[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1747 Received in Senate (RDS)]
1st Session
H. R. 1747
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 13, 1995
Received
_______________________________________________________________________
AN ACT
To amend the Public Health Service Act to permanently extend and
clarify malpractice coverage for health centers, 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; REFERENCES.
(a) Short Title.--This Act may be cited as the ``Federally
Supported Health Centers Assistance Act of 1995''.
(b) References.--Except as otherwise expressly provided, whenever
in this Act an amendment or repeal is expressed in terms of an
amendment to, or repeal of, a section or other provision, the reference
shall be considered to be made to a section or other provision of the
Public Health Service Act.
SEC. 2. PERMANENT EXTENSION OF PROGRAM.
(a) In General.--Section 224(g)(3) (42 U.S.C. 233(g)(3)) is amended
by striking the last sentence.
(b) Conforming Amendments.--Section 224(k) (42 U.S.C. 233(k)) is
amended--
(1) in paragraph (1)(A)--
(A) by striking ``For each of the fiscal years
1993, 1994, and 1995'' and inserting ``For each fiscal
year''; and
(B) by striking ``(except'' and all that follows
through ``thereafter)''; and
(2) in paragraph (2), by striking ``for each of the fiscal
years 1993, 1994, and 1995'' and inserting ``for each fiscal
year''.
SEC. 3. CLARIFICATION OF COVERAGE.
Section 224 (42 U.S.C. 233) is amended--
(1) in subsection (g)(1), by striking ``an entity described
in paragraph (4)'' in the first sentence and all that follows
through ``contractor'' in the second sentence and inserting the
following: ``an entity described in paragraph (4), and any
officer, governing board member, or employee of such an entity,
and any contractor of such an entity who is a physician or
other licensed or certified health care practitioner (subject
to paragraph (5)), shall be deemed to be an employee of the
Public Health Service for a calendar year that begins during a
fiscal year for which a transfer was made under subsection
(k)(3) (subject to paragraph (3)). The remedy against the
United States for an entity described in paragraph (4) and any
officer, governing board member, employee, or contractor''; and
(2) in subsection (k)(3), by inserting ``governing board
member,'' after ``officer,''.
SEC. 4. COVERAGE FOR SERVICES FURNISHED TO INDIVIDUALS OTHER THAN
CENTER PATIENTS.
Section 224(g)(1) (42 U.S.C. 233(g)) is amended--
(1) by redesignating paragraph (1) as paragraph (1)(A); and
(2) by adding at the end thereof the following:
``(B) The deeming of any entity or officer, governing board member,
employee, or contractor of the entity to be an employee of the Public
Health Service for purposes of this section shall apply with respect to
services provided--
``(i) to all patients of the entity, and
``(ii) subject to subparagraph (C), to individuals who are
not patients of the entity.
``(C) Subparagraph (B)(ii) applies to services provided to
individuals who are not patients of an entity if the Secretary
determines, after reviewing an application submitted under subparagraph
(D), that the provision of the services to such individuals--
``(i) benefits patients of the entity and general
populations that could be served by the entity through
community-wide intervention efforts within the communities
served by such entity;
``(ii) facilitates the provision of services to patients of
the entity; or
``(iii) are otherwise required under an employment contract
(or similar arrangement) between the entity and an officer,
governing board member, employee, or contractor of the
entity.''.
SEC. 5. APPLICATION PROCESS.
(a) Application Requirement.--Section 224(g)(1) (42 U.S.C.
233(g)(1)) (as amended by section 4) is further amended--
(1) in subparagraph (A), by inserting after ``For purposes
of this section'' the following: ``and subject to the approval
by the Secretary of an application under subparagraph (D)'';
and
(2) by adding at the end thereof the following:
``(D) The Secretary may not under subparagraph (A) deem an entity
or an officer, governing board member, employee, or contractor of the
entity to be an employee of the Public Health Service for purposes of
this section, and may not apply such deeming to services described in
subparagraph (B)(ii), unless the entity has submitted an application
for such deeming to the Secretary in such form and such manner as the
Secretary shall prescribe. The application shall contain detailed
information, along with supporting documentation, to verify that the
entity, and the officer, governing board member, employee, or
contractor of the entity, as the case may be, meets the requirements of
subparagraphs (B) and (C) of this paragraph and that the entity meets
the requirements of paragraphs (1) through (4) of subsection (h).
``(E) The Secretary shall make a determination of whether an entity
or an officer, governing board member, employee, or contractor of the
entity is deemed to be an employee of the Public Health Service for
purposes of this section within 30 days after the receipt of an
application under subparagraph (D). The determination of the Secretary
that an entity or an officer, governing board member, employee, or
contractor of the entity is deemed to be an employee of the Public
Health Service for purposes of this section shall apply for the period
specified by the Secretary under subparagraph (A).
