[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3694 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 3694

  To prohibit insurers from offering monetary rewards, penalties, or 
 inducements to licensed health care practitioners on the basis of the 
   health care practitioners' decisions to limit the availability of 
          appropriate medical tests, services, or treatments.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 20, 1996

  Mr. Nadler introduced the following bill; which was referred to the 
                         Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
  To prohibit insurers from offering monetary rewards, penalties, or 
 inducements to licensed health care practitioners on the basis of the 
   health care practitioners' decisions to limit the availability of 
          appropriate medical tests, services, or treatments.

    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 ``Health Care Integrity Act of 1996''.

SEC. 2. REGULATIONS TO DETER REWARDS, PENALTIES OR INDUCEMENTS TO 
              LICENSED HEALTH CARE PRACTITIONERS.

    (a) Promulgation of Regulations.--The Secretary of Health and Human 
Services shall promulgate regulations to ensure that an insurer not 
offer monetary rewards, penalties, or inducements to a licensed health 
care practitioner, or condition the continued participation of a 
licensed health care practitioner in a plan on the basis of the health 
care practitioner's decisions to limit the availability of appropriate 
medical tests, services, or treatments.
    (b) Penalties and Enforcement.--
            (1) Penalties.--An insurer that violates the regulations 
        described in subsection (a) shall be subject to a civil money 
        penalty in an amount to be determined by the Secretary of 
        Health and Human Services.
            (2) Enforcement.--The provisions of section 1128A of the 
        Social Security Act (42 U.S.C. 1320a-7a) (other than 
        subsections (a) and (b)) shall apply to civil money penalties 
        under this section in the same manner as they apply to a 
        penalty or proceeding under section 1128A(a) of such Act.

SEC. 3. DEFINITIONS.

    For purposes of this Act:
            (1) Insurer.--The term ``insurer'' means an insurance 
        company, insurance service, or insurance organization licensed 
        to engage in the business of insurance in a State, and a health 
        maintenance organization.
            (2) Health insurance coverage.--The term ``health insurance 
        coverage'' means any hospital or medical service policy or 
        certificate, hospital or medical service plan contract, or 
        health maintenance organization contract offered by an insurer.
            (3) Health plan.--The term ``health plan'' means a plan 
        that provides health insurance coverage.
            (4) Licensed health care practitioner.--The term ``licensed 
        health care practitioner'' has the meaning given such term in 
        section 431(6) of the Health Care Quality Improvement Act of 
        1986 (Public Law 99-660; 42 U.S.C. 11151(6)).
            (5) State.--The term ``State'' means each of the 50 States, 
        the District of Columbia, Puerto Rico, the Northern Mariana 
        Islands, the Virgin Islands, American Samoa, and Guam.
                                 <all>