[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1747 Reported in House (RH)]





                                                 Union Calendar No. 204

104th CONGRESS

  1st Session

                               H. R. 1747

                          [Report No. 104-398]

_______________________________________________________________________

                                 A BILL

   To amend the Public Health Service Act to permanently extend and 
    clarify malpractice coverage for health centers, and for other 
                               purposes.

_______________________________________________________________________

                           December 12, 1995

Reported with amendments, committed to the Committee of the Whole House 
          on the State of the Union, and ordered to be printed
                                                 Union Calendar No. 204
104th CONGRESS
  1st Session
                                H. R. 1747

                          [Report No. 104-398]

   To amend the Public Health Service Act to permanently extend and 
    clarify malpractice coverage for health centers, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 6, 1995

 Mrs. Johnson of Connecticut (for herself, Mr. Wyden, and Mr. Frank of 
Massachusetts) introduced the following bill; which was referred to the 
                         Committee on Commerce

                           December 12, 1995

 Additional sponsors: Mr. Goss, Mr. Sanders, Mr. Barrett of Wisconsin, 
 Mr. Callahan, Mr. Ehlers, Mr. Williams, Mr. Stupak, Mr. Mascara, Mr. 
    Hastert, Mr. Kolbe, Mr. Gutierrez, Mr. Tauzin, Mrs. Collins of 
Illinois, Mr. Waxman, Mr. Serrano, Mr. Engel, Mr. Wicker, Mr. Moorhead, 
 Mr. Greenwood, Ms. Pelosi, Ms. Molinari, Mr. Dingell, Mr. Tejeda, Mr. 
 Payne of Virginia, Mr. Bonior, Mr. Dellums, Mr. Blute, Mr. Stenholm, 
  Mrs. Kelly, Mr. Kildee, Mr. Pastor, and Mr. Kennedy of Rhode Island

                           December 12, 1995

Reported with amendments, committed to the Committee of the Whole House 
          on the State of the Union, and ordered to be printed
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]
[For text of introduced bill, see copy of bill as introduced on June 6, 
                                 1995]

_______________________________________________________________________

                                 A BILL


 
   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. EXTENSION OF PROGRAM.

    (a) In General.--Section 224(g)(3) (42 U.S.C. 233(g)(3)) is amended 
in the last sentence by striking ``January 1, 1996'' and inserting 
``January 1, 1999''.
    (b) Conforming Amendments.--Section 224(k) (42 U.S.C. 233(k)) is 
amended--
            (1) in paragraph (1)(A), by striking ``each of the fiscal 
        years 1993, 1994, and 1995'' and inserting ``each of the fiscal 
        years 1996 through 1998''; and
            (2) in paragraph (2), by striking ``each of the fiscal 
        years 1993, 1994, and 1995'' and inserting ``each of the fiscal 
        years 1996 through 1998''.

SEC. 3. CLARIFICATION OF COVERAGE.

    Section 224(g)(1) (42 U.S.C. 233(g)(1)) is amended--
            (1) in the first sentence, by striking ``officer, employee, 
        or contractor'' and inserting ``officer, governing board 
        member, or employee of such an entity, and any contractor''; 
        and
            (2) in the second sentence, by inserting after ``officer,'' 
        the following ``governing board member,''.

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 under subparagraph (A) 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 ``and subject to the 
        approval by the Secretary of an application under subparagraph 
        (D)'' after ``For purposes of this section''; and
            (2) by adding at the end thereof the following:
    ``(D) The Secretary may not deem an entity or an officer, governing 
board member, employee, or contractor of the entity to be an employee 
of the Public Health Service under subparagraph (A), 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.''.
    (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''.

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 April 1, 1997, the Secretary, in 
consultation with the Attorney General, shall submit to the Congress a 
report on the medical malpractice liability claims experience of 
entities that have been deemed to be employees for purposes of this 
section, and the risk exposure associated with such entities.
    ``(2) The report under paragraph (1) shall include an analysis by 
the Secretary comparing--
            ``(A) the Secretary's 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 to obtain medical malpractice 
        liability insurance coverage if this section were not in 
        effect; with
            ``(B) the aggregate amounts by which the grants received by 
        such entities under this Act were reduced pursuant to 
        subsection (k)(2).
    ``(3) In preparing the report under paragraph (1), the Secretary 
shall consult with public and private entities with expertise on the 
matters with which the report is concerned.''.
            Amend the title so as to read: ``A bill to amend the Public 
        Health Service Act to extend and clarify malpractice coverage 
        for health centers, and for other purposes.''.