect.
    (d) Withdrawal of Application.--Any party that submits an 
application under this section may withdraw such application at any 
time before the Attorney General's response to the application.
    (e) Requirements Relating to Notice and Publication of Exemptions 
and Related Information.--
            (1) Publication of approved applications for exemptions in 
        federal register.--
                    (A) In general.--With respect to each exemption for 
                a health care joint venture provided under subsection 
                (a), the Attorney General (acting jointly with the 
                Secretary) shall--
                            (i) prepare a notice with respect to the 
                        joint venture that identifies the parties to 
                        the venture and that describes the planned 
                        activities of the venture;
                            (ii) submit the notice to the entities 
                        participating in the joint venture; and
                            (iii) after submitting the notice to such 
                        entities (but not later than 30 days after 
                        approving the application for the exemption for 
                        the joint venture), publish the notice in the 
                        Federal Register.
                    (B) Effect of publication.--An exemption provided 
                by the Attorney General under subsection (a) shall take 
                effect as of the date of the publication in the Federal 
                Register of the notice with respect to the exemption 
                pursuant to subparagraph (A).
            (2) Waiver of disclosure requirements for information 
        relating to applications for exemptions.--
                    (A) In general.--All information and documentary 
                material submitted as part of an application of a 
                health care joint venture for an exemption under 
                subsection (a), together with any other information 
                obtained by the Attorney General, the Secretary, or the 
                Advisory Committee in the course of any investigation, 
                administrative proceeding, or case with respect to a 
                potential violation of the antitrust laws by the joint 
                venture with respect to which the exemption applies, 
                shall be exempt from disclosure under section 552 of 
                title 5, United States Code, and shall not be made 
                publicly available by any agency of the United States 
                to which such section applies, except as relevant to a 
                law enforcement investigation or in a judicial or 
                administrative proceeding in which such information and 
                material is subject to any protective order.
                    (B) Exception for information included in federal 
                register notice.--Subparagraph (A) shall not apply with 
                respect to information contained in a notice published 
                in the Federal Register pursuant to paragraph (1).
            (3) Use of information to support or answer claims under 
        antitrust laws.--
                    (A) In general.--Except as provided in subparagraph 
                (B), the fact of disclosure of conduct under an 
                application for an exemption under subsection (a) and 
                the fact of publication of a notice in the Federal 
                Register under paragraph (1) shall be admissible into 
                evidence in any judicial or administrative proceeding 
                for the sole purpose of establishing that a person is 
                entitled to the protections provided by an exemption 
                granted under subsection (a).
                    (B) Effect of rejected application.--If the 
                Attorney General denies, in whole or in part, an 
                application for an exemption under subsection (a), or 
                revokes an exemption under such section, neither the 
                negative determination nor the statement of reasons 
                therefor shall be admissible into evidence in any 
                administrative or judicial proceeding for the purpose 
                of supporting or answering any claim under the 
                antitrust laws.

SEC. 402. ISSUANCE OF HEALTH CARE CERTIFICATES OF PUBLIC ADVANTAGE.

