[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2342 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 2342
To amend title XXVII of the Public Health Service Act, the Employee
Retirement Income Security Act of 1974, and the Internal Revenue Code
of 1986 to assure patient access to primary pediatric care through
pediatricians under group health plans and group health insurance
coverage.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 27, 2001
Ms. Granger introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Education and the Workforce, and Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend title XXVII of the Public Health Service Act, the Employee
Retirement Income Security Act of 1974, and the Internal Revenue Code
of 1986 to assure patient access to primary pediatric care through
pediatricians under group health plans and group health insurance
coverage.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Primary Care for Children Act of
2001''.
SEC. 2. PATIENT ACCESS TO PEDIATRIC CARE THROUGH PEDIATRICIANS.
(a) Amendment to Public Health Service Act.--Subpart 2 of part A of
title XXVII of the Public Health Service Act is amended by adding at
the end the following new section:
``SEC. 2707. PATIENT ACCESS TO PEDIATRIC CARE THROUGH PEDIATRICIANS.
``(a) Patient Access to Pediatric Care.--In any case in which a
group health plan (or a health insurance issuer offering health
insurance coverage in connection with the plan) provides benefits
consisting of primary pediatric care provided by a participating
primary care physician who specializes in pediatrics (or consisting of
payment for such care) and the plan requires or provides for
designation by a participant or beneficiary of a participating primary
care physician with respect to such care, the plan (or issuer) shall
provide that such a participating physician who specializes in
pediatrics may be designated, if available, by a parent or guardian of
any beneficiary under the plan who is under 18 years of age, as the
primary care physician with respect to any such benefits.
``(b) Construction.--Nothing in subsection (a) shall waive any
requirements of coverage relating to medical necessity or
appropriateness with respect to coverage of pediatric care.''.
(b) ERISA Amendments.--
(1) In general.--Subpart B of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974 is
amended by adding at the end the following new section:
``SEC. 714. PATIENT ACCESS TO PEDIATRIC CARE.
``(a) Patient Access to Pediatric Care.--In any case in which a
group health plan (or a health insurance issuer offering health
insurance coverage in connection with the plan) provides benefits
consisting of primary pediatric care provided by a participating
primary care physician who specializes in pediatrics (or consisting of
payment for such care) and the plan requires or provides for
designation by a participant or beneficiary of a participating primary
care physician with respect to such care, the plan (or issuer) shall
provide that such a participating physician who specializes in
pediatrics may be designated, if available, by a parent or guardian of
any beneficiary under the plan who is under 18 years of age, as the
primary care physician with respect to any such benefits.
``(b) Construction.--Nothing in subsection (a) shall waive any
requirements of coverage relating to medical necessity or
appropriateness with respect to coverage of pediatric care.''.
(2) Clerical amendment.--The table of contents in section 1
of such Act is amended by inserting after the item relating to
section 713 the following new item:
``Sec. 714. Patient access to pediatric care.''.
(c) Internal Revenue Code Amendments.--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. Patient access to pediatric
care.''; and
(2) by inserting after section 9812 the following:
``SEC. 9813. PATIENT ACCESS TO PEDIATRIC CARE.
``(a) Patient Access to Pediatric Care.--In any case in which a
group health plan provides benefits consisting of primary pediatric
care provided by a participating primary care physician who specializes
in pediatrics (or consisting of payment for such care) and the plan
requires or provides for designation by a participant or beneficiary of
a participating primary care physician with respect to such care, the
plan shall provide that such a participating physician who specializes
in pediatrics may be designated, if available, by a parent or guardian
of any beneficiary under the plan is who under 18 years of age, as the
primary care physician with respect to any such benefits.
``(b) Construction.--Nothing in subsection (a) shall waive any
requirements of coverage relating to medical necessity or
appropriateness with respect to coverage of pediatric care.''
(d) Effective Date and Related Rules.--
(1) In general.--The amendments made by this section apply
with respect to plan years beginning on or after January 1,
2003, except that the Secretaries of Health and Human Services,
of Labor, and of the Treasury may issue regulations before such
date under such amendments. Such Secretaries shall first issue
all regulations necessary to carry out such amendments before
the effective date thereof.
(2) Limitation on enforcement actions.--No enforcement
action shall be taken, pursuant to the amendments made by this
section, against a group health plan or health insurance issuer
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 or issuer has
sought to comply in good faith with such requirement.
(3) Special rule for collective bargaining agreements.--In
the case of a group health plan maintained pursuant to one or
more collective bargaining agreements between employee
representatives and one or more employers ratified before the
date of the enactment of this Act, the amendments made by this
section shall not apply with respect to plan years beginning
before the later of--
(1) the date on which the last of the collective
bargaining agreements relating to the plan terminates
(determined without regard to any extension thereof
agreed to after the date of the enactment of this Act);
or
(2) January 1, 2003.
For purposes of this paragraph, any plan amendments made
pursuant to a collective bargaining agreement relating to the
plan which amends the plan solely to conform to any requirement
added by this section shall not be treated as a termination of
such collective bargaining agreement.
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