[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2990 Engrossed Amendment Senate (EAS)]

  
  
  
  
  

                  In the Senate of the United States,

                                                      October 14, 1999.
      Resolved, That the bill from the House of Representatives (H.R. 
2990) entitled ``An Act to amend the Internal Revenue Code of 1986 to 
allow individuals greater access to health insurance through a health 
care tax deduction, a long-term care deduction, and other health-
related tax incentives, to amend the Employee Retirement Income 
Security Act of 1974 to provide access to and choice in health care 
through association health plans, to amend the Public Health Service 
Act to create new pooling opportunities for small employers to obtain 
greater access to health coverage through HealthMarts; to amend title I 
of the Employee Retirement Income Security Act of 1974, title XXVII of 
the Public Health Service Act, and the Internal Revenue Code of 1986 to 
protect consumers in managed care plans and other health coverage; and 
for other purposes.'', do pass with the following

                               AMENDMENT:

            Strike out all after the enacting clause and insert:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Patients' Bill of 
Rights Plus Act''.
    (b) Table Of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.

                   TITLE I--PATIENTS' BILL OF RIGHTS

                  Subtitle A--Right to Advice and Care

Sec. 101.``subpart c--patient right to medical advice and care
        ``Sec. 721. Patient access to emergency medical care.
        ``Sec. 722. Offering of choice of coverage options.
        ``Sec. 723. Patient access to obstetric and gynecological care.
        ``Sec. 724. Patient access to pediatric care.
        ``Sec. 725. Timely access to specialists.
        ``Sec. 726. Continuity of care.
        ``Sec. 727. Protection of patient-provider communications.
        ``Sec. 728. Patient's right to prescription drugs.
        ``Sec. 729. Self-payment for behavioral health care services.
        ``Sec. 730. Coverage for individuals participating in approved 
                            cancer clinical trials.
        ``Sec. 730A. Prohibiting discrimination against providers.
        ``Sec. 730B. Generally applicable provision.''.
Sec. 102``subchapter c--patient right to medical advice and care986.
        ``Sec. 9821. Patient access to emergency medical care.
        ``Sec. 9822. Offering of choice of coverage options.
        ``Sec. 9823. Patient access to obstetric and gynecological 
                            care.
        ``Sec. 9824. Patient access to pediatric care.
        ``Sec. 9825. Timely access to specialists.
        ``Sec. 9826. Continuity of care.
        ``Sec. 9827. Protection of patient-provider communications.
        ``Sec. 9828. Patient's right to prescription drugs.
        ``Sec. 9829. Self-payment for behavioral health care services.
        ``Sec. 9830. Coverage for individuals participating in approved 
                            cancer clinical trials.
        ``Sec. 9830A. Prohibiting discrimination against providers.
        ``Sec. 9830B. Generally applicable provision.''.
Sec. 103. Effective date and related rules.

       Subtitle B--Right to Information About Plans and Providers

Sec. 111. Information about plans.
Sec. 112. Information about providers.

           Subtitle C--Right to Hold Health Plans Accountable

Sec. 121. Amendment to Employee Retirement Income Security Act of 1974.

               TITLE II--WOMEN'S HEALTH AND CANCER RIGHTS

Sec. 201. Women's health and cancer rights.

              TITLE III--GENETIC INFORMATION AND SERVICES

Sec. 301. Short title.
Sec. 302. Amendments to Employee Retirement Income Security Act of 
                            1974.
Sec. 303. Amendments to the Public Health Service Act.
Sec. 304. Amendments to the Internal Revenue Code of 1986.

               TITLE IV--HEALTHCARE RESEARCH AND QUALITY

Sec. 401. Short title.
Sec. 402. Amendment to the Public Health Service Act.

         ``TITLE IX--AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

               ``Part A--Establishment and General Duties

        ``Sec. 901. Mission and duties.
        ``Sec. 902. General authorities.

               ``Part B--Healthcare Improvement Research

        ``Sec. 911. Healthcare outcome improvement research.
        ``Sec. 912. Private-public partnerships to improve organization 
                            and delivery.
        ``Sec. 913. Information on quality and cost of care.
        ``Sec. 914. Information systems for healthcare improvement.
        ``Sec. 915. Research supporting primary care and access in 
                            underserved areas.
        ``Sec. 916. Clinical practice and technology innovation.
        ``Sec. 917. Coordination of Federal government quality 
                            improvement efforts.

                      ``Part C--General Provisions

        ``Sec. 921. Advisory Council for Healthcare Research and 
                            Quality.
        ``Sec. 922. Peer review with respect to grants and contracts.
        ``Sec. 923. Certain provisions with respect to development, 
                            collection, and dissemination of data.
        ``Sec. 924. Dissemination of information.
        ``Sec. 925. Additional provisions with respect to grants and 
                            contracts.
        ``Sec. 926. Certain administrative authorities.
        ``Sec. 927. Funding.
        ``Sec. 928. Definitions.''.
Sec. 403. References.

         TITLE V--ENHANCED ACCESS TO HEALTH INSURANCE COVERAGE

Sec. 501. Full deduction of health insurance costs for self-employed 
                            individuals.
Sec. 502. Full availability of medical savings accounts.
Sec. 503. Permitting contribution towards medical savings account 
                            through Federal employees health benefits 
                            program (FEHBP).
Sec. 504. Carryover of unused benefits from cafeteria plans, flexible 
                            spending arrangements, and health flexible 
                            spending accounts.

       TITLE VI--PROVISIONS RELATING TO LONG-TERM CARE INSURANCE

Sec. 601. Inclusion of qualified long-term care insurance contracts in 
                            cafeteria plans, flexible spending 
                            arrangements, and health flexible spending 
                            accounts.
Sec. 602. Deduction for premiums for long-term care insurance.
Sec. 603. Study of long-term care needs in the 21st century.

                 TITLE VII--INDIVIDUAL RETIREMENT PLANS

Sec. 701. Modification of income limits on contributions and rollovers 
                            to Roth IRAs.

                     TITLE VIII--REVENUE PROVISIONS

Sec. 801. Modification to foreign tax credit carryback and carryover 
                            periods.
Sec. 802. Limitation on use of non-accrual experience method of 
                            accounting.
Sec. 803. Returns relating to cancellations of indebtedness by 
                            organizations lending money.
Sec. 804. Extension of Internal Revenue Service user fees.
Sec. 805. Property subject to a liability treated in same manner as 
                            assumption of liability.
Sec. 806. Charitable split-dollar life insurance, annuity, and 
                            endowment contracts.
Sec. 807. Transfer of excess defined benefit plan assets for retiree 
                            health benefits.
Sec. 808. Limitations on welfare benefit funds of 10 or more employer 
                            plans.
Sec. 809. Modification of installment method and repeal of installment 
                            method for accrual method taxpayers.
Sec. 810. Inclusion of certain vaccines against streptococcus 
                            pneumoniae to list of taxable vaccines.

                   TITLE IX--MISCELLANEOUS PROVISIONS

Sec. 901. Medicare competitive pricing demonstration project.

                   TITLE I--PATIENTS' BILL OF RIGHTS

                  Subtitle A--Right to Advice and Care

SEC. 101. PATIENT RIGHT TO MEDICAL ADVICE AND CARE.

    (a) In General.--Part 7 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1181 et seq.) is 
amended--
            (1) by redesignating subpart C as subpart D; and
            (2) by inserting after subpart B the following:

         ``Subpart C--Patient Right to Medical Advice and Care

``SEC. 721. PATIENT ACCESS TO EMERGENCY MEDICAL CARE.

    ``(a) Coverage of Emergency Care.--
            ``(1) In general.--To the extent that the group health plan 
        (other than a fully insured group health plan) provides 
        coverage for benefits consisting of emergency medical care (as 
        defined in subsection (c)) or emergency ambulance services, 
        except for items or services specifically excluded--
                    ``(A) the plan shall provide coverage for benefits, 
                without requiring preauthorization, for emergency 
                medical screening examinations or emergency ambulance 
                services, to the extent that a prudent layperson, who 
                possesses an average knowledge of health and medicine, 
                would determine such examinations or emergency 
                ambulance services to be necessary to determine whether 
                emergency medical care (as so defined) is necessary; 
                and
                    ``(B) the plan shall provide coverage for benefits, 
                without requiring preauthorization, for additional 
                emergency medical care to stabilize an emergency 
                medical condition following an emergency medical 
                screening examination (if determined necessary under 
                subparagraph (A)), pursuant to the definition of 
                stabilize under section 1867(e)(3) of the Social 
                Security Act (42 U.S.C. 1395dd(e)(3)).
            ``(2) Reimbursement for care to maintain medical 
        stability.--
                    ``(A) In general.--In the case of services provided 
                to a participant or beneficiary by a nonparticipating 
                provider in order to maintain the medical stability of 
                the participant or beneficiary, the group health plan 
                involved shall provide for reimbursement with respect 
                to such services if--
                            ``(i) coverage for services of the type 
                        furnished is available under the group health 
                        plan;
                            ``(ii) the services were provided for care 
                        related to an emergency medical condition and 
                        in an emergency department in order to maintain 
                        the medical stability of the participant or 
                        beneficiary; and
                            ``(iii) the nonparticipating provider 
                        contacted the plan regarding approval for such 
                        services.
                    ``(B) Failure to respond.--If a group health plan 
                fails to respond within 1 hours of being contacted in 
                accordance with subparagraph (A)(iii), then the plan 
                shall be liable for the cost of services provided by 
                the nonparticipating provider in order to maintain the 
                stability of the participant or beneficiary.
                    ``(C) Limitation.--The liability of a group health 
                plan to provide reimbursement under subparagraph (A) 
                shall terminate when the plan has contacted the 
                nonparticipating provider to arrange for discharge or 
                transfer.
                    ``(D) Liability of participant.--A participant or 
                beneficiary shall not be liable for the costs of 
                services to which subparagraph (A) in an amount that 
                exceeds the amount of liability that would be incurred 
                if the services were provided by a participating health 
                care provider with prior authorization by the plan.
    ``(b) In-Network Uniform Costs-Sharing and Out-of-Network Care.--
            ``(1) In-network uniform cost-sharing.--Nothing in this 
        section shall be construed as preventing a group health plan 
        (other than a fully insured group health plan) from imposing 
        any form of cost-sharing applicable to any participant or 
        beneficiary (including coinsurance, copayments, deductibles, 
        and any other charges) in relation to coverage for benefits 
        described in subsection (a), if such form of cost-sharing is 
        uniformly applied under such plan, with respect to similarly 
        situated participants and beneficiaries, to all benefits 
        consisting of emergency medical care (as defined in subsection 
        (c)) provided to such similarly situated participants and 
        beneficiaries under the plan, and such cost-sharing is 
        disclosed in accordance with section 714.
            ``(2) Out-of-network care.--If a group health plan (other 
        than a fully insured group health plan) provides any benefits 
        with respect to emergency medical care (as defined in 
        subsection (c)), the plan shall cover emergency medical care 
        under the plan in a manner so that, if such care is provided to 
        a participant or beneficiary by a nonparticipating health care 
        provider, the participant or beneficiary is not liable for 
        amounts that exceed any form of cost-sharing (including co-
        insurance, co-payments, deductibles, and any other charges) 
        that would be incurred if the services were provided by a 
        participating provider.
    ``(c) Definition of Emergency Medical Care.--In this section:
            ``(1) In general.--The term `emergency medical care' means, 
        with respect to a participant or beneficiary under a group 
        health plan (other than a fully insured group health plan), 
        covered inpatient and outpatient services that--
                    ``(A) are furnished by any provider, including a 
                nonparticipating provider, that is qualified to furnish 
                such services; and
                    ``(B) are needed to evaluate or stabilize (as such 
                term is defined in section 1867(e)(3) of the Social 
                Security Act (42 U.S.C. 1395dd)(e)(3)) an emergency 
                medical condition (as defined in paragraph (2)).
            ``(2) Emergency medical condition.--The term `emergency 
        medical condition' means a medical condition manifesting itself 
        by acute symptoms of sufficient severity (including severe 
        pain) such that a prudent layperson, who possesses an average 
        knowledge of health and medicine, could reasonably expect the 
        absence of immediate medical attention to result in--
                    ``(A) placing the health of the participant or 
                beneficiary (or, with respect to a pregnant woman, the 
                health of the woman or her unborn child) in serious 
                jeopardy,
                    ``(B) serious impairment to bodily functions, or
                    ``(C) serious dysfunction of any bodily organ or 
                part.

``SEC. 722. OFFERING OF CHOICE OF COVERAGE OPTIONS.

    ``(a) Requirement.--
            ``(1) Offering of point-of-service coverage option.--Except 
        as provided in paragraph (2), if a group health plan (other 
        than a fully insured group health plan) provides coverage for 
        benefits only through a defined set of participating health 
        care professionals, the plan shall offer the participant the 
        option to purchase point-of-service coverage (as defined in 
        subsection (b)) for all such benefits for which coverage is 
        otherwise so limited. Such option shall be made available to 
        the participant at the time of enrollment under the plan and at 
        such other times as the plan offers the participant a choice of 
        coverage options.
            ``(2) Exception in case of lack of availability.--Paragraph 
        (1) shall not apply with respect to a group health plan (other 
        than a fully insured group health plan) if care relating to the 
        point-of-service coverage would not be available and accessible 
        to the participant with reasonable promptness (consistent with 
        section 1301(b)(4) of the Public Health Service Act (42 U.S.C. 
        300e(b)(4))).
    ``(b) Point-of-Service Coverage Defined.--In this section, the term 
`point-of-service coverage' means, with respect to benefits covered 
under a group health plan (other than a fully insured group health 
plan), coverage of such benefits when provided by a nonparticipating 
health care professional.
    ``(c) Small Employer Exemption.--
            ``(1) In general.--This section shall not apply to any 
        group health plan (other than a fully insured group health 
        plan) of a small employer.
            ``(2) Small employer.--For purposes of paragraph (1), the 
        term `small employer' means, in connection with a group health 
        plan (other than a fully insured group health plan) with 
        respect to a calendar year and a plan year, an employer who 
        employed an average of at least 2 but not more than 50 
        employees on business days during the preceding calendar year 
        and who employs at least 2 employees on the first day of the 
        plan year. For purposes of this paragraph, the provisions of 
        subparagraph (C) of section 712(c)(1) shall apply in 
        determining employer size.
    ``(d) Rule of Construction.--Nothing in this section shall be 
construed--
            ``(1) as requiring coverage for benefits for a particular 
        type of health care professional;
            ``(2) as requiring an employer to pay any costs as a result 
        of this section or to make equal contributions with respect to 
        different health coverage options;
            ``(3) as preventing a group health plan (other than a fully 
        insured group health plan) from imposing higher premiums or 
        cost-sharing on a participant for the exercise of a point-of-
        service coverage option; or
            ``(4) to require that a group health plan (other than a 
        fully insured group health plan) include coverage of health 
        care professionals that the plan excludes because of fraud, 
        quality of care, or other similar reasons with respect to such 
        professionals.

``SEC. 723. PATIENT ACCESS TO OBSTETRIC AND GYNECOLOGICAL CARE.

    ``(a) General Rights.--
            ``(1) Waiver of plan referral requirement.--If a group 
        health plan described in subsection (b) requires a referral to 
        obtain coverage for specialty care, the plan shall waive the 
        referral requirement in the case of a female participant or 
        beneficiary who seeks coverage for obstetrical care and related 
        follow-up obstetrical care or routine gynecological care (such 
        as preventive gynecological care).
            ``(2) Related routine care.--With respect to a participant 
        or beneficiary described in paragraph (1), a group health plan 
        described in subsection (b) shall treat the ordering of other 
        routine care that is related to routine gynecologic care, by a 
        physician who specializes in obstetrics and gynecology as the 
        authorization of the primary care provider for such other care.
    ``(b) Application of Section.--A group health plan described in 
this subsection is a group health plan (other than a fully insured 
group health plan), that--
            ``(1) provides coverage for obstetric care (such as 
        pregnancy-related services) or routine gynecologic care (such 
        as preventive women's health examinations); and
            ``(2) requires the designation by a participant or 
        beneficiary of a participating primary care provider who is not 
        a physician who specializes in obstetrics or gynecology.
    ``(c) Rules of Construction.--Nothing in this section shall be 
construed--
            ``(1) as waiving any coverage requirement relating to 
        medical necessity or appropriateness with respect to the 
        coverage of obstetric or gynecologic care described in 
        subsection (a);
            ``(2) to preclude the plan from requiring that the 
        physician who specializes in obstetrics or gynecology notify 
        the designated primary care provider or the plan of treatment 
        decisions;
            ``(3) to preclude a group health plan from allowing health 
        care professionals other than physicians to provide routine 
        obstetric or routine gynecologic care; or
            ``(4) to preclude a group health plan from permitting a 
        physician who specializes in obstetrics and gynecology from 
        being a primary care provider under the plan.

``SEC. 724. PATIENT ACCESS TO PEDIATRIC CARE.

    ``(a) In General.--In the case of a group health plan (other than a 
fully insured group health plan) that provides coverage for routine 
pediatric care and that requires the designation by a participant or 
beneficiary of a participating primary care provider, if the designated 
primary care provider is not a physician who specializes in 
pediatrics--
            ``(1) the plan may not require authorization or referral by 
        the primary care provider in order for a participant or 
        beneficiary to obtain coverage for routine pediatric care; and
            ``(2) the plan shall treat the ordering of other routine 
        care related to routine pediatric care by such a specialist as 
        having been authorized by the designated primary care provider.
    ``(b) Rules of Construction.--Nothing in subsection (a) shall be 
construed--
            ``(1) as waiving any coverage requirement relating to 
        medical necessity or appropriateness with respect to the 
        coverage of any pediatric care provided to, or ordered for, a 
        participant or beneficiary;
            ``(2) to preclude a group health plan from requiring that a 
        specialist described in subsection (a) notify the designated 
        primary care provider or the plan of treatment decisions; or
            ``(3) to preclude a group health plan from allowing health 
        care professionals other than physicians to provide routine 
        pediatric care.

``SEC. 725. TIMELY ACCESS TO SPECIALISTS.

    ``(a) Timely Access.--
            ``(1) In general.--A group health plan (other than a fully 
        insured group health plan) shall ensure that participants and 
        beneficiaries have timely, in accordance with the medical 
        exigencies of the case, access to primary and specialty health 
        care professionals who are appropriate to the condition of the 
        participant or beneficiary, when such care is covered under the 
        plan. Such access may be provided through contractual 
        arrangements with specialized providers outside of the network 
        of the plan.
            ``(2) Rule of construction.--Nothing in paragraph (1) shall 
        be construed--
                    ``(A) to require the coverage under a group health 
                plan of particular benefits or services or to prohibit 
                a plan from including providers only to the extent 
                necessary to meet the needs of the plan's participants 
                or beneficiaries or from establishing any measure 
                designed to maintain quality and control costs 
                consistent with the responsibilities of the plan; or
                    ``(B) to override any State licensure or scope-of-
                practice law.
    ``(b) Treatment Plans.--
            ``(1) In general.--Nothing in this section shall be 
        construed to prohibit a group health plan (other than a fully 
        insured group health plan) from requiring that specialty care 
        be provided pursuant to a treatment plan so long as the 
        treatment plan is--
                    ``(A) developed by the specialist, in consultation 
                with the case manager or primary care provider, and the 
                participant or beneficiary;
                    ``(B) approved by the plan in a timely manner in 
                accordance with the medical exigencies of the case; and
                    ``(C) in accordance with the applicable quality 
                assurance and utilization review standards of the plan.
            ``(2) Notification.--Nothing in paragraph (1) shall be 
        construed as prohibiting a plan from requiring the specialist 
        to provide the case manager or primary care provider with 
        regular updates on the specialty care provided, as well as all 
        other necessary medical information.
    ``(c) Referrals.--Nothing in this section shall be construed to 
prohibit a plan from requiring an authorization by the case manager or 
primary care provider of the participant or beneficiary in order to 
obtain coverage for specialty services so long as such authorization is 
for an adequate number of referrals.
    ``(d) Specialty Care Defined.--For purposes of this subsection, the 
term `specialty care' means, with respect to a condition, care and 
treatment provided by a health care practitioner, facility, or center 
(such as a center of excellence) that has adequate expertise (including 
age-appropriate expertise) through appropriate training and experience.

``SEC. 726. CONTINUITY OF CARE.

    ``(a) In General.--
            ``(1) Termination of provider.--If a contract between a 
        group health plan (other than a fully insured group health 
        plan) and a health care provider is terminated (as defined in 
        paragraph (2)), or benefits or coverage provided by a health 
        care provider are terminated because of a change in the terms 
        of provider participation in such group health plan, and an 
        individual who is a participant or beneficiary in the plan is 
        undergoing a course of treatment from the provider at the time 
        of such termination, the plan shall--
                    ``(A) notify the individual on a timely basis of 
                such termination;
                    ``(B) provide the individual with an opportunity to 
                notify the plan of a need for transitional care; and
                    ``(C) in the case of termination described in 
                paragraph (2), (3), or (4) of subsection (b), and 
                subject to subsection (c), permit the individual to 
                continue or be covered with respect to the course of 
                treatment with the provider's consent during a 
                transitional period (as provided under subsection (b)).
            ``(2) Terminated.--In this section, the term `terminated' 
        includes, with respect to a contract, the expiration or 
        nonrenewal of the contract by the group health plan, but does 
        not include a termination of the contract by the plan for 
        failure to meet applicable quality standards or for fraud.
            ``(3) Contracts.--For purposes of this section, the term 
        `contract between a group health plan (other than a fully 
        insured group health plan) and a health care provider' shall 
        include a contract between such a plan and an organized network 
        of providers.
    ``(b) Transitional Period.--
            ``(1) General rule.--Except as provided in paragraph (3), 
        the transitional period under this subsection shall permit the 
        participant or beneficiary to extend the coverage involved for 
        up to 90 days from the date of the notice described in 
        subsection (a)(1)(A) of the provider's termination.
            ``(2) Institutional care.--Subject to paragraph (1), the 
        transitional period under this subsection for institutional or 
        inpatient care from a provider shall extend until the discharge 
        or termination of the period of institutionalization and also 
        shall include institutional care provided within a reasonable 
        time of the date of termination of the provider status if the 
        care was scheduled before the date of the announcement of the 
        termination of the provider status under subsection (a)(1)(A) 
        or if the individual on such date was on an established waiting 
        list or otherwise scheduled to have such care.
            ``(3) Pregnancy.--Notwithstanding paragraph (1), if--
                    ``(A) a participant or beneficiary has entered the 
                second trimester of pregnancy at the time of a 
                provider's termination of participation; and
                    ``(B) the provider was treating the pregnancy 
                before the date of the termination;
        the transitional period under this subsection with respect to 
        provider's treatment of the pregnancy shall extend through the 
        provision of post-partum care directly related to the delivery.
            ``(4) Terminal illness.--Notwithstanding paragraph (1), 
        if--
                    ``(A) a participant or beneficiary was determined 
                to be terminally ill (as determined under section 
                1861(dd)(3)(A) of the Social Security Act) prior to a 
                provider's termination of participation; and
                    ``(B) the provider was treating the terminal 
                illness before the date of termination;
        the transitional period under this subsection shall be for care 
        directly related to the treatment of the terminal illness and 
        shall extend for the remainder of the individual's life for 
        such care.
    ``(c) Permissible Terms and Conditions.--A group health plan (other 
than a fully insured group health plan) may condition coverage of 
continued treatment by a provider under subsection (a)(1)(C) upon the 
provider agreeing to the following terms and conditions:
            ``(1) The provider agrees to accept reimbursement from the 
        plan and individual involved (with respect to cost-sharing) at 
        the rates applicable prior to the start of the transitional 
        period as payment in full (or at the rates applicable under the 
        replacement plan after the date of the termination of the 
        contract with the group health plan) and not to impose cost-
        sharing with respect to the individual in an amount that would 
        exceed the cost-sharing that could have been imposed if the 
        contract referred to in subsection (a)(1) had not been 
        terminated.
            ``(2) The provider agrees to adhere to the quality 
        assurance standards of the plan responsible for payment under 
        paragraph (1) and to provide to such plan necessary medical 
        information related to the care provided.
            ``(3) The provider agrees otherwise to adhere to such 
        plan's policies and procedures, including procedures regarding 
        referrals and obtaining prior authorization and providing 
        services pursuant to a treatment plan (if any) approved by the 
        plan.
    ``(d) Rule of Construction.--Nothing in this section shall be 
construed to require the coverage of benefits which would not have been 
covered if the provider involved remained a participating provider.
    ``(e) Definition.--In this section, the term `health care provider' 
or `provider' means--
            ``(1) any individual who is engaged in the delivery of 
        health care services in a State and who is required by State 
        law or regulation to be licensed or certified by the State to 
        engage in the delivery of such services in the State; and
            ``(2) any entity that is engaged in the delivery of health 
        care services in a State and that, if it is required by State 
        law or regulation to be licensed or certified by the State to 
        engage in the delivery of such services in the State, is so 
        licensed.
    ``(f) Comprehensive Study of Cost, Quality and Coordination of 
Coverage for Patients at the End of Life.--
            ``(1) Study by the medicare payment advisory commission.--
        The Medicare Payment Advisory Commission shall conduct a study 
        of the costs and patterns of care for persons with serious and 
        complex conditions and the possibilities of improving upon that 
        care to the degree it is triggered by the current category of 
        terminally ill as such term is used for purposes of section 
        1861(dd) of the Social Security Act (relating to hospice 
        benefits) or of utilizing care in other payment settings in 
        Medicare.
            ``(2) Agency for health care policy and research.--The 
        Agency for Health Care Policy and Research shall conduct 
        studies of the possible thresholds for major conditions causing 
        serious and complex illness, their administrative parameters 
        and feasibility, and their impact upon costs and quality.
            ``(3) Health care financing administration.--The Health 
        Care Financing Administration shall conduct studies of the 
        merits of applying similar thresholds in Medicare+Choice 
        programs, including adapting risk adjustment methods to account 
        for this category.
            ``(4) Initial report.--
                    ``(A) In general.--Not later than 12 months after 
                the date of enactment of this section, the Medicare 
                Payment Advisory Commission and the Agency for Health 
                Care Policy and Research shall each prepare and submit 
                to the Committee on Health, Education, Labor and 
                Pensions of the Senate a report concerning the results 
                of the studies conducted under paragraphs (1) and (2), 
                respectively.
                    ``(B) Copy to secretary.--Concurrent with the 
                submission of the reports under subparagraph (A), the 
                Medicare Payment Advisory Commission and the Agency for 
                health Care Policy and Research shall transmit a copy 
                of the reports under such subparagraph to the 
                Secretary.
            ``(5) Final report.--
                    ``(A) Contract with institute of medicine.--Not 
                later than 1 year after the submission of the reports 
                under paragraph (4), the Secretary of Health and Human 
                Services shall contract with the Institute of Medicine 
                to conduct a study of the practices and their effects 
                arising from the utilization of the category ``serious 
                and complex'' illness.
                    ``(B) Report.--Not later than 1 year after the date 
                of the execution of the contract referred to in 
                subparagraph (A), the Institute of Medicine shall 
                prepare and submit to the Committee on Health, 
                Education, Labor and Pensions of the Senate a report 
                concerning the study conducted pursuant to such 
                contract.
            ``(6) Funding.--From funds appropriated to the Department 
        of Health and Human Services, the Secretary of Health and Human 
        Services shall make available such funds as the Secretary 
        determines is necessary to carry out this subsection.

``SEC. 727. PROTECTION OF PATIENT-PROVIDER COMMUNICATIONS.

    ``(a) In General.--Subject to subsection (b), a group health plan 
(other than a fully insured group health plan and in relation to a 
participant or beneficiary) shall not prohibit or otherwise restrict a 
health care professional from advising such a participant or 
beneficiary who is a patient of the professional about the health 
status of the participant or beneficiary or medical care or treatment 
for the condition or disease of the participant or beneficiary, 
regardless of whether coverage for such care or treatment are provided 
under the contract, if the professional is acting within the lawful 
scope of practice.
    ``(b) Rule of Construction.--Nothing in this section shall be 
construed as requiring a group health plan (other than a fully insured 
group health plan) to provide specific benefits under the terms of such 
plan.

``SEC. 728. PATIENT'S RIGHT TO PRESCRIPTION DRUGS.

    ``To the extent that a group health plan (other than a fully 
insured group health plan) provides coverage for benefits with respect 
to prescription drugs, and limits such coverage to drugs included in a 
formulary, the plan shall--
            ``(1) ensure the participation of physicians and 
        pharmacists in developing and reviewing such formulary; and
            ``(2) in accordance with the applicable quality assurance 
        and utilization review standards of the plan, provide for 
        exceptions from the formulary limitation when a non-formulary 
        alternative is medically necessary and appropriate.

``SEC. 729. SELF-PAYMENT FOR BEHAVIORAL HEALTH CARE SERVICES.

    ``(a) In General.--A group health plan (other than a fully insured 
group health plan) may not--
            ``(1) prohibit or otherwise discourage a participant or 
        beneficiary from self-paying for behavioral health care 
        services once the plan has denied coverage for such services; 
        or
            ``(2) terminate a health care provider because such 
        provider permits participants or beneficiaries to self-pay for 
        behavioral health care services--
                    ``(A) that are not otherwise covered under the 
                plan; or
                    ``(B) for which the group health plan provides 
                limited coverage, to the extent that the group health 
                plan denies coverage of the services.
    ``(b) Rule of Construction.--Nothing in subsection (a)(2)(B) shall 
be construed as prohibiting a group health plan from terminating a 
contract with a health care provider for failure to meet applicable 
quality standards or for fraud.

``SEC. 730. COVERAGE FOR INDIVIDUALS PARTICIPATING IN APPROVED CANCER 
              CLINICAL TRIALS.

