[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1219 Introduced in House (IH)]







108th CONGRESS
  1st Session
                                H. R. 1219

To limit frivolous medical malpractice lawsuits, to reform the medical 
 malpractice insurance business in order to reduce the cost of medical 
 malpractice insurance, to enhance patient access to medical care, and 
                          for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 12, 2003

  Mr. Conyers (for himself and Mr. Dingell) introduced the following 
  bill; which was referred to the Committee on the Judiciary, and in 
 addition to the Committee on Energy and Commerce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
To limit frivolous medical malpractice lawsuits, to reform the medical 
 malpractice insurance business in order to reduce the cost of medical 
 malpractice insurance, to enhance patient access to medical care, and 
                          for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medical 
Malpractice and Insurance Reform Act of 2003''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
        TITLE I--LIMITING FRIVOLOUS MEDICAL MALPRACTICE LAWSUITS

Sec. 101. Statute of limitations.
Sec. 102. Health care specialist affidavit.
Sec. 103. Sanctions for frivolous actions and pleadings.
Sec. 104. Mandatory mediation.
Sec. 105. Limitation on punitive damages.
Sec. 106. Reduction in premiums paid by physicians for medical 
                            malpractice insurance coverage.
Sec. 107. Definitions.
Sec. 108. Applicability.
             TITLE II--MEDICAL MALPRACTICE INSURANCE REFORM

Sec. 201. Prohibition on anticompetitive activities by medical 
                            malpractice insurers.
Sec. 202. Medical malpractice insurance price comparison.
 TITLE III--ENHANCING PATIENT ACCESS TO CARE THROUGH DIRECT ASSISTANCE

Sec. 301. Grants and contracts regarding health provider shortages.
Sec. 302. Health professional assignments to trauma centers through 
                            national health service corps.
   TITLE IV--INDEPENDENT ADVISORY COMMISSION ON MEDICAL MALPRACTICE 
                               INSURANCE

Sec. 401. Establishment.
Sec. 402. Duties.
Sec. 403. Report.
Sec. 404. Membership.
Sec. 405. Director and staff; experts and consultants.
Sec. 406. Powers.
Sec. 407. Authorization of appropriations.

        TITLE I--LIMITING FRIVOLOUS MEDICAL MALPRACTICE LAWSUITS

SEC. 101. STATUTE OF LIMITATIONS.

    (a) In General.--A medical malpractice action shall be barred 
unless the complaint is filed within 3 years after the right of action 
accrues.
    (b) Accrual.--A right of action referred to in subsection (a) 
accrues upon the last to occur of the following dates:
            (1) The date of the injury.
            (2) The date on which the claimant discovers, or through 
        the use of reasonable diligence should have discovered, the 
        injury.
            (3) The date on which the claimant becomes 18 years of age.
    (c) Applicability.--This section shall apply to any injury 
occurring after the date of the enactment of this Act.

SEC. 102. HEALTH CARE SPECIALIST AFFIDAVIT.

    (a) Requiring Submission With Complaint.--No medical malpractice 
action may be brought by any individual unless, at the time the 
individual brings the action (except as provided in subsection (b)(1)), 
it is accompanied by the affidavit of a qualified specialist that 
includes the specialist's statement of belief that, based on a review 
of the available medical record and other relevant material, there is a 
reasonable and meritorious cause for the filing of the action against 
the defendant.
    (b) Extension in Certain Instances.--
            (1) In general.--Subject to paragraph (2), subsection (a) 
        shall not apply with respect to an individual who brings a 
        medical malpractice action without submitting an affidavit 
        described in such subsection if, as of the time the individual 
        brings the action, the individual has been unable to obtain 
        adequate medical records or other information necessary to 
        prepare the affidavit.
            (2) Deadline for submission where extension applies.--In 
        the case of an individual who brings an action for which 
        paragraph (1) applies, the action shall be dismissed unless the 
        individual (or the individual's attorney) submits the affidavit 
        described in subsection (a) not later than 90 days after 
        obtaining the information described in such paragraph.
    (c) Qualified Specialist Defined.--In subsection (a), a ``qualified 
specialist'' means, with respect to a medical malpractice action, a 
health care professional who is reasonably believed by the individual 
bringing the action (or the individual's attorney)--
            (1) to be knowledgeable in the relevant issues involved in 
        the action;
            (2) to practice (or to have practiced) or to teach (or to 
        have taught) in the same area of health care or medicine that 
        is at issue in the action; and
            (3) in the case of an action against a physician, to be 
        board certified in a specialty relating to that area of 
        medicine.
    (d) Confidentiality of Specialist.--Upon a showing of good cause by 
a defendant, the court may ascertain the identity of a specialist 
referred to in subsection (a) while preserving confidentiality.

