[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 1343 Introduced in Senate (IS)]


104th CONGRESS
  1st Session
                                S. 1343

    To amend title XVIII of the Social Security Act to provide that 
          eligible organizations assure out-of-network access.


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                   IN THE SENATE OF THE UNITED STATES

             October 19 (legislative day, October 18), 1995

   Mr. Helms introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII of the Social Security Act to provide that 
          eligible organizations assure out-of-network access.

    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 ``Senior Citizens Health Freedom Act 
of 1995''.

SEC. 2. ASSURING OUT-OF-NETWORK ACCESS.

    Section 1876 of the Social Security Act (42 U.S.C. 1395mm) is 
amended by adding at the end the following new subsection:
    ``(k)(1) An eligible organization that contracts with a specific 
network of providers must not limit the ability of its enrollees under 
this section to seek at any time items, treatment, and services from 
out-of-network providers for all covered benefits.
    ``(2) An eligible organization under this section shall provide for 
reimbursement for the enrollee in an amount equal to 70 percent of the 
reasonable charges for such services, with respect to out-of-network 
services which are described in paragraph (1), so long as the services 
are medically appropriate and are covered benefits in-network.''.
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