    ``(a) Coverage.--
            ``(1) In general.--If a group health plan (other than a 
        fully insured group health plan) provides coverage to a 
        qualified individual (as defined in subsection (b)), the plan--
                    ``(A) may not deny the individual participation in 
                the clinical trial referred to in subsection (b)(2);
                    ``(B) subject to subsections (b), (c), and (d) may 
                not deny (or limit or impose additional conditions on) 
                the coverage of routine patient costs for items and 
                services furnished in connection with participation in 
                the trial; and
                    ``(C) may not discriminate against the individual 
                on the basis of the participant's or beneficiaries 
                participation in such trial.
            ``(2) Exclusion of certain costs.--For purposes of 
        paragraph (1)(B), routine patient costs do not include the cost 
        of the tests or measurements conducted primarily for the 
        purpose of the clinical trial involved.
            ``(3) Use of in-network providers.--If one or more 
        participating providers is participating in a clinical trial, 
        nothing in paragraph (1) shall be construed as preventing a 
        plan from requiring that a qualified individual participate in 
        the trial through such a participating provider if the provider 
        will accept the individual as a participant in the trial.
    ``(b) Qualified Individual Defined.--For purposes of subsection 
(a), the term ``qualified individual'' means an individual who is a 
participant or beneficiary in a group health plan and who meets the 
following conditions:
            ``(1)(A) The individual has been diagnosed with cancer for 
        which no standard treatment is effective.
            ``(B) The individual is eligible to participate in an 
        approved clinical trial according to the trial protocol with 
        respect to treatment of such illness.
            ``(C) The individual's participation in the trial offers 
        meaningful potential for significant clinical benefit for the 
        individual.
            ``(2) Either--
                    ``(A) the referring physician is a participating 
                health care professional and has concluded that the 
                individual's participation in such trial would be 
                appropriate based upon the individual meeting the 
                conditions described in paragraph (1); or
                    ``(B) the participant or beneficiary provides 
                medical and scientific information establishing that 
                the individual's participation in such trial would be 
                appropriate based upon the individual meeting the 
                conditions described in paragraph (1).
    ``(c) Payment.--
            ``(1) In general.--Under this section a group health plan 
        (other than a fully insured group health plan) shall provide 
        for payment for routine patient costs described in subsection 
        (a)(2) but is not required to pay for costs of items and 
        services that are reasonably expected to be paid for by the 
        sponsors of an approved clinical trial.
            ``(2) Standards for determining routine patient costs 
        associated with clinical trial participation.--
                    ``(A) In general.--The Secretary shall establish, 
                on an expedited basis and using a negotiated rulemaking 
                process under subchapter III of chapter 5 of title 5, 
                United States Code, standards relating to the coverage 
                of routine patient costs for individuals participating 
                in clinical trials that group health plans must meet 
                under this section.
                    ``(B) Factors.--In establishing routine patient 
                cost standards under subparagraph (A), the Secretary 
                shall consult with interested parties and take into 
                account --
                            ``(i) quality of patient care;
                            ``(ii) routine patient care costs versus 
                        costs associated with the conduct of clinical 
                        trials, including unanticipated patient care 
                        costs as a result of participation in clinical 
                        trials; and
                            ``(iii) previous and on-going studies 
                        relating to patient care costs associated with 
                        participation in clinical trials.
                    ``(C) Publication of notice.--In carrying out the 
                rulemaking process under this paragraph, the Secretary, 
                after consultation with organizations representing 
                cancer patients, health care practitioners, medical 
                researchers, employers, group health plans, 
                manufacturers of drugs, biologics and medical devices, 
                medical economists, hospitals, and other interested 
                parties, shall publish notice provided for under 
                section 564(a) of title 5, United States Code, by not 
                later than 45 days after the date of the enactment of 
                this section.
                    ``(D) Target date for publication of rule.--As part 
                of the notice under subparagraph (C), and for purposes 
                of this paragraph, the `target date for publication' 
                (referred to in section 564(a)(5) of such title 5) 
                shall be June 30, 2000.
                    ``(E) Abbreviated period for submission of 
                comments.--In applying section 564(c) of such title 5 
                under this paragraph, `15 days' shall be substituted 
                for `30 days'.
                    ``(F) Appointment of negotiated rulemaking 
                committee and facilitator.--The Secretary shall provide 
                for--
                            ``(i) the appointment of a negotiated 
                        rulemaking committee under section 565(a) of 
                        such title 5 by not later than 30 days after 
                        the end of the comment period provided for 
                        under section 564(c) of such title 5 (as 
                        shortened under subparagraph (E)), and
                            ``(ii) the nomination of a facilitator 
                        under section 566(c) of such title 5 by not 
                        later than 10 days after the date of 
                        appointment of the committee.
                    ``(G) Preliminary committee report.--The negotiated 
                rulemaking committee appointed under subparagraph (F) 
                shall report to the Secretary, by not later than March 
                29, 2000, regarding the committee's progress on 
                achieving a consensus with regard to the rulemaking 
                proceeding and whether such consensus is likely to 
                occur before 1 month before the target date for 
                publication of the rule. If the committee reports that 
                the committee has failed to make significant progress 
                towards such consensus or is unlikely to reach such 
                consensus by the target date, the Secretary may 
                terminate such process and provide for the publication 
                of a rule under this paragraph through such other 
                methods as the Secretary may provide.
                    ``(H) Final committee report.--If the committee is 
                not terminated under subparagraph (G), the rulemaking 
                committee shall submit a report containing a proposed 
                rule by not later than 1 month before the target date 
                of publication.
                    ``(I) Final effect.--The Secretary shall publish a 
                rule under this paragraph in the Federal Register by 
                not later than the target date of publication.
                    ``(J) Publication of rule after public comment.--
                The Secretary shall provide for consideration of such 
                comments and republication of such rule by not later 
                than 1 year after the target date of publication.
                    ``(K) Effective date.--The provisions of this 
                paragraph shall apply to group health plans (other than 
                a fully insured group health plan) for plan years 
                beginning on or after January 1, 2001.
            ``(3) Payment rate.--In the case of covered items and 
        services provided by--
                    ``(A) a participating provider, the payment rate 
                shall be at the agreed upon rate, or
                    ``(B) a nonparticipating provider, the payment rate 
                shall be at the rate the plan would normally pay for 
                comparable services under subparagraph (A).
    ``(d) Approved Clinical Trial Defined.--
            ``(1) In general.--In this section, the term `approved 
        clinical trial' means a cancer clinical research study or 
        cancer clinical investigation approved and funded (which may 
        include funding through in-kind contributions) by one or more 
        of the following:
                    ``(A) The National Institutes of Health.
                    ``(B) A cooperative group or center of the National 
                Institutes of Health.
                    ``(C) Either of the following if the conditions 
                described in paragraph (2) are met:
                            ``(i) The Department of Veterans Affairs.
                            ``(ii) The Department of Defense.
            ``(2) Conditions for departments.--The conditions described 
        in this paragraph, for a study or investigation conducted by a 
        Department, are that the study or investigation has been 
        reviewed and approved through a system of peer review that the 
        Secretary determines--
                    ``(A) to be comparable to the system of peer review 
                of studies and investigations used by the National 
                Institutes of Health, and
                    ``(B) assures unbiased review of the highest 
                scientific standards by qualified individuals who have 
                no interest in the outcome of the review.
    ``(e) Construction.--Nothing in this section shall be construed to 
limit a plan's coverage with respect to clinical trials.
    ``(f) Plan Satisfaction of Certain Requirements; Responsibilities 
of Fiduciaries.--
            ``(1) In general.--For purposes of this section, insofar as 
        a group health plan provides benefits in the form of health 
        insurance coverage through a health insurance issuer, the plan 
        shall be treated as meeting the requirements of this section 
        with respect to such benefits and not be considered as failing 
        to meet such requirements because of a failure of the issuer to 
        meet such requirements so long as the plan sponsor or its 
        representatives did not cause such failure by the issuer.
            ``(2) Construction.--Nothing in this section shall be 
        construed to affect or modify the responsibilities of the 
        fiduciaries of a group health plan under part 4 of subtitle B.
    ``(g) Study and Report.--
            ``(1) Study.--The Secretary shall study the impact on group 
        health plans for covering routine patient care costs for 
        individuals who are entitled to benefits under this section and 
        who are enrolled in an approved cancer clinical trial program.
            ``(2) Report to congress.--Not later than January 1, 2005, 
        the Secretary shall submit a report to Congress that contains 
        an assessment of--
                    ``(A) any incremental cost to group health plans 
                resulting from the provisions of this section;
                    ``(B) a projection of expenditures to such plans 
                resulting from this section; and
                    ``(C) any impact on premiums resulting from this 
                section.

``SEC. 730A. PROHIBITING DISCRIMINATION AGAINST PROVIDERS.

    ``(a) In General.--A group health plan (other than a fully insured 
group health plan) shall not discriminate with respect to participation 
or indemnification as to any provider who is acting within the scope of 
the provider's license or certification under applicable State law, 
solely on the basis of such license or certification. This subsection 
shall not be construed as requiring the coverage under a plan of 
particular benefits or services or to prohibit a plan from including 
providers only to the extent necessary to meet the needs of the plan's 
participants and beneficiaries or from establishing any measure 
designed to maintain quality and control costs consistent with the 
responsibilities of the plan.
    ``(b) No Requirement for any Willing Provider.--Nothing in this 
section shall be construed as requiring a group health plan that offers 
network coverage to include for participation every willing provider or 
health professional who meets the terms and conditions of the plan.

``SEC. 730B. GENERALLY APPLICABLE PROVISION.

    ``In the case of a group health plan that provides benefits under 2 
or more coverage options, the requirements of this subpart shall apply 
separately with respect to each coverage option.''.
    (b) Rule With Respect to Certain Plans.--
            (1) In general.--Notwithstanding any other provision of 
        law, health insurance issuers may offer, and eligible 
        individuals may purchase, high deductible health plans 
        described in section 220(c)(2)(A) of the Internal Revenue Code 
        of 1986. Effective for the 4-year period beginning on the date 
        of the enactment of this Act, such health plans shall not be 
        required to provide payment for any health care items or 
        services that are exempt from the plan's deductible.
            (2) Existing state laws.--A State law relating to payment 
        for health care items and services in effect on the date of 
        enactment of this Act that is preempted under paragraph (1), 
        shall not apply to high deductible health plans after the 
        expiration of the 4-year period described in such paragraph 
        unless the State reenacts such law after such period.
    (c) Definition.--Section 733(a) of the Employee Retirement Income 
Security Act of 1974 (42 U.S.C. 1191(a)) is amended by adding at the 
end the following:
            ``(3) Fully insured group health plan.--The term `fully 
        insured group health plan' means a group health plan where 
        benefits under the plan are provided pursuant to the terms of 
        an arrangement between a group health plan and a health 
        insurance issuer and are guaranteed by the health insurance 
        issuer under a contract or policy of insurance.''.
    (d) Conforming Amendment.--The table of contents in section 1 of 
such Act is amended--
            (1) in the item relating to subpart C, by striking 
        ``Subpart C'' and inserting ``Subpart D''; and
            (2) by adding at the end of the items relating to subpart B 
        of part 7 of subtitle B of title I of such Act the following 
        new items:

         ``subpart c--patient right to medical advice and care
``Sec. 721. Patient access to emergency medical care.
``Sec. 722. Offering of choice of coverage options.
``Sec. 723. Patient access to obstetric and gynecological care.
``Sec. 724. Patient access to pediatric care.
``Sec. 725. Timely access to specialists.
``Sec. 726. Continuity of care.
``Sec. 727. Protection of patient-provider communications.
``Sec. 728. Patient's right to prescription drugs.
``Sec. 729. Self-payment for behavioral health care services.
``Sec. 730. Coverage for individuals participating in approved cancer 
                            clinical trials.
``Sec. 730A. Prohibiting discrimination against providers.
``Sec. 730B. Generally applicable provision.''.

SEC. 102. CONFORMING AMENDMENT TO THE INTERNAL REVENUE CODE OF 1986.

    (a) In General.--Chapter 100 of the Internal Revenue Code of 1986 
is amended--
            (1) by redesignating subchapter C as subchapter D; and
            (2) by inserting after subchapter B the following:

        ``Subchapter C--Patient Right to Medical Advice and Care

``Sec. 9821. Patient access to emergency medical care.
``Sec. 9822. Offering of choice of coverage options.
``Sec. 9823. Patient access to obstetric and gynecological care.
``Sec. 9824. Patient access to pediatric care.
``Sec. 9825. Timely access to specialists.
``Sec. 9826. Continuity of care.
``Sec. 9827. Protection of patient-provider communications.
``Sec. 9828. Patient's right to prescription drugs.
``Sec. 9829. Self-payment for behavioral health care services.
``Sec. 9830. Coverage for individuals participating in approved cancer 
                            clinical trials.
``Sec. 9830A. Prohibiting discrimination against providers.
``Sec. 9830B. Generally applicable provision.

``SEC. 9821. PATIENT ACCESS TO EMERGENCY MEDICAL CARE.

    ``(a) Coverage of Emergency Care.--
            ``(1) In general.--To the extent that the group health plan 
        (other than a fully insured group health plan) provides 
        coverage for benefits consisting of emergency medical care (as 
        defined in subsection (c)) or emergency ambulance services, 
        except for items or services specifically excluded--
                    ``(A) the plan shall provide coverage for benefits, 
                without requiring preauthorization, for emergency 
                medical screening examinations or emergency ambulance 
                services, to the extent that a prudent layperson, who 
                possesses an average knowledge of health and medicine, 
                would determine such examinations or emergency 
                ambulance services to be necessary to determine whether 
                emergency medical care (as so defined) is necessary; 
                and
                    ``(B) the plan shall provide coverage for benefits, 
                without requiring preauthorization, for additional 
                emergency medical care to stabilize an emergency 
                medical condition following an emergency medical 
                screening examination (if determined necessary under 
                subparagraph (A)), pursuant to the definition of 
                stabilize under section 1867(e)(3) of the Social 
                Security Act (42 U.S.C. 1395dd(e)(3)).
            ``(2) Reimbursement for care to maintain medical 
        stability.--
                    ``(A) In general.--In the case of services provided 
                to a participant or beneficiary by a nonparticipating 
                provider in order to maintain the medical stability of 
                the participant or beneficiary, the group health plan 
                involved shall provide for reimbursement with respect 
                to such services if--
                            ``(i) coverage for services of the type 
                        furnished is available under the group health 
                        plan;
                            ``(ii) the services were provided for care 
                        related to an emergency medical condition and 
                        in an emergency department in order to maintain 
                        the medical stability of the participant or 
                        beneficiary; and
                            ``(iii) the nonparticipating provider 
                        contacted the plan regarding approval for such 
                        services.
                    ``(B) Failure to respond.--If a group health plan 
                fails to respond within 1 hours of being contacted in 
                accordance with subparagraph (A)(iii), then the plan 
                shall be liable for the cost of services provided by 
                the nonparticipating provider in order to maintain the 
                stability of the participant or beneficiary.
                    ``(C) Limitation.--The liability of a group health 
                plan to provide reimbursement under subparagraph (A) 
                shall terminate when the plan has contacted the 
                nonparticipating provider to arrange for discharge or 
                transfer.
                    ``(D) Liability of participant.--A participant or 
                beneficiary shall not be liable for the costs of 
                services to which subparagraph (A) in an amount that 
                exceeds the amount of liability that would be incurred 
                if the services were provided by a participating health 
                care provider with prior authorization by the plan.
    ``(b) In-Network Uniform Costs-Sharing and Out-of-Network Care.--
            ``(1) In-network uniform cost-sharing.--Nothing in this 
        section shall be construed as preventing a group health plan 
        (other than a fully insured group health plan) from imposing 
        any form of cost-sharing applicable to any participant or 
        beneficiary (including coinsurance, copayments, deductibles, 
        and any other charges) in relation to coverage for benefits 
        described in subsection (a), if such form of cost-sharing is 
        uniformly applied under such plan, with respect to similarly 
        situated participants and beneficiaries, to all benefits 
        consisting of emergency medical care (as defined in subsection 
        (c)) provided to such similarly situated participants and 
        beneficiaries under the plan, and such cost-sharing is 
        disclosed in accordance with section 9814.
            ``(2) Out-of-network care.--If a group health plan (other 
        than a fully insured group health plan) provides any benefits 
        with respect to emergency medical care (as defined in 
        subsection (c)), the plan shall cover emergency medical care 
        under the plan in a manner so that, if such care is provided to 
        a participant or beneficiary by a nonparticipating health care 
        provider, the participant or beneficiary is not liable for 
        amounts that exceed any form of cost-sharing (including 
        coinsurance, copayments, deductibles, and any other charges) 
        that would be incurred if the services were provided by a 
        participating provider.
    ``(c) Definition of Emergency Medical Care.--In this section:
            ``(1) In general.--The term `emergency medical care' means, 
        with respect to a participant or beneficiary under a group 
        health plan (other than a fully insured group health plan), 
        covered inpatient and outpatient services that--
                    ``(A) are furnished by any provider, including a 
                nonparticipating provider, that is qualified to furnish 
                such services; and
                    ``(B) are needed to evaluate or stabilize (as such 
                term is defined in section 1867(e)(3) of the Social 
                Security Act (42 U.S.C. 1395dd)(e)(3)) an emergency 
                medical condition (as defined in paragraph (2)).
            ``(2) Emergency medical condition.--The term `emergency 
        medical condition' means a medical condition manifesting itself 
        by acute symptoms of sufficient severity (including severe 
        pain) such that a prudent layperson, who possesses an average 
        knowledge of health and medicine, could reasonably expect the 
        absence of immediate medical attention to result in--
                    ``(A) placing the health of the participant or 
                beneficiary (or, with respect to a pregnant woman, the 
                health of the woman or her unborn child) in serious 
                jeopardy,
                    ``(B) serious impairment to bodily functions, or
                    ``(C) serious dysfunction of any bodily organ or 
                part.

``SEC. 9822. OFFERING OF CHOICE OF COVERAGE OPTIONS.

    ``(a) Requirement.--
            ``(1) Offering of point-of-service coverage option.--Except 
        as provided in paragraph (2), if a group health plan (other 
        than a fully insured group health plan) provides coverage for 
        benefits only through a defined set of participating health 
        care professionals, the plan shall offer the participant the 
        option to purchase point-of-service coverage (as defined in 
        subsection (b)) for all such benefits for which coverage is 
        otherwise so limited. Such option shall be made available to 
        the participant at the time of enrollment under the plan and at 
        such other times as the plan offers the participant a choice of 
        coverage options.
            ``(2) Exception in case of lack of availability.--Paragraph 
        (1) shall not apply with respect to a group health plan (other 
        than a fully insured group health plan) if care relating to the 
        point-of-service coverage would not be available and accessible 
        to the participant with reasonable promptness (consistent with 
        section 1301(b)(4) of the Public Health Service Act (42 U.S.C. 
        300e(b)(4))).
    ``(b) Point-of-Service Coverage Defined.--In this section, the term 
`point-of-service coverage' means, with respect to benefits covered 
under a group health plan (other than a fully insured group health 
plan), coverage of such benefits when provided by a nonparticipating 
health care professional.
    ``(c) Small Employer Exemption.--
            ``(1) In general.--This section shall not apply to any 
        group health plan (other than a fully insured group health 
        plan) of a small employer.
            ``(2) Small employer.--For purposes of paragraph (1), the 
        term `small employer' means, in connection with a group health 
        plan (other than a fully insured group health plan) with 
        respect to a calendar year and a plan year, an employer who 
        employed an average of at least 2 but not more than 50 
        employees on business days during the preceding calendar year 
        and who employs at least 2 employees on the first day of the 
        plan year. For purposes of this paragraph, the provisions of 
        subparagraph (C) of section 4980D(d)(2) shall apply in 
        determining employer size.
    ``(d) Rule of Construction.--Nothing in this section shall be 
construed--
            ``(1) as requiring coverage for benefits for a particular 
        type of health care professional;
            ``(2) as requiring an employer to pay any costs as a result 
        of this section or to make equal contributions with respect to 
        different health coverage options;
            ``(3) as preventing a group health plan (other than a fully 
        insured group health plan) from imposing higher premiums or 
        cost-sharing on a participant for the exercise of a point-of-
        service coverage option; or
            ``(4) to require that a group health plan (other than a 
        fully insured group health plan) include coverage of health 
        care professionals that the plan excludes because of fraud, 
        quality of care, or other similar reasons with respect to such 
        professionals.

``SEC. 9823. PATIENT ACCESS TO OBSTETRIC AND GYNECOLOGICAL CARE.

    ``(a) General Rights.--
            ``(1) Waiver of plan referral requirement.--If a group 
        health plan described in subsection (b) requires a referral to 
        obtain coverage for specialty care, the plan shall waive the 
        referral requirement in the case of a female participant or 
        beneficiary who seeks coverage for obstetrical care and related 
        follow-up obstetrical care or routine gynecological care (such 
        as preventive gynecological care).
            ``(2) Related routine care.--With respect to a participant 
        or beneficiary described in paragraph (1), a group health plan 
        described in subsection (b) shall treat the ordering of other 
        routine care that is related to routine gynecologic care, by a 
        physician who specializes in obstetrics and gynecology as the 
        authorization of the primary care provider for such other care.
    ``(b) Application of Section.--A group health plan described in 
this subsection is a group health plan (other than a fully insured 
group health plan), that--
            ``(1) provides coverage for obstetric care (such as 
        pregnancy-related services) or routine gynecologic care (such 
        as preventive women's health examinations); and
            ``(2) requires the designation by a participant or 
        beneficiary of a participating primary care provider who is not 
        a physician who specializes in obstetrics or gynecology.
    ``(c) Rules of Construction.--Nothing in this section shall be 
construed--
            ``(1) as waiving any coverage requirement relating to 
        medical necessity or appropriateness with respect to the 
        coverage of obstetric or gynecologic care described in 
        subsection (a);
            ``(2) to preclude the plan from requiring that the 
        physician who specializes in obstetrics or gynecology notify 
        the designated primary care provider or the plan of treatment 
        decisions;
            ``(3) to preclude a group health plan from allowing health 
        care professionals other than physicians to provide routine 
        obstetric or routine gynecologic care; or
            ``(4) to preclude a group health plan from permitting a 
        physician who specializes in obstetrics and gynecology from 
        being a primary care provider under the plan.

``SEC. 9824. PATIENT ACCESS TO PEDIATRIC CARE.

    ``(a) In General.--In the case of a group health plan (other than a 
fully insured group health plan) that provides coverage for routine 
pediatric care and that requires the designation by a participant or 
beneficiary of a participating primary care provider, if the designated 
primary care provider is not a physician who specializes in 
pediatrics--
            ``(1) the plan may not require authorization or referral by 
        the primary care provider in order for a participant or 
        beneficiary to obtain coverage for routine pediatric care; and
            ``(2) the plan shall treat the ordering of other routine 
        care related to routine pediatric care by such a specialist as 
        having been authorized by the designated primary care provider.
    ``(b) Rules of Construction.--Nothing in subsection (a) shall be 
construed--
            ``(1) as waiving any coverage requirement relating to 
        medical necessity or appropriateness with respect to the 
        coverage of any pediatric care provided to, or ordered for, a 
        participant or beneficiary;
            ``(2) to preclude a group health plan from requiring that a 
        specialist described in subsection (a) notify the designated 
        primary care provider or the plan of treatment decisions; or
            ``(3) to preclude a group health plan from allowing health 
        care professionals other than physicians to provide routine 
        pediatric care.

``SEC. 9825. TIMELY ACCESS TO SPECIALISTS.

    ``(a) Timely Access.--
            ``(1) In general.--A group health plan (other than a fully 
        insured group health plan) shall ensure that participants and 
        beneficiaries have timely, in accordance with the medical 
        exigencies of the case, access to primary and specialty health 
        care professionals who are appropriate to the condition of the 
        participant or beneficiary, when such care is covered under the 
        plan. Such access may be provided through contractual 
        arrangements with specialized providers outside of the network 
        of the plan.
            ``(2) Rule of construction.--Nothing in paragraph (1) shall 
        be construed--
                    ``(A) to require the coverage under a group health 
                plan of particular benefits or services or to prohibit 
                a plan from including providers only to the extent 
                necessary to meet the needs of the plan's participants 
                or beneficiaries or from establishing any measure 
                designed to maintain quality and control costs 
                consistent with the responsibilities of the plan; or
                    ``(B) to override any State licensure or scope-of-
                practice law.
    ``(b) Treatment Plans.--
            ``(1) In general.--Nothing in this section shall be 
        construed to prohibit a group health plan (other than a fully 
        insured group health plan) from requiring that specialty care 
        be provided pursuant to a treatment plan so long as the 
        treatment plan is--
                    ``(A) developed by the specialist, in consultation 
                with the case manager or primary care provider, and the 
                participant or beneficiary;
                    ``(B) approved by the plan in a timely manner in 
                accordance with the medical exigencies of the case; and
                    ``(C) in accordance with the applicable quality 
                assurance and utilization review standards of the plan.
            ``(2) Notification.--Nothing in paragraph (1) shall be 
        construed as prohibiting a plan from requiring the specialist 
        to provide the case manager or primary care provider with 
        regular updates on the specialty care provided, as well as all 
        other necessary medical information.
    ``(c) Referrals.--Nothing in this section shall be construed to 
prohibit a plan from requiring an authorization by the case manager or 
primary care provider of the participant or beneficiary in order to 
obtain coverage for specialty services so long as such authorization is 
for an adequate number of referrals.
    ``(d) Specialty Care Defined.--For purposes of this subsection, the 
term `specialty care' means, with respect to a condition, care and 
treatment provided by a health care practitioner, facility, or center 
(such as a center of excellence) that has adequate expertise (including 
age-appropriate expertise) through appropriate training and experience.

``SEC. 9826. CONTINUITY OF CARE.

    ``(a) In General.--
            ``(1) Termination of provider.--If a contract between a 
        group health plan (other than a fully insured group health 
        plan) and a health care provider is terminated (as defined in 
        paragraph (2)), or benefits or coverage provided by a health 
        care provider are terminated because of a change in the terms 
        of provider participation in such group health plan, and an 
        individual who is a participant or beneficiary in the plan is 
        undergoing a course of treatment from the provider at the time 
        of such termination, the plan shall--
                    ``(A) notify the individual on a timely basis of 
                such termination;
                    ``(B) provide the individual with an opportunity to 
                notify the plan of a need for transitional care; and
                    ``(C) in the case of termination described in 
                paragraph (2), (3), or (4) of subsection (b), and 
                subject to subsection (c), permit the individual to 
                continue or be covered with respect to the course of 
                treatment with the provider's consent during a 
                transitional period (as provided under subsection (b)).
            ``(2) Terminated.--In this section, the term `terminated' 
        includes, with respect to a contract, the expiration or 
        nonrenewal of the contract by the group health plan, but does 
        not include a termination of the contract by the plan for 
        failure to meet applicable quality standards or for fraud.
            ``(3) Contracts.--For purposes of this section, the term 
        `contract between a group health plan (other than a fully 
        insured group health plan) and a health care provider' shall 
        include a contract between such a plan and an organized network 
        of providers.
    ``(b) Transitional Period.--
            ``(1) General rule.--Except as provided in paragraph (3), 
        the transitional period under this subsection shall permit the 
        participant or beneficiary to extend the coverage involved for 
        up to 90 days from the date of the notice described in 
        subsection (a)(1)(A) of the provider's termination.
            ``(2) Institutional care.--Subject to paragraph (1), the 
        transitional period under this subsection for institutional or 
        inpatient care from a provider shall extend until the discharge 
        or termination of the period of institutionalization and also 
        shall include institutional care provided within a reasonable 
        time of the date of termination of the provider status if the 
        care was scheduled before the date of the announcement of the 
        termination of the provider status under subsection (a)(1)(A) 
        or if the individual on such date was on an established waiting 
        list or otherwise scheduled to have such care.
            ``(3) Pregnancy.--Notwithstanding paragraph (1), if--
                    ``(A) a participant or beneficiary has entered the 
                second trimester of pregnancy at the time of a 
                provider's termination of participation; and
                    ``(B) the provider was treating the pregnancy 
                before the date of the termination;
        the transitional period under this subsection with respect to 
        provider's treatment of the pregnancy shall extend through the 
        provision of post-partum care directly related to the delivery.
            ``(4) Terminal illness.--Notwithstanding paragraph (1), 
        if--
                    ``(A) a participant or beneficiary was determined 
                to be terminally ill (as determined under section 
                1861(dd)(3)(A) of the Social Security Act) prior to a 
                provider's termination of participation; and
                    ``(B) the provider was treating the terminal 
                illness before the date of termination;
        the transitional period under this subsection shall be for care 
        directly related to the treatment of the terminal illness and 
        shall extend for the remainder of the individual's life for 
        such care.
    ``(c) Permissible Terms and Conditions.--A group health plan (other 
than a fully insured group health plan) may condition coverage of 
continued treatment by a provider under subsection (a)(1)(C) upon the 
provider agreeing to the following terms and conditions:
            ``(1) The provider agrees to accept reimbursement from the 
        plan and individual involved (with respect to cost-sharing) at 
        the rates applicable prior to the start of the transitional 
        period as payment in full (or at the rates applicable under the 
        replacement plan after the date of the termination of the 
        contract with the group health plan) and not to impose cost-
        sharing with respect to the individual in an amount that would 
        exceed the cost-sharing that could have been imposed if the 
        contract referred to in subsection (a)(1) had not been 
        terminated.
            ``(2) The provider agrees to adhere to the quality 
        assurance standards of the plan responsible for payment under 
        paragraph (1) and to provide to such plan necessary medical 
        information related to the care provided.
            ``(3) The provider agrees otherwise to adhere to such 
        plan's policies and procedures, including procedures regarding 
        referrals and obtaining prior authorization and providing 
        services pursuant to a treatment plan (if any) approved by the 
        plan.
    ``(d) Rule of Construction.--Nothing in this section shall be 
construed to require the coverage of benefits which would not have been 
covered if the provider involved remained a participating provider.
    ``(e) Definition.--In this section, the term `health care provider' 
or `provider' means--
            ``(1) any individual who is engaged in the delivery of 
        health care services in a State and who is required by State 
        law or regulation to be licensed or certified by the State to 
        engage in the delivery of such services in the State; and
            ``(2) any entity that is engaged in the delivery of health 
        care services in a State and that, if it is required by State 
        law or regulation to be licensed or certified by the State to 
        engage in the delivery of such services in the State, is so 
        licensed.
    ``(f) Comprehensive Study of Cost, Quality and Coordination of 
Coverage for Patients at the End of Life.--
            ``(1) Study by the medicare payment advisory commission.--
        The Medicare Payment Advisory Commission shall conduct a study 
        of the costs and patterns of care for persons with serious and 
        complex conditions and the possibilities of improving upon that 
        care to the degree it is triggered by the current category of 
        terminally ill as such term is used for purposes of section 
        1861(dd) of the Social Security Act (relating to hospice 
        benefits) or of utilizing care in other payment settings in 
        Medicare.
            ``(2) Agency for health care policy and research.--The 
        Agency for Health Care Policy and Research shall conduct 
        studies of the possible thresholds for major conditions causing 
        serious and complex illness, their administrative parameters 
        and feasibility, and their impact upon costs and quality.
            ``(3) Health care financing administration.--The Health 
        Care Financing Administration shall conduct studies of the 
        merits of applying similar thresholds in Medicare+Choice 
        programs, including adapting risk adjustment methods to account 
        for this category.
            ``(4) Initial report.--
                    ``(A) In general.--Not later than 12 months after 
                the date of enactment of this section, the Medicare 
                Payment Advisory Commission and the Agency for Health 
                Care Policy and Research shall each prepare and submit 
                to the Committee on Health, Education, Labor and 
                Pensions of the Senate a report concerning the results 
                of the studies conducted under paragraphs (1) and (2), 
                respectively.
                    ``(B) Copy to secretary.--Concurrent with the 
                submission of the reports under subparagraph (A), the 
                Medicare Payment Advisory Commission and the Agency for 
                health Care Policy and Research shall transmit a copy 
                of the reports under such subparagraph to the 
                Secretary.
            ``(5) Final report.--
                    ``(A) Contract with institute of medicine.--Not 
                later than 1 year after the submission of the reports 
                under paragraph (4), the Secretary of Health and Human 
                Services shall contract with the Institute of Medicine 
                to conduct a study of the practices and their effects 
                arising from the utilization of the category ``serious 
                and complex'' illness.
                    ``(B) Report.--Not later than 1 year after the date 
                of the execution of the contract referred to in 
                subparagraph (A), the Institute of Medicine shall 
                prepare and submit to the Committee on Health, 
                Education, Labor and Pensions of the Senate a report 
                concerning the study conducted pursuant to such 
                contract.
            ``(6) Funding.--From funds appropriated to the Department 
        of Health and Human Services, the Secretary of Health and Human 
        Services shall make available such funds as the Secretary 
        determines is necessary to carry out this subsection.

