[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2976 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 2976

  To prohibit health plans from interfering with health care provider 
                  communications with their patients.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 27, 1996

Mr. Ganske (for himself, Mr. Markey, Mr. Barr of Georgia, Mr. Boucher, 
   Mr. Coburn, Mr. Durbin, Mr. Gene Green of Texas, Mr. Johnston of 
 Florida, Mr. Kennedy of Massachusetts, Mr. Kleczka, Ms. Lofgren, Mr. 
 McDermott, Mrs. Meek of Florida, Mr. Moran, Mr. Nadler, Mr. Sanders, 
   Mr. Serrano, Mrs. Smith of Washington, Mr. Stark, Mr. Studds, Mr. 
  Traficant, Mr. Waxman, Mr. Whitfield, and Mr. Wise) introduced the 
following bill; which was referred to the Committee on Commerce, and in 
 addition to the Committee on Ways and Means, Economic and Educational 
Opportunities, and Government Reform and Oversight, 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 prohibit health plans from interfering with health care provider 
                  communications with their patients.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Patient Right To 
Know Act of 1996''.
    (b) Findings.--Congress finds the following:
            (1) Patients cannot make appropriate health care decisions 
        without access to all relevant information relating to those 
        decisions.
            (2) Restrictions on the ability of physicians and other 
        health care providers to provide full disclosure of all 
        relevant information to patients making health care decisions 
        violate the principles of informed consent and the ethical 
        standards of the health care professions.
            (3) Serious concerns have been raised about the use by 
        health plans of contractual clauses or policies that interfere 
        with communications between physicians and other health care 
        providers and their patients and the impact of such clauses and 
        policies on the quality of care received by those patients.
            (4) The offering and operation of health plans affects 
        commerce among the States, health care providers located in one 
        State serve patients who reside in other States as well as that 
        State, and, in order to provide for uniform treatment of health 
        care providers and patients among the States, it is necessary 
        to cover health plans operating in one State as well as those 
        operating among the several States.

SEC. 2. PROHIBITION OF INTERFERENCE WITH CERTAIN MEDICAL 
              COMMUNICATIONS.

    (a) In General.--
            (1) Prohibition of contractual provision.--An entity 
        offering a health plan (as defined in subsection (d)(2)) may 
        not provide, as part of any contract or agreement with a health 
        care provider, any restriction on or interference with any 
        medical communication, as defined in subsection (b).
            (2) Prohibition of adverse action.--An entity offering a 
        health plan may not take any of the following actions against a 
        health care provider on the basis of a medical communication:
                    (A) Refusal to contract with the health care 
                provider.
                    (B) Termination or refusal to renew a contract with 
                the health care provider.
                    (C) Refusal to refer patients to or allow others to 
                refer patients to the health care provider.
                    (D) Refusal to compensate the health care provider 
                for covered services.
                    (E) Any other retaliatory action against the health 
                care provider.
            (3) Nullification.--Any provision that is prohibited under 
        paragraph (1) is null and void.
    (b) Medical Communication Defined.--In this section, the term 
``medical communication''--
            (1) means any communication, other than a knowing and 
        willful misrepresentation, made by the health care provider--
                    (A) regarding the mental or physical health care 
                needs or treatment of a patient and the provisions, 
                terms, or requirements of the health plan or another 
                health plan relating to such needs or treatment, and
                    (B) between--
                            (i) the provider and a current, former, or 
                        prospective patient (or the guardian or legal 
                        representative of a patient),
                            (ii) the provider and any employee or 
                        representative of the entity offering such 
                        plan, or
                            (iii) the provider and any employee or 
                        representative of any State or Federal 
                        authority with responsibility for the licensing 
                        or oversight with respect to such entity or 
                        plan; and
            (2) includes communications concerning--
                    (A) any tests, consultations, and treatment 
                options,
                    (B) any risks or benefits associated with such 
                tests, consultations, and options,
                    (C) variation among any health care providers and 
                any institutions providing such services in experience, 
                quality, or outcomes,
                    (D) the basis or standard for the decision of an 
                entity offering a health plan to authorize or deny 
                health care services or benefits,
                    (E) the process used by such an entity to determine 
                whether to authorize or deny health care services or 
                benefits, and
                    (F) any financial incentives or disincentives 
                provided by such an entity to a health care provider 
                that are based on service utilization.
    (c) Enforcement Through Imposition of Civil Money Penalty.--
            (1) In general.--Any entity that violates paragraph (1) or 
        (2) of subsection (a) shall be subject to a civil money penalty 
        of--
                    (A) up to $25,000 for each violation, or
                    (B) up to $100,000 for each violation if the 
                Secretary determines that the entity has engaged, 
                within the 5 years immediately preceding such 
                violation, in a pattern of such violations.
            (2) Procedures.--The provisions of subsections (c) through 
        (l) of section 1128A of the Social Security Act (42 U.S.C. 
        1320a-7a) shall apply to civil money penalties under this 
        paragraph in the same manner as they apply to a penalty or 
        proceeding under section 1128A(a) of such Act.
    (d) Definitions.--For purposes of this section:
            (1) Health care provider.--The term ``health care 
        provider'' means anyone licensed under State law to provide 
        health care services.
            (2) Health plan.--The term ``health plan'' means any public 
        or private health plan or arrangement (including an employee 
        welfare benefit plan) which provides, or pays the cost of, 
        health benefits, and includes an organization of health care 
        providers that furnishes health services under a contract or 
        agreement with such a plan.
            (3) Secretary.--The term ``Secretary'' means Secretary of 
        Health and Human Services.
            (4) Coverage of third party administrators.--In the case of 
        a health plan that is an employee welfare benefit plan (as 
        defined in section 3(1) of the Employee Retirement Income 
        Security Act of 1974), any third party administrator or other 
        person with responsibility for contracts with health care 
        providers under the plan shall be considered, for purposes of 
        this section, to be an entity offering such health plan.
    (e) Non-Preemption of State Law.--A State may establish or enforce 
requirements with respect to the subject matter of this section, but 
only if such requirements are more protective of medical communications 
than the requirements established under this section.
    (f) Construction.--Nothing in this section shall be construed as--
            (1) as requiring an entity offering a health plan to enter 
        into or renew a contract or agreement with any willing health 
        care provider, or
            (2) preventing an entity from acting on information 
        relating to treatment actually provided to a patient or the 
        failure of a health care provider to comply with legal 
        standards relating to the provision of care.
    (g) Effective Dates.--
            (1) Contracts.--Subsection (a)(1) shall apply to contracts 
        or agreements entered into or renewed on or after the date of 
        the enactment of this Act, and to contracts and agreements 
        entered into before such date as of 30 days after the date of 
        the enactment of this Act.
            (2) Retaliatory actions.--Subsection (a)(2) shall apply to 
        actions taken on or after the date of the enactment of this 
        Act, regardless of when the communication on which the action 
        is based occurred.
            (3) Nullification.--Subsection (a)(3) shall apply to 
        provisions as of the date of the enactment of this Act.
                                 <all>