[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 459 Introduced in House (IH)]







105th CONGRESS
  1st Session
                                H. R. 459

   To amend title XVIII of the Social Security Act to require health 
  maintenance organizations participating in the Medicare program to 
  assure access to out-of-network services to Medicare beneficiaries 
                   enrolled with such organizations.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 21, 1997

 Mr. Coburn (for himself, Mr. Canady of Florida, Mr. Cardin, Mr. Davis 
 of Virginia, Mr. Deal of Georgia, Mr. DeFazio, Mr. Ehlers, Mr. Foley, 
 Mr. Hostettler, Mr. Largent, Mr. Lewis of Georgia, Mr. LoBiondo, Mrs. 
 Lowey, Mr. McHugh, Mr. Norwood, Mr. Pallone, Ms. Pelosi, Mr. Regula, 
     Mr. Sanders, Mr. Stark, Mr. Stump, and Mr. Weldon of Florida) 
 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 require health 
  maintenance organizations participating in the Medicare program to 
  assure access to out-of-network services to Medicare beneficiaries 
                   enrolled with such organizations.

    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' Access to Health 
Care Act of 1997''.

SEC. 2. REQUIRING MEDICARE HEALTH MAINTENANCE ORGANIZATIONS TO OFFER 
              COVERAGE FOR OUT-OF-NETWORK SERVICES.

    (a) In General.--Section 1876 of the Social Security Act (42 U.S.C. 
1395mm) is amended by adding at the end the following new subsection:
    ``(k) If an eligible organization offers to members enrolled under 
this section a plan which provides for coverage of services covered 
under parts A and B of this title only if such services are furnished 
through providers and other persons who are members of a network of 
providers and other persons who have entered into a contract with the 
organization to provide such services, the contract with the 
organization under this section shall provide that the organization 
shall also offer to members enrolled under this section (at the time of 
enrollment) a plan which provides for coverage of such services which 
are not furnished through providers and other persons who are members 
of such a network.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to contracts with eligible organizations under section 1876 of 
the Social Security Act for years beginning with 1998.
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