``SEC. 9827. PROTECTION OF PATIENT-PROVIDER COMMUNICATIONS.

    ``(a) In General.--Subject to subsection (b), a group health plan 
(other than a fully insured group health plan and in relation to a 
participant or beneficiary) shall not prohibit or otherwise restrict a 
health care professional from advising such a participant or 
beneficiary who is a patient of the professional about the health 
status of the participant or beneficiary or medical care or treatment 
for the condition or disease of the participant or beneficiary, 
regardless of whether coverage for such care or treatment are provided 
under the contract, if the professional is acting within the lawful 
scope of practice.
    ``(b) Rule of Construction.--Nothing in this section shall be 
construed as requiring a group health plan (other than a fully insured 
group health plan) to provide specific benefits under the terms of such 
plan.

``SEC. 9828. PATIENT'S RIGHT TO PRESCRIPTION DRUGS.

    ``To the extent that a group health plan (other than a fully 
insured group health plan) provides coverage for benefits with respect 
to prescription drugs, and limits such coverage to drugs included in a 
formulary, the plan shall--
            ``(1) ensure the participation of physicians and 
        pharmacists in developing and reviewing such formulary; and
            ``(2) in accordance with the applicable quality assurance 
        and utilization review standards of the plan, provide for 
        exceptions from the formulary limitation when a non-formulary 
        alternative is medically necessary and appropriate.

``SEC. 9829. SELF-PAYMENT FOR BEHAVIORAL HEALTH CARE SERVICES.

    ``(a) In General.--A group health plan (other than a fully insured 
group health plan) may not--
            ``(1) prohibit or otherwise discourage a participant or 
        beneficiary from self-paying for behavioral health care 
        services once the plan has denied coverage for such services; 
        or
            ``(2) terminate a health care provider because such 
        provider permits participants or beneficiaries to self-pay for 
        behavioral health care services--
                    ``(A) that are not otherwise covered under the 
                plan; or
                    ``(B) for which the group health plan provides 
                limited coverage, to the extent that the group health 
                plan denies coverage of the services.
    ``(b) Rule of Construction.--Nothing in subsection (a)(2)(B) shall 
be construed as prohibiting a group health plan from terminating a 
contract with a health care provider for failure to meet applicable 
quality standards or for fraud.

``SEC. 9830. COVERAGE FOR INDIVIDUALS PARTICIPATING IN APPROVED CANCER 
              CLINICAL TRIALS.

    ``(a) Coverage.--
            ``(1) In general.--If a group health plan (other than a 
        fully insured group health plan) provides coverage to a 
        qualified individual (as defined in subsection (b)), the plan--
                    ``(A) may not deny the individual participation in 
                the clinical trial referred to in subsection (b)(2);
                    ``(B) subject to subsections (b), (c), and (d) may 
                not deny (or limit or impose additional conditions on) 
                the coverage of routine patient costs for items and 
                services furnished in connection with participation in 
                the trial; and
                    ``(C) may not discriminate against the individual 
                on the basis of the participant's or beneficiaries 
                participation in such trial.
            ``(2) Exclusion of certain costs.--For purposes of 
        paragraph (1)(B), routine patient costs do not include the cost 
        of the tests or measurements conducted primarily for the 
        purpose of the clinical trial involved.
            ``(3) Use of in-network providers.--If one or more 
        participating providers is participating in a clinical trial, 
        nothing in paragraph (1) shall be construed as preventing a 
        plan from requiring that a qualified individual participate in 
        the trial through such a participating provider if the provider 
        will accept the individual as a participant in the trial.
    ``(b) Qualified Individual Defined.--For purposes of subsection 
(a), the term ``qualified individual'' means an individual who is a 
participant or beneficiary in a group health plan and who meets the 
following conditions:
            ``(1)(A) The individual has been diagnosed with cancer for 
        which no standard treatment is effective.
            ``(B) The individual is eligible to participate in an 
        approved clinical trial according to the trial protocol with 
        respect to treatment of such illness.
            ``(C) The individual's participation in the trial offers 
        meaningful potential for significant clinical benefit for the 
        individual.
            ``(2) Either--
                    ``(A) the referring physician is a participating 
                health care professional and has concluded that the 
                individual's participation in such trial would be 
                appropriate based upon the individual meeting the 
                conditions described in paragraph (1); or
                    ``(B) the participant or beneficiary provides 
                medical and scientific information establishing that 
                the individual's participation in such trial would be 
                appropriate based upon the individual meeting the 
                conditions described in paragraph (1).
    ``(c) Payment.--
            ``(1) In general.--Under this section a group health plan 
        (other than a fully insured group health plan) shall provide 
        for payment for routine patient costs described in subsection 
        (a)(2) but is not required to pay for costs of items and 
        services that are reasonably expected to be paid for by the 
        sponsors of an approved clinical trial.
            ``(2) Standards for determining routine patient costs 
        associated with clinical trial participation.--
                    ``(A) In general.--The Secretary shall establish, 
                on an expedited basis and using a negotiated rulemaking 
                process under subchapter III of chapter 5 of title 5, 
                United States Code, standards relating to the coverage 
                of routine patient costs for individuals participating 
                in clinical trials that group health plans must meet 
                under this section.
                    ``(B) Factors.--In establishing routine patient 
                cost standards under subparagraph (A), the Secretary 
                shall consult with interested parties and take into 
                account --
                            ``(i) quality of patient care;
                            ``(ii) routine patient care costs versus 
                        costs associated with the conduct of clinical 
                        trials, including unanticipated patient care 
                        costs as a result of participation in clinical 
                        trials; and
                            ``(iii) previous and on-going studies 
                        relating to patient care costs associated with 
                        participation in clinical trials.
                    ``(C) Publication of notice.--In carrying out the 
                rulemaking process under this paragraph, the Secretary, 
                after consultation with organizations representing 
                cancer patients, health care practitioners, medical 
                researchers, employers, group health plans, 
                manufacturers of drugs, biologics and medical devices, 
                medical economists, hospitals, and other interested 
                parties, shall publish notice provided for under 
                section 564(a) of title 5, United States Code, by not 
                later than 45 days after the date of the enactment of 
                this section.
                    ``(D) Target date for publication of rule.--As part 
                of the notice under subparagraph (C), and for purposes 
                of this paragraph, the `target date for publication' 
                (referred to in section 564(a)(5) of such title 5) 
                shall be June 30, 2000.
                    ``(E) Abbreviated period for submission of 
                comments.--In applying section 564(c) of such title 5 
                under this paragraph, `15 days' shall be substituted 
                for `30 days'.
                    ``(F) Appointment of negotiated rulemaking 
                committee and facilitator.--The Secretary shall provide 
                for--
                            ``(i) the appointment of a negotiated 
                        rulemaking committee under section 565(a) of 
                        such title 5 by not later than 30 days after 
                        the end of the comment period provided for 
                        under section 564(c) of such title 5 (as 
                        shortened under subparagraph (E)), and
                            ``(ii) the nomination of a facilitator 
                        under section 566(c) of such title 5 by not 
                        later than 10 days after the date of 
                        appointment of the committee.
                    ``(G) Preliminary committee report.--The negotiated 
                rulemaking committee appointed under subparagraph (F) 
                shall report to the Secretary, by not later than March 
                29, 2000, regarding the committee's progress on 
                achieving a consensus with regard to the rulemaking 
                proceeding and whether such consensus is likely to 
                occur before 1 month before the target date for 
                publication of the rule. If the committee reports that 
                the committee has failed to make significant progress 
                towards such consensus or is unlikely to reach such 
                consensus by the target date, the Secretary may 
                terminate such process and provide for the publication 
                of a rule under this paragraph through such other 
                methods as the Secretary may provide.
                    ``(H) Final committee report.--If the committee is 
                not terminated under subparagraph (G), the rulemaking 
                committee shall submit a report containing a proposed 
                rule by not later than 1 month before the target date 
                of publication.
                    ``(I) Final effect.--The Secretary shall publish a 
                rule under this paragraph in the Federal Register by 
                not later than the target date of publication.
                    ``(J) Publication of rule after public comment.--
                The Secretary shall provide for consideration of such 
                comments and republication of such rule by not later 
                than 1 year after the target date of publication.
                    ``(K) Effective date.--The provisions of this 
                paragraph shall apply to group health plans (other than 
                a fully insured group health plan) for plan years 
                beginning on or after January 1, 2001.
            ``(3) Payment rate.--In the case of covered items and 
        services provided by--
                    ``(A) a participating provider, the payment rate 
                shall be at the agreed upon rate, or
                    ``(B) a nonparticipating provider, the payment rate 
                shall be at the rate the plan would normally pay for 
                comparable services under subparagraph (A).
    ``(d) Approved Clinical Trial Defined.--
            ``(1) In general.--In this section, the term `approved 
        clinical trial' means a cancer clinical research study or 
        cancer clinical investigation approved and funded (which may 
        include funding through in-kind contributions) by one or more 
        of the following:
                    ``(A) The National Institutes of Health.
                    ``(B) A cooperative group or center of the National 
                Institutes of Health.
                    ``(C) Either of the following if the conditions 
                described in paragraph (2) are met:
                            ``(i) The Department of Veterans Affairs.
                            ``(ii) The Department of Defense.
            ``(2) Conditions for departments.--The conditions described 
        in this paragraph, for a study or investigation conducted by a 
        Department, are that the study or investigation has been 
        reviewed and approved through a system of peer review that the 
        Secretary determines--
                    ``(A) to be comparable to the system of peer review 
                of studies and investigations used by the National 
                Institutes of Health, and
                    ``(B) assures unbiased review of the highest 
                scientific standards by qualified individuals who have 
                no interest in the outcome of the review.
    ``(e) Construction.--Nothing in this section shall be construed to 
limit a plan's coverage with respect to clinical trials.
    ``(f) Plan Satisfaction of Certain Requirements; Responsibilities 
of Fiduciaries.--
            ``(1) In general.--For purposes of this section, insofar as 
        a group health plan provides benefits in the form of health 
        insurance coverage through a health insurance issuer, the plan 
        shall be treated as meeting the requirements of this section 
        with respect to such benefits and not be considered as failing 
        to meet such requirements because of a failure of the issuer to 
        meet such requirements so long as the plan sponsor or its 
        representatives did not cause such failure by the issuer.
            ``(2) Construction.--Nothing in this section shall be 
        construed to affect or modify the responsibilities of the 
        fiduciaries of a group health plan under part 4 of subtitle B 
        of title I of the Employee Retirement Income Security Act of 
        1974.
    ``(g) Study and Report.--
            ``(1) Study.--The Secretary shall study the impact on group 
        health plans for covering routine patient care costs for 
        individuals who are entitled to benefits under this section and 
        who are enrolled in an approved cancer clinical trial program.
            ``(2) Report to congress.--Not later than January 1, 2005, 
        the Secretary shall submit a report to Congress that contains 
        an assessment of--
                    ``(A) any incremental cost to group health plans 
                resulting from the provisions of this section;
                    ``(B) a projection of expenditures to such plans 
                resulting from this section; and
                    ``(C) any impact on premiums resulting from this 
                section.

``SEC. 9830A. PROHIBITING DISCRIMINATION AGAINST PROVIDERS.

    ``(a) In General.--A group health plan (other than a fully insured 
group health plan) shall not discriminate with respect to participation 
or indemnification as to any provider who is acting within the scope of 
the provider's license or certification under applicable State law, 
solely on the basis of such license or certification. This subsection 
shall not be construed as requiring the coverage under a plan of 
particular benefits or services or to prohibit a plan from including 
providers only to the extent necessary to meet the needs of the plan's 
participants and beneficiaries or from establishing any measure 
designed to maintain quality and control costs consistent with the 
responsibilities of the plan.
    ``(b) No Requirement for any Willing Provider.--Nothing in this 
section shall be construed as requiring a group health plan that offers 
network coverage to include for participation every willing provider or 
health professional who meets the terms and conditions of the plan.

``SEC. 9830B. GENERALLY APPLICABLE PROVISION.

    ``In the case of a group health plan that provides benefits under 2 
or more coverage options, the requirements of this subchapter shall 
apply separately with respect to each coverage option.''.
    (b) Definition.--Section 9832(b) of the Internal Revenue Code of 
1986 is amended by adding at the end the following:
            ``(4) Fully insured group health plan.--The term `fully 
        insured group health plan' means a group health plan where 
        benefits under the plan are provided pursuant to the terms of 
        an arrangement between a group health plan and a health 
        insurance issuer and are guaranteed by the health insurance 
        issuer under a contract or policy of insurance.''.
    (c) Conforming Amendment.--Chapter 98 of the Internal Revenue Code 
of 1986 is amended in the table of subchapters in the item relating to 
subchapter C, by striking ``Subchapter C'' and inserting ``Subchapter 
D''.

SEC. 103. EFFECTIVE DATE AND RELATED RULES.

    (a) In General.--The amendments made by this subtitle shall apply 
with respect to plan years beginning on or after January 1 of the 
second calendar year following the date of the enactment of this Act. 
The Secretary shall issue all regulations necessary to carry out the 
amendments made by this section before the effective date thereof.
    (b) Limitation on Enforcement Actions.--No enforcement action shall 
be taken, pursuant to the amendments made by this subtitle, against a 
group health plan with respect to a violation of a requirement imposed 
by such amendments before the date of issuance of regulations issued in 
connection with such requirement, if the plan has sought to comply in 
good faith with such requirement.

       Subtitle B--Right to Information About Plans and Providers

SEC. 111. INFORMATION ABOUT PLANS.

    (a) Employee Retirement Income Security Act of 1974.--
            (1) In general.--Subpart B of part 7 of subtitle B of title 
        I of the Employee Retirement Income Security Act of 1974 (29 
        U.S.C. 1185 et seq.) is amended by adding at the end the 
        following:

``SEC. 714. HEALTH PLAN COMPARATIVE INFORMATION.

    ``(a) Requirement.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer that provides coverage in connection with 
        group health insurance coverage, shall, not later than 12 
        months after the date of enactment of this section, and at 
        least annually thereafter, provide for the disclosure, in a 
        clear and accurate form to each participant and each 
        beneficiary who does not reside at the same address as the 
        participant, or upon request to an individual eligible for 
        coverage under the plan, of the information described in 
        subsection (b).
            ``(2) Rule of construction.--Nothing in this section shall 
        be construed to prevent a plan or issuer from entering into any 
        agreement under which the issuer agrees to assume 
        responsibility for compliance with the requirements of this 
        section and the plan is released from liability for such 
        compliance.
            ``(3) Provision of information.--Information shall be 
        provided to participants and beneficiaries under this section 
        at the address maintained by the plan or issuer with respect to 
        such participants or beneficiaries.
    ``(b) Required Information.--The informational materials to be 
distributed under this section shall include for each package option 
available under a group health plan the following:
            ``(1) A description of the covered items and services under 
        each such plan and any in- and out-of-network features of each 
        such plan, including a summary description of the specific 
        exclusions from coverage under the plan.
            ``(2) A description of any cost-sharing, including 
        premiums, deductibles, coinsurance, and copayment amounts, for 
        which the participant or beneficiary will be responsible, 
        including any annual or lifetime limits on benefits, for each 
        such plan.
            ``(3) A description of any optional supplemental benefits 
        offered by each such plan and the terms and conditions 
        (including premiums or cost-sharing) for such supplemental 
        coverage.
            ``(4) A description of any restrictions on payments for 
        services furnished to a participant or beneficiary by a health 
        care professional that is not a participating professional and 
        the liability of the participant or beneficiary for additional 
        payments for these services.
            ``(5) A description of the service area of each such plan, 
        including the provision of any out-of-area coverage.
            ``(6) A description of the extent to which participants and 
        beneficiaries may select the primary care provider of their 
        choice, including providers both within the network and outside 
        the network of each such plan (if the plan permits out-of-
        network services).
            ``(7) A description of the procedures for advance 
        directives and organ donation decisions if the plan maintains 
        such procedures.
            ``(8) A description of the requirements and procedures to 
        be used to obtain preauthorization for health services 
        (including telephone numbers and mailing addresses), including 
        referrals for specialty care.
            ``(9) A description of the definition of medical necessity 
        used in making coverage determinations by each such plan.
            ``(10) A summary of the rules and methods for appealing 
        coverage decisions and filing grievances (including telephone 
        numbers and mailing addresses), as well as other available 
        remedies.
            ``(11) A summary description of any provisions for 
        obtaining off-formulary medications if the plan utilizes a 
        defined formulary for providing specific prescription 
        medications.
            ``(12) A summary of the rules for access to emergency room 
        care. Also, any available educational material regarding proper 
        use of emergency services.
            ``(13) A description of whether or not coverage is provided 
        for experimental treatments, investigational treatments, or 
        clinical trials and the circumstances under which access to 
        such treatments or trials is made available.
            ``(14) A description of the specific preventative services 
        covered under the plan if such services are covered.
            ``(15) A statement regarding--
                    ``(A) the manner in which a participant or 
                beneficiary may access an obstetrician, gynecologist, 
                or pediatrician in accordance with section 723 or 724; 
                and
                    ``(B) the manner in which a participant or 
                beneficiary obtains continuity of care as provided for 
                in section 726.
            ``(16) A statement that the following information, and 
        instructions on obtaining such information (including telephone 
        numbers and, if available, Internet websites), shall be made 
        available upon request:
                    ``(A) The names, addresses, telephone numbers, and 
                State licensure status of the plan's participating 
                health care professionals and participating health care 
                facilities, and, if available, the education, training, 
                specialty qualifications or certifications of such 
                professionals.
                    ``(B) A summary description of the methods used for 
                compensating participating health care professionals, 
                such as capitation, fee-for-service, salary, or a 
                combination thereof. The requirement of this 
                subparagraph shall not be construed as requiring plans 
                to provide information concerning proprietary payment 
                methodology.
                    ``(C) A summary description of the methods used for 
                compensating health care facilities, including per 
                diem, fee-for-service, capitation, bundled payments, or 
                a combination thereof. The requirement of this 
                subparagraph shall not be construed as requiring plans 
                to provide information concerning proprietary payment 
                methodology.
                    ``(D) A summary description of the procedures used 
                for utilization review.
                    ``(E) The list of the specific prescription 
                medications included in the formulary of the plan, if 
                the plan uses a defined formulary.
                    ``(F) A description of the specific exclusions from 
                coverage under the plan.
                    ``(G) Any available information related to the 
                availability of translation or interpretation services 
                for non-English speakers and people with communication 
                disabilities, including the availability of audio tapes 
                or information in Braille.
                    ``(H) Any information that is made public by 
                accrediting organizations in the process of 
                accreditation if the plan is accredited, or any 
                additional quality indicators that the plan makes 
                available.
    ``(c) Manner of Distribution.--The information described in this 
section shall be distributed in an accessible format that is 
understandable to an average plan participant or beneficiary.
    ``(d) Rule of Construction.--Nothing in this section may be 
construed to prohibit a group health plan, or health insurance issuer 
in connection with group health insurance coverage, from distributing 
any other additional information determined by the plan or issuer to be 
important or necessary in assisting participants and beneficiaries or 
upon request potential participants and beneficiaries in the selection 
of a health plan or from providing information under subsection (b)(15) 
as part of the required information.
    ``(e) Conforming Regulations.--The Secretary shall issue 
regulations to coordinate the requirements on group health plans and 
health insurance issuers under this section with the requirements 
imposed under part 1, to reduce duplication with respect to any 
information that is required to be provided under any such 
requirements.
    ``(f) Health Care Professional.--In this section, the term `health 
care professional' means a physician (as defined in section 1861(r) of 
the Social Security Act) or other health care professional if coverage 
for the professional's services is provided under the health plan 
involved for the services of the professional. Such term includes a 
podiatrist, optometrist, chiropractor, psychologist, dentist, physician 
assistant, physical or occupational therapist and therapy assistant, 
speech-language pathologist, audiologist, registered or licensed 
practical nurse (including nurse practitioner, clinical nurse 
specialist, certified registered nurse anesthetist, and certified 
nurse-midwife), licensed certified social worker, registered 
respiratory therapist, and certified respiratory therapy technician.''.
            (2) Conforming amendments.--
                    (A) Section 732(a) of the Employee Retirement 
                Income Security Act of 1974 (29 U.S.C. 1191a(a)) is 
                amended by striking ``section 711, and inserting 
                ``sections 711 and 714''.
                    (B) The table of contents in section 1 of the 
                Employee Retirement Income Security Act of 1974 (29 
                U.S.C. 1001) is amended by inserting after the item 
                relating to section 713, the following:

        ``Sec. 714. Health plan comparative information.''.
    (b) Internal Revenue Code of 1986.--Subchapter B of chapter 100 of 
the Internal Revenue Code of 1986 is amended--
            (1) in the table of sections, by inserting after the item 
        relating to section 9812 the following new item:

``Sec. 9813. Health plan comparative information.'';
        and
            (2) by inserting after section 9812 the following:

``SEC. 9813. HEALTH PLAN COMPARATIVE INFORMATION.

    ``(a) Requirement.--
            ``(1) In general.--A group health plan shall, not later 
        than 12 months after the date of enactment of this section, and 
        at least annually thereafter, provide for the disclosure, in a 
        clear and accurate form to each participant and each 
        beneficiary who does not reside at the same address as the 
        participant, or upon request to an individual eligible for 
        coverage under the plan, of the information described in 
        subsection (b).
            ``(2) Rules of construction.--Nothing in this section shall 
        be construed to prevent a plan from entering into any agreement 
        under which a health insurance issuer agrees to assume 
        responsibility for compliance with the requirements of this 
        section and the plan is released from liability for such 
        compliance.
            ``(3) Provision of information.--Information shall be 
        provided to participants and beneficiaries under this section 
        at the address maintained by the plan with respect to such 
        participants or beneficiaries.
    ``(b) Required Information.--The informational materials to be 
distributed under this section shall include for each package option 
available under a group health plan the following:
            ``(1) A description of the covered items and services under 
        each such plan and any in- and out-of-network features of each 
        such plan, including a summary description of the specific 
        exclusions from coverage under the plan.
            ``(2) A description of any cost-sharing, including 
        premiums, deductibles, coinsurance, and copayment amounts, for 
        which the participant or beneficiary will be responsible, 
        including any annual or lifetime limits on benefits, for each 
        such plan.
            ``(3) A description of any optional supplemental benefits 
        offered by each such plan and the terms and conditions 
        (including premiums or cost-sharing) for such supplemental 
        coverage.
            ``(4) A description of any restrictions on payments for 
        services furnished to a participant or beneficiary by a health 
        care professional that is not a participating professional and 
        the liability of the participant or beneficiary for additional 
        payments for these services.
            ``(5) A description of the service area of each such plan, 
        including the provision of any out-of-area coverage.
            ``(6) A description of the extent to which participants and 
        beneficiaries may select the primary care provider of their 
        choice, including providers both within the network and outside 
        the network of each such plan (if the plan permits out-of-
        network services).
            ``(7) A description of the procedures for advance 
        directives and organ donation decisions if the plan maintains 
        such procedures.
            ``(8) A description of the requirements and procedures to 
        be used to obtain preauthorization for health services 
        (including telephone numbers and mailing addresses), including 
        referrals for specialty care.
            ``(9) A description of the definition of medical necessity 
        used in making coverage determinations by each such plan.
            ``(10) A summary of the rules and methods for appealing 
        coverage decisions and filing grievances (including telephone 
        numbers and mailing addresses), as well as other available 
        remedies.
            ``(11) A summary description of any provisions for 
        obtaining off-formulary medications if the plan utilizes a 
        defined formulary for providing specific prescription 
        medications.
            ``(12) A summary of the rules for access to emergency room 
        care. Also, any available educational material regarding proper 
        use of emergency services.
            ``(13) A description of whether or not coverage is provided 
        for experimental treatments, investigational treatments, or 
        clinical trials and the circumstances under which access to 
        such treatments or trials is made available.
            ``(14) A description of the specific preventative services 
        covered under the plan if such services are covered.
            ``(15) A statement regarding--
                    ``(A) the manner in which a participant or 
                beneficiary may access an obstetrician, gynecologist, 
                or pediatrician in accordance with section 723 or 724; 
                and
                    ``(B) the manner in which a participant or 
                beneficiary obtains continuity of care as provided for 
                in section 726.
            ``(16) A statement that the following information, and 
        instructions on obtaining such information (including telephone 
        numbers and, if available, Internet websites), shall be made 
        available upon request:
                    ``(A) The names, addresses, telephone numbers, and 
                State licensure status of the plan's participating 
                health care professionals and participating health care 
                facilities, and, if available, the education, training, 
                specialty qualifications or certifications of such 
                professionals.
                    ``(B) A summary description of the methods used for 
                compensating participating health care professionals, 
                such as capitation, fee-for-service, salary, or a 
                combination thereof. The requirement of this 
                subparagraph shall not be construed as requiring plans 
                to provide information concerning proprietary payment 
                methodology.
                    ``(C) A summary description of the methods used for 
                compensating health care facilities, including per 
                diem, fee-for-service, capitation, bundled payments, or 
                a combination thereof. The requirement of this 
                subparagraph shall not be construed as requiring plans 
                to provide information concerning proprietary payment 
                methodology.
                    ``(D) A summary description of the procedures used 
                for utilization review.
                    ``(E) The list of the specific prescription 
                medications included in the formulary of the plan, if 
                the plan uses a defined formulary.
                    ``(F) A description of the specific exclusions from 
                coverage under the plan.
                    ``(G) Any available information related to the 
                availability of translation or interpretation services 
                for non-English speakers and people with communication 
                disabilities, including the availability of audio tapes 
                or information in Braille.
                    ``(H) Any information that is made public by 
                accrediting organizations in the process of 
                accreditation if the plan is accredited, or any 
                additional quality indicators that the plan makes 
                available.
    ``(c) Manner of Distribution.--The information described in this 
section shall be distributed in an accessible format that is 
understandable to an average plan participant or beneficiary.
    ``(d) Rule of Construction.--Nothing in this section may be 
construed to prohibit a group health plan from distributing any other 
additional information determined by the plan to be important or 
necessary in assisting participants and beneficiaries or upon request 
potential participants and beneficiaries in the selection of a health 
plan or from providing information under subsection (b)(15) as part of 
the required information.
    ``(e) Health Care Professional.--In this section, the term `health 
care professional' means a physician (as defined in section 1861(r) of 
the Social Security Act) or other health care professional if coverage 
for the professional's services is provided under the health plan 
involved for the services of the professional. Such term includes a 
podiatrist, optometrist, chiropractor, psychologist, dentist, physician 
assistant, physical or occupational therapist and therapy assistant, 
speech-language pathologist, audiologist, registered or licensed 
practical nurse (including nurse practitioner, clinical nurse 
specialist, certified registered nurse anesthetist, and certified 
nurse-midwife), licensed certified social worker, registered 
respiratory therapist, and certified respiratory therapy technician.''.

SEC. 112. INFORMATION ABOUT PROVIDERS.

    (a) Study.--The Secretary of Health and Human Services shall enter 
into a contract with the Institute of Medicine for the conduct of a 
study, and the submission to the Secretary of a report, that includes--
            (1) an analysis of information concerning health care 
        professionals that is currently available to patients, 
        consumers, States, and professional societies, nationally and 
        on a State-by-State basis, including patient preferences with 
        respect to information about such professionals and their 
        competencies;
            (2) an evaluation of the legal and other barriers to the 
        sharing of information concerning health care professionals; 
        and
            (3) recommendations for the disclosure of information on 
        health care professionals, including the competencies and 
        professional qualifications of such practitioners, to better 
        facilitate patient choice, quality improvement, and market 
        competition.
    (b) Report.--Not later than 18 months after the date of enactment 
of this Act, the Secretary of Health and Human Services shall forward 
to the appropriate committees of Congress a copy of the report and 
study conducted under subsection (a).

           Subtitle C--Right to Hold Health Plans Accountable

SEC. 121. AMENDMENT TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.

    (a) In General.--Section 503 of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1133) is amended to read as follows:

``SEC. 503. CLAIMS PROCEDURE, COVERAGE DETERMINATION, GRIEVANCES AND 
              APPEALS.