``(F) Once the Secretary makes a determination that an entity or an
officer, governing board member, employee, or contractor of an entity
is deemed to be an employee of the Public Health Service for purposes
of this section, the determination shall be final and binding upon the
Secretary and the Attorney General and other parties to any civil
action or proceeding. Except as provided in subsection (i), the
Secretary and the Attorney General may not determine that the provision
of services which are the subject of such a determination are not
covered under this section.
``(G) In the case of an entity described in paragraph (4) that has
not submitted an application under subparagraph (D):
``(i) The Secretary may not consider the entity in making
estimates under subsection (k)(1).
``(ii) This section does not affect any authority of the
entity to purchase medical malpractice liability insurance
coverage with Federal funds provided to the entity under
section 329, 330, 340, or 340A.
``(H) In the case of an entity described in paragraph (4) for which
an application under subparagraph (D) is in effect, the entity may,
through notifying the Secretary in writing, elect to terminate the
applicability of this subsection to the entity. With respect to such
election by the entity:
``(i) The election is effective upon the expiration of the
30-day period beginning on the date on which the entity submits
such notification.
``(ii) Upon taking effect, the election terminates the
applicability of this subsection to the entity and each
officer, governing board member, employee, and contractor of
the entity.
``(iii) Upon the effective date for the election, clauses
(i) and (ii) of subparagraph (G) apply to the entity to the
same extent and in the same manner as such clauses apply to an
entity that has not submitted an application under subparagraph
(D).
``(iv) If after making the election the entity submits an
application under subparagraph (D), the election does not
preclude the Secretary from approving the application (and
thereby restoring the applicability of this subsection to the
entity and each officer, governing board member, employee, and
contractor of the entity, subject to the provisions of this
subsection and the subsequent provisions of this section.''.
(b) Approval Process.--Section 224(h) (42 U.S.C. 233(h)) is
amended--
(1) in the matter preceding paragraph (1), by striking
``Notwithstanding'' and all that follows through ``entity--''
and inserting the following: ``The Secretary may not approve an
application under subsection (g)(1)(D) unless the Secretary
determines that the entity--''; and
(2) by striking ``has fully cooperated'' in paragraph (4)
and inserting ``will fully cooperate''.
(c) Delayed Applicability for Current Participants.--If, on the day
before the date of the enactment of this Act, an entity was deemed to
be an employee of the Public Health Service for purposes of section
224(g) of the Public Health Service Act, the condition under paragraph
(1)(D) of such section (as added by subsection (a) of this section)
that an application be approved with respect to the entity does not
apply until the expiration of the 180-day period beginning on such
date.
SEC. 6. TIMELY RESPONSE TO FILING OF ACTION OR PROCEEDING.
Section 224 (42 U.S.C. 233) is amended by adding at the end thereof
the following subsection:
``(l)(1) If a civil action or proceeding is filed in a State court
against any entity described in subsection (g)(4) or any officer,
governing board member, employee, or any contractor of such an entity
for damages described in subsection (a), the Attorney General, within
15 days after being notified of such filing, shall make an appearance
in such court and advise such court as to whether the Secretary has
determined under subsections (g) and (h), that such entity, officer,
governing board member, employee, or contractor of the entity is deemed
to be an employee of the Public Health Service for purposes of this
section with respect to the actions or omissions that are the subject
of such civil action or proceeding. Such advice shall be deemed to
satisfy the provisions of subsection (c) that the Attorney General
certify that an entity, officer, governing board member, employee, or
contractor of the entity was acting within the scope of their
employment or responsibility.
``(2) If the Attorney General fails to appear in State court within
the time period prescribed under paragraph (1), upon petition of any
entity or officer, governing board member, employee, or contractor of
the entity named, the civil action or proceeding shall be removed to
the appropriate United States district court. The civil action or
proceeding shall be stayed in such court until such court conducts a
hearing, and makes a determination, as to the appropriate forum or
procedure for the assertion of the claim for damages described in
subsection (a) and issues an order consistent with such
determination.''.
SEC. 7. APPLICATION OF COVERAGE TO MANAGED CARE PLANS.
Section 224 (42 U.S.C. 223) (as amended by section 6) is amended by
adding at the end thereof the following subsection:
``(m)(1) An entity or officer, governing board member, employee, or
contractor of an entity described in subsection (g)(1) shall, for
purposes of this section, be deemed to be an employee of the Public
Health Service with respect to services provided to individuals who are
enrollees of a managed care plan if the entity contracts with such
managed care plan for the provision of services.
