[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3239 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 3239

    To amend the Social Security Act to require health maintenance 
 organizations under the Medicare Program to disclose to enrollees and 
     potential enrollees certain information on the credentials of 
   physicians providing services by or through the organization, the 
  financial status of the organization, and the compensation paid to 
              officers and executives of the organization.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 12, 1998

   Mr. Shaw 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 the Social Security Act to require health maintenance 
 organizations under the Medicare Program to disclose to enrollees and 
     potential enrollees certain information on the credentials of 
   physicians providing services by or through the organization, the 
  financial status of the organization, and the compensation paid to 
              officers and executives of the organization.

    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 ``Medicare Managed Health Care 
Sunshine Act of 1998''.

SEC. 2. PROVIDING MEDICARE MANAGED CARE ENROLLEES WITH CERTAIN 
              INFORMATION ON HEALTH PLANS.

    (a) Information on Physician Credentialing.--Section 1852(c)(2) of 
the Social Security Act (42 U.S.C. 1395w-22(c)(2)) is amended by adding 
at the end the following new subparagraph:
                    ``(E) Descriptive information regarding the 
                credentials of each physician who is authorized by the 
                organization to provide services by or through the 
                organization to enrollees under this part, including 
                the medical education and training received by the 
                physician, the physician's history of medical practice 
                (whether domestic or foreign), and the positions held 
                by the physician at the time of the request.''.
    (b) Certain Financial Information.--Section 1857(d)(4)(A) of such 
Act (42 U.S.C. 1395w-27(d)(4)(A)) is amended by adding at the end the 
following new clauses:
                            ``(iv) An audited financial statement of 
                        the organization for the most recently 
                        concluded fiscal year that complies with 
                        generally accepted accounting principles.
                            ``(v) A statement identifying the salaries, 
                        bonuses, and other remuneration paid to the 5 
                        highest-paid officers or executives of the 
                        organization, as well as the other benefits 
                        provided to such officers or executives.''.
    (c) Availability of Information.--
            (1) Disclosure of availability of information.--Section 
        1851(d)(3) of such Act (42 U.S.C. 1395w-21(d)(3)) is amended by 
        adding at the end the following new subparagraph:
                    ``(F) Availability of certain information.--A 
                statement as to the availability, upon request, of 
                information on physician credentialing under section 
                1852(c)(2)(E) and on the financial status of a 
                Medicare+Choice organization under section 
                1857(d)(4)(C).''.
            (2) Conforming amendment to apply financial disclosure to 
        prospective enrollees.--Section 1857(d)(4)(C) of such Act (42 
        U.S.C. 1395w-27(d)(4)(C)) is amended by inserting ``and 
        prospective enrollees'' after ``its enrollees''.
    (d) Application of Requirements Under Section 1876 Contracts.--
Section 1876(k)(4) of such Act (42 U.S.C. 1395mm(k)(4)) is amended by 
adding at the end the following new subparagraph:
            ``(E) Disclosure of certain information under sections 
        1851(d)(3)(F), 1852(c)(2)(E), and 1857(d)(4)(C).''.
    (e) Effective Date.--The amendments made by this section apply with 
respect to contract years beginning on or after the date that is 6 
months after the date of the enactment of this Act.
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