    ``(a) Claims Procedure.--In accordance with regulations of the 
Secretary, every employee benefit plan shall--
            ``(1) provide adequate notice in writing to any participant 
        or beneficiary whose claim for benefits under the plan has been 
        denied, setting forth the specific reasons for such denial, 
        written in a manner calculated to be understood by the 
        participant; and
            ``(2) afford a reasonable opportunity to any participant 
        whose claim for benefits has been denied for a full and fair 
        review by the appropriate named fiduciary of the decision 
        denying the claim.
    ``(b) Coverage Determinations Under Group Health Plans.--
            ``(1) Procedures.--
                    ``(A) In general.--A group health plan or health 
                insurance issuer conducting utilization review shall 
                ensure that procedures are in place for--
                            ``(i) making determinations regarding 
                        whether a participant or beneficiary is 
                        eligible to receive a payment or coverage for 
                        health services under the plan or coverage 
                        involved and any cost-sharing amount that the 
                        participant or beneficiary is required to pay 
                        with respect to such service;
                            ``(ii) notifying a covered participant or 
                        beneficiary (or the authorized representative 
                        of such participant or beneficiary) and the 
                        treating health care professionals involved 
                        regarding determinations made under the plan or 
                        issuer and any additional payments that the 
                        participant or beneficiary may be required to 
                        make with respect to such service; and
                            ``(iii) responding to requests, either 
                        written or oral, for coverage determinations or 
                        for internal appeals from a participant or 
                        beneficiary (or the authorized representative 
                        of such participant or beneficiary) or the 
                        treating health care professional with the 
                        consent of the participant or beneficiary.
                    ``(B) Oral requests.--With respect to an oral 
                request described in subparagraph (A)(iii), a group 
                health plan or health insurance issuer may require that 
                the requesting individual provide written evidence of 
                such request.
            ``(2) Timeline for making determinations.--
                    ``(A) Routine determination.--A group health plan 
                or a health insurance issuer shall maintain procedures 
                to ensure that prior authorization determinations 
                concerning the provision of non-emergency items or 
                services are made within 30 days from the date on which 
                the request for a determination is submitted, except 
                that such period may be extended where certain 
                circumstances exist that are determined by the 
                Secretary to be beyond control of the plan or issuer.
                    ``(B) Expedited determination.--
                            ``(i) In general.--A prior authorization 
                        determination under this subsection shall be 
                        made within 72 hours, in accordance with the 
                        medical exigencies of the case, after a request 
                        is received by the plan or issuer under clause 
                        (ii) or (iii).
                            ``(ii) Request by participant or 
                        beneficiary.--A plan or issuer shall maintain 
                        procedures for expediting a prior authorization 
                        determination under this subsection upon the 
                        request of a participant or beneficiary if, 
                        based on such a request, the plan or issuer 
                        determines that the normal time for making such 
                        a determination could seriously jeopardize the 
                        life or health of the participant or 
                        beneficiary.
                            ``(iii) Documentation by health care 
                        professional.--A plan or issuer shall maintain 
                        procedures for expediting a prior authorization 
                        determination under this subsection if the 
                        request involved indicates that the treating 
                        health care professional has reasonably 
                        documented, based on the medical exigencies, 
                        that a determination under the procedures 
                        described in subparagraph (A) could seriously 
                        jeopardize the life or health of the 
                        participant or beneficiary.
                    ``(C) Concurrent determinations.--A plan or issuer 
                shall maintain procedures to certify or deny coverage 
                of an extended stay or additional services.
                    ``(D) Retrospective determination.--A plan or 
                issuer shall maintain procedures to ensure that, with 
                respect to the retrospective review of a determination 
                made under paragraph (1), the determination shall be 
                made within 30 working days of the date on which the 
                plan or issuer receives necessary information.
            ``(3) Notice of determinations.--
                    ``(A) Routine determination.--With respect to a 
                coverage determination of a plan or issuer under 
                paragraph (2)(A), the plan or issuer shall issue notice 
                of such determination to the participant or beneficiary 
                (or the authorized representative of the participant or 
                beneficiary) and, consistent with the medical 
                exigencies of the case, to the treating health care 
                professional involved not later than 2 working days 
                after the date on which the determination is made.
                    ``(B) Expedited determination.--With respect to a 
                coverage determination of a plan or issuer under 
                paragraph (2)(B), the plan or issuer shall issue notice 
                of such determination to the participant or beneficiary 
                (or the authorized representative of the participant or 
                beneficiary), and consistent with the medical 
                exigencies of the case, to the treating health care 
                professional involved within the 72 hour period 
                described in paragraph (2)(B).
                    ``(C) Concurrent reviews.--With respect to the 
                determination under a plan or issuer under paragraph 
                (2)(C) to certify or deny coverage of an extended stay 
                or additional services, the plan or issuer shall issue 
                notice of such determination to the treating health 
                care professional and to the participant or beneficiary 
                involved (or the authorized representative of the 
                participant or beneficiary) within 1 working day of the 
                determination.
                    ``(D) Retrospective reviews.--With respect to the 
                retrospective review under a plan or issuer of a 
                determination made under paragraph (2)(D), the plan or 
                issuer shall issue written notice of an approval or 
                disapproval of a determination under this subparagraph 
                to the participant or beneficiary (or the authorized 
                representative of the participant or beneficiary) and 
                health care provider involved within 5 working days of 
                the date on which such determination is made.
                    ``(E) Requirements of notice of adverse coverage 
                determinations.--A written notice of an adverse 
                coverage determination under this subsection, or of an 
                expedited adverse coverage determination under 
                paragraph (2)(B), shall be provided to the participant 
                or beneficiary (or the authorized representative of the 
                participant or beneficiary) and treating health care 
                professional (if any) involved and shall include--
                            ``(i) the reasons for the determination 
                        (including the clinical or scientific-evidence 
                        based rationale used in making the 
                        determination) written in a manner to be 
                        understandable to the average participant or 
                        beneficiary;
                            ``(ii) the procedures for obtaining 
                        additional information concerning the 
                        determination; and
                            ``(iii) notification of the right to appeal 
                        the determination and instructions on how to 
                        initiate an appeal in accordance with 
                        subsection (d).
    ``(c) Grievances.--A group health plan or a health insurance issuer 
shall have written procedures for addressing grievances between the 
plan or issuer offering health insurance coverage in connection with a 
group health plan and a participant or beneficiary. Determinations 
under such procedures shall be non-appealable.
    ``(d) Internal Appeal of Coverage Determinations.--
            ``(1) Right to appeal.--
                    ``(A) In general.--A participant or beneficiary (or 
                the authorized representative of the participant or 
                beneficiary) or the treating health care professional 
                with the consent of the participant or beneficiary (or 
                the authorized representative of the participant or 
                beneficiary), may appeal any adverse coverage 
                determination under subsection (b) under the procedures 
                described in this subsection.
                    ``(B) Time for appeal.--A plan or issuer shall 
                ensure that a participant or beneficiary has a period 
                of not less than 180 days beginning on the date of an 
                adverse coverage determination under subsection (b) in 
                which to appeal such determination under this 
                subsection.
                    ``(C) Failure to act.--The failure of a plan or 
                issuer to issue a determination under subsection (b) 
                within the applicable timeline established for such a 
                determination under such subsection shall be treated as 
                an adverse coverage determination for purposes of 
                proceeding to internal review under this subsection.
            ``(2) Records.--A group health plan and a health insurance 
        issuer shall maintain written records, for at least 6 years, 
        with respect to any appeal under this subsection for purposes 
        of internal quality assurance and improvement. Nothing in the 
        preceding sentence shall be construed as preventing a plan and 
        issuer from entering into an agreement under which the issuer 
        agrees to assume responsibility for compliance with the 
        requirements of this section and the plan is released from 
        liability for such compliance.
            ``(3) Routine determinations.--A group health plan or a 
        health insurance issuer shall complete the consideration of an 
        appeal of an adverse routine determination under this 
        subsection not later than 30 working days after the date on 
        which a request for such appeal is received.
            ``(4) Expedited determination.--
                    ``(A) In general.--An expedited determination with 
                respect to an appeal under this subsection shall be 
                made in accordance with the medical exigencies of the 
                case, but in no case more than 72 hours after the 
                request for such appeal is received by the plan or 
                issuer under subparagraph (B) or (C).
                    ``(B) Request by participant or beneficiary.--A 
                plan or issuer shall maintain procedures for expediting 
                a prior authorization determination under this 
                subsection upon the request of a participant or 
                beneficiary if, based on such a request, the plan or 
                issuer determines that the normal time for making such 
                a determination could seriously jeopardize the life or 
                health of the participant or beneficiary.
                    ``(C) Documentation by health care professional.--A 
                plan or issuer shall maintain procedures for expediting 
                a prior authorization determination under this 
                subsection if the request involved indicates that the 
                treating health care professional has reasonably 
                documented, based on the medical exigencies of the case 
                that a determination under the procedures described in 
                paragraph (2) could seriously jeopardize the life or 
                health of the participant or beneficiary.
            ``(5) Conduct of review.--A review of an adverse coverage 
        determination under this subsection shall be conducted by an 
        individual with appropriate expertise who was not directly 
        involved in the initial determination.
            ``(6) Lack of medical necessity.--A review of an appeal 
        under this subsection relating to a determination to deny 
        coverage based on a lack of medical necessity and 
        appropriateness, or based on an experimental or investigational 
        treatment, shall be made only by a physician with appropriate 
        expertise, including age-appropriate expertise, who was not 
        involved in the initial determination.
            ``(7) Notice.--
                    ``(A) In general.--Written notice of a 
                determination made under an internal review process 
                shall be issued to the participant or beneficiary (or 
                the authorized representative of the participant or 
                beneficiary) and the treating health care professional 
                not later than 2 working days after the completion of 
                the review (or within the 72-hour period referred to in 
                paragraph (4) if applicable).
                    ``(B) Adverse coverage determinations.--With 
                respect to an adverse coverage determination made under 
                this subsection, the notice described in subparagraph 
                (A) shall include--
                            ``(i) the reasons for the determination 
                        (including the clinical or scientific-evidence 
                        based rationale used in making the 
                        determination) written in a manner to be 
                        understandable to the average participant or 
                        beneficiary;
                            ``(ii) the procedures for obtaining 
                        additional information concerning the 
                        determination; and
                            ``(iii) notification of the right to an 
                        independent external review under subsection 
                        (e) and instructions on how to initiate such a 
                        review.
    ``(e) Independent External Review.--
            ``(1) Access to review.--
                    ``(A) In general.--A group health plan or a health 
                insurance issuer offering health insurance coverage in 
                connection with a group health plan shall have written 
                procedures to permit a participant or beneficiary (or 
                the authorized representative of the participant or 
                beneficiary) access to an independent external review 
                with respect to an adverse coverage determination 
                concerning a particular item or service (including a 
                circumstance treated as an adverse coverage 
                determination under subparagraph (B)) where--
                            ``(i) the particular item or service 
                        involved--
                                    ``(I)(aa) would be a covered 
                                benefit, when medically necessary and 
                                appropriate under the terms and 
                                conditions of the plan, and the item or 
                                service has been determined not to be 
                                medically necessary and appropriate 
                                under the internal appeals process 
                                required under subsection (d) or there 
                                has been a failure to issue a coverage 
                                determination as described in 
                                subparagraph (B); and
                                    ``(bb)(AA) the amount of such item 
                                or service involved exceeds a 
                                significant financial threshold; or
                                    ``(BB) there is a significant risk 
                                of placing the life or health of the 
                                participant or beneficiary in jeopardy; 
                                or
                                    ``(II) would be a covered benefit, 
                                when not considered experimental or 
                                investigational under the terms and 
                                conditions of the plan, and the item or 
                                service has been determined to be 
                                experimental or investigational under 
                                the internal appeals process required 
                                under subsection (d) or there has been 
                                a failure to issue a coverage 
                                determination as described in 
                                subparagraph (B); and
                            ``(ii) the participant or beneficiary has 
                        completed the internal appeals process under 
                        subsection (d) with respect to such 
                        determination.
                    ``(B) Failure to act.--The failure of a plan or 
                issuer to issue a coverage determination under 
                subsection (d)(6) within the applicable timeline 
                established for such a determination under such 
                subsection shall be treated as an adverse coverage 
                determination for purposes of proceeding to independent 
                external review under this subsection.
            ``(2) Initiation of the independent external review 
        process.--
                    ``(A) Filing of request.--A participant or 
                beneficiary (or the authorized representative of the 
                participant or beneficiary) who desires to have an 
                independent external review conducted under this 
                subsection shall file a written request for such a 
                review with the plan or issuer involved not later than 
                30 working days after the receipt of a final denial of 
                a claim under subsection (d). Any such request shall 
                include the consent of the participant or beneficiary 
                (or the authorized representative of the participant or 
                beneficiary) for the release of medical information and 
                records to independent external reviewers regarding the 
                participant or beneficiary.
                    ``(B) Timeframe for selection of appeals entity.--
                Not later than 5 working days after the receipt of a 
                request under subparagraph (A), or earlier in 
                accordance with the medical exigencies of the case, the 
                plan or issuer involved shall--
                            ``(i) select an external appeals entity 
                        under paragraph (3)(A) that shall be 
                        responsible for designating an independent 
                        external reviewer under paragraph (3)(B); and
                            ``(ii) provide notice of such selection to 
                        the participant or beneficiary (which shall 
                        include the name and address of the entity).
                    ``(C) Provision of information.--Not later than 5 
                working days after the plan or issuer provides the 
                notice required under subparagraph (B)(ii), or earlier 
                in accordance with the medical exigencies of the case, 
                the plan, issuer, participant, beneficiary or physician 
                (of the participant or beneficiary) involved shall 
                forward necessary information (including, only in the 
                case of a plan or issuer, medical records, any relevant 
                review criteria, the clinical rationale consistent with 
                the terms and conditions of the contract between the 
                plan or issuer and the participant or beneficiary for 
                the coverage denial, and evidence of the coverage of 
                the participant or beneficiary) to the qualified 
                external appeals entity designated under paragraph 
                (3)(A).
                    ``(D) Follow-up written notification.--The plan or 
                issuer involved shall send a follow-up written 
                notification, in a timely manner, to the participant or 
                beneficiary (or the authorized representative of the 
                participant or beneficiary) and the plan administrator, 
                indicating that an independent external review has been 
                initiated.
            ``(3) Conduct of independent external review.--
                    ``(A) Designation of external appeals entity by 
                plan or issuer.--
                            ``(i) In general.--A plan or issuer that 
                        receives a request for an independent external 
                        review under paragraph (2)(A) shall designate a 
                        qualified entity described in clause (ii), in a 
                        manner designed to ensure that the entity so 
                        designated will make a decision in an unbiased 
                        manner, to serve as the external appeals 
                        entity.
                            ``(ii) Qualified entities.--A qualified 
                        entity shall be--
                                    ``(I) an independent external 
                                review entity licensed or credentialed 
                                by a State;
                                    ``(II) a State agency established 
                                for the purpose of conducting 
                                independent external reviews;
                                    ``(III) any entity under contract 
                                with the Federal Government to provide 
                                independent external review services;
                                    ``(IV) any entity accredited as an 
                                independent external review entity by 
                                an accrediting body recognized by the 
                                Secretary for such purpose; or
                                    ``(V) any other entity meeting 
                                criteria established by the Secretary 
                                for purposes of this subparagraph.
                    ``(B) Designation of independent external reviewer 
                by external appeals entity.--The external appeals 
                entity designated under subparagraph (A) shall, not 
                later than 30 days after the date on which such entity 
                is designated under subparagraph (A), or earlier in 
                accordance with the medical exigencies of the case, 
                designate one or more individuals to serve as 
                independent external reviewers with respect to a 
                request received under paragraph (2)(A). Such reviewers 
                shall be independent medical experts who shall--
                            ``(i) be appropriately credentialed or 
                        licensed in any State to deliver health care 
                        services;
                            ``(ii) not have any material, professional, 
                        familial, or financial affiliation with the 
                        case under review, the participant or 
                        beneficiary involved, the treating health care 
                        professional, the institution where the 
                        treatment would take place, or the manufacturer 
                        of any drug, device, procedure, or other 
                        therapy proposed for the participant or 
                        beneficiary whose treatment is under review;
                            ``(iii) have expertise (including age-
                        appropriate expertise) in the diagnosis or 
                        treatment under review and be a physician of 
                        the same specialty, when reasonably available, 
                        as the physician treating the participant or 
                        beneficiary or recommending or prescribing the 
                        treatment in question;
                            ``(iv) receive only reasonable and 
                        customary compensation from the group health 
                        plan or health insurance issuer in connection 
                        with the independent external review that is 
                        not contingent on the decision rendered by the 
                        reviewer; and
                            ``(v) not be held liable for decisions 
                        regarding medical determinations (but may be 
                        held liable for actions that are arbitrary and 
                        capricious).
            ``(4) Standard of review.--
                    ``(A) In general.--An independent external reviewer 
                shall--
                            ``(i) make an independent determination 
                        based on the valid, relevant, scientific and 
                        clinical evidence to determine the medical 
                        necessity, appropriateness, experimental or 
                        investigational nature of the proposed 
                        treatment; and
                            ``(ii) take into consideration appropriate 
                        and available information, including any 
                        evidence-based decision making or clinical 
                        practice guidelines used by the group health 
                        plan or health insurance issuer; timely 
                        evidence or information submitted by the plan, 
                        issuer, patient or patient's physician; the 
                        patient's medical record; expert consensus 
                        including both generally accepted medical 
                        practice and recognized best practice; medical 
                        literature as defined in section 556(5) of the 
                        Federal Food, Drug, and Cosmetic Act; the 
                        following standard reference compendia: The 
                        American Hospital Formulary Service-Drug 
                        Information, the American Dental Association 
                        Accepted Dental Therapeutics, and the United 
                        States Pharmacopoeia-Drug Information; and 
                        findings, studies, or research conducted by or 
                        under the auspices of Federal Government 
                        agencies and nationally recognized Federal 
                        research institutes including the Agency for 
                        Healthcare Research and Quality, National 
                        Institutes of Health, National Academy of 
                        Sciences, Health Care Financing Administration, 
                        and any national board recognized by the 
                        National Institutes of Health for the purposes 
                        of evaluating the medical value of health 
                        services.
                    ``(B) Notice.--The plan or issuer involved shall 
                ensure that the participant or beneficiary receives 
                notice, within 30 days after the determination of the 
                independent medical expert, regarding the actions of 
                the plan or issuer with respect to the determination of 
                such expert under the independent external review.
            ``(5) Timeframe for review.--
                    ``(A) In general.--The independent external 
                reviewer shall complete a review of an adverse coverage 
                determination in accordance with the medical exigencies 
                of the case.
                    ``(B) Expedited review.--Notwithstanding 
                subparagraph (A), a review described in such 
                subparagraph shall be completed not later than 72 hours 
                after the later of--
                            ``(i) the date on which such reviewer is 
                        designated; or
                            ``(ii) the date on which all information 
                        necessary to completing such review is 
                        received;
                if the completion of such review in a period of time in 
                excess of 72 hours would seriously jeopardize the life 
                or health of the participant or beneficiary.
                    ``(C) Limitation.--Notwithstanding subparagraph 
                (A), and except as provided in subparagraph (B), a 
                review described in subparagraph (A) shall be completed 
                not later than 30 working days after the later of--
                            ``(i) the date on which such reviewer is 
                        designated; or
                            ``(ii) the date on which all information 
                        necessary to completing such review is 
                        received.
            ``(6) Binding determination and access to care.--
                    ``(A) In general.--The determination of an 
                independent external reviewer under this subsection 
                shall be binding upon the plan or issuer if the 
                provisions of this subsection or the procedures 
                implemented under such provisions were complied with by 
                the independent external reviewer.
                    ``(B) Timetable for commencement of care.--Where an 
                independent external reviewer determines that the 
                participant or beneficiary is entitled to coverage of 
                the items or services that were the subject of the 
                review, the reviewer shall establish a timeframe, in 
                accordance with the medical exigencies of the case, 
                during which the plan or issuer shall comply with the 
                decision of the reviewer with respect to the coverage 
                of such items or services under the terms and 
                conditions of the plan.
                    ``(C) Failure to comply.--If a plan or issuer fails 
                to comply with the timeframe established under 
                subparagraph (B) with respect to a participant or 
                beneficiary, where such failure to comply is caused by 
                the plan or issuer, the participant or beneficiary may 
                obtain the items or services involved (in a manner 
                consistent with the determination of the independent 
                external reviewer) from any provider regardless of 
                whether such provider is a participating provider under 
                the plan or coverage.
                    ``(D) Reimbursement.--
                            ``(i) In general.--Where a participant or 
                        beneficiary obtains items or services in 
                        accordance with subparagraph (C), the plan or 
                        issuer involved shall provide for reimbursement 
                        of the costs of such items of services. Such 
                        reimbursement shall be made to the treating 
                        provider or to the participant or beneficiary 
                        (in the case of a participant or beneficiary 
                        who pays for the costs of such items or 
                        services).
                            ``(ii) Amount.--The plan or issuer shall 
                        fully reimburse a provider, participant or 
                        beneficiary under clause (i) for the total 
                        costs of the items or services provided 
                        (regardless of any plan limitations that may 
                        apply to the coverage of such items of 
                        services) so long as--
                                    ``(I) the items or services would 
                                have been covered under the terms of 
                                the plan or coverage if provided by the 
                                plan or issuer; and
                                    ``(II) the items or services were 
                                provided in a manner consistent with 
                                the determination of the independent 
                                external reviewer.
                    ``(E) Failure to reimburse.--Where a plan or issuer 
                fails to provide reimbursement to a provider, 
                participant or beneficiary in accordance with this 
                paragraph, the provider, participant or beneficiary may 
                commence a civil action (or utilize other remedies 
                available under law) to recover only the amount of any 
                such reimbursement that is unpaid and any necessary 
                legal costs or expenses (including attorneys' fees) 
                incurred in recovering such reimbursement.
            ``(7) Study.--Not later than 2 years after the date of 
        enactment of this section, the General Accounting Office shall 
        conduct a study of a statistically appropriate sample of 
        completed independent external reviews. Such study shall 
        include an assessment of the process involved during an 
        independent external review and the basis of decisionmaking by 
        the independent external reviewer. The results of such study 
        shall be submitted to the appropriate committees of Congress.
            ``(8) Effect on certain provisions.--Nothing in this 
        section shall be construed as affecting or modifying section 
        514 of this Act with respect to a group health plan.
    ``(f) Rule of Construction.--Nothing in this section shall be 
construed to prohibit a plan administrator or plan fiduciary or health 
plan medical director from requesting an independent external review by 
an independent external reviewer without first completing the internal 
review process.
    ``(g) Definitions.--In this section:
            ``(1) Adverse coverage determination.--The term `adverse 
        coverage determination' means a coverage determination under 
        the plan which results in a denial of coverage or 
        reimbursement.
            ``(2) Coverage determination.--The term `coverage 
        determination' means with respect to items and services for 
        which coverage may be provided under a health plan, a 
        determination of whether or not such items and services are 
        covered or reimbursable under the coverage and terms of the 
        contract.
            ``(3) Grievance.--The term `grievance' means any complaint 
        made by a participant or beneficiary that does not involve a 
        coverage determination.
            ``(4) Group health plan.--The term `group health plan' 
        shall have the meaning given such term in section 733(a). In 
        applying this paragraph, excepted benefits described in section 
        733(c) shall not be treated as benefits consisting of medical 
        care.
            ``(5) Health insurance coverage.--The term `health 
        insurance coverage' has the meaning given such term in section 
        733(b)(1). In applying this paragraph, excepted benefits 
        described in section 733(c) shall not be treated as benefits 
        consisting of medical care.
            ``(6) Health insurance issuer.--The term `health insurance 
        issuer' has the meaning given such term in section 733(b)(2).
            ``(7) Prior authorization determination.--The term `prior 
        authorization determination' means a coverage determination 
        prior to the provision of the items and services as a condition 
        of coverage of the items and services under the coverage.
            ``(8) Treating health care professional.--The term 
        `treating health care professional' with respect to a group 
        health plan, health insurance issuer or provider sponsored 
        organization means a physician (medical doctor or doctor of 
        osteopathy) or other health care practitioner who is acting 
        within the scope of his or her State licensure or certification 
        for the delivery of health care services and who is primarily 
        responsible for delivering those services to the participant or 
        beneficiary.
            ``(9) Utilization review.--The term `utilization review' 
        with respect to a group health plan or health insurance 
        coverage means a set of formal techniques designed to monitor 
        the use of, or evaluate the clinical necessity, 
        appropriateness, efficacy, or efficiency of, health care 
        services, procedures, or settings. Techniques may include 
        ambulatory review, prospective review, second opinion, 
        certification, concurrent review, case management, discharge 
        planning or retrospective review.''.
    (b) Enforcement.--Section 502(c) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1132(c)) is amended by adding at the 
end the following:
    ``(8) The Secretary may assess a civil penalty against any plan of 
up to $10,000 for the plan's failure or refusal to comply with any 
timeline applicable under section 503(e) or any determination under 
such section, except that in any case in which treatment was not 
commenced by the plan in accordance with the determination of an 
independent external reviewer, the Secretary shall assess a civil 
penalty of $10,000 against the plan and the plan shall pay such penalty 
to the participant or beneficiary involved.''.
    (c) Conforming Amendment.--The table of contents in section 1 of 
the Employee Retirement Income Security Act of 1974 is amended by 
striking the item relating to section 503 and inserting the following 
new item:

``Sec. 503. Claims procedures, coverage determination, grievances and 
                            appeals.''.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after 1 year after the 
date of enactment of this Act. The Secretary shall issue all 
regulations necessary to carry out the amendments made by this section 
before the effective date thereof.

               TITLE II--WOMEN'S HEALTH AND CANCER RIGHTS

SEC. 201. WOMEN'S HEALTH AND CANCER RIGHTS.

    (a) Short Title.--This section may be cited as the ``Women's Health 
and Cancer Rights Act of 1999''.
    (b) Findings.--Congress finds that--
            (1) the offering and operation of health plans affect 
        commerce among the States;
            (2) health care providers located in a State serve patients 
        who reside in the State and patients who reside in other 
        States; and
            (3) in order to provide for uniform treatment of health 
        care providers and patients among the States, it is necessary 
        to cover health plans operating in 1 State as well as health 
        plans operating among the several States.
    (c) Amendments to ERISA.--
            (1) In general.--Subpart B of part 7 of subtitle B of title 
        I of the Employee Retirement Income Security Act of 1974, as 
        amended by section 111(a), is further amended by adding at the 
        end the following:

``SEC. 715. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR 
              MASTECTOMIES AND LYMPH NODE DISSECTIONS FOR THE TREATMENT 
              OF BREAST CANCER AND COVERAGE FOR SECONDARY 
              CONSULTATIONS.

    ``(a) Inpatient Care.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer providing health insurance coverage in 
        connection with a group health plan, that provides medical and 
        surgical benefits shall ensure that inpatient coverage with 
        respect to the treatment of breast cancer is provided for a 
        period of time as is determined by the attending physician, in 
        consultation with the patient, to be medically necessary and 
        appropriate following--
                    ``(A) a mastectomy;
                    ``(B) a lumpectomy; or
                    ``(C) a lymph node dissection for the treatment of 
                breast cancer.
            ``(2) Exception.--Nothing in this section shall be 
        construed as requiring the provision of inpatient coverage if 
        the attending physician and patient determine that a shorter 
        period of hospital stay is medically appropriate.
    ``(b) Prohibition on Certain Modifications.--In implementing the 
requirements of this section, a group health plan, and a health 
insurance issuer providing health insurance coverage in connection with 
a group health plan, may not modify the terms and conditions of 
coverage based on the determination by a participant or beneficiary to 
request less than the minimum coverage required under subsection (a).
    ``(c) Notice.--A group health plan, and a health insurance issuer 
providing health insurance coverage in connection with a group health 
plan shall provide notice to each participant and beneficiary under 
such plan regarding the coverage required by this section in accordance 
with regulations promulgated by the Secretary. Such notice shall be in 
writing and prominently positioned in any literature or correspondence 
made available or distributed by the plan or issuer and shall be 
transmitted--
            ``(1) in the next mailing made by the plan or issuer to the 
        participant or beneficiary;
            ``(2) as part of any yearly informational packet sent to 
        the participant or beneficiary; or
            ``(3) not later than January 1, 2000;
whichever is earlier.
    ``(d) Secondary Consultations.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer providing health insurance coverage in 
        connection with a group health plan, that provides coverage 
        with respect to medical and surgical services provided in 
        relation to the diagnosis and treatment of cancer shall ensure 
        that full coverage is provided for secondary consultations by 
        specialists in the appropriate medical fields (including 
        pathology, radiology, and oncology) to confirm or refute such 
        diagnosis. Such plan or issuer shall ensure that full coverage 
        is provided for such secondary consultation whether such 
        consultation is based on a positive or negative initial 
        diagnosis. In any case in which the attending physician 
        certifies in writing that services necessary for such a 
        secondary consultation are not sufficiently available from 
        specialists operating under the plan with respect to whose 
        services coverage is otherwise provided under such plan or by 
        such issuer, such plan or issuer shall ensure that coverage is 
        provided with respect to the services necessary for the 
        secondary consultation with any other specialist selected by 
        the attending physician for such purpose at no additional cost 
        to the individual beyond that which the individual would have 
        paid if the specialist was participating in the network of the 
        plan.
            ``(2) Exception.--Nothing in paragraph (1) shall be 
        construed as requiring the provision of secondary consultations 
        where the patient determines not to seek such a consultation.
    ``(e) Prohibition on Penalties or Incentives.--A group health plan, 
and a health insurance issuer providing health insurance coverage in 
connection with a group health plan, may not--
            ``(1) penalize or otherwise reduce or limit the 
        reimbursement of a provider or specialist because the provider 
        or specialist provided care to a participant or beneficiary in 
        accordance with this section;
            ``(2) provide financial or other incentives to a physician 
        or specialist to induce the physician or specialist to keep the 
        length of inpatient stays of patients following a mastectomy, 
        lumpectomy, or a lymph node dissection for the treatment of 
        breast cancer below certain limits or to limit referrals for 
        secondary consultations; or
            ``(3) provide financial or other incentives to a physician 
        or specialist to induce the physician or specialist to refrain 
        from referring a participant or beneficiary for a secondary 
        consultation that would otherwise be covered by the plan or 
        coverage involved under subsection (d).''.
            (2) Clerical amendment.--The table of contents in section 1 
        of the Employee Retirement Income Security Act of 1974 is 
        amended by inserting after the item relating to section 714 the 
        following new item:

``Sec. 715. Required coverage for minimum hospital stay for 
                            mastectomies and lymph node dissections for 
                            the treatment of breast cancer and coverage 
                            for secondary consultations.''.
    (d) Amendments to PHSA Relating to the Group Market.--Subpart 2 of 
part A of title XXVII of the Public Health Service Act (42 U.S.C. 
300gg-4 et seq.) is amended by adding at the end the following new 
section:

``SEC. 2707. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR 
              MASTECTOMIES AND LYMPH NODE DISSECTIONS FOR THE TREATMENT 
              OF BREAST CANCER AND COVERAGE FOR SECONDARY 
              CONSULTATIONS.