``(2) Each managed care plan which enters into a contract with an
entity described in subsection (g)(4) shall deem the entity and any
officer, governing board member, employee, or contractor of the entity
as meeting whatever malpractice coverage requirements such plan may
require of contracting providers for a calendar year if such entity or
officer, governing board member, employee, or contractor of the entity
has been deemed to be an employee of the Public Health Service for
purposes of this section for such calendar year. Any plan which is
found by the Secretary on the record, after notice and an opportunity
for a full and fair hearing, to have violated this subsection shall
upon such finding cease, for a period to be determined by the
Secretary, to receive and to be eligible to receive any Federal funds
under titles XVIII or XIX of the Social Security Act.
``(3) For purposes of this subsection, the term `managed care plan'
shall mean health maintenance organizations and similar entities that
contract at-risk with payors for the provision of health services or
plan enrollees and which contract with providers (such as entities
described in subsection (g)(4)) for the delivery of such services to
plan enrollees.''.
SEC. 8. COVERAGE FOR PART-TIME PROVIDERS UNDER CONTRACTS.
Section 224(g)(5)(B) (42 U.S.C. 223(g)(5)(B)) is amended to read as
follows:
``(B) in the case of an individual who normally performs an
average of less than 32\1/2\ hours of services per week for the
entity for the period of the contract, the individual is a
licensed or certified provider of services in the fields of
family practice, general internal medicine, general pediatrics,
or obstetrics and gynecology.''.
SEC. 9. DUE PROCESS FOR LOSS OF COVERAGE.
Section 224(i)(1) (42 U.S.C. 233(i)(1)) is amended by striking
``may determine, after notice and opportunity for a hearing'' and
inserting ``may on the record determine, after notice and opportunity
for a full and fair hearing''.
SEC. 10. AMOUNT OF RESERVE FUND.
Section 224(k)(2) (42 U.S.C. 223(k)(2)) is amended by striking
``$30,000,000'' and inserting ``$10,000,000''.
SEC. 11. REPORT ON RISK EXPOSURE OF COVERED ENTITIES.
Section 224 (as amended by section 7) is amended by adding at the
end thereof the following subsection:
``(n)(1) Not later than one year after the date of the enactment of
the Federally Supported Health Centers Assistance Act of 1995, the
Comptroller General of the United States shall submit to the Congress a
report on the following:
``(A) The medical malpractice liability claims experience
of entities that have been deemed to be employees for purposes
of this section.
``(B) The risk exposure of such entities.
``(C) The value of private sector risk-management services,
and the value of risk-management services and procedures
required as a condition of receiving a grant under section 329,
330, 340, or 340A.
``(D) A comparison of the costs and the benefits to
taxpayers of maintaining medical malpractice liability coverage
for such entities pursuant to this section, taking into
account--
``(i) a comparison of the costs of premiums paid by
such entities for private medical malpractice liability
insurance with the cost of coverage pursuant to this
section; and
``(ii) an analysis of whether the cost of premiums
for private medical malpractice liability insurance
coverage is consistent with the liability claims
experience of such entities.
``(2) The report under paragraph (1) shall include the following:
``(A) A comparison of--
``(i) an estimate of the aggregate amounts that
such entities (together with the officers, governing
board members, employees, and contractors of such
entities who have been deemed to be employees for
purposes of this section) would have directly or
indirectly paid in premiums to obtain medical
malpractice liability insurance coverage if this
section were not in effect; with
``(ii) the aggregate amounts by which the grants
received by such entities under this Act were reduced
pursuant to subsection (k)(2).
``(B) A comparison of--
``(i) an estimate of the amount of privately
offered such insurance that such entities (together
with the officers, governing board members, employees,
and contractors of such entities who have been deemed
to be employees for purposes of this section) purchased
during the three-year period beginning on January 1,
1993; with
``(ii) an estimate of the amount of such insurance
that such entities (together with the officers,
governing board members, employees, and contractors of
such entities who have been deemed to be employees for
purposes of this section) will purchase after the date
of the enactment of the Federally Supported Health
Centers Assistance Act of 1995.
``(C) An estimate of the medical malpractice liability loss
history of such entities for the 10-year period preceding
October 1, 1996, including but not limited to the following:
``(i) Claims that have been paid and that are
estimated to be paid, and legal expenses to handle such
claims that have been paid and that are estimated to be
paid, by the Federal Government pursuant to deeming
entities as employees for purposes of this section.
``(ii) Claims that have been paid and that are
estimated to be paid, and legal expenses to handle such
claims that have been paid and that are estimated to be
paid, by private medical malpractice liability
insurance.
``(D) An analysis of whether the cost of premiums for private
medical malpractice liability insurance coverage is consistent
with the liability claims experience of entities that have been
deemed as employees for purposes of this section.
``(3) In preparing the report under paragraph (1), the Comptroller
General of the United States shall consult with public and private
entities with expertise on the matters with which the report is
concerned.''.
Passed the House of Representatives December 12, 1995.
Attest:
ROBIN H. CARLE,
Clerk.