[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3079 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 3079

  To amend title XVIII of the Social Security Act to assure access to 
  services under the Medicare Health Maintenance Organization Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 13, 1996

Mr. Coburn (for himself and Mr. Brown of Ohio) introduced the following 
  bill; which was referred to the Committee on Ways and Means, 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 XVIII of the Social Security Act to assure access to 
  services under the Medicare Health Maintenance Organization Program.

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

SECTION 1. ASSURING ACCESS TO SERVICES UNDER THE MEDICARE HMO PROGRAM.

    (a) Adequate Provider Arrangements.--Section 1876(c)(4)(A) of the 
Social Security Act (42 U.S.C. 1395mm(c)(4)(A)) is amended by inserting 
``establish and maintain adequate arrangements with a sufficient 
number, mix, and distribution of health professionals to'' after 
``(A)''.
    (b) Physician Participation Rules.--Section 1876(c) of such Act is 
amended by adding at the end the following new paragraph:
            ``(9) An eligible organization must--
                    ``(A) provide for the full participation of all 
                eligible physicians--
                            ``(i) who are graduates of either 
                        allopathic or osteopathic medical schools, and
                            ``(ii) who have received training from 
                        programs approved by either the Accreditation 
                        Council for Graduate Medical Education or the 
                        American Osteopathic Association; and
                    ``(B) not discriminate against a health physician, 
                based solely on the physician's certification or 
                license (as applicable under State law), in 
                participation in providing covered health services or 
                reimbursement or indemnification for providing such 
                services, if the physician may legally provide such 
                services in accordance with State law.''.
    (c) Nonphysician Health Care Professional Participation Rules.--
Section 1876(c) of such Act is further amended by adding at the end the 
following new paragraph:
            ``(9) An eligible organization shall not--
                    ``(A) exclude a health professional from 
                participation in its provider network based solely on--
                            ``(i) the health professional's 
                        certification or license (as applicable under 
                        State law), or
                            ``(ii) the health professional's lack of 
                        affiliation with, or admitting privileges at, a 
                        hospital, if such lack of affiliation is due to 
                        the health professional's type of license; or
                    ``(B) discriminate against a health professional, 
                based solely on the professional's certification or 
                license (as applicable under State law), in 
                participation in providing covered health services or 
                reimbursement or indemnification for providing such 
                services, if the professional may legally provide such 
                services in accordance with State law.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to contract years beginning on or after the date of enactment of 
this Act.
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