    ``(a) Inpatient Care.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer providing health insurance coverage in 
        connection with a group health plan, that provides medical and 
        surgical benefits shall ensure that inpatient coverage with 
        respect to the treatment of breast cancer is provided for a 
        period of time as is determined by the attending physician, in 
        consultation with the patient, to be medically necessary and 
        appropriate following--
                    ``(A) a mastectomy;
                    ``(B) a lumpectomy; or
                    ``(C) a lymph node dissection for the treatment of 
                breast cancer.
            ``(2) Exception.--Nothing in this section shall be 
        construed as requiring the provision of inpatient coverage if 
        the attending physician and patient determine that a shorter 
        period of hospital stay is medically appropriate.
    ``(b) Prohibition on Certain Modifications.--In implementing the 
requirements of this section, a group health plan, and a health 
insurance issuer providing health insurance coverage in connection with 
a group health plan, may not modify the terms and conditions of 
coverage based on the determination by a participant or beneficiary to 
request less than the minimum coverage required under subsection (a).
    ``(c) Notice.--A group health plan, and a health insurance issuer 
providing health insurance coverage in connection with a group health 
plan shall provide notice to each participant and beneficiary under 
such plan regarding the coverage required by this section in accordance 
with regulations promulgated by the Secretary. Such notice shall be in 
writing and prominently positioned in any literature or correspondence 
made available or distributed by the plan or issuer and shall be 
transmitted--
            ``(1) in the next mailing made by the plan or issuer to the 
        participant or beneficiary;
            ``(2) as part of any yearly informational packet sent to 
        the participant or beneficiary; or
            ``(3) not later than January 1, 2000;
whichever is earlier.
    ``(d) Secondary Consultations.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer providing health insurance coverage in 
        connection with a group health plan that provides coverage with 
        respect to medical and surgical services provided in relation 
        to the diagnosis and treatment of cancer shall ensure that full 
        coverage is provided for secondary consultations by specialists 
        in the appropriate medical fields (including pathology, 
        radiology, and oncology) to confirm or refute such diagnosis. 
        Such plan or issuer shall ensure that full coverage is provided 
        for such secondary consultation whether such consultation is 
        based on a positive or negative initial diagnosis. In any case 
        in which the attending physician certifies in writing that 
        services necessary for such a secondary consultation are not 
        sufficiently available from specialists operating under the 
        plan with respect to whose services coverage is otherwise 
        provided under such plan or by such issuer, such plan or issuer 
        shall ensure that coverage is provided with respect to the 
        services necessary for the secondary consultation with any 
        other specialist selected by the attending physician for such 
        purpose at no additional cost to the individual beyond that 
        which the individual would have paid if the specialist was 
        participating in the network of the plan.
            ``(2) Exception.--Nothing in paragraph (1) shall be 
        construed as requiring the provision of secondary consultations 
        where the patient determines not to seek such a consultation.
    ``(e) Prohibition on Penalties or Incentives.--A group health plan, 
and a health insurance issuer providing health insurance coverage in 
connection with a group health plan, may not--
            ``(1) penalize or otherwise reduce or limit the 
        reimbursement of a provider or specialist because the provider 
        or specialist provided care to a participant or beneficiary in 
        accordance with this section;
            ``(2) provide financial or other incentives to a physician 
        or specialist to induce the physician or specialist to keep the 
        length of inpatient stays of patients following a mastectomy, 
        lumpectomy, or a lymph node dissection for the treatment of 
        breast cancer below certain limits or to limit referrals for 
        secondary consultations; or
            ``(3) provide financial or other incentives to a physician 
        or specialist to induce the physician or specialist to refrain 
        from referring a participant or beneficiary for a secondary 
        consultation that would otherwise be covered by the plan or 
        coverage involved under subsection (d).''.
    (e) Amendments to PHSA Relating to the Individual Market.--The 
first subpart 3 of part B of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg-51 et seq.) (relating to other requirements) (42 
U.S.C. 300gg-51 et seq.) is amended--
            (1) by redesignating such subpart as subpart 2; and
            (2) by adding at the end the following:

``SEC. 2753. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR 
              MASTECTOMIES AND LYMPH NODE DISSECTIONS FOR THE TREATMENT 
              OF BREAST CANCER AND SECONDARY CONSULTATIONS.

    ``The provisions of section 2707 shall apply to health insurance 
coverage offered by a health insurance issuer in the individual market 
in the same manner as they apply to health insurance coverage offered 
by a health insurance issuer in connection with a group health plan in 
the small or large group market.''.
    (f) Amendments to the IRC.--
            (1) In general.--Subchapter B of chapter 100 of the 
        Internal Revenue Code of 1986, as amended by section 111(b), is 
        further amended by inserting after section 9813 the following:

``SEC. 9814. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR 
              MASTECTOMIES AND LYMPH NODE DISSECTIONS FOR THE TREATMENT 
              OF BREAST CANCER AND COVERAGE FOR SECONDARY 
              CONSULTATIONS.

    ``(a) Inpatient Care.--
            ``(1) In general.--A group health plan that provides 
        medical and surgical benefits shall ensure that inpatient 
        coverage with respect to the treatment of breast cancer is 
        provided for a period of time as is determined by the attending 
        physician, in consultation with the patient, to be medically 
        necessary and appropriate following--
                    ``(A) a mastectomy;
                    ``(B) a lumpectomy; or
                    ``(C) a lymph node dissection for the treatment of 
                breast cancer.
            ``(2) Exception.--Nothing in this section shall be 
        construed as requiring the provision of inpatient coverage if 
        the attending physician and patient determine that a shorter 
        period of hospital stay is medically appropriate.
    ``(b) Prohibition on Certain Modifications.--In implementing the 
requirements of this section, a group health plan may not modify the 
terms and conditions of coverage based on the determination by a 
participant or beneficiary to request less than the minimum coverage 
required under subsection (a).
    ``(c) Notice.--A group health plan shall provide notice to each 
participant and beneficiary under such plan regarding the coverage 
required by this section in accordance with regulations promulgated by 
the Secretary. Such notice shall be in writing and prominently 
positioned in any literature or correspondence made available or 
distributed by the plan and shall be transmitted--
            ``(1) in the next mailing made by the plan to the 
        participant or beneficiary;
            ``(2) as part of any yearly informational packet sent to 
        the participant or beneficiary; or
            ``(3) not later than January 1, 2000;
whichever is earlier.
    ``(d) Secondary Consultations.--
            ``(1) In general.--A group health plan that provides 
        coverage with respect to medical and surgical services provided 
        in relation to the diagnosis and treatment of cancer shall 
        ensure that full coverage is provided for secondary 
        consultations by specialists in the appropriate medical fields 
        (including pathology, radiology, and oncology) to confirm or 
        refute such diagnosis. Such plan or issuer shall ensure that 
        full coverage is provided for such secondary consultation 
        whether such consultation is based on a positive or negative 
        initial diagnosis. In any case in which the attending physician 
        certifies in writing that services necessary for such a 
        secondary consultation are not sufficiently available from 
        specialists operating under the plan with respect to whose 
        services coverage is otherwise provided under such plan or by 
        such issuer, such plan or issuer shall ensure that coverage is 
        provided with respect to the services necessary for the 
        secondary consultation with any other specialist selected by 
        the attending physician for such purpose at no additional cost 
        to the individual beyond that which the individual would have 
        paid if the specialist was participating in the network of the 
        plan.
            ``(2) Exception.--Nothing in paragraph (1) shall be 
        construed as requiring the provision of secondary consultations 
        where the patient determines not to seek such a consultation.
    ``(e) Prohibition on Penalties.--A group health plan may not--
            ``(1) penalize or otherwise reduce or limit the 
        reimbursement of a provider or specialist because the provider 
        or specialist provided care to a participant or beneficiary in 
        accordance with this section;
            ``(2) provide financial or other incentives to a physician 
        or specialist to induce the physician or specialist to keep the 
        length of inpatient stays of patients following a mastectomy, 
        lumpectomy, or a lymph node dissection for the treatment of 
        breast cancer below certain limits or to limit referrals for 
        secondary consultations; or
            ``(3) provide financial or other incentives to a physician 
        or specialist to induce the physician or specialist to refrain 
        from referring a participant or beneficiary for a secondary 
        consultation that would otherwise be covered by the plan 
        involved under subsection (d).''.
            (2) Clerical amendment.--The table of contents for chapter 
        100 of such Code is amended by inserting after the item 
        relating to section 9813 the following new item:

``Sec. 9814. Required coverage for minimum hospital stay for 
                            mastectomies and lymph node dissections for 
                            the treatment of breast cancer and coverage 
                            for secondary consultations.''.

              TITLE III--GENETIC INFORMATION AND SERVICES

SEC. 301. SHORT TITLE.

    This title may be cited as the ``Genetic Information 
Nondiscrimination in Health Insurance Act of 1999''.

SEC. 302. AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 
              1974.

    (a) Prohibition of Health Discrimination on the Basis of Genetic 
Information or Genetic Services.--
            (1) No enrollment restriction for genetic services.--
        Section 702(a)(1)(F) of the Employee Retirement Income Security 
        Act of 1974 (29 U.S.C. 1182(a)(1)(F)) is amended by inserting 
        before the period the following: ``(including information about 
        a request for or receipt of genetic services)''.
            (2) No discrimination in group premiums based on predictive 
        genetic information.--Subpart B of part 7 of subtitle B of 
        title I of the Employee Retirement Income Security Act of 1974, 
        as amended by sections 111(a) and 201, is further amended by 
        adding at the end the following:

``SEC. 716. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE 
              BASIS OF PREDICTIVE GENETIC INFORMATION.

    ``A group health plan, or a health insurance issuer offering group 
health insurance coverage in connection with a group health plan, shall 
not adjust premium or contribution amounts for a group on the basis of 
predictive genetic information concerning any individual (including a 
dependent) or family member of the individual (including information 
about a request for or receipt of genetic services).''.
            (3) Conforming amendments.--
                    (A) In general.--Section 702(b) of the Employee 
                Retirement Income Security Act of 1974 (29 U.S.C. 
                1182(b)) is amended by adding at the end the following:
            ``(3) Reference to related provision.--For a provision 
        prohibiting the adjustment of premium or contribution amounts 
        for a group under a group health plan on the basis of 
        predictive genetic information (including information about a 
        request for or receipt of genetic services), see section 
        716.''.
                    (B) Table of contents.--The table of contents in 
                section 1 of the Employee Retirement Income Security 
                Act of 1974, as amended by sections 111(a) and 201, is 
                further amended by inserting after the item relating to 
                section 715 the following new item:

``Sec. 716. Prohibiting premium discrimination against groups on the 
                            basis of predictive genetic information.''.
    (b) Limitation on Collection of Predictive Genetic Information.--
Section 702 of the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1182) is amended by adding at the end the following:
    ``(c) Collection of Predictive Genetic Information.--
            ``(1) Limitation on requesting or requiring predictive 
        genetic information.--Except as provided in paragraph (2), a 
        group health plan, or a health insurance issuer offering health 
        insurance coverage in connection with a group health plan, 
        shall not request or require predictive genetic information 
        concerning any individual (including a dependent) or family 
        member of the individual (including information about a request 
        for or receipt of genetic services).
            ``(2) Information needed for diagnosis, treatment, or 
        payment.--
                    ``(A) In general.--Notwithstanding paragraph (1), a 
                group health plan, or a health insurance issuer 
                offering health insurance coverage in connection with a 
                group health plan, that provides health care items and 
                services to an individual or dependent may request (but 
                may not require) that such individual or dependent 
                disclose, or authorize the collection or disclosure of, 
                predictive genetic information for purposes of 
                diagnosis, treatment, or payment relating to the 
                provision of health care items and services to such 
                individual or dependent.
                    ``(B) Notice of confidentiality practices and 
                description of safeguards.--As a part of a request 
                under subparagraph (A), the group health plan, or a 
                health insurance issuer offering health insurance 
                coverage in connection with a group health plan, shall 
                provide to the individual or dependent a description of 
                the procedures in place to safeguard the 
                confidentiality, as described in subsection (d), of 
                such predictive genetic information.
    ``(d) Confidentiality with Respect to Predictive Genetic 
Information.--
            ``(1) Notice of confidentiality practices.--
                    ``(A) Preparation of written notice.--A group 
                health plan, or a health insurance issuer offering 
                health insurance coverage in connection with a group 
                health plan, shall post or provide, in writing and in a 
                clear and conspicuous manner, notice of the plan or 
                issuer's confidentiality practices, that shall 
                include--
                            ``(i) a description of an individual's 
                        rights with respect to predictive genetic 
                        information;
                            ``(ii) the procedures established by the 
                        plan or issuer for the exercise of the 
                        individual's rights; and
                            ``(iii) the right to obtain a copy of the 
                        notice of the confidentiality practices 
                        required under this subsection.
                    ``(B) Model notice.--The Secretary, in consultation 
                with the National Committee on Vital and Health 
                Statistics and the National Association of Insurance 
                Commissioners, and after notice and opportunity for 
                public comment, shall develop and disseminate model 
                notices of confidentiality practices. Use of the model 
                notice shall serve as a defense against claims of 
                receiving inappropriate notice.
            ``(2) Establishment of safeguards.--A group health plan, or 
        a health insurance issuer offering health insurance coverage in 
        connection with a group health plan, shall establish and 
        maintain appropriate administrative, technical, and physical 
        safeguards to protect the confidentiality, security, accuracy, 
        and integrity of predictive genetic information created, 
        received, obtained, maintained, used, transmitted, or disposed 
        of by such plan or issuer.''.
    (c) Definitions.--Section 733(d) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1191b(d)) is amended by adding at the 
end the following:
            ``(5) Family member.--The term `family member' means with 
        respect to an individual--
                    ``(A) the spouse of the individual;
                    ``(B) a dependent child of the individual, 
                including a child who is born to or placed for adoption 
                with the individual; and
                    ``(C) all other individuals related by blood to the 
                individual or the spouse or child described in 
                subparagraph (A) or (B).
            ``(6) Genetic information.--The term `genetic information' 
        means information about genes, gene products, or inherited 
        characteristics that may derive from an individual or a family 
        member (including information about a request for or receipt of 
        genetic services).
            ``(7) Genetic services.--The term `genetic services' means 
        health services provided to obtain, assess, or interpret 
        genetic information for diagnostic and therapeutic purposes, 
        and for genetic education and counseling.
            ``(8) Predictive genetic information.--
                    ``(A) In general.--The term `predictive genetic 
                information' means, in the absence of symptoms, 
                clinical signs, or a diagnosis of the condition related 
                to such information--
                            ``(i) information about an individual's 
                        genetic tests;
                            ``(ii) information about genetic tests of 
                        family members of the individual; or
                            ``(iii) information about the occurrence of 
                        a disease or disorder in family members.
                    ``(B) Exceptions.--The term `predictive genetic 
                information' shall not include--
                            ``(i) information about the sex or age of 
                        the individual;
                            ``(ii) information derived from physical 
                        tests, such as the chemical, blood, or urine 
                        analyses of the individual including 
                        cholesterol tests; and
                            ``(iii) information about physical exams of 
                        the individual.
            ``(9) Genetic test.--The term `genetic test' means the 
        analysis of human DNA, RNA, chromosomes, proteins, and certain 
        metabolites, including analysis of genotypes, mutations, 
        phenotypes, or karyotypes, for the purpose of predicting risk 
        of disease in asymptomatic or undiagnosed individuals. Such 
        term does not include physical tests, such as the chemical, 
        blood, or urine analyses of the individual including 
        cholesterol tests, and physical exams of the individual, in 
        order to detect symptoms, clinical signs, or a diagnosis of 
        disease.''.
    (d) Effective Date.--Except as provided in this section, this 
section and the amendments made by this section shall apply with 
respect to group health plans for plan years beginning 1 year after the 
date of the enactment of this Act.

SEC. 303. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

    (a) Amendments Relating to the Group Market.--
            (1) Prohibition of health discrimination on the basis of 
        genetic information in the group market.--
                    (A) No enrollment restriction for genetic 
                services.--Section 2702(a)(1)(F) of the Public Health 
                Service Act (42 U.S.C. 300gg-1(a)(1)(F)) is amended by 
                inserting before the period the following: ``(including 
                information about a request for or receipt of genetic 
                services)''.
                    (B) No discrimination in premiums based on 
                predictive genetic information.--Subpart 2 of part A of 
                title XXVII of the Public Health Service Act, as 
                amended by section 201, is further amended by adding at 
                the end the following new section:

``SEC. 2708. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE 
              BASIS OF PREDICTIVE GENETIC INFORMATION IN THE GROUP 
              MARKET.

    ``A group health plan, or a health insurance issuer offering group 
health insurance coverage in connection with a group health plan shall 
not adjust premium or contribution amounts for a group on the basis of 
predictive genetic information concerning any individual (including a 
dependent) or family member of the individual (including information 
about a request for or receipt of genetic services).''.
                    (C) Conforming amendment.--Section 2702(b) of the 
                Public Health Service Act (42 U.S.C. 300gg-1(b)) is 
                amended by adding at the end the following:
            ``(3) Reference to related provision.--For a provision 
        prohibiting the adjustment of premium or contribution amounts 
        for a group under a group health plan on the basis of 
        predictive genetic information (including information about a 
        request for or receipt of genetic services), see section 
        2708.''.
                    (D) Limitation on collection and disclosure of 
                predictive genetic information.--Section 2702 of the 
                Public Health Service Act (42 U.S.C. 300gg-1) is 
                amended by adding at the end the following:
    ``(c) Collection of Predictive Genetic Information.--
            ``(1) Limitation on requesting or requiring predictive 
        genetic information.--Except as provided in paragraph (2), a 
        group health plan, or a health insurance issuer offering health 
        insurance coverage in connection with a group health plan, 
        shall not request or require predictive genetic information 
        concerning any individual (including a dependent) or a family 
        member of the individual (including information about a request 
        for or receipt of genetic services).
            ``(2) Information needed for diagnosis, treatment, or 
        payment.--
                    ``(A) In general.--Notwithstanding paragraph (1), a 
                group health plan, or a health insurance issuer 
                offering health insurance coverage in connection with a 
                group health plan, that provides health care items and 
                services to an individual or dependent may request (but 
                may not require) that such individual or dependent 
                disclose, or authorize the collection or disclosure of, 
                predictive genetic information for purposes of 
                diagnosis, treatment, or payment relating to the 
                provision of health care items and services to such 
                individual or dependent.
                    ``(B) Notice of confidentiality practices and 
                description of safeguards.--As a part of a request 
                under subparagraph (A), the group health plan, or a 
                health insurance issuer offering health insurance 
                coverage in connection with a group health plan, shall 
                provide to the individual or dependent a description of 
                the procedures in place to safeguard the 
                confidentiality, as described in subsection (d), of 
                such predictive genetic information.
    ``(d) Confidentiality with Respect to Predictive Genetic 
Information.--
            ``(1) Notice of confidentiality practices.--
                    ``(A) Preparation of written notice.--A group 
                health plan, or a health insurance issuer offering 
                health insurance coverage in connection with a group 
                health plan, shall post or provide, in writing and in a 
                clear and conspicuous manner, notice of the plan or 
                issuer's confidentiality practices, that shall 
                include--
                            ``(i) a description of an individual's 
                        rights with respect to predictive genetic 
                        information;
                            ``(ii) the procedures established by the 
                        plan or issuer for the exercise of the 
                        individual's rights; and
                            ``(iii) the right to obtain a copy of the 
                        notice of the confidentiality practices 
                        required under this subsection.
                    ``(B) Model notice.--The Secretary, in consultation 
                with the National Committee on Vital and Health 
                Statistics and the National Association of Insurance 
                Commissioners, and after notice and opportunity for 
                public comment, shall develop and disseminate model 
                notices of confidentiality practices. Use of the model 
                notice shall serve as a defense against claims of 
                receiving inappropriate notice.
            ``(2) Establishment of safeguards.--A group health plan, or 
        a health insurance issuer offering health insurance coverage in 
        connection with a group health plan, shall establish and 
        maintain appropriate administrative, technical, and physical 
        safeguards to protect the confidentiality, security, accuracy, 
        and integrity of predictive genetic information created, 
        received, obtained, maintained, used, transmitted, or disposed 
        of by such plan or issuer.''.
            (2) Definitions.--Section 2791(d) of the Public Health 
        Service Act (42 U.S.C. 300gg-91(d)) is amended by adding at the 
        end the following:
            ``(15) Family member.--The term `family member' means, with 
        respect to an individual--
                    ``(A) the spouse of the individual;
                    ``(B) a dependent child of the individual, 
                including a child who is born to or placed for adoption 
                with the individual; and
                    ``(C) all other individuals related by blood to the 
                individual or the spouse or child described in 
                subparagraph (A) or (B).
            ``(16) Genetic information.--The term `genetic information' 
        means information about genes, gene products, or inherited 
        characteristics that may derive from an individual or a family 
        member (including information about a request for or receipt of 
        genetic services).
            ``(17) Genetic services.--The term `genetic services' means 
        health services provided to obtain, assess, or interpret 
        genetic information for diagnostic and therapeutic purposes, 
        and for genetic education and counseling.
            ``(18) Predictive genetic information.--
                    ``(A) In general.--The term `predictive genetic 
                information' means, in the absence of symptoms, 
                clinical signs, or a diagnosis of the condition related 
                to such information--
                            ``(i) information about an individual's 
                        genetic tests;
                            ``(ii) information about genetic tests of 
                        family members of the individual; or
                            ``(iii) information about the occurrence of 
                        a disease or disorder in family members.
                    ``(B) Exceptions.--The term `predictive genetic 
                information' shall not include--
                            ``(i) information about the sex or age of 
                        the individual;
                            ``(ii) information derived from physical 
                        tests, such as the chemical, blood, or urine 
                        analyses of the individual including 
                        cholesterol tests; and
                            ``(iii) information about physical exams of 
                        the individual.
            ``(19) Genetic test.--The term `genetic test' means the 
        analysis of human DNA, RNA, chromosomes, proteins, and certain 
        metabolites, including analysis of genotypes, mutations, 
        phenotypes, or karyotypes, for the purpose of predicting risk 
        of disease in asymptomatic or undiagnosed individuals. Such 
        term does not include physical tests, such as the chemical, 
        blood, or urine analyses of the individual including 
        cholesterol tests, and physical exams of the individual, in 
        order to detect symptoms, clinical signs, or a diagnosis of 
        disease.''.
    (b) Amendment Relating to the Individual Market.--Subpart 2 of part 
B of title XXVII of the Public Health Service Act, as amended by 
section 201, is further amended by adding at the end the following new 
section:

``SEC. 2754. PROHIBITION OF HEALTH DISCRIMINATION ON THE BASIS OF 
              PREDICTIVE GENETIC INFORMATION.

    ``(a) Prohibition on Predictive Genetic Information as a Condition 
of Eligibility.--A health insurance issuer offering health insurance 
coverage in the individual market may not use predictive genetic 
information as a condition of eligibility of an individual to enroll in 
individual health insurance coverage (including information about a 
request for or receipt of genetic services).
    ``(b) Prohibition on Predictive Genetic Information in Setting 
Premium Rates.--A health insurance issuer offering health insurance 
coverage in the individual market shall not adjust premium rates for 
individuals on the basis of predictive genetic information concerning 
such an individual (including a dependent) or a family member of the 
individual (including information about a request for or receipt of 
genetic services).
    ``(c) Collection of Predictive Genetic Information.--
            ``(1) Limitation on requesting or requiring predictive 
        genetic information.--Except as provided in paragraph (2), a 
        health insurance issuer offering health insurance coverage in 
        the individual market shall not request or require predictive 
        genetic information concerning any individual (including a 
        dependent) or a family member of the individual (including 
        information about a request for or receipt of genetic 
        services).
            ``(2) Information needed for diagnosis, treatment, or 
        payment.--
                    ``(A) in general.--Notwithstanding paragraph (1), a 
                health insurance issuer offering health insurance 
                coverage in the individual market that provides health 
                care items and services to an individual or dependent 
                may request (but may not require) that such individual 
                or dependent disclose, or authorize the collection or 
                disclosure of, predictive genetic information for 
                purposes of diagnosis, treatment, or payment relating 
                to the provision of health care items and services to 
                such individual or dependent.
                    ``(B) Notice of confidentiality practices and 
                description of safeguards.--As a part of a request 
                under subparagraph (A), the health insurance issuer 
                offering health insurance coverage in the individual 
                market shall provide to the individual or dependent a 
                description of the procedures in place to safeguard the 
                confidentiality, as described in subsection (d), of 
                such predictive genetic information.
    ``(d) Confidentiality with Respect to Predictive Genetic 
Information.--
            ``(1) Notice of confidentiality practices.--
                    ``(A) Preparation of written notice.--A health 
                insurance issuer offering health insurance coverage in 
                the individual market shall post or provide, in writing 
                and in a clear and conspicuous manner, notice of the 
                issuer's confidentiality practices, that shall 
                include--
                            ``(i) a description of an individual's 
                        rights with respect to predictive genetic 
                        information;
                            ``(ii) the procedures established by the 
                        issuer for the exercise of the individual's 
                        rights; and
                            ``(iii) the right to obtain a copy of the 
                        notice of the confidentiality practices 
                        required under this subsection.
                    ``(B) Model notice.--The Secretary, in consultation 
                with the National Committee on Vital and Health 
                Statistics and the National Association of Insurance 
                Commissioners, and after notice and opportunity for 
                public comment, shall develop and disseminate model 
                notices of confidentiality practices. Use of the model 
                notice shall serve as a defense against claims of 
                receiving inappropriate notice.
            ``(2) Establishment of safeguards.--A health insurance 
        issuer offering health insurance coverage in the individual 
        market shall establish and maintain appropriate administrative, 
        technical, and physical safeguards to protect the 
        confidentiality, security, accuracy, and integrity of 
        predictive genetic information created, received, obtained, 
        maintained, used, transmitted, or disposed of by such 
        issuer.''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to--
            (1) group health plans, and health insurance coverage 
        offered in connection with group health plans, for plan years 
        beginning after 1 year after the date of enactment of this Act; 
        and
            (2) health insurance coverage offered, sold, issued, 
        renewed, in effect, or operated in the individual market after 
        1 year after the date of enactment of this Act.

SEC. 304. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.

    (a) Prohibition of Health Discrimination on the Basis of Genetic 
Information or Genetic Services.--
            (1) No enrollment restriction for genetic services.--
        Section 9802(a)(1)(F) of the Internal Revenue Code of 1986 is 
        amended by inserting before the period the following: 
        ``(including information about a request for or receipt of 
        genetic services)''.
            (2) No discrimination in group premiums based on predictive 
        genetic information.--
                    (A) In general.--Subchapter B of chapter 100 of the 
                Internal Revenue Code of 1986, as amended by sections 
                111(b) and 201, is further amended by adding at the end 
                the following:

``SEC. 9815. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE 
              BASIS OF PREDICTIVE GENETIC INFORMATION.

    ``A group health plan shall not adjust premium or contribution 
amounts for a group on the basis of predictive genetic information 
concerning any individual (including a dependent) or a family member of 
the individual (including information about a request for or receipt of 
genetic services).''.
                    (B) Conforming amendment.--Section 9802(b) of the 
                Internal Revenue Code of 1986 is amended by adding at 
                the end the following:
            ``(3) Reference to related provision.--For a provision 
        prohibiting the adjustment of premium or contribution amounts 
        for a group under a group health plan on the basis of 
        predictive genetic information (including information about a 
        request for or the receipt of genetic services), see section 
        9815.''.
                    (C) Amendment to table of sections.--The table of 
                sections for subchapter B of chapter 100 of the 
                Internal Revenue Code of 1986, as amended by sections 
                111(b) and 201, is further amended by adding at the end 
                the following:

``Sec. 9816. Prohibiting premium discrimination against groups on the 
                            basis of predictive genetic information.''.
    (b) Limitation on Collection of Predictive Genetic Information.--
Section 9802 of the Internal Revenue Code of 1986 is amended by adding 
at the end the following:
    ``(d) Collection of Predictive Genetic Information.--
            ``(1) Limitation on requesting or requiring predictive 
        genetic information.--Except as provided in paragraph (2), a 
        group health plan shall not request or require predictive 
        genetic information concerning any individual (including a 
        dependent) or a family member of the individual (including 
        information about a request for or receipt of genetic 
        services).
            ``(2) Information needed for diagnosis, treatment, or 
        payment.--
                    ``(A) In general.--Notwithstanding paragraph (1), a 
                group health plan that provides health care items and 
                services to an individual or dependent may request (but 
                may not require) that such individual or dependent 
                disclose, or authorize the collection or disclosure of, 
                predictive genetic information for purposes of 
                diagnosis, treatment, or payment relating to the 
                provision of health care items and services to such 
                individual or dependent.
                    ``(B) Notice of confidentiality practices; 
                description of safeguards.--As a part of a request 
                under subparagraph (A), the group health plan shall 
                provide to the individual or dependent a description of 
                the procedures in place to safeguard the 
                confidentiality, as described in subsection (e), of 
                such predictive genetic information.
    ``(e) Confidentiality with Respect to Predictive Genetic 
Information.--
            ``(1) Notice of confidentiality practices.--
                    ``(A) Preparation of written notice.--A group 
                health plan shall post or provide, in writing and in a 
                clear and conspicuous manner, notice of the plan's 
                confidentiality practices, that shall include--
                            ``(i) a description of an individual's 
                        rights with respect to predictive genetic 
                        information;
                            ``(ii) the procedures established by the 
                        plan for the exercise of the individual's 
                        rights; and
                            ``(iii) the right to obtain a copy of the 
                        notice of the confidentiality practices 
                        required under this subsection.
                    ``(B) Model notice.--The Secretary, in consultation 
                with the National Committee on Vital and Health 
                Statistics and the National Association of Insurance 
                Commissioners, and after notice and opportunity for 
                public comment, shall develop and disseminate model 
                notices of confidentiality practices. Use of the model 
                notice shall serve as a defense against claims of 
                receiving inappropriate notice.
            ``(2) Establishment of safeguards.--A group health plan 
        shall establish and maintain appropriate administrative, 
        technical, and physical safeguards to protect the 
        confidentiality, security, accuracy, and integrity of 
        predictive genetic information created, received, obtained, 
        maintained, used, transmitted, or disposed of by such plan.''.
    (c) Definitions.--Section 9832(d) of the Internal Revenue Code of 
1986 is amended by adding at the end the following:
            ``(6) Family member.--The term `family member' means, with 
        respect to an individual--
                    ``(A) the spouse of the individual;
                    ``(B) a dependent child of the individual, 
                including a child who is born to or placed for adoption 
                with the individual; and
                    ``(C) all other individuals related by blood to the 
                individual or the spouse or child described in 
                subparagraph (A) or (B).
            ``(7) Genetic information.--The term `genetic information' 
        means information about genes, gene products, or inherited 
        characteristics that may derive from an individual or a family 
        member (including information about a request for or receipt of 
        genetic services).
            ``(8) Genetic services.--The term `genetic services' means 
        health services provided to obtain, assess, or interpret 
        genetic information for diagnostic and therapeutic purposes, 
        and for genetic education and counseling.
            ``(9) Predictive genetic information.--
                    ``(A) In general.--The term `predictive genetic 
                information' means, in the absence of symptoms, 
                clinical signs, or a diagnosis of the condition related 
                to such information--
                            ``(i) information about an individual's 
                        genetic tests;
                            ``(ii) information about genetic tests of 
                        family members of the individual; or
                            ``(iii) information about the occurrence of 
                        a disease or disorder in family members.
                    ``(B) Exceptions.--The term `predictive genetic 
                information' shall not include--
                            ``(i) information about the sex or age of 
                        the individual;
                            ``(ii) information derived from physical 
                        tests, such as the chemical, blood, or urine 
                        analyses of the individual including 
                        cholesterol tests; and
                            ``(iii) information about physical exams of 
                        the individual.
            ``(10) Genetic test.--The term `genetic test' means the 
        analysis of human DNA, RNA, chromosomes, proteins, and certain 
        metabolites, including analysis of genotypes, mutations, 
        phenotypes, or karyotypes, for the purpose of predicting risk 
        of disease in asymptomatic or undiagnosed individuals. Such 
        term does not include physical tests, such as the chemical, 
        blood, or urine analyses of the individual including 
        cholesterol tests, and physical exams of the individual, in 
        order to detect symptoms, clinical signs, or a diagnosis of 
        disease.''.
    (d) Effective Date.--Except as provided in this section, this 
section and the amendments made by this section shall apply with 
respect to group health plans for plan years beginning after 1 year 
after the date of the enactment of this Act.

