[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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