    (a) Issuance and Effect of Certificate.--The Attorney General, 
after consultation with the Secretary and the Advisory Committee, shall 
issue in accordance with this section a certificate of public advantage 
to each eligible health care joint venture that complies with the 
requirements in effect under this section on or after the expiration of 
the 1-year period that begins on the date of the enactment of this Act 
(without regard to whether or not the Attorney General has promulgated 
regulations to carry out this section by such date). Such venture, and 
the parties to such venture, shall not be liable under any of the 
antitrust laws for conduct described in such certificate and engaged in 
by such venture if such conduct occurs while such certificate is in 
effect.
    (b) Requirements Applicable to Issuance of Certificates.--
            (1) Standards to be met.--The Attorney General shall issue 
        a certificate to an eligible health care joint venture if the 
        Attorney General finds that--
                    (A) the benefits that are likely to result from 
                carrying out the venture outweigh the reduction in 
                competition (if any) that is likely to result from the 
                venture, and
                    (B) such reduction in competition is reasonably 
                necessary to obtain such benefits.
            (2) Factors to be considered.--
                    (A) Weighing of benefits against reduction in 
                competition.--For purposes of making the finding 
                described in paragraph (1)(A), the Attorney General 
                shall consider whether the venture is likely--
                            (i) to maintain or to increase the quality 
                        of health care,
                            (ii) to increase access to health care,
                            (iii) to achieve cost efficiencies that 
                        will be passed on to health care consumers, 
                        such as economies of scale, reduced transaction 
                        costs, and reduced administrative costs,
                            (iv) to preserve the operation of health 
                        care facilities located in underserved 
                        geographical areas,
                            (v) to improve utilization of health care 
                        resources, and
                            (vi) to reduce inefficient health care 
                        resource duplication.
                    (B) Necessity of reduction in competition.--For 
                purposes of making the finding described in paragraph 
                (1)(B), the Attorney General shall consider--
                            (i) the ability of the providers of health 
                        care services that are (or likely to be) 
                        affected by the health care joint venture and 
                        the entities responsible for making payments to 
                        such providers to negotiate societally optimal 
                        payment and service arrangements,
                            (ii) the effects of the health care joint 
                        venture on premiums and other charges imposed 
                        by the entities described in clause (i), and
                            (iii) the availability of equally 
                        efficient, less restrictive alternatives to 
                        achieve the benefits that are intended to be 
                        achieved by carrying out the venture.
    (c) Establishment of Criteria and Procedures.--Subject to 
subsections (d) and (e), not later than 1 year after the date of the 
enactment of this Act, the Attorney General and the Secretary shall 
establish jointly by rule the criteria and procedures applicable to the 
issuance of certificates under subsection (a). The rules shall specify 
the form and content of the application to be submitted to the Attorney 
General to request a certificate, the information required to be 
submitted in support of such application, the procedures applicable to 
denying and to revoking a certificate, and the procedures applicable to 
the administrative appeal (if such appeal is authorized by rule) of the 
denial and the revocation of a certificate. Such information may 
include the terms of the health care joint venture (in the case of a 
venture in existence as of the time of the application) and 
implementation plan for the joint venture.
    (d) Eligible Health Care Joint Venture.--To be an eligible health 
care joint venture for purposes of this section, a health care joint 
venture shall submit to the Attorney General an application that 
complies with the rules in effect under subsection (c) and that 
includes--
            (1) an agreement by the parties to the venture that the 
        venture will not foreclose competition by entering into 
        contracts that prevent health care providers from providing 
        health care in competition with the venture,
            (2) an agreement that the venture will submit to the 
        Attorney General annually a report that describes the 
        operations of the venture and information regarding the impact 
        of the venture on health care and on competition in health 
        care, and
            (3) an agreement that the parties to the venture will 
        notify the Attorney General and the Secretary of the 
        termination of the venture not later than 30 days after such 
        termination occurs.
    (e) Review of Applications for Certificates.--Not later than 30 
days after an eligible health care joint venture submits to the 
Attorney General an application that complies with the rules in effect 
under subsection (c) and with subsection (d), the Attorney General 
shall issue or deny the issuance of such certificate. If, before the 
expiration of such 30-day period, the Attorney General fails to issue 
or deny the issuance of such certificate, the Attorney General shall be 
deemed to have issued such certificate.
    (f) Revocation of Certificate.--Whenever the Attorney General finds 
that a health care joint venture with respect to which a certificate is 
in effect does not meet the standards specified in subsection (b), the 
Attorney General shall revoke such certificate.
    (g) Written Reasons; Judicial Review.--
            (1) Denial and revocation of certificates.--If the Attorney 
        General denies an application for a certificate or revokes a 
        certificate, the Attorney General shall include in the notice 
        of denial or revocation a statement of the reasons relied upon 
        for the denial or revocation of such certificate.
            (2) Judicial review.--
                    (A) After administrative proceeding.--(i) If the 
                Attorney General denies an application submitted or 
                revokes a certificate issued under this section after 
                an opportunity for hearing on the record, then any 
                party to the health care joint venture involved may 
                commence a civil action, not later than 60 days after 
                receiving notice of the denial or revocation, in an 
                appropriate district court of the United States for 
                review of the record of such denial or revocation.
                    (ii) As part of the Attorney General's answer, the 
                Attorney General shall file in such court a certified 
                copy of the record on which such denial or revocation 
                is based. The findings of fact of the Attorney General 
                may be set aside only if found to be unsupported by 
                substantial evidence in such record taken as a whole.
                    (B) Denial or revocation without administrative 
                proceeding.--If the Attorney General denies an 
                application submitted or revokes a certificate issued 
                under this section without an opportunity for hearing 
                on the record, then any party to the health care joint 
                venture involved may commence a civil action, not later 
                than 60 days after receiving notice of the denial or 
                revocation, in an appropriate district court of the 
                United States for de novo review of such denial or 
                revocation.
    (h) Exemption.--A person shall not be liable under any of the 
antitrust laws for conduct necessary--
            (1) to prepare, agree to prepare, or attempt to agree to 
        prepare an application to request a certificate under this 
        section, or
            (2) to attempt to enter into any health care joint venture 
        with respect to which such a certificate is in effect.