               TITLE IV--HEALTHCARE RESEARCH AND QUALITY

SEC. 401. SHORT TITLE.

    This title may be cited as the ``Healthcare Research and Quality 
Act of 1999''.

SEC. 402. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    Title IX of the Public Health Service Act (42 U.S.C. 299 et seq.) 
is amended to read as follows:

         ``TITLE IX--AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

               ``PART A--ESTABLISHMENT AND GENERAL DUTIES

``SEC. 901. MISSION AND DUTIES.

    ``(a) In General.--There is established within the Public Health 
Service an agency to be known as the Agency for Healthcare Research and 
Quality. In carrying out this subsection, the Secretary shall 
redesignate the Agency for Health Care Policy and Research as the 
Agency for Healthcare Research and Quality.
    ``(b) Mission.--The purpose of the Agency is to enhance the 
quality, appropriateness, and effectiveness of healthcare services, and 
access to such services, through the establishment of a broad base of 
scientific research and through the promotion of improvements in 
clinical and health system practices, including the prevention of 
diseases and other health conditions. The Agency shall promote 
healthcare quality improvement by--
            ``(1) conducting and supporting research that develops and 
        presents scientific evidence regarding all aspects of 
        healthcare, including--
                    ``(A) the development and assessment of methods for 
                enhancing patient participation in their own care and 
                for facilitating shared patient-physician decision-
                making;
                    ``(B) the outcomes, effectiveness, and cost-
                effectiveness of healthcare practices, including 
                preventive measures and long-term care;
                    ``(C) existing and innovative technologies;
                    ``(D) the costs and utilization of, and access to 
                healthcare;
                    ``(E) the ways in which healthcare services are 
                organized, delivered, and financed and the interaction 
                and impact of these factors on the quality of patient 
                care;
                    ``(F) methods for measuring quality and strategies 
                for improving quality; and
                    ``(G) ways in which patients, consumers, 
                purchasers, and practitioners acquire new information 
                about best practices and health benefits, the 
                determinants and impact of their use of this 
                information;
            ``(2) synthesizing and disseminating available scientific 
        evidence for use by patients, consumers, practitioners, 
        providers, purchasers, policy makers, and educators; and
            ``(3) advancing private and public efforts to improve 
        healthcare quality.
    ``(c) Requirements With Respect to Rural Areas and Priority 
Populations.--In carrying out subsection (b), the Director shall 
undertake and support research, demonstration projects, and evaluations 
with respect to the delivery of health services--
            ``(1) in rural areas (including frontier areas);
            ``(2) for low-income groups, and minority groups;
            ``(3) for children;
            ``(4) for elderly; and
            ``(5) for people with special healthcare needs, including 
        disabilities, chronic care and end-of-life healthcare.
    ``(d) Appointment of Director.--There shall be at the head of the 
Agency an official to be known as the Director for Healthcare Research 
and Quality. The Director shall be appointed by the Secretary. The 
Secretary, acting through the Director, shall carry out the authorities 
and duties established in this title.

``SEC. 902. GENERAL AUTHORITIES.

    ``(a) In General.--In carrying out section 901(b), the Director 
shall support demonstration projects, conduct and support research, 
evaluations, training, research networks, multi-disciplinary centers, 
technical assistance, and the dissemination of information, on 
healthcare, and on systems for the delivery of such care, including 
activities with respect to--
            ``(1) the quality, effectiveness, efficiency, 
        appropriateness and value of healthcare services;
            ``(2) quality measurement and improvement;
            ``(3) the outcomes, cost, cost-effectiveness, and use of 
        healthcare services and access to such services;
            ``(4) clinical practice, including primary care and 
        practice-oriented research;
            ``(5) healthcare technologies, facilities, and equipment;
            ``(6) healthcare costs, productivity, organization, and 
        market forces;
            ``(7) health promotion and disease prevention, including 
        clinical preventive services;
            ``(8) health statistics, surveys, database development, and 
        epidemiology; and
            ``(9) medical liability.
    ``(b) Health Services Training Grants.--
            ``(1) In general.--The Director may provide training grants 
        in the field of health services research related to activities 
        authorized under subsection (a), to include pre- and post-
        doctoral fellowships and training programs, young investigator 
        awards, and other programs and activities as appropriate. In 
        carrying out this subsection, the Director shall make use of 
        funds made available under section 487 as well as other 
        appropriated funds.
            ``(2) Requirements.--In developing priorities for the 
        allocation of training funds under this subsection, the 
        Director shall take into consideration shortages in the number 
        of trained researchers addressing the priority populations.
    ``(c) Multidisciplinary Centers.--The Director may provide 
financial assistance to assist in meeting the costs of planning and 
establishing new centers, and operating existing and new centers, for 
multidisciplinary health services research, demonstration projects, 
evaluations, training, and policy analysis with respect to the matters 
referred to in subsection (a).
    ``(d) Relation to Certain Authorities Regarding Social Security.--
Activities authorized in this section shall be appropriately 
coordinated with experiments, demonstration projects, and other related 
activities authorized by the Social Security Act and the Social 
Security Amendments of 1967. Activities under subsection (a)(2) of this 
section that affect the programs under titles XVIII, XIX and XXI of the 
Social Security Act shall be carried out consistent with section 1142 
of such Act.
    ``(e) Disclaimer.--The Agency shall not mandate national standards 
of clinical practice or quality healthcare standards. Recommendations 
resulting from projects funded and published by the Agency shall 
include a corresponding disclaimer.
    ``(f) Rule of Construction.--Nothing in this section shall be 
construed to imply that the Agency's role is to mandate a national 
standard or specific approach to quality measurement and reporting. In 
research and quality improvement activities, the Agency shall consider 
a wide range of choices, providers, healthcare delivery systems, and 
individual preferences.

               ``PART B--HEALTHCARE IMPROVEMENT RESEARCH

``SEC. 911. HEALTHCARE OUTCOME IMPROVEMENT RESEARCH.

    ``(a) Evidence Rating Systems.--In collaboration with experts from 
the public and private sector, the Agency shall identify and 
disseminate methods or systems that it uses to assess healthcare 
research results, particularly methods or systems that it uses to rate 
the strength of the scientific evidence behind healthcare practice, 
recommendations in the research literature, and technology assessments. 
The Agency shall make methods and systems for evidence rating widely 
available. Agency publications containing healthcare recommendations 
shall indicate the level of substantiating evidence using such methods 
or systems.
    ``(b) Healthcare Improvement Research Centers and Provider-Based 
Research Networks.--In order to address the full continuum of care and 
outcomes research, to link research to practice improvement, and to 
speed the dissemination of research findings to community practice 
settings, the Agency shall employ research strategies and mechanisms 
that will link research directly with clinical practice in 
geographically diverse locations throughout the United States, 
including--
            ``(1) Healthcare Improvement Research Centers that combine 
        demonstrated multidisciplinary expertise in outcomes or quality 
        improvement research with linkages to relevant sites of care;
            ``(2) Provider-based Research Networks, including plan, 
        facility, or delivery system sites of care (especially primary 
        care), that can evaluate and promote quality improvement; and
            ``(3) other innovative mechanisms or strategies to link 
        research with clinical practice.

``SEC. 912. PRIVATE-PUBLIC PARTNERSHIPS TO IMPROVE ORGANIZATION AND 
              DELIVERY.

    ``(a) Support for Efforts To Develop Information on Quality.--
            ``(1) Scientific and technical support.--In its role as the 
        principal agency for healthcare research and quality, the 
        Agency may provide scientific and technical support for private 
        and public efforts to improve healthcare quality, including the 
        activities of accrediting organizations.
            ``(2) Role of the agency.--With respect to paragraph (1), 
        the role of the Agency shall include--
                    ``(A) the identification and assessment of methods 
                for the evaluation of the health of--
                            ``(i) enrollees in health plans by type of 
                        plan, provider, and provider arrangements; and
                            ``(ii) other populations, including those 
                        receiving long-term care services;
                    ``(B) the ongoing development, testing, and 
                dissemination of quality measures, including measures 
                of health and functional outcomes;
                    ``(C) the compilation and dissemination of 
                healthcare quality measures developed in the private 
                and public sector;
                    ``(D) assistance in the development of improved 
                healthcare information systems;
                    ``(E) the development of survey tools for the 
                purpose of measuring participant and beneficiary 
                assessments of their healthcare; and
                    ``(F) identifying and disseminating information on 
                mechanisms for the integration of information on 
                quality into purchaser and consumer decision-making 
                processes.
    ``(b) Centers for Education and Research on Therapeutics.--
            ``(1) In general.--The Secretary, acting through the 
        Director and in consultation with the Commissioner of Food and 
        Drugs, shall establish a program for the purpose of making one 
        or more grants for the establishment and operation of one or 
        more centers to carry out the activities specified in paragraph 
        (2).
            ``(2) Required activities.--The activities referred to in 
        this paragraph are the following:
                    ``(A) The conduct of state-of-the-art clinical, 
                laboratory, or health services research for the 
                following purposes:
                            ``(i) To increase awareness of--
                                    ``(I) new uses of drugs, biological 
                                products, and devices;
                                    ``(II) ways to improve the 
                                effective use of drugs, biological 
                                products, and devices; and
                                    ``(III) risks of new uses and risks 
                                of combinations of drugs and biological 
                                products.
                            ``(ii) To provide objective clinical 
                        information to the following individuals and 
                        entities:
                                    ``(I) Healthcare practitioners and 
                                other providers of healthcare goods or 
                                services.
                                    ``(II) Pharmacists, pharmacy 
                                benefit managers and purchasers.
                                    ``(III) Health maintenance 
                                organizations and other managed 
                                healthcare organizations.
                                    ``(IV) Healthcare insurers and 
                                governmental agencies.
                                    ``(V) Patients and consumers.
                            ``(iii) To improve the quality of 
                        healthcare while reducing the cost of 
                        Healthcare through--
                                    ``(I) an increase in the 
                                appropriate use of drugs, biological 
                                products, or devices; and
                                    ``(II) the prevention of adverse 
                                effects of drugs, biological products, 
                                and devices and the consequences of 
                                such effects, such as unnecessary 
                                hospitalizations.
                    ``(B) The conduct of research on the comparative 
                effectiveness, cost-effectiveness, and safety of drugs, 
                biological products, and devices.
                    ``(C) Such other activities as the Secretary 
                determines to be appropriate, except that grant funds 
                may not be used by the Secretary in conducting 
                regulatory review of new drugs.
    ``(c) Reducing Errors in Medicine.--The Director shall conduct and 
support research and build private-public partnerships to--
            ``(1) identify the causes of preventable healthcare errors 
        and patient injury in healthcare delivery;
            ``(2) develop, demonstrate, and evaluate strategies for 
        reducing errors and improving patient safety; and
            ``(3) promote the implementation of effective strategies 
        throughout the healthcare industry.

``SEC. 913. INFORMATION ON QUALITY AND COST OF CARE.

    ``(a) In General.--In carrying out 902(a), the Director shall--
            ``(1) conduct a survey to collect data on a nationally 
        representative sample of the population on the cost, use and, 
        for fiscal year 2001 and subsequent fiscal years, quality of 
        healthcare, including the types of healthcare services 
        Americans use, their access to healthcare services, frequency 
        of use, how much is paid for the services used, the source of 
        those payments, the types and costs of private health 
        insurance, access, satisfaction, and quality of care for the 
        general population including rural residents and for the 
        populations identified in section 901(c); and
            ``(2) develop databases and tools that provide information 
        to States on the quality, access, and use of healthcare 
        services provided to their residents.
    ``(b) Quality and Outcomes Information.--
            ``(1) In general.--Beginning in fiscal year 2001, the 
        Director shall ensure that the survey conducted under 
        subsection (a)(1) will--
                    ``(A) identify determinants of health outcomes and 
                functional status, and their relationships to 
                healthcare access and use, determine the ways and 
                extent to which the priority populations enumerated in 
                section 901(c) differ from the general population with 
                respect to such variables, measure changes over time 
                with respect to such variable, and monitor the overall 
                national impact of changes in Federal and State policy 
                on healthcare;
                    ``(B) provide information on the quality of care 
                and patient outcomes for frequently occurring clinical 
                conditions for a nationally representative sample of 
                the population including rural residents; and
                    ``(C) provide reliable national estimates for 
                children and persons with special healthcare needs 
                through the use of supplements or periodic expansions 
                of the survey.
        In expanding the Medical Expenditure Panel Survey, as in 
        existence on the date of enactment of this title, in fiscal 
        year 2001 to collect information on the quality of care, the 
        Director shall take into account any outcomes measurements 
        generally collected by private sector accreditation 
        organizations.
            ``(2) Annual report.--Beginning in fiscal year 2003, the 
        Secretary, acting through the Director, shall submit to 
        Congress an annual report on national trends in the quality of 
        healthcare provided to the American people.

``SEC. 914. INFORMATION SYSTEMS FOR HEALTHCARE IMPROVEMENT.

    ``(a) In General.--In order to foster a range of innovative 
approaches to the management and communication of health information, 
the Agency shall support research, evaluations and initiatives to 
advance--
            ``(1) the use of information systems for the study of 
        healthcare quality, including the generation of both individual 
        provider and plan-level comparative performance data;
            ``(2) training for healthcare practitioners and researchers 
        in the use of information systems;
            ``(3) the creation of effective linkages between various 
        sources of health information, including the development of 
        information networks;
            ``(4) the delivery and coordination of evidence-based 
        healthcare services, including the use of real-time healthcare 
        decision-support programs;
            ``(5) the utility and comparability of health information 
        data and medical vocabularies by addressing issues related to 
        the content, structure, definitions and coding of such 
        information and data in consultation with appropriate Federal, 
        State and private entities;
            ``(6) the use of computer-based health records in all 
        settings for the development of personal health records for 
        individual health assessment and maintenance, and for 
        monitoring public health and outcomes of care within 
        populations; and
            ``(7) the protection of individually identifiable 
        information in health services research and healthcare quality 
        improvement.
    ``(b) Demonstration.--The Agency shall support demonstrations into 
the use of new information tools aimed at improving shared decision-
making between patients and their care-givers.

``SEC. 915. RESEARCH SUPPORTING PRIMARY CARE AND ACCESS IN UNDERSERVED 
              AREAS.

    ``(a) Preventive Services Task Force.--
            ``(1) Establishment and purpose.--The Director may 
        periodically convene a Preventive Services Task Force to be 
        composed of individuals with appropriate expertise. Such a task 
        force shall review the scientific evidence related to the 
        effectiveness, appropriateness, and cost-effectiveness of 
        clinical preventive services for the purpose of developing 
        recommendations for the healthcare community, and updating 
        previous clinical preventive recommendations.
            ``(2) Role of agency.--The Agency shall provide ongoing 
        administrative, research, and technical support for the 
        operations of the Preventive Services Task Force, including 
        coordinating and supporting the dissemination of the 
        recommendations of the Task Force.
            ``(3) Operation.--In carrying out its responsibilities 
        under paragraph (1), the Task Force is not subject to the 
        provisions of Appendix 2 of title 5, United States Code.
    ``(b) Primary Care Research.--
            ``(1) In general.--There is established within the Agency a 
        Center for Primary Care Research (referred to in this 
        subsection as the `Center') that shall serve as the principal 
        source of funding for primary care practice research in the 
        Department of Health and Human Services. For purposes of this 
        paragraph, primary care research focuses on the first contact 
        when illness or health concerns arise, the diagnosis, treatment 
        or referral to specialty care, preventive care, and the 
        relationship between the clinician and the patient in the 
        context of the family and community.
            ``(2) Research.--In carrying out this section, the Center 
        shall conduct and support research concerning--
                    ``(A) the nature and characteristics of primary 
                care practice;
                    ``(B) the management of commonly occurring clinical 
                problems;
                    ``(C) the management of undifferentiated clinical 
                problems; and
                    ``(D) the continuity and coordination of health 
                services.

``SEC. 916. CLINICAL PRACTICE AND TECHNOLOGY INNOVATION.

    ``(a) In General.--The Director shall promote innovation in 
evidence-based clinical practice and healthcare technologies by--
            ``(1) conducting and supporting research on the 
        development, diffusion, and use of healthcare technology;
            ``(2) developing, evaluating, and disseminating 
        methodologies for assessments of healthcare practices and 
        healthcare technologies;
            ``(3) conducting intramural and supporting extramural 
        assessments of existing and new healthcare practices and 
        technologies;
            ``(4) promoting education, training, and providing 
        technical assistance in the use of healthcare practice and 
        healthcare technology assessment methodologies and results; and
            ``(5) working with the National Library of Medicine and the 
        public and private sector to develop an electronic 
        clearinghouse of currently available assessments and those in 
        progress.
    ``(b) Specification of Process.--
            ``(1) In general.--Not later than December 31, 2000, the 
        Director shall develop and publish a description of the 
        methodology used by the Agency and its contractors in 
        conducting practice and technology assessment.
            ``(2) Consultations.--In carrying out this subsection, the 
        Director shall cooperate and consult with the Assistant 
        Secretary for Health, the Administrator of the Health Care 
        Financing Administration, the Director of the National 
        Institutes of Health, the Commissioner of Food and Drugs, and 
        the heads of any other interested Federal department or agency, 
        and shall seek input, where appropriate, from professional 
        societies and other private and public entities.
            ``(3) Methodology.--The Director, in developing assessment 
        methodology, shall consider--
                    ``(A) safety, efficacy, and effectiveness;
                    ``(B) legal, social, and ethical implications;
                    ``(C) costs, benefits, and cost-effectiveness;
                    ``(D) comparisons to alternate technologies and 
                practices; and
                    ``(E) requirements of Food and Drug Administration 
                approval to avoid duplication.
    ``(c) Specific Assessments.--
            ``(1) In general.--The Director shall conduct or support 
        specific assessments of healthcare technologies and practices.
            ``(2) Requests for assessments.--The Director is authorized 
        to conduct or support assessments, on a reimbursable basis, for 
        the Health Care Financing Administration, the Department of 
        Defense, the Department of Veterans Affairs, the Office of 
        Personnel Management, and other public or private entities.
            ``(3) Grants and contracts.--In addition to conducting 
        assessments, the Director may make grants to, or enter into 
        cooperative agreements or contracts with, entities described in 
        paragraph (4) for the purpose of conducting assessments of 
        experimental, emerging, existing, or potentially outmoded 
        healthcare technologies, and for related activities.
            ``(4) Eligible entities.--An entity described in this 
        paragraph is an entity that is determined to be appropriate by 
        the Director, including academic medical centers, research 
        institutions and organizations, professional organizations, 
        third party payers, governmental agencies, and consortia of 
        appropriate research entities established for the purpose of 
        conducting technology assessments.

``SEC. 917. COORDINATION OF FEDERAL GOVERNMENT QUALITY IMPROVEMENT 
              EFFORTS.

    ``(a) Requirement.--
            ``(1) In general.--To avoid duplication and ensure that 
        Federal resources are used efficiently and effectively, the 
        Secretary, acting through the Director, shall coordinate all 
        research, evaluations, and demonstrations related to health 
        services research, quality measurement and quality improvement 
        activities undertaken and supported by the Federal Government.
            ``(2) Specific activities.--The Director, in collaboration 
        with the appropriate Federal officials representing all 
        concerned executive agencies and departments, shall develop and 
        manage a process to--
                    ``(A) improve interagency coordination, priority 
                setting, and the use and sharing of research findings 
                and data pertaining to Federal quality improvement 
                programs, technology assessment, and health services 
                research;
                    ``(B) strengthen the research information 
                infrastructure, including databases, pertaining to 
                Federal health services research and healthcare quality 
                improvement initiatives;
                    ``(C) set specific goals for participating agencies 
                and departments to further health services research and 
                healthcare quality improvement; and
                    ``(D) strengthen the management of Federal 
                healthcare quality improvement programs.
    ``(b) Study by the Institute of Medicine.--
            ``(1) In general.--To provide Congress, the Department of 
        Health and Human Services, and other relevant departments with 
        an independent, external review of their quality oversight, 
        quality improvement and quality research programs, the 
        Secretary shall enter into a contract with the Institute of 
        Medicine--
                    ``(A) to describe and evaluate current quality 
                improvement, quality research and quality monitoring 
                processes through--
                            ``(i) an overview of pertinent health 
                        services research activities and quality 
                        improvement efforts conducted by all Federal 
                        programs, with particular attention paid to 
                        those under titles XVIII, XIX, and XXI of the 
                        Social Security Act; and
                            ``(ii) a summary of the partnerships that 
                        the Department of Health and Human Services has 
                        pursued with private accreditation, quality 
                        measurement and improvement organizations; and
                    ``(B) to identify options and make recommendations 
                to improve the efficiency and effectiveness of quality 
                improvement programs through--
                            ``(i) the improved coordination of 
                        activities across the medicare, medicaid and 
                        child health insurance programs under titles 
                        XVIII, XIX and XXI of the Social Security Act 
                        and health services research programs;
                            ``(ii) the strengthening of patient choice 
                        and participation by incorporating state-of-
                        the-art quality monitoring tools and making 
                        information on quality available; and
                            ``(iii) the enhancement of the most 
                        effective programs, consolidation as 
                        appropriate, and elimination of duplicative 
                        activities within various federal agencies.
            ``(2) Requirements.--
                    ``(A) In general.--The Secretary shall enter into a 
                contract with the Institute of Medicine for the 
                preparation--
                            ``(i) not later than 12 months after the 
                        date of enactment of this title, of a report 
                        providing an overview of the quality 
                        improvement programs of the Department of 
                        Health and Human Services for the medicare, 
                        medicaid, and CHIP programs under titles XVIII, 
                        XIX, and XXI of the Social Security Act; and
                            ``(ii) not later than 24 months after the 
                        date of enactment of this title, of a final 
                        report containing recommendations.
                    ``(B) Reports.--The Secretary shall submit the 
                reports described in subparagraph (A) to the Committee 
                on Finance and the Committee on Health, Education, 
                Labor, and Pensions of the Senate and the Committee on 
                Ways and Means and the Committee on Commerce of the 
                House of Representatives.

                      ``PART C--GENERAL PROVISIONS

``SEC. 921. ADVISORY COUNCIL FOR HEALTHCARE RESEARCH AND QUALITY.

    ``(a) Establishment.--There is established an advisory council to 
be known as the Advisory Council for Healthcare Research and Quality.
    ``(b) Duties.--
            ``(1) In general.--The Advisory Council shall advise the 
        Secretary and the Director with respect to activities proposed 
        or undertaken to carry out the purpose of the Agency under 
        section 901(b).
            ``(2) Certain recommendations.--Activities of the Advisory 
        Council under paragraph (1) shall include making 
        recommendations to the Director regarding--
                    ``(A) priorities regarding healthcare research, 
                especially studies related to quality, outcomes, cost 
                and the utilization of, and access to, healthcare 
                services;
                    ``(B) the field of healthcare research and related 
                disciplines, especially issues related to training 
                needs, and dissemination of information pertaining to 
                healthcare quality; and
                    ``(C) the appropriate role of the Agency in each of 
                these areas in light of private sector activity and 
                identification of opportunities for public-private 
                sector partnerships.
    ``(c) Membership.--
            ``(1) In general.--The Advisory Council shall, in 
        accordance with this subsection, be composed of appointed 
        members and ex officio members. All members of the Advisory 
        Council shall be voting members other than the individuals 
        designated under paragraph (3)(B) as ex officio members.
            ``(2) Appointed members.--The Secretary shall appoint to 
        the Advisory Council 21 appropriately qualified individuals. At 
        least 17 members of the Advisory Council shall be 
        representatives of the public who are not officers or employees 
        of the United States. The Secretary shall ensure that the 
        appointed members of the Council, as a group, are 
        representative of professions and entities concerned with, or 
        affected by, activities under this title and under section 1142 
        of the Social Security Act. Of such members--
                    ``(A) 4 shall be individuals distinguished in the 
                conduct of research, demonstration projects, and 
                evaluations with respect to healthcare;
                    ``(B) 4 shall be individuals distinguished in the 
                practice of medicine of which at least 1 shall be a 
                primary care practitioner;
                    ``(C) 3 shall be individuals distinguished in the 
                other health professions;
                    ``(D) 4 shall be individuals either representing 
                the private healthcare sector, including health plans, 
                providers, and purchasers or individuals distinguished 
                as administrators of healthcare delivery systems;
                    ``(E) 4 shall be individuals distinguished in the 
                fields of healthcare quality improvement, economics, 
                information systems, law, ethics, business, or public 
                policy, including at least 1 individual specializing in 
                rural aspects in 1 or more of these fields; and
                    ``(F) 2 shall be individuals representing the 
                interests of patients and consumers of healthcare.
            ``(3) Ex officio members.--The Secretary shall designate as 
        ex officio members of the Advisory Council--
                    ``(A) the Assistant Secretary for Health, the 
                Director of the National Institutes of Health, the 
                Director of the Centers for Disease Control and 
                Prevention, the Administrator of the Health Care 
                Financing Administration, the Assistant Secretary of 
                Defense (Health Affairs), and the Under Secretary for 
                Health of the Department of Veterans Affairs; and
                    ``(B) such other Federal officials as the Secretary 
                may consider appropriate.
    ``(d) Terms.--Members of the Advisory Council appointed under 
subsection (c)(2) shall serve for a term of 3 years. A member of the 
Council appointed under such subsection may continue to serve after the 
expiration of the term of the members until a successor is appointed.
    ``(e) Vacancies.--If a member of the Advisory Council appointed 
under subsection (c)(2) does not serve the full term applicable under 
subsection (d), the individual appointed to fill the resulting vacancy 
shall be appointed for the remainder of the term of the predecessor of 
the individual.
    ``(f) Chair.--The Director shall, from among the members of the 
Advisory Council appointed under subsection (c)(2), designate an 
individual to serve as the chair of the Advisory Council.
    ``(g) Meetings.--The Advisory Council shall meet not less than once 
during each discrete 4-month period and shall otherwise meet at the 
call of the Director or the chair.
    ``(h) Compensation and Reimbursement of Expenses.--
            ``(1) Appointed members.--Members of the Advisory Council 
        appointed under subsection (c)(2) shall receive compensation 
        for each day (including travel time) engaged in carrying out 
        the duties of the Advisory Council unless declined by the 
        member. Such compensation may not be in an amount in excess of 
        the daily equivalent of the annual rate of basic pay prescribed 
        for level IV of the Executive Schedule under section 5315 of 
        title 5, United States Code, for each day during which such 
        member is engaged in the performance of the duties of the 
        Advisory Council.
            ``(2) Ex officio members.--Officials designated under 
        subsection (c)(3) as ex officio members of the Advisory Council 
        may not receive compensation for service on the Advisory 
        Council in addition to the compensation otherwise received for 
        duties carried out as officers of the United States.
    ``(i) Staff.--The Director shall provide to the Advisory Council 
such staff, information, and other assistance as may be necessary to 
carry out the duties of the Council.

``SEC. 922. PEER REVIEW WITH RESPECT TO GRANTS AND CONTRACTS.

