[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1084 Introduced in House (IH)]







104th CONGRESS
  1st Session
                                H. R. 1084

  To amend title 5, United States Code, to make the Federal Employees 
Health Benefits Program available to the general public, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 28, 1995

Mrs. Schroeder introduced the following bill; which was referred to the 
 Committee on Government Reform and Oversight and, in addition, to the 
 Committee on Commerce, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend title 5, United States Code, to make the Federal Employees 
Health Benefits Program available to the general public, 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.

    This Act may be cited as the ``Federal Employees Health Benefits 
Access Act''.

SEC. 2. PROVISIONS TO MAKE FEHBP AVAILABLE TO THE GENERAL PUBLIC.

    (a) In General.--Chapter 89 of title 5, United States Code, is 
amended by adding at the end the following:
``Sec. 8915. Provisions to require that benefits be extended to the 
              general public
    ``(a) A contract may not be made or a plan approved unless the 
carrier agrees to offer to the general public, throughout each term for 
which the contract or approval remains effective, the same benefits 
(subject to the same maximums, limitations, exclusions, and other 
similar terms or conditions) as would be offered under such contract or 
plan to employees and annuitants and their family members.
    ``(b)(1) Premiums for coverage under this section shall be 
established in conformance with such requirements as the Office of 
Personnel Management shall by regulation prescribe, including 
provisions to ensure conformance with generally accepted standards and 
practices associated with community rating.
    ``(2) In no event shall the enactment of this section result in--
            ``(A) any increase in the level of individual or Government 
        contributions required under section 8906 or any other 
        provision of this chapter, including copayments or deductibles;
            ``(B) any decrease in the types of benefits offered under 
        this chapter; or
            ``(C) any other change that would adversely affect the 
        coverage afforded under this chapter to employees and 
        annuitants and their family members.
    ``(c) Benefits under this section shall, with respect to an 
individual who is entitled to benefits under part A of title XVIII of 
the Social Security Act, be offered (for use in coordination with those 
Social Security benefits) to the same extent and in the same manner as 
if coverage were under the preceding provisions of this chapter, rather 
than under this section.
    ``(d)(1) A carrier may file an application with the Office setting 
forth reasons why it, or a plan provided by such carrier, should be 
excluded from the requirements of this section.
    ``(2) In reviewing any such application, the Office may consider 
such factors as--
            ``(A) any bona fide enrollment restrictions which would 
        make the application of this section inappropriate, including 
        those common to plans which are limited to individuals having a 
        past or current employment relationship with a particular 
        agency or other authority of the Government;
            ``(B) whether compliance with this section would jeopardize 
        the financial solvency of the plan or carrier, or otherwise 
        compromise its ability to offer health benefits under the 
        preceding provisions of this chapter; and
            ``(C) the anticipated duration of the requested exclusion, 
        and what efforts the plan or carrier proposes to take in order 
        to be able to comply with this section.
    ``(e) Except as the Office may by regulation prescribe, any 
reference to this chapter (or any requirement of this chapter), made in 
any provision of law, shall not be considered to include this section 
(or any requirement of this section).''.
    (b) Conforming Amendment.--The table of sections for chapter 89 of 
title 5, United States Code, is amended by adding at the end the 
following:

``8915. Provisions to require that benefits be extended to the general 
                            public.''.

SEC. 3. STANDARDIZED CLAIMS PROCESSING.

    Section 8902 of title 5, United States Code, is amended by adding 
at the end the following:
    ``(o) A claim for payment or reimbursement under this chapter 
(whether electronic or otherwise) shall be submitted on such a standard 
form or in such a standard manner as may be required by the Office in 
relation to health benefit plans. Each contract under this chapter 
shall include appropriate provisions to carry out the preceding 
sentence.''.

SEC. 4. ADVANCE DIRECTIVES.

    Section 8907 of title 5, United States Code, is amended by adding 
at the end the following:
    ``(c) The Office shall--
            ``(1) prepare information relating to the use of advance 
        directives regarding the type or intensity of care which an 
        individual desires in the event that such individual becomes 
        unable to communicate by reason of incapacity due to illness or 
        injury; and
            ``(2) require, as a condition for approval of any contract 
        under section 8902, that appropriate provisions be included so 
        that such information may be made available to enrollees of the 
        plan involved.''.

SEC. 5. DEMONSTRATION PROJECT TO EXAMINE THE FEASIBILITY OF OFFERING 
              FEHBP ENROLLEES THE OPTION OF USING ARBITRATION INSTEAD 
              OF LITIGATION TO RESOLVE MEDICAL MALPRACTICE CLAIMS.

    (a) In General.--The Office of Personnel Management shall conduct a 
demonstration project to assess the feasibility and desirability of 
offering the use of arbitration, instead of litigation, to resolve 
medical malpractice claims arising out of covered health care services.
    (b) Definition.--For the purpose of this section, the term 
``covered health care services'' means any care, treatment, or other 
service for which the individual who receives such service has coverage 
under chapter 89 of title 5, United States Code.
    (c) Project Requirements.--
            (1) In general.--The demonstration project shall be 
        conducted as a demonstration project under section 4703 of 
        title 5, United States Code.
            (2) Plan design.--In developing a plan for such project 
        under section 4703 of title 5, United States Code, the Office 
        shall include (in addition to any information otherwise 
        required)--
                    (A) suggestions for incentives that may be offered 
                in order to obtain the voluntary participation of 
                enrollees, such as reductions in premiums, copayments, 
                or deductibles;
                    (B) the criteria for identifying the types of 
                health benefit plans which are appropriate for 
                inclusion, and the procedures and conditions in 
                accordance with which any such plan may participate;
                    (C) the general framework for arbitration, 
                including (to the extent the Office considers 
                appropriate) methods for the selection of arbitrators, 
                length of hearings, and limitations on damages; and
                    (D) the effect of an award resulting from the 
                arbitration process, and the extent to which review of 
                such an award may be obtained.
    (d) Evaluation.--The evaluation required under section 4703(h) of 
title 5, United States Code, with respect to the demonstration project 
shall include data and analysis relating to matters such as--
            (1) the number of claims brought for arbitration;
            (2) how those claims were disposed of (whether by 
        settlement, hearing, or otherwise), and the percentage of the 
        total number of claims represented by each;
            (3) the average dollar amount of those awards or 
        settlements;
            (4) the various costs involved in connection with those 
        claims; and
            (5) the advantages and disadvantages of arbitration, 
        relative to other methods of dispute resolution, and the extent 
        to which arbitration should continue to be used under chapter 
        89 of such title.

SEC. 6. APPLICABILITY.

    The amendments made by this Act shall apply with respect to 
contract terms beginning after the end of the 6-month period beginning 
on the date of the enactment of this Act.
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