SEC. 403. INTERAGENCY ADVISORY COMMITTEE ON COMPETITION, ANTITRUST 
              POLICY, AND HEALTH CARE.

    (a) Establishment.--There is hereby established the Interagency 
Advisory Committee on Competition, Antitrust Policy, and Health Care. 
The Advisory Committee shall be composed of--
            (1) the Secretary of Health and Human Services (or the 
        designee of the Secretary);
            (2) the Attorney General (or the designee of the Attorney 
        General);
            (3) the Director of the Office of Management and Budget (or 
        the designee of the Director); and
            (4) a representative of the Federal Trade Commission.
    (b) Duties.--The duties of the Advisory Committee are--
            (1) to discuss and evaluate competition and antitrust 
        policy, and their implications with respect to the performance 
        of health care markets;
            (2) to analyze the effectiveness of health care joint 
        ventures receiving exemptions under the program established 
        under section 401(a) or certificates under section 402 in 
        reducing the costs of and expanding access to the health care 
        services that are the subject of such ventures; and
            (3) to make such recommendations to Congress not later than 
        2 years after the date of the enactment of this Act (and at 
        such subsequent periods as the Advisory Committee considers 
        appropriate) regarding modifications to the program established 
        under section 401(a) or to section 402 as the Advisory 
        Committee considers appropriate, including modifications 
        relating to the costs to health care providers of obtaining an 
        exemption for a joint venture under such program.

SEC. 404. DEFINITIONS.

    For purposes of this title:
            (1) The term ``Advisory Committee'' means the Interagency 
        Advisory Committee on Competition, Antitrust Policy, and Health 
        Care established under section 403.
            (2) The term ``antitrust laws''--
                    (A) has the meaning given it in subsection (a) of 
                the first section of the Clayton Act (15 U.S.C. 12(a)), 
                except that such term includes section 5 of the Federal 
                Trade Commission Act (15 U.S.C. 45) to the extent such 
                section applies to unfair methods of competition; and
                    (B) includes any State law similar to the laws 
                referred to in subparagraph (A).
            (3) The term ``certificate'' means a certificate of public 
        advantage authorized to be issued under section 402(a).
            (4) The term ``health care joint venture'' means an 
        agreement (whether existing or proposed) between 2 or more 
        providers of health care services that is entered into solely 
        for the purpose of sharing in the provision of health care 
        services and that involves substantial integration or financial 
        risk-sharing between the parties, but does not include the 
        exchanging of information, the entering into of any agreement, 
        or the engagement in any other conduct that is not reasonably 
        required to carry out such agreement.
            (5) The term ``health care services'' includes services 
        related to the delivery or administration of health care 
        services.
            (6) The term ``liable'' means liable for any civil or 
        criminal violation of the antitrust laws.
            (7) The term ``provider of health care services'' means any 
        individual or entity that is engaged in the delivery of health 
        care services in a State and that is required by State law or 
        regulation to be licensed or certified by the State to engage 
        in the delivery of such services in the State.
            (8) The term ``Secretary'' means the Secretary of Health 
        and Human Services.

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