    ``(a) Requirement of Review.--
            ``(1) In general.--Appropriate technical and scientific 
        peer review shall be conducted with respect to each application 
        for a grant, cooperative agreement, or contract under this 
        title.
            ``(2) Reports to director.--Each peer review group to which 
        an application is submitted pursuant to paragraph (1) shall 
        report its finding and recommendations respecting the 
        application to the Director in such form and in such manner as 
        the Director shall require.
    ``(b) Approval as Precondition of Awards.--The Director may not 
approve an application described in subsection (a)(1) unless the 
application is recommended for approval by a peer review group 
established under subsection (c).
    ``(c) Establishment of Peer Review Groups.--
            ``(1) In general.--The Director shall establish such 
        technical and scientific peer review groups as may be necessary 
        to carry out this section. Such groups shall be established 
        without regard to the provisions of title 5, United States 
        Code, that govern appointments in the competitive service, and 
        without regard to the provisions of chapter 51, and subchapter 
        III of chapter 53, of such title that relate to classification 
        and pay rates under the General Schedule.
            ``(2) Membership.--The members of any peer review group 
        established under this section shall be appointed from among 
        individuals who by virtue of their training or experience are 
        eminently qualified to carry out the duties of such peer review 
        group. Officers and employees of the United States may not 
        constitute more than 25 percent of the membership of any such 
        group. Such officers and employees may not receive compensation 
        for service on such groups in addition to the compensation 
        otherwise received for these duties carried out as such 
        officers and employees.
            ``(3) Duration.--Notwithstanding section 14(a) of the 
        Federal Advisory Committee Act, peer review groups established 
        under this section may continue in existence until otherwise 
        provided by law.
            ``(4) Qualifications.--Members of any peer-review group 
        shall, at a minimum, meet the following requirements:
                    ``(A) Such members shall agree in writing to treat 
                information received, pursuant to their work for the 
                group, as confidential information, except that this 
                subparagraph shall not apply to public records and 
                public information.
                    ``(B) Such members shall agree in writing to recuse 
                themselves from participation in the peer-review of 
                specific applications which present a potential 
                personal conflict of interest or appearance of such 
                conflict, including employment in a directly affected 
                organization, stock ownership, or any financial or 
                other arrangement that might introduce bias in the 
                process of peer-review.
    ``(d) Authority for Procedural Adjustments in Certain Cases.--In 
the case of applications for financial assistance whose direct costs 
will not exceed $100,000, the Director may make appropriate adjustments 
in the procedures otherwise established by the Director for the conduct 
of peer review under this section. Such adjustments may be made for the 
purpose of encouraging the entry of individuals into the field of 
research, for the purpose of encouraging clinical practice-oriented or 
provider-based research, and for such other purposes as the Director 
may determine to be appropriate.
    ``(e) Regulations.--The Director shall issue regulations for the 
conduct of peer review under this section.

``SEC. 923. CERTAIN PROVISIONS WITH RESPECT TO DEVELOPMENT, COLLECTION, 
              AND DISSEMINATION OF DATA.

    ``(a) Standards With Respect to Utility of Data.--
            ``(1) In general.--To ensure the utility, accuracy, and 
        sufficiency of data collected by or for the Agency for the 
        purpose described in section 901(b), the Director shall 
        establish standard methods for developing and collecting such 
        data, taking into consideration--
                    ``(A) other Federal health data collection 
                standards; and
                    ``(B) the differences between types of healthcare 
                plans, delivery systems, healthcare providers, and 
                provider arrangements.
            ``(2) Relationship with other department programs.--In any 
        case where standards under paragraph (1) may affect the 
        administration of other programs carried out by the Department 
        of Health and Human Services, including the programs under 
        title XVIII, XIX or XXI of the Social Security Act, or may 
        affect health information that is subject to a standard 
        developed under part C of title XI of the Social Security Act, 
        they shall be in the form of recommendations to the Secretary 
        for such program.
    ``(b) Statistics and Analyses.--The Director shall--
            ``(1) take appropriate action to ensure that statistics and 
        analyses developed under this title are of high quality, 
        timely, and duly comprehensive, and that the statistics are 
        specific, standardized, and adequately analyzed and indexed; 
        and
            ``(2) publish, make available, and disseminate such 
        statistics and analyses on as wide a basis as is practicable.
    ``(c) Authority Regarding Certain Requests.--Upon request of a 
public or private entity, the Director may conduct or support research 
or analyses otherwise authorized by this title pursuant to arrangements 
under which such entity will pay the cost of the services provided. 
Amounts received by the Director under such arrangements shall be 
available to the Director for obligation until expended.

``SEC. 924. DISSEMINATION OF INFORMATION.

    ``(a) In General.--The Director shall--
            ``(1) without regard to section 501 of title 44, United 
        States Code, promptly publish, make available, and otherwise 
        disseminate, in a form understandable and on as broad a basis 
        as practicable so as to maximize its use, the results of 
        research, demonstration projects, and evaluations conducted or 
        supported under this title;
            ``(2) ensure that information disseminated by the Agency is 
        science-based and objective and undertakes consultation as 
        necessary to assess the appropriateness and usefulness of the 
        presentation of information that is targeted to specific 
        audiences;
            ``(3) promptly make available to the public data developed 
        in such research, demonstration projects, and evaluations;
            ``(4) provide, in collaboration with the National Library 
        of Medicine where appropriate, indexing, abstracting, 
        translating, publishing, and other services leading to a more 
        effective and timely dissemination of information on research, 
        demonstration projects, and evaluations with respect to 
        healthcare to public and private entities and individuals 
        engaged in the improvement of healthcare delivery and the 
        general public, and undertake programs to develop new or 
        improved methods for making such information available; and
            ``(5) as appropriate, provide technical assistance to State 
        and local government and health agencies and conduct liaison 
        activities to such agencies to foster dissemination.
    ``(b) Prohibition Against Restrictions.--Except as provided in 
subsection (c), the Director may not restrict the publication or 
dissemination of data from, or the results of, projects conducted or 
supported under this title.
    ``(c) Limitation on Use of Certain Information.--No information, if 
an establishment or person supplying the information or described in it 
is identifiable, obtained in the course of activities undertaken or 
supported under this title may be used for any purpose other than the 
purpose for which it was supplied unless such establishment or person 
has consented (as determined under regulations of the Director) to its 
use for such other purpose. Such information may not be published or 
released in other form if the person who supplied the information or 
who is described in it is identifiable unless such person has consented 
(as determined under regulations of the Director) to its publication or 
release in other form.
    ``(d) Penalty.--Any person who violates subsection (c) shall be 
subject to a civil monetary penalty of not more than $10,000 for each 
such violation involved. Such penalty shall be imposed and collected in 
the same manner as civil money penalties under subsection (a) of 
section 1128A of the Social Security Act are imposed and collected.

``SEC. 925. ADDITIONAL PROVISIONS WITH RESPECT TO GRANTS AND CONTRACTS.

    ``(a) Financial Conflicts of Interest.--With respect to projects 
for which awards of grants, cooperative agreements, or contracts are 
authorized to be made under this title, the Director shall by 
regulation define--
            ``(1) the specific circumstances that constitute financial 
        interests in such projects that will, or may be reasonably 
        expected to, create a bias in favor of obtaining results in the 
        projects that are consistent with such interests; and
            ``(2) the actions that will be taken by the Director in 
        response to any such interests identified by the Director.
    ``(b) Requirement of Application.--The Director may not, with 
respect to any program under this title authorizing the provision of 
grants, cooperative agreements, or contracts, provide any such 
financial assistance unless an application for the assistance is 
submitted to the Secretary and the application is in such form, is made 
in such manner, and contains such agreements, assurances, and 
information as the Director determines to be necessary to carry out the 
program in involved.
    ``(c) Provision of Supplies and Services in Lieu of Funds.--
            ``(1) In general.--Upon the request of an entity receiving 
        a grant, cooperative agreement, or contract under this title, 
        the Secretary may, subject to paragraph (2), provide supplies, 
        equipment, and services for the purpose of aiding the entity in 
        carrying out the project involved and, for such purpose, may 
        detail to the entity any officer or employee of the Department 
        of Health and Human Services.
            ``(2) Corresponding reduction in funds.--With respect to a 
        request described in paragraph (1), the Secretary shall reduce 
        the amount of the financial assistance involved by an amount 
        equal to the costs of detailing personnel and the fair market 
        value of any supplies, equipment, or services provided by the 
        Director. The Secretary shall, for the payment of expenses 
        incurred in complying with such request, expend the amounts 
        withheld.
    ``(d) Applicability of Certain Provisions With Respect to 
Contracts.--Contracts may be entered into under this part without 
regard to sections 3648 and 3709 of the Revised Statutes (31 U.S.C. 
529; 41 U.S.C. 5).

``SEC. 926. CERTAIN ADMINISTRATIVE AUTHORITIES.

    ``(a) Deputy Director and Other Officers and Employees.--
            ``(1) Deputy director.--The Director may appoint a deputy 
        director for the Agency.
            ``(2) Other officers and employees.--The Director may 
        appoint and fix the compensation of such officers and employees 
        as may be necessary to carry out this title. Except as 
        otherwise provided by law, such officers and employees shall be 
        appointed in accordance with the civil service laws and their 
        compensation fixed in accordance with title 5, United States 
        Code.
    ``(b) Facilities.--The Secretary, in carrying out this title--
            ``(1) may acquire, without regard to the Act of March 3, 
        1877 (40 U.S.C. 34), by lease or otherwise through the Director 
        of General Services, buildings or portions of buildings in the 
        District of Columbia or communities located adjacent to the 
        District of Columbia for use for a period not to exceed 10 
        years; and
            ``(2) may acquire, construct, improve, repair, operate, and 
        maintain laboratory, research, and other necessary facilities 
        and equipment, and such other real or personal property 
        (including patents) as the Secretary deems necessary.
    ``(c) Provision of Financial Assistance.--The Director, in carrying 
out this title, may make grants to public and nonprofit entities and 
individuals, and may enter into cooperative agreements or contracts 
with public and private entities and individuals.
    ``(d) Utilization of Certain Personnel and Resources.--
            ``(1) Department of health and human services.--The 
        Director, in carrying out this title, may utilize personnel and 
        equipment, facilities, and other physical resources of the 
        Department of Health and Human Services, permit appropriate (as 
        determined by the Secretary) entities and individuals to 
        utilize the physical resources of such Department, and provide 
        technical assistance and advice.
            ``(2) Other agencies.--The Director, in carrying out this 
        title, may use, with their consent, the services, equipment, 
        personnel, information, and facilities of other Federal, State, 
        or local public agencies, or of any foreign government, with or 
        without reimbursement of such agencies.
    ``(e) Consultants.--The Secretary, in carrying out this title, may 
secure, from time to time and for such periods as the Director deems 
advisable but in accordance with section 3109 of title 5, United States 
Code, the assistance and advice of consultants from the United States 
or abroad.
    ``(f) Experts.--
            ``(1) In general.--The Secretary may, in carrying out this 
        title, obtain the services of not more than 50 experts or 
        consultants who have appropriate scientific or professional 
        qualifications. Such experts or consultants shall be obtained 
        in accordance with section 3109 of title 5, United States Code, 
        except that the limitation in such section on the duration of 
        service shall not apply.
            ``(2) Travel expenses.--
                    ``(A) In general.--Experts and consultants whose 
                services are obtained under paragraph (1) shall be paid 
                or reimbursed for their expenses associated with 
                traveling to and from their assignment location in 
                accordance with sections 5724, 5724a(a), 5724a(c), and 
                5726(C) of title 5, United States Code.
                    ``(B) Limitation.--Expenses specified in 
                subparagraph (A) may not be allowed in connection with 
                the assignment of an expert or consultant whose 
                services are obtained under paragraph (1) unless and 
                until the expert agrees in writing to complete the 
                entire period of assignment, or 1 year, whichever is 
                shorter, unless separated or reassigned for reasons 
                that are beyond the control of the expert or consultant 
                and that are acceptable to the Secretary. If the expert 
                or consultant violates the agreement, the money spent 
                by the United States for the expenses specified in 
                subparagraph (A) is recoverable from the expert or 
                consultant as a statutory obligation owed to the United 
                States. The Secretary may waive in whole or in part a 
                right of recovery under this subparagraph.
    ``(g) Voluntary and Uncompensated Services.--The Director, in 
carrying out this title, may accept voluntary and uncompensated 
services.

``SEC. 927. FUNDING.

    ``(a) Intent.--To ensure that the United States's investment in 
biomedical research is rapidly translated into improvements in the 
quality of patient care, there must be a corresponding investment in 
research on the most effective clinical and organizational strategies 
for use of these findings in daily practice. The authorization levels 
in subsection (b) provide for a proportionate increase in healthcare 
research as the United States investment in biomedical research 
increases.
    ``(b) Authorization of Appropriations.--For the purpose of carrying 
out this title, there are authorized to be appropriated $250,000,000 
for fiscal year 2000, and such sums as may be necessary for each of the 
fiscal years 2001 through 2006.
    ``(c) Evaluations.--In addition to amounts available pursuant to 
subsection (b) for carrying out this title, there shall be made 
available for such purpose, from the amounts made available pursuant to 
section 241 (relating to evaluations), an amount equal to 40 percent of 
the maximum amount authorized in such section 241 to be made available 
for a fiscal year.

``SEC. 928. DEFINITIONS.

    ``In this title:
            ``(1) Advisory council.--The term `Advisory Council' means 
        the Advisory Council on Healthcare Research and Quality 
        established under section 921.
            ``(2) Agency.--The term `Agency' means the Agency for 
        Healthcare Research and Quality.
            ``(3) Director.--The term `Director' means the Director for 
        the Agency for Healthcare Research and Quality.''.

SEC. 403. REFERENCES.

    Effective upon the date of enactment of this Act, any reference in 
law to the ``Agency for Health Care Policy and Research'' shall be 
deemed to be a reference to the ``Agency for Healthcare Research and 
Quality''.

         TITLE V--ENHANCED ACCESS TO HEALTH INSURANCE COVERAGE

SEC. 501. FULL DEDUCTION OF HEALTH INSURANCE COSTS FOR SELF-EMPLOYED 
              INDIVIDUALS.

    (a) In General.--Section 162(l)(1) of the Internal Revenue Code of 
1986 (relating to allowance of deductions) is amended to read as 
follows:
            ``(1) Allowance of deduction.--In the case of an individual 
        who is an employee within the meaning of section 401(c)(1), 
        there shall be allowed as a deduction under this section an 
        amount equal to the amount paid during the taxable year for 
        insurance which constitutes medical care for the taxpayer, his 
        spouse, and his dependents.''.
    (b) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 1999.

SEC. 502. FULL AVAILABILITY OF MEDICAL SAVINGS ACCOUNTS.

    (a) Availability Not Limited To Accounts for Employees of Small 
Employers and Self-Employed Individuals.--
            (1) In general.--Section 220(c)(1)(A) of the Internal 
        Revenue Code of 1986 (relating to eligible individual) is 
        amended to read as follows:
                    ``(A) In general.--The term `eligible individual' 
                means, with respect to any month, any individual if--
                            ``(i) such individual is covered under a 
                        high deductible health plan as of the 1st day 
                        of such month, and
                            ``(ii) such individual is not, while 
                        covered under a high deductible health plan, 
                        covered under any health plan--
                                    ``(I) which is not a high 
                                deductible health plan, and
                                    ``(II) which provides coverage for 
                                any benefit which is covered under the 
                                high deductible health plan.''.
            (2) Conforming amendments.--
                    (A) Section 220(c)(1) of such Code is amended by 
                striking subparagraphs (C) and (D).
                    (B) Section 220(c) of such Code is amended by 
                striking paragraph (4) (defining small employer) and by 
                redesignating paragraph (5) as paragraph (4).
                    (C) Section 220(b) of such Code is amended by 
                striking paragraph (4) (relating to deduction limited 
                by compensation) and by redesignating paragraphs (5), 
                (6), and (7) as paragraphs (4), (5), and (6), 
                respectively.
    (b) Removal of Limitation on Number of Taxpayers Having Medical 
Savings Accounts.--
            (1) In general.--Section 220 of the Internal Revenue Code 
        of 1986 (relating to medical savings accounts) is amended by 
        striking subsections (i) and (j).
            (2) Medicare+choice.--Section 138 of such Code (relating to 
        Medicare+Choice MSA) is amended by striking subsection (f).
    (c) Reduction in High Deductible Plan Minimum Annual Deductible.--
            (1) In general.--Subparagraph (A) of section 220(c)(2) of 
        such Code (defining high deductible health plan) is amended--
                    (A) by striking ``$1,500'' and inserting 
                ``$1,000'', and
                    (B) by striking ``$3,000'' in clause (ii) and 
                inserting ``$2,000''.
            (2) Conforming amendment.--Subsection (g) of section 220 of 
        such Code is amended--
                    (A) by striking ``1998'' and inserting ``1999''; 
                and
                    (B) by striking ``1997'' and inserting ``1998''.
    (d) Increase in Contribution Limit to 100 Percent of Annual 
Deductible.--
            (1) In general.--Section 220(b)(2) of the Internal Revenue 
        Code of 1986 (relating to monthly limitation) is amended to 
        read as follows:
            ``(2) Monthly limitation.--The monthly limitation for any 
        month is the amount equal to \1/12\ of the annual deductible of 
        the high deductible health plan of the individual.''.
            (2) Conforming amendment.--Section 220(d)(1)(A) of such 
        Code is amended by striking ``75 percent of''.
    (e) Limitation on Additional Tax on Distributions Not Used for 
Qualified Medical Expenses.--Section 220(f)(4) of the Internal Revenue 
Code of 1986 (relating to additional tax on distributions not used for 
qualified medical expenses) is amended by adding at the end the 
following:
                    ``(D) Exception in case of sufficient account 
                balance.--Subparagraph (A) shall not apply to any 
                payment or distribution in any taxable year, but only 
                to the extent such payment or distribution does not 
                reduce the fair market value of the assets of the 
                medical savings account to an amount less than the 
                annual deductible for the high deductible health plan 
                of the account holder (determined as of January 1 of 
                the calendar year in which the taxable year begins).''.
    (f) Treatment of Network-Based Managed Care Plans.--Section 
220(c)(2)(B) of the Internal Revenue Code of 1986 (relating to special 
rules for high deductible health plans) is amended by adding at the end 
the following:
                            ``(iii) Treatment of network-based managed 
                        care plans.--A plan that provides health care 
                        services through a network of contracted or 
                        affiliated health care providers, if the 
                        benefits provided when services are obtained 
                        through network providers meet the requirements 
                        of subparagraph (A), shall not fail to be 
                        treated as a high deductible health plan by 
                        reason of providing benefits for services 
                        rendered by providers who are not members of 
                        the network, so long as the annual deductible 
                        and annual limit on out-of-pocket expenses 
                        applicable to services received from non-
                        network providers are not lower than those 
                        applicable to services received from the 
                        network providers.''.
    (g) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 1999.

SEC. 503. PERMITTING CONTRIBUTION TOWARDS MEDICAL SAVINGS ACCOUNT 
              THROUGH FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM 
              (FEHBP).

    (a) Authority To Contract for Catastrophic Plans.--Section 8902 of 
title 5, United States Code, is amended by adding at the end the 
following:
    ``(p)(1) The Office shall contract under this chapter for a 
catastrophic plan with any qualified carrier that--
            ``(A) offers such a plan; and
            ``(B) as of the date of enactment of the Patients' Bill of 
        Rights Plus Act, offers a health benefits plan under this 
        chapter.
    ``(2) The Office may contract under this chapter for a catastrophic 
plan with any qualified carrier that--
            ``(A) offers such a plan; but
            ``(B) does not satisfy the requirement under paragraph 
        (1)(B).''.
    (b) Government Contribution to Medical Savings Account.--
            (1) In general.--Section 8906 of title 5, United States 
        Code, is amended by adding at the end the following:
    ``(j)(1) In the case of an employee or annuitant who is enrolled in 
a catastrophic plan described by section 8903(5), there shall be a 
Government contribution under this subsection to a medical savings 
account established or maintained for the benefit of the individual. 
The contribution under this subsection shall be in addition to the 
Government contribution under subsection (b).
    ``(2) The amount of the Government contribution under this 
subsection with respect to an individual is equal to the amount by 
which--
            ``(A) the maximum contribution allowed under subsection 
        (b)(1) with respect to any employee or annuitant, exceeds
            ``(B) the amount of the Government contribution actually 
        made with respect to the individual under subsection (b) for 
        coverage under the catastrophic plan.
    ``(3) The Government contributions under this subsection shall be 
paid into a medical savings account (designated by the individual 
involved) in a manner that is specified by the Office and consistent 
with the timing of contributions under subsection (b).
    ``(4) Subsections (f) and (g) shall apply to contributions under 
this section in the same manner as they apply to contributions under 
subsection (b).
    ``(5) For the purpose of this subsection, the term `medical savings 
account' has the meaning given such term by section 220(d) of the 
Internal Revenue Code of 1986.''.
            (2) Allowing payment of full amount of charge for 
        catastrophic plan.--Section 8906(b)(2) of such title is amended 
        by inserting ``(or 100 percent of the subscription charge in 
        the case of a catastrophic plan)'' after ``75 percent of the 
        subscription charge''.
    (c) Offering of Catastrophic Plans.--
            (1) In general.--Section 8903 of title 5, United States 
        Code, is amended by adding at the end the following:
            ``(5) Catastrophic plans.--(A) One or more plans described 
        in paragraph (1), (2), or (3), but which provide benefits of 
        the types referred to by paragraph (5) of section 8904(a), 
        instead of the types referred to in paragraphs (1), (2), and 
        (3) of such section.
            ``(B) Nothing in this section shall be considered--
                    ``(i) to prevent a carrier from simultaneously 
                offering a plan described by subparagraph (A) and a 
                plan described by paragraph (1) or (2);
                    ``(ii) to require that a catastrophic plan offer 
                two levels of benefits; or
                    ``(iii) to allow, in any contract year, for--
                            ``(I) more than one plan to be offered 
                        which satisfies both subparagraph (A) and 
                        paragraph (1) (subject to clause (ii)); and
                            ``(II) more than one plan which satisfies 
                        both subparagraph (A) and paragraph (2) 
                        (subject to clause (ii)).''.
            (2) Types of benefits.--Section 8904(a) of such title is 
        amended by inserting after paragraph (4) the following new 
        paragraph:
            ``(5) Catastrophic plans.--Benefits of the types named 
        under paragraph (1) or (2) of this subsection or both, except 
        that the plan shall meet the annual deductible and annual out-
        of-pocket expenses requirements under section 220(c)(2) of the 
        Internal Revenue Code of 1986.''.
            (3) Determining level of government contributions.--Section 
        8906(b) of such title is amended by adding at the end the 
        following: ``Subscription charges for medical savings accounts 
        shall be deemed to be the amount of Government contributions 
        made under subsection (j)(2).''.
    (d) Conforming Amendments.--
            (1) Additional health benefits plans.--Section 8903a of 
        title 5, United States Code, is amended by redesignating 
        subsection (d) as subsection (e) and by inserting after 
        subsection (c) the following:
    ``(d) The plans under this section may include one or more plans, 
otherwise allowable under this section, that satisfy the requirements 
of clauses (i) and (ii) of section 8903(5)(A).''.
            (2) Reference.--Section 8909(d) of title 5, United States 
        Code, is amended by striking ``8903a(d)'' and inserting 
        ``8903a(e)''.
    (e) References.--Section 8903 of title 5, United States Code, is 
amended by adding at the end (as a flush left sentence) the following:
``The Office shall prescribe regulations under which the requirements 
of section 8902(c), 8902(n), 8909(e), and any other provision of this 
chapter that applies with respect to a plan described by paragraph (1), 
(2), (3), or (4) of this section shall apply with respect to the 
corresponding plan under paragraph (5) of this section. Similar 
regulations shall be prescribed with respect to any plan under section 
8903a(d).''.
    (f) Effective Date.--The amendments made by this section shall 
apply to contract terms beginning on or after January 1, 2000.

SEC. 504. CARRYOVER OF UNUSED BENEFITS FROM CAFETERIA PLANS, FLEXIBLE 
              SPENDING ARRANGEMENTS, AND HEALTH FLEXIBLE SPENDING 
              ACCOUNTS.

    (a) In General.--Section 125 of the Internal Revenue Code of 1986 
(relating to cafeteria plans) is amended by redesignating subsections 
(h) and (i) as subsections (i) and (j) and by inserting after 
subsection (g) the following new subsection:
    ``(h) Allowance of Carryovers of Unused Benefits to Later Taxable 
Years.--
            ``(1) In general.--For purposes of this title--
                    ``(A) notwithstanding subsection (d)(2), a plan or 
                other arrangement shall not fail to be treated as a 
                cafeteria plan or flexible spending or similar 
                arrangement, and
                    ``(B) no amount shall be required to be included in 
                gross income by reason of this section or any other 
                provision of this chapter,
        solely because under such plan or other arrangement any 
        nontaxable benefit which is unused as of the close of a taxable 
        year may be carried forward to 1 or more succeeding taxable 
        years.
            ``(2) Limitation.--Paragraph (1) shall not apply to amounts 
        carried from a plan to the extent such amounts exceed $500 
        (applied on an annual basis). For purposes of this paragraph, 
        all plans and arrangements maintained by an employer or any 
        related person shall be treated as 1 plan.
            ``(3) Allowance of rollover.--
                    ``(A) In general.--In the case of any unused 
                benefit described in paragraph (1) which consists of 
                amounts in a health flexible spending account or 
                dependent care flexible spending account, the plan or 
                arrangement shall provide that a participant may elect, 
                in lieu of such carryover, to have such amounts 
                distributed to the participant.
                    ``(B) Amounts not included in income.--Any 
                distribution under subparagraph (A) shall not be 
                included in gross income to the extent that such amount 
                is transferred in a trustee-to-trustee transfer, or is 
                contributed within 60 days of the date of the 
                distribution, to--
                            ``(i) a qualified cash or deferred 
                        arrangement described in section 401(k),
                            ``(ii) a plan under which amounts are 
                        contributed by an individual's employer for an 
                        annuity contract described in section 403(b),
                            ``(iii) an eligible deferred compensation 
                        plan described in section 457, or
                            ``(iv) a medical savings account (within 
                        the meaning of section 220).
                Any amount rolled over under this subparagraph shall be 
                treated as a rollover contribution for the taxable year 
                from which the unused amount would otherwise be 
                carried.
                    ``(C) Treatment of rollover.--Any amount rolled 
                over under subparagraph (B) shall be treated as an 
                eligible rollover under section 220, 401(k), 403(b), or 
                457, whichever is applicable, and shall be taken into 
                account in applying any limitation (or participation 
                requirement) on employer or employee contributions 
                under such section or any other provision of this 
                chapter for the taxable year of the rollover.
            ``(4) Cost-of-living adjustment.--In the case of any 
        taxable year beginning in a calendar year after 1999, the $500 
        amount under paragraph (2) shall be adjusted at the same time 
        and in the same manner as under section 415(d)(2), except that 
        the base period taken into account shall be the calendar 
        quarter beginning October 1, 1998, and any increase which is 
        not a multiple of $50 shall be rounded to the next lowest 
        multiple of $50.
            ``(5) Applicability.--This subsection shall apply to 
        taxable years beginning after December 31, 1999.''.
    (b) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 1999.

       TITLE VI--PROVISIONS RELATING TO LONG-TERM CARE INSURANCE

SEC. 601. INCLUSION OF QUALIFIED LONG-TERM CARE INSURANCE CONTRACTS IN 
              CAFETERIA PLANS, FLEXIBLE SPENDING ARRANGEMENTS, AND 
              HEALTH FLEXIBLE SPENDING ACCOUNTS.

    (a) In General.--Section 125(f) of the Internal Revenue Code of 
1986 (defining qualified benefits) is amended by striking the last 
sentence and inserting the following: ``Such term includes any 
qualified long-term care insurance contract.''.
    (b) Effective Date.--The amendment made by this section shall apply 
to taxable years beginning after December 31, 1999.

SEC. 602. DEDUCTION FOR PREMIUMS FOR LONG-TERM CARE INSURANCE.

    (a) In General.--Part VII of subchapter B of chapter 1 of the 
Internal Revenue Code of 1986 (relating to additional itemized 
deductions) is amended by redesignating section 222 as section 223 and 
by inserting after section 221 the following:

``SEC. 222. PREMIUMS FOR LONG-TERM CARE INSURANCE.

    ``(a) In General.--In the case of an eligible individual, there 
shall be allowed as a deduction an amount equal to 100 percent of the 
amount paid during the taxable year for any coverage for qualified 
long-term care services (as defined in section 7702B(c)) or any 
qualified long-term care insurance contract (as defined in section 
7702B(b)) which constitutes medical care for the taxpayer, his spouse, 
and dependents.
    ``(b) Limitations.--
            ``(1) Deduction not available to individuals eligible for 
        employer-subsidized coverage.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), subsection (a) shall not apply to any 
                taxpayer for any calendar month for which the taxpayer 
                is eligible to participate in any plan which includes 
                coverage for qualified long-term care services (as so 
                defined) or is a qualified long-term care insurance 
                contract (as so defined) maintained by any employer (or 
                former employer) of the taxpayer or of the spouse of 
                the taxpayer.
                    ``(B) Continuation coverage.--Coverage shall not be 
                treated as subsidized for purposes of this paragraph 
                if--
                            ``(i) such coverage is continuation 
                        coverage (within the meaning of section 
                        4980B(f)) required to be provided by the 
                        employer, and
                            ``(ii) the taxpayer or the taxpayer's 
                        spouse is required to pay a premium for such 
                        coverage in an amount not less than 100 percent 
                        of the applicable premium (within the meaning 
                        of section 4980B(f)(4)) for the period of such 
                        coverage.
            ``(2) Limitation on long-term care premiums.--In the case 
        of a qualified long-term care insurance contract (as so 
        defined), only eligible long-term care premiums (as defined in 
        section 213(d)(10)) shall be taken into account under 
        subsection (a)(2).
    ``(c) Special Rules.--For purposes of this section--
            ``(1) Coordination with medical deduction, etc.--Any amount 
        paid by a taxpayer for insurance to which subsection (a) 
        applies shall not be taken into account in computing the amount 
        allowable to the taxpayer as a deduction under section 213(a).
            ``(2) Deduction not allowed for self-employment tax 
        purposes.--The deduction allowable by reason of this section 
        shall not be taken into account in determining an individual's 
        net earnings from self-employment (within the meaning of 
        section 1402(a)) for purposes of chapter 2.''.
    (b) Conforming Amendments.--
            (1) Subsection (a) of section 62 of the Internal Revenue 
        Code of 1986 is amended by inserting after paragraph (17) the 
        following:
            ``(18) Long-term care insurance costs of certain 
        individuals.--The deduction allowed by section 222.''.
            (2) The table of sections for part VII of subchapter B of 
        chapter 1 of such Code is amended by striking the last item and 
        inserting the following:

``Sec. 222. Premiums for long-term care insurance.
``Sec. 223. Cross reference.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 1999.

