[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3222 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 3222

    To prohibit gag rule clauses, improper incentive programs, and 
 indemnification clauses in health care insurance contracts and health 
           care employment contracts, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 29, 1996

  Mr. Sanders (for himself, Mr. Stark, Ms. McKinney, Mr. Dellums, Mr. 
  Hilliard, and Mr. Frazer) introduced the following bill; which was 
referred to the Committee on Commerce, and in addition to the Committee 
 on Ways and Means, and Economic and Educational Opportunities, 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 gag rule clauses, improper incentive programs, and 
 indemnification clauses in health care insurance contracts and health 
           care employment contracts, 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 ``Hippocratic Oath and Patient 
Protection Act of 1996''.

SEC. 2. DUTIES OF A HEALTH CARRIER.

    Under a contract or agreement with a health care provider or 
enrollee, a health carrier--
            (1) shall not--
                    (A) prevent or limit a health care provider's 
                protected communication to a patient or the public as 
                described in section 3;
                    (B) operate an improper incentive plan as described 
                in section 4; or
                    (C) include indemnification clauses as described in 
                section 5; and
            (2) shall disclose (in plain English understandable by a 
        layperson) to a health care provider and to an enrollee--
                    (A) a list of all services and benefits offered 
                under the health plan, including any service or benefit 
                maximum, limitation, or exclusion;
                    (B) the procedures used in authorizing, approving, 
                limiting, or denying services or benefits under the 
                health plan; and
                    (C) any health care provider incentive plan as 
                described in section 4(b) that exists under the 
                contract or agreement.

SEC. 3. PROTECTED COMMUNICATION.

    (a) In General.--Except as limited in subsection (b), for purposes 
of section 2(1)(A) a protected communication is a communication of 
information relevant to the care or course of treatment of a patient.
    (b) Limitations.--Such a protected communication does not include--
            (1) a trade secret; or
            (2) a knowing misrepresentation by a health care provider.

SEC. 4. IMPROPER HEALTH CARE PROVIDER INCENTIVE PLAN.

    (a) In General.--For purposes of section 2(1)(B), a health care 
provider incentive plan is improper, unless such plan meets the 
requirements of section 1876(i)(8)(A) of the Social Security Act (42 
U.S.C. 1395mm(i)(8)(A)) for physician incentive plans in contracts with 
eligible organizations under section 1876 of such Act.
    (b) Incentive Plan Defined.--The term ``health care provider 
incentive plan'' means any compensation or other financial arrangement 
between a health carrier and a health care provider that may directly 
or indirectly have the effect of limiting services provided with 
respect to an enrollee.

SEC. 5. PROHIBITED INDEMNIFICATION CLAUSES.

    For purposes of section 2(1)(C), a prohibited indemnification 
clause is any provision to indemnify a health carrier against liability 
from a civil action brought by, or on behalf of, an enrollee or a 
health care provider for any damage caused to the enrollee or the 
health care provider by the health carrier.

SEC. 6. ENFORCEMENT.

    (a) In General.--The Secretary of Health and Human Services may 
impose upon a health carrier who violates a provision of this Act a 
civil money penalty of--
            (1) up to $25,000 for each violation, or
            (2) up to $100,000 for each violation if the Secretary 
        determines that the health carrier has engaged, within the 5 
        years immediately preceding such violation, in a pattern of 
        such violations.
    (b) Procedures.--Subsections (c) through (l) of section 1128A of 
the Social Security Act (42 U.S.C. 1320a-7a) apply to a civil penalty 
under this paragraph in the same manner as they apply to a civil 
penalty under section 1128A(a) of such Act.

SEC. 7. PRIVATE CAUSE OF ACTION.

    Whoever is aggrieved by a violation of this Act may in a civil 
action obtain appropriate relief.

SEC. 8. REPORT TO CONGRESS.

    (a) In General.--Not later than 1 year after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
submit a report to Congress that evaluates--
            (1) the impact of this Act on health carriers, health care 
        providers, and enrollees; and
            (2) the enforcement of this Act by the Secretary.
    (b) Recommendations.--The Secretary shall include in the report 
required under subsection (a) recommendations for such changes as may 
be needed to ensure compliance by health carriers with this Act.

SEC. 9. DEFINITIONS.

    As used in this Act--
            (1) the term ``health plan'' means any public or private 
        entity or program that provides for payments for health care, 
        including--
                    (A) a group health plan (as defined in section 607 
                of the Employee Retirement Income Security Act of 1974) 
                or a multiple employer welfare arrangement (as defined 
                in section 3(40) of such Act) that provides health 
                benefits;
                    (B) any other health insurance arrangement, 
                including any arrangement consisting of a hospital or 
                medical expense incurred policy or certificate, 
                hospital or medical service plan contract, or health 
                maintenance organization subscriber contract;
                    (C) workers' compensation or similar insurance to 
                the extent that it relates to workers' compensation 
                medical benefits (as defined by the Federal Trade 
                Commission); and
                    (D) automobile medical insurance to the extent that 
                it relates to medical benefits (as defined by the 
                Federal Trade Commission);
            (2) the term ``health care provider'' means a person who 
        contracts with a health carrier to provide health care services 
        to enrollees;
            (3) the term ``health carrier'' means a person who 
        contracts or offers to contract on a risk-assuming basis--
                    (A) to provide, deliver, or arrange for health care 
                services; or
                    (B) to pay for or reimburse any of the cost of 
                health care services; and
            (4) the term ``enrollee'' means a person enrolled under a 
        health plan.

SEC. 10. EFFECTIVE DATES.

    (a) Subsections 2(1) (A) and (C) shall take effect on the date of 
the enactment of this Act, and apply to contracts or agreements entered 
into or renewed before, on, or after the date of the enactment of this 
Act.
    (b) Subsections 2(1)(B) and 2(2) shall take effect 90 days after 
the date of the enactment of this Act, and apply to contracts or 
agreements entered into or renewed before, on, or after the date of the 
enactment of this Act.
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