SEC. 603. STUDY OF LONG-TERM CARE NEEDS IN THE 21ST CENTURY.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall provide, in 
accordance with this section, for a study in order to determine--
            (1) future demand for long-term health care services 
        (including institutional and home and community-based services) 
        in the United States in order to meet the needs in the 21st 
        century; and
            (2) long-term options to finance the provision of such 
        services.
    (b) Details.--The study conducted under subsection (a) shall 
include the following:
            (1) An identification of the relevant demographic 
        characteristics affecting demand for long-term health care 
        services, at least through the year 2030.
            (2) The viability and capacity of community-based and other 
        long-term health care services under different federal 
        programs, including through the medicare and medicaid programs, 
        grants to States, housing services, and changes in tax policy.
            (3) How to improve the quality of long-term health care 
        services.
            (4) The integration of long-term health care services for 
        individuals between different classes of health care providers 
        (such as hospitals, nursing facilities, and home care agencies) 
        and different Federal programs (such as the medicare and 
        medicaid programs).
            (5) The possibility of expanding private sector 
        initiatives, including long-term care insurance, to meet the 
        need to finance such services.
            (6) An examination of the effect of enactment of the Health 
        Insurance Portability and Accountability Act of 1996 on the 
        provision and financing of long-term health care services, 
        including on portability and affordability of private long-term 
        care insurance, the impact of insurance options on low-income 
        older Americans, and the options for eligibility to improve 
        access to such insurance.
            (7) The financial impact of the provision of long-term 
        health care services on caregivers and other family members.
    (c) Report and Recommendations.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act, the Secretary shall provide for a 
        report on the study under this section.
            (2) Recommendations.--The report under paragraph (1) shall 
        include findings and recommendations regarding each of the 
        following:
                    (A) The most effective and efficient manner that 
                the Federal government may use its resources to educate 
                the public on planning for needs for long-term health 
                care services.
                    (B) The public, private, and joint public-private 
                strategies for meeting identified needs for long-term 
                health care services.
                    (C) The role of States and local communities in the 
                financing of long-term health care services.
            (3) Inclusion of cost estimates.--The report under 
        paragraph (1) shall include cost estimates of the various 
        options for which recommendations are made.
    (d) Conduct of Study.--
            (1) Use of institute of medicine.--The Secretary of Health 
        and Human Services shall seek to enter into an appropriate 
        arrangement with the Institute of Medicine of the National 
        Academy of Sciences to conduct the study under this section. If 
        such an arrangement cannot be made, the Secretary may provide 
        for the conduct of the study by any other qualified non-
        governmental entity.
            (2) Consultation.--The study should be conducted under this 
        section in consultation with experts from a wide-range of 
        groups from the public and private sectors.

                 TITLE VII--INDIVIDUAL RETIREMENT PLANS

SEC. 701. MODIFICATION OF INCOME LIMITS ON CONTRIBUTIONS AND ROLLOVERS 
              TO ROTH IRAS.

    (a) Increase in AGI Limit for Rollover Contributions.--Clause (i) 
of section 408A(c)(3)(A) of the Internal Revenue Code of 1986 (relating 
to rollover from IRA), as redesignated by subsection (a), is amended by 
striking ``$100,000'' and inserting ``$1,000,000''.
    (b) Conforming Amendments.--
            (1)(A) Subparagraph (B) of section 408A(c)(3) of the 
        Internal Revenue Code of 1986, as redesignated by subsection 
        (a), is amended to read as follows:
                    ``(B) Definition of adjusted gross income.--For 
                purposes of subparagraph (A), adjusted gross income 
                shall be determined--
                            ``(i) after application of sections 86 and 
                        469, and
                            ``(ii) without regard to sections 135, 137, 
                        221, and 911, the deduction allowable under 
                        section 219, or any amount included in gross 
                        income under subsection (d)(3).''.
            (B) Effective date.--The amendment made by this paragraph 
        shall apply to taxable years beginning after December 31, 1999.
            (2)(A) Subparagraph (B) of section 408A(c)(3) of such Code, 
        as amended by paragraph (1), is amended to read as follows:
                    ``(B) Definition of adjusted gross income.--For 
                purposes of subparagraph (A), adjusted gross income 
                shall be determined--
                            ``(i) after application of sections 86 and 
                        469, and
                            ``(ii) without regard to sections 135, 137, 
                        221, and 911, the deduction allowable under 
                        section 219, or any amount included in gross 
                        income under subsection (d)(3) or by reason of 
                        a required distribution under a provision 
                        described in paragraph (5).''.
            (B) Effective date.--The amendment made by this paragraph 
        shall apply to taxable years beginning after December 31, 2004.
    (c) Effective Date.--Except as otherwise provided in this section, 
the amendments made by this section shall apply to taxable years 
beginning after December 31, 1999.

                     TITLE VIII--REVENUE PROVISIONS

SEC. 801. MODIFICATION TO FOREIGN TAX CREDIT CARRYBACK AND CARRYOVER 
              PERIODS.

    (a) In General.--Section 904(c) of the Internal Revenue Code of 
1986 (relating to limitation on credit) is amended--
            (1) by striking ``in the second preceding taxable year,'', 
        and
            (2) by striking ``or fifth'' and inserting ``fifth, sixth, 
        or seventh''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to credits arising in taxable years beginning after December 31, 
2001.

SEC. 802. LIMITATION ON USE OF NON-ACCRUAL EXPERIENCE METHOD OF 
              ACCOUNTING.

    (a) In General.--Section 448(d)(5) of the Internal Revenue Code of 
1986 (relating to special rule for services) is amended--
            (1) by inserting ``in fields described in paragraph 
        (2)(A)'' after ``services by such person'', and
            (2) by inserting ``certain personal'' before ``services'' 
        in the heading.
    (b) Effective Date.--
            (1) In general.--The amendments made by this section shall 
        apply to taxable years ending after the date of the enactment 
        of this Act.
            (2) Change in method of accounting.--In the case of any 
        taxpayer required by the amendments made by this section to 
        change its method of accounting for its first taxable year 
        ending after the date of the enactment of this Act--
                    (A) such change shall be treated as initiated by 
                the taxpayer,
                    (B) such change shall be treated as made with the 
                consent of the Secretary of the Treasury, and
                    (C) the net amount of the adjustments required to 
                be taken into account by the taxpayer under section 481 
                of the Internal Revenue Code of 1986 shall be taken 
                into account over a period (not greater than 4 taxable 
                years) beginning with such first taxable year.

SEC. 803. RETURNS RELATING TO CANCELLATIONS OF INDEBTEDNESS BY 
              ORGANIZATIONS LENDING MONEY.

    (a) In General.--Paragraph (2) of section 6050P(c) of the Internal 
Revenue Code of 1986 (relating to definitions and special rules) is 
amended by striking ``and'' at the end of subparagraph (B), by striking 
the period at the end of subparagraph (C) and inserting ``, and'', and 
by inserting after subparagraph (C) the following new subparagraph:
                    ``(D) any organization a significant trade or 
                business of which is the lending of money.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to discharges of indebtedness after December 31, 1999.

SEC. 804. EXTENSION OF INTERNAL REVENUE SERVICE USER FEES.

    (a) In General.--Chapter 77 of the Internal Revenue Code of 1986 
(relating to miscellaneous provisions) is amended by adding at the end 
the following new section:

``SEC. 7527. INTERNAL REVENUE SERVICE USER FEES.

    ``(a) General Rule.--The Secretary shall establish a program 
requiring the payment of user fees for--
            ``(1) requests to the Internal Revenue Service for ruling 
        letters, opinion letters, and determination letters, and
            ``(2) other similar requests.
    ``(b) Program Criteria.--
            ``(1) In general.--The fees charged under the program 
        required by subsection (a)--
                    ``(A) shall vary according to categories (or 
                subcategories) established by the Secretary,
                    ``(B) shall be determined after taking into account 
                the average time for (and difficulty of) complying with 
                requests in each category (and subcategory), and
                    ``(C) shall be payable in advance.
            ``(2) Exemptions, etc.--The Secretary shall provide for 
        such exemptions (and reduced fees) under such program as the 
        Secretary determines to be appropriate.
            ``(3) Average fee requirement.--The average fee charged 
        under the program required by subsection (a) shall not be less 
        than the amount determined under the following table:

``Category                                                  Average Fee
    Employee plan ruling and opinion..............                $250 
    Exempt organization ruling....................                $350 
    Employee plan determination...................                $300 
    Exempt organization determination.............                $275 
    Chief counsel ruling..........................                $200.
    ``(c) Termination.--No fee shall be imposed under this section with 
respect to requests made after September 30, 2009.''.
    (b) Conforming Amendments.--
            (1) The table of sections for chapter 77 of the Internal 
        Revenue Code of 1986 is amended by adding at the end the 
        following new item:

``Sec. 7527. Internal Revenue Service user fees.''.
            (2) Section 10511 of the Revenue Act of 1987 is repealed.
    (c) Effective Date.--The amendments made by this section shall 
apply to requests made after the date of the enactment of this Act.

SEC. 805. PROPERTY SUBJECT TO A LIABILITY TREATED IN SAME MANNER AS 
              ASSUMPTION OF LIABILITY.

    (a) Repeal of Property Subject to a Liability Test.--
            (1) Section 357.--Section 357(a)(2) of the Internal Revenue 
        Code of 1986 (relating to assumption of liability) is amended 
        by striking ``, or acquires from the taxpayer property subject 
        to a liability''.
            (2) Section 358.--Section 358(d)(1) of such Code (relating 
        to assumption of liability) is amended by striking ``or 
        acquired from the taxpayer property subject to a liability''.
            (3) Section 368.--
                    (A) Section 368(a)(1)(C) of such Code is amended by 
                striking ``, or the fact that property acquired is 
                subject to a liability,''.
                    (B) The last sentence of section 368(a)(2)(B) of 
                such Code is amended by striking ``, and the amount of 
                any liability to which any property acquired from the 
                acquiring corporation is subject,''.
    (b) Clarification of Assumption of Liability.--
            (1) In general.--Section 357 of the Internal Revenue Code 
        of 1986 is amended by adding at the end the following new 
        subsection:
    ``(d) Determination of Amount of Liability Assumed.--
            ``(1) In general.--For purposes of this section, section 
        358(d), section 362(d), section 368(a)(1)(C), and section 
        368(a)(2)(B), except as provided in regulations--
                    ``(A) a recourse liability (or portion thereof) 
                shall be treated as having been assumed if, as 
                determined on the basis of all facts and circumstances, 
                the transferee has agreed to, and is expected to, 
                satisfy such liability (or portion), whether or not the 
                transferor has been relieved of such liability, and
                    ``(B) except to the extent provided in paragraph 
                (2), a nonrecourse liability shall be treated as having 
                been assumed by the transferee of any asset subject to 
                such liability.
            ``(2) Exception for nonrecourse liability.--The amount of 
        the nonrecourse liability treated as described in paragraph 
        (1)(B) shall be reduced by the lesser of--
                    ``(A) the amount of such liability which an owner 
                of other assets not transferred to the transferee and 
                also subject to such liability has agreed with the 
                transferee to, and is expected to, satisfy, or
                    ``(B) the fair market value of such other assets 
                (determined without regard to section 7701(g)).
            ``(3) Regulations.--The Secretary shall prescribe such 
        regulations as may be necessary to carry out the purposes of 
        this subsection and section 362(d). The Secretary may also 
        prescribe regulations which provide that the manner in which a 
        liability is treated as assumed under this subsection is 
        applied, where appropriate, elsewhere in this title.''.
            (2) Limitation on basis increase attributable to assumption 
        of liability.--Section 362 of such Code is amended by adding at 
        the end the following new subsection:
    ``(d) Limitation on Basis Increase Attributable to Assumption of 
Liability.--
            ``(1) In general.--In no event shall the basis of any 
        property be increased under subsection (a) or (b) above the 
        fair market value of such property (determined without regard 
        to section 7701(g)) by reason of any gain recognized to the 
        transferor as a result of the assumption of a liability.
            ``(2) Treatment of gain not subject to tax.--Except as 
        provided in regulations, if--
                    ``(A) gain is recognized to the transferor as a 
                result of an assumption of a nonrecourse liability by a 
                transferee which is also secured by assets not 
                transferred to such transferee, and
                    ``(B) no person is subject to tax under this title 
                on such gain,
        then, for purposes of determining basis under subsections (a) 
        and (b), the amount of gain recognized by the transferor as a 
        result of the assumption of the liability shall be determined 
        as if the liability assumed by the transferee equaled such 
        transferee's ratable portion of such liability determined on 
        the basis of the relative fair market values (determined 
        without regard to section 7701(g)) of all of the assets subject 
        to such liability.''.
    (c) Application to Provisions Other Than Subchapter C.--
            (1) Section 584.--Section 584(h)(3) of the Internal Revenue 
        Code of 1986 is amended--
                    (A) by striking ``, and the fact that any property 
                transferred by the common trust fund is subject to a 
                liability,'' in subparagraph (A), and
                    (B) by striking clause (ii) of subparagraph (B) and 
                inserting:
                            ``(ii) Assumed liabilities.--For purposes 
                        of clause (i), the term `assumed liabilities' 
                        means any liability of the common trust fund 
                        assumed by any regulated investment company in 
                        connection with the transfer referred to in 
                        paragraph (1)(A).
                    ``(C) Assumption.--For purposes of this paragraph, 
                in determining the amount of any liability assumed, the 
                rules of section 357(d) shall apply.''.
            (2) Section 1031.--The last sentence of section 1031(d) of 
        such Code is amended--
                    (A) by striking ``assumed a liability of the 
                taxpayer or acquired from the taxpayer property subject 
                to a liability'' and inserting ``assumed (as determined 
                under section 357(d)) a liability of the taxpayer'', 
                and
                    (B) by striking ``or acquisition (in the amount of 
                the liability)''.
    (d) Conforming Amendments.--
            (1) Section 351(h)(1) of the Internal Revenue Code of 1986 
        is amended by striking ``, or acquires property subject to a 
        liability,''.
            (2) Section 357 of such Code is amended by striking ``or 
        acquisition'' each place it appears in subsection (a) or (b).
            (3) Section 357(b)(1) of such Code is amended by striking 
        ``or acquired''.
            (4) Section 357(c)(1) of such Code is amended by striking 
        ``, plus the amount of the liabilities to which the property is 
        subject,''.
            (5) Section 357(c)(3) of such Code is amended by striking 
        ``or to which the property transferred is subject''.
            (6) Section 358(d)(1) of such Code is amended by striking 
        ``or acquisition (in the amount of the liability)''.
    (e) Effective Date.--The amendments made by this section shall 
apply to transfers after October 19, 1998.

SEC. 806. CHARITABLE SPLIT-DOLLAR LIFE INSURANCE, ANNUITY, AND 
              ENDOWMENT CONTRACTS.

    (a) In General.--Subsection (f) of section 170 of the Internal 
Revenue Code of 1986 (relating to disallowance of deduction in certain 
cases and special rules) is amended by adding at the end the following 
new paragraph:
            ``(10) Split-dollar life insurance, annuity, and endowment 
        contracts.--
                    ``(A) In general.--Nothing in this section or in 
                section 545(b)(2), 556(b)(2), 642(c), 2055, 2106(a)(2), 
                or 2522 shall be construed to allow a deduction, and no 
                deduction shall be allowed, for any transfer to or for 
                the use of an organization described in subsection (c) 
                if in connection with such transfer--
                            ``(i) the organization directly or 
                        indirectly pays, or has previously paid, any 
                        premium on any personal benefit contract with 
                        respect to the transferor, or
                            ``(ii) there is an understanding or 
                        expectation that any person will directly or 
                        indirectly pay any premium on any personal 
                        benefit contract with respect to the 
                        transferor.
                    ``(B) Personal benefit contract.--For purposes of 
                subparagraph (A), the term `personal benefit contract' 
                means, with respect to the transferor, any life 
                insurance, annuity, or endowment contract if any direct 
                or indirect beneficiary under such contract is the 
                transferor, any member of the transferor's family, or 
                any other person (other than an organization described 
                in subsection (c)) designated by the transferor.
                    ``(C) Application to charitable remainder trusts.--
                In the case of a transfer to a trust referred to in 
                subparagraph (E), references in subparagraphs (A) and 
                (F) to an organization described in subsection (c) 
                shall be treated as a reference to such trust.
                    ``(D) Exception for certain annuity contracts.--If, 
                in connection with a transfer to or for the use of an 
                organization described in subsection (c), such 
                organization incurs an obligation to pay a charitable 
                gift annuity (as defined in section 501(m)) and such 
                organization purchases any annuity contract to fund 
                such obligation, persons receiving payments under the 
                charitable gift annuity shall not be treated for 
                purposes of subparagraph (B) as indirect beneficiaries 
                under such contract if--
                            ``(i) such organization possesses all of 
                        the incidents of ownership under such contract,
                            ``(ii) such organization is entitled to all 
                        the payments under such contract, and
                            ``(iii) the timing and amount of payments 
                        under such contract are substantially the same 
                        as the timing and amount of payments to each 
                        such person under such obligation (as such 
                        obligation is in effect at the time of such 
                        transfer).
                    ``(E) Exception for certain contracts held by 
                charitable remainder trusts.--A person shall not be 
                treated for purposes of subparagraph (B) as an indirect 
                beneficiary under any life insurance, annuity, or 
                endowment contract held by a charitable remainder 
                annuity trust or a charitable remainder unitrust (as 
                defined in section 664(d)) solely by reason of being 
                entitled to any payment referred to in paragraph (1)(A) 
                or (2)(A) of section 664(d) if--
                            ``(i) such trust possesses all of the 
                        incidents of ownership under such contract, and
                            ``(ii) such trust is entitled to all the 
                        payments under such contract.
                    ``(F) Excise tax on premiums paid.--
                            ``(i) In general.--There is hereby imposed 
                        on any organization described in subsection (c) 
                        an excise tax equal to the premiums paid by 
                        such organization on any life insurance, 
                        annuity, or endowment contract if the payment 
                        of premiums on such contract is in connection 
                        with a transfer for which a deduction is not 
                        allowable under subparagraph (A), determined 
                        without regard to when such transfer is made.
                            ``(ii) Payments by other persons.--For 
                        purposes of clause (i), payments made by any 
                        other person pursuant to an understanding or 
                        expectation referred to in subparagraph (A) 
                        shall be treated as made by the organization.
                            ``(iii) Reporting.--Any organization on 
                        which tax is imposed by clause (i) with respect 
                        to any premium shall file an annual return 
                        which includes--
                                    ``(I) the amount of such premiums 
                                paid during the year and the name and 
                                TIN of each beneficiary under the 
                                contract to which the premium relates, 
                                and
                                    ``(II) such other information as 
                                the Secretary may require.
                        The penalties applicable to returns required 
                        under section 6033 shall apply to returns 
                        required under this clause. Returns required 
                        under this clause shall be furnished at such 
                        time and in such manner as the Secretary shall 
                        by forms or regulations require.
                            ``(iv) Certain rules to apply.--The tax 
                        imposed by this subparagraph shall be treated 
                        as imposed by chapter 42 for purposes of this 
                        title other than subchapter B of chapter 42.
                    ``(G) Special rule where state requires 
                specification of charitable gift annuitant in 
                contract.--In the case of an obligation to pay a 
                charitable gift annuity referred to in subparagraph (D) 
                which is entered into under the laws of a State which 
                requires, in order for the charitable gift annuity to 
                be exempt from insurance regulation by such State, that 
                each beneficiary under the charitable gift annuity be 
                named as a beneficiary under an annuity contract issued 
                by an insurance company authorized to transact business 
                in such State, the requirements of clauses (i) and (ii) 
                of subparagraph (D) shall be treated as met if--
                            ``(i) such State law requirement was in 
                        effect on February 8, 1999,
                            ``(ii) each such beneficiary under the 
                        charitable gift annuity is a bona fide resident 
                        of such State at the time the obligation to pay 
                        a charitable gift annuity is entered into, and
                            ``(iii) the only persons entitled to 
                        payments under such contract are persons 
                        entitled to payments as beneficiaries under 
                        such obligation on the date such obligation is 
                        entered into.
                    ``(H) Regulations.--The Secretary shall prescribe 
                such regulations as may be necessary or appropriate to 
                carry out the purposes of this paragraph, including 
                regulations to prevent the avoidance of such 
                purposes.''.
    (b) Effective Date.--
            (1) In general.--Except as otherwise provided in this 
        section, the amendment made by this section shall apply to 
        transfers made after February 8, 1999.
            (2) Excise tax.--Except as provided in paragraph (3) of 
        this subsection, section 170(f)(10)(F) of the Internal Revenue 
        Code of 1986 (as added by this section) shall apply to premiums 
        paid after the date of the enactment of this Act.
            (3) Reporting.--Clause (iii) of such section 170(f)(10)(F) 
        shall apply to premiums paid after February 8, 1999 (determined 
        as if the tax imposed by such section applies to premiums paid 
        after such date).

SEC. 807. TRANSFER OF EXCESS DEFINED BENEFIT PLAN ASSETS FOR RETIREE 
              HEALTH BENEFITS.

    (a) Extension.--
            (1) In general.--Section 420(b)(5) of the Internal Revenue 
        Code of 1986 (relating to expiration) is amended by striking 
        ``in any taxable year beginning after December 31, 2000'' and 
        inserting ``made after September 30, 2009''.
            (2) Conforming amendments.--
                    (A) Section 101(e)(3) of the Employee Retirement 
                Income Security Act of 1974 (29 U.S.C. 1021(e)(3)) is 
                amended by striking ``1995'' and inserting ``2001''.
            (B) Section 403(c)(1) of such Act (29 U.S.C. 1103(c)(1)) is 
        amended by striking ``1995'' and inserting ``2001''.
            (C) Paragraph (13) of section 408(b) of such Act (29 U.S.C. 
        1108(b)(13)) is amended--
                    (i) by striking ``in a taxable year beginning 
                before January 1, 2001'' and inserting ``made before 
                October 1, 2009'', and
                    (ii) by striking ``1995'' and inserting ``2001''.
    (b) Application of Minimum Cost Requirements.--
            (1) In general.--Section 420(c)(3) of the Internal Revenue 
        Code of 1986 is amended to read as follows:
            ``(3) Minimum cost requirements.--
                    ``(A) In general.--The requirements of this 
                paragraph are met if each group health plan or 
                arrangement under which applicable health benefits are 
                provided provides that the applicable employer cost for 
                each taxable year during the cost maintenance period 
                shall not be less than the higher of the applicable 
                employer costs for each of the 2 taxable years 
                immediately preceding the taxable year of the qualified 
                transfer.
                    ``(B) Applicable employer cost.--For purposes of 
                this paragraph, the term `applicable employer cost' 
                means, with respect to any taxable year, the amount 
                determined by dividing--
                            ``(i) the qualified current retiree health 
                        liabilities of the employer for such taxable 
                        year determined--
                                    ``(I) without regard to any 
                                reduction under subsection (e)(1)(B), 
                                and
                                    ``(II) in the case of a taxable 
                                year in which there was no qualified 
                                transfer, in the same manner as if 
                                there had been such a transfer at the 
                                end of the taxable year, by
                            ``(ii) the number of individuals to whom 
                        coverage for applicable health benefits was 
                        provided during such taxable year.
                    ``(C) Election to compute cost separately.--An 
                employer may elect to have this paragraph applied 
                separately with respect to individuals eligible for 
                benefits under title XVIII of the Social Security Act 
                at any time during the taxable year and with respect to 
                individuals not so eligible.
                    ``(D) Cost maintenance period.--For purposes of 
                this paragraph, the term `cost maintenance period' 
                means the period of 5 taxable years beginning with the 
                taxable year in which the qualified transfer occurs. If 
                a taxable year is in 2 or more overlapping cost 
                maintenance periods, this paragraph shall be applied by 
                taking into account the highest applicable employer 
                cost required to be provided under subparagraph (A) for 
                such taxable year.''.
            (2) Conforming amendments.--
                    (A) Section 420(b)(1)(C)(iii) of such Code is 
                amended by striking ``benefits'' and inserting 
                ``cost''.
                    (B) Section 420(e)(1)(D) of such Code is amended by 
                striking ``and shall not be subject to the minimum 
                benefit requirements of subsection (c)(3)'' and 
                inserting ``or in calculating applicable employer cost 
                under subsection (c)(3)(B)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to qualified transfers occurring after December 31, 2000, and 
before October 1, 2009.

SEC. 808. LIMITATIONS ON WELFARE BENEFIT FUNDS OF 10 OR MORE EMPLOYER 
              PLANS.

    (a) Benefits to Which Exception Applies.--Section 419A(f)(6)(A) of 
the Internal Revenue Code of 1986 (relating to exception for 10 or more 
employer plans) is amended to read as follows:
                    ``(A) In general.--This subpart shall not apply to 
                a welfare benefit fund which is part of a 10 or more 
                employer plan if the only benefits provided through the 
                fund are 1 or more of the following:
                            ``(i) Medical benefits.
                            ``(ii) Disability benefits.
                            ``(iii) Group term life insurance benefits 
                        which do not provide for any cash surrender 
                        value or other money that can be paid, 
                        assigned, borrowed, or pledged for collateral 
                        for a loan.
                The preceding sentence shall not apply to any plan 
                which maintains experience-rating arrangements with 
                respect to individual employers.''.
    (b) Limitation on Use of Amounts for Other Purposes.--Section 
4976(b) of the Internal Revenue Code of 1986 (defining disqualified 
benefit) is amended by adding at the end the following new paragraph:
            ``(5) Special rule for 10 or more employer plans exempted 
        from prefunding limits.--For purposes of paragraph (1)(C), if--
                    ``(A) subpart D of part I of subchapter D of 
                chapter 1 does not apply by reason of section 
                419A(f)(6) to contributions to provide 1 or more 
                welfare benefits through a welfare benefit fund under a 
                10 or more employer plan, and
                    ``(B) any portion of the welfare benefit fund 
                attributable to such contributions is used for a 
                purpose other than that for which the contributions 
                were made,
        then such portion shall be treated as reverting to the benefit 
        of the employers maintaining the fund.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to contributions paid or accrued after the date of the enactment 
of this Act, in taxable years ending after such date.

SEC. 809. MODIFICATION OF INSTALLMENT METHOD AND REPEAL OF INSTALLMENT 
              METHOD FOR ACCRUAL METHOD TAXPAYERS.

    (a) Repeal of Installment Method for Accrual Basis Taxpayers.--
            (1) In general.--Subsection (a) of section 453 of the 
        Internal Revenue Code of 1986 (relating to installment method) 
        is amended to read as follows:
    ``(a) Use of Installment Method.--
            ``(1) In general.--Except as otherwise provided in this 
        section, income from an installment sale shall be taken into 
        account for purposes of this title under the installment 
        method.
            ``(2) Accrual method taxpayer.--The installment method 
        shall not apply to income from an installment sale if such 
        income would be reported under an accrual method of accounting 
        without regard to this section. The preceding sentence shall 
        not apply to a disposition described in subparagraph (A) or (B) 
        of subsection (l)(2).''.
            (2) Conforming amendments.--Sections 453(d)(1), 453(i)(1), 
        and 453(k) of such Code are each amended by striking ``(a)'' 
        each place it appears and inserting ``(a)(1)''.
    (b) Modification of Pledge Rules.--Paragraph (4) of section 453A(d) 
of the Internal Revenue Code of 1986 (relating to pledges, etc., of 
installment obligations) is amended by adding at the end the following: 
``A payment shall be treated as directly secured by an interest in an 
installment obligation to the extent an arrangement allows the taxpayer 
to satisfy all or a portion of the indebtedness with the installment 
obligation.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to sales or other dispositions occurring on or after the date of 
the enactment of this Act.

SEC. 810. INCLUSION OF CERTAIN VACCINES AGAINST STREPTOCOCCUS 
              PNEUMONIAE TO LIST OF TAXABLE VACCINES.

    (a) In General.--Section 4132(a)(1) of the Internal Revenue Code of 
1986 (defining taxable vaccine) is amended by adding at the end the 
following new subparagraph:
                    ``(L) Any conjugate vaccine against streptococcus 
                pneumoniae.''.
    (b) Effective Date.--
            (1) Sales.--The amendment made by this section shall apply 
        to vaccine sales beginning on the day after the date on which 
        the Centers for Disease Control makes a final recommendation 
        for routine administration to children of any conjugate vaccine 
        against streptococcus pneumoniae.
            (2) Deliveries.--For purposes of paragraph (1), in the case 
        of sales on or before the date described in such paragraph for 
        which delivery is made after such date, the delivery date shall 
        be considered the sale date.

                   TITLE IX--MISCELLANEOUS PROVISIONS

SEC. 901. MEDICARE COMPETITIVE PRICING DEMONSTRATION PROJECT.

    (a) Finding.--The Senate finds that implementing competitive 
pricing in the medicare program under title XVIII of the Social 
Security Act is an important goal.
    (b) Prohibition on Implementation of Project in Certain Areas.--
Notwithstanding subsection (b) of section 4011 of the Balanced Budget 
Act of 1997 (Public Law 105-33)), the Secretary of Health and Human 
Services may not implement the Medicare Competitive Pricing 
Demonstration Project (operated by the Secretary of Health and Human 
Services pursuant to such section) in Kansas City, Missouri or Kansas 
City, Kansas, or in any area in Arizona.
    (c) Moratorium on Implementation of Project in any Area until 
January, 1, 2001.--Notwithstanding any provision of section 4011 of the 
Balanced Budget Act of 1997 (Public Law 105-33)), the Secretary of 
Health and Human Services may not implement the Medicare Competitive 
Pricing Demonstration Project in any area before January 1, 2001.
    (d) Study and Report to Congress.--
            (1) Study.--The Secretary of Health and Human Services, in 
        conjunction with the Competitive Pricing Advisory Committee, 
        shall conduct a study on the different approaches of 
        implementing the Medicare Competitive Pricing Demonstration 
        Project on a voluntary basis.
            (2) Report.--Not later than June 30, 2000, the Secretary of 
        Health and Human Services shall submit a report to Congress 
        which shall contain a detailed description of the study 
        conducted under paragraph (1), together with the 
        recommendations of the Secretary and the Competitive Pricing 
        Advisory Committee regarding the implementation of the Medicare 
        Competitive Pricing Demonstration Project.

            Attest:

                                                             Secretary.
106th CONGRESS

  1st Session

                               H. R. 2990

_______________________________________________________________________

                               AMENDMENT

HR 2990 EAS----2
HR 2990 EAS----3
HR 2990 EAS----4
HR 2990 EAS----5
HR 2990 EAS----6
HR 2990 EAS----7
HR 2990 EAS----8
HR 2990 EAS----9
HR 2990 EAS----10
HR 2990 EAS----11
HR 2990 EAS----12
HR 2990 EAS----13
HR 2990 EAS----14
HR 2990 EAS----15
HR 2990 EAS----16
HR 2990 EAS----17
HR 2990 EAS----18
HR 2990 EAS----19
HR 2990 EAS----20