SEC. 103. SANCTIONS FOR FRIVOLOUS ACTIONS AND PLEADINGS.

    (a) Signature Required.--Every pleading, written motion, and other 
paper in any medical malpractice action shall be signed by at least 1 
attorney of record in the attorney's individual name, or, if the party 
is not represented by an attorney, shall be signed by the party. Each 
paper shall state the signer's address and telephone number, if any. An 
unsigned paper shall be stricken unless omission of the signature is 
corrected promptly after being called to the attention of the attorney 
or party.
    (b) Certificate of Merit.--(1) A medical malpractice action shall 
be dismissed unless the attorney or unrepresented party presenting the 
complaint certifies that, to the best of the person's knowledge, 
information, and belief, formed after an inquiry reasonable under the 
circumstances--
            (A) it is not being presented for any improper purpose, 
        such as to harass or to cause unnecessary delay or needless 
        increase in the cost of litigation;
            (B) the claims and other legal contentions therein are 
        warranted by existing law or by a nonfrivolous argument for the 
        extension, modification, or reversal of existing law or the 
        establishment of new law; and
            (C) the allegations and other factual contentions have 
        evidentiary support or, if specifically so identified, are 
        likely to have evidentiary support after a reasonable 
        opportunity for further investigation and discovery.
    (2) By presenting to the court (whether by signing, filing, 
submitting, or later advocating) a pleading, written motion, or other 
paper, an attorney or unrepresented party is certifying that to the 
best of the person's knowledge, information and belief, formed after an 
inquiry reasonable under the circumstances--
            (A) it is not being presented for any improper purpose, 
        such as to harass or to cause unnecessary delay or needless 
        increase in the cost of litigation;
            (B) the claims, defenses, and other legal contentions 
        therein are warranted by existing law or by a nonfrivolous 
        argument for the extension, modification, or reversal of 
        existing law or the establishment of new law; and
            (C) the allegations and other factual contentions have 
        evidentiary support or, if specifically so identified, are 
        reasonable based on a lack of information or belief.
    (c) Mandatory Sanctions.--
            (1) First violation.--If, after notice and a reasonable 
        opportunity to respond, a court, upon motion or upon its own 
        initiative, determines that subsection (b) has been violated, 
        the court shall find each attorney or party in violation in 
        contempt of court and shall require the payment of costs and 
        attorneys fees. The court may also impose additional 
        appropriate sanctions, such as striking the pleadings, 
        dismissing the suit, and sanctions plus interest, upon the 
        person in violation, or upon both such person and such person's 
        attorney or client (as the case may be).
            (2) Second violation.--If, after notice and a reasonable 
        opportunity to respond, a court, upon motion or upon its own 
        initiative, determines that subsection (b) has been violated 
        and that the attorney or party with respect to which the 
        determination was made has committed one previous violation of 
        subsection (b) before this or any other court, the court shall 
        find each such attorney or party in contempt of court and shall 
        require the payment of costs and attorneys fees, and require 
        such person in violation (or both such person and such person's 
        attorney or client (as the case may be)) to pay a monetary 
        fine. The court may also impose additional appropriate 
        sanctions, such as striking the pleadings, dismissing the suit 
        and sanctions plus interest, upon such person in violation, or 
        upon both such person and such person's attorney or client (as 
        the case may be).
            (3) Third violation.--If, after notice and a reasonable 
        opportunity to respond, a court, upon motion or upon its own 
        initiative, determines that subsection (b) has been violated 
        and that the attorney or party with respect to which the 
        determination was made has committed more than one previous 
        violation of subsection (b) before this or any other court, the 
        court shall find each such attorney or party in contempt of 
        court, refer each such attorney to one or more appropriate 
        State bar associations for disciplinary proceedings, require 
        the payment of costs and attorneys fees, and require such 
        person in violation (or both such person and such person's 
        attorney or client (as the case may be)) to pay a monetary 
        fine. The court may also impose additional appropriate 
        sanctions, such as striking the pleadings, dismissing the suit, 
        and sanctions plus interest, upon such person in violation, or 
        upon both such person and such person's attorney or client (as 
        the case may be).

SEC. 104. MANDATORY MEDIATION.

    (a) In General.--In any medical malpractice action, before such 
action comes to trial, mediation shall be required. Such mediation 
shall be conducted by one or more mediators who are selected by 
agreement of the parties or, if the parties do not agree, who are 
qualified under applicable State law and selected by the court.
    (b) Requirements.--Mediation under subsection (a) shall be made 
available by a State subject to the following requirements:
            (1) Participation in such mediation shall be in lieu of any 
        alternative dispute resolution method required by any other law 
        or by any contractual arrangement made by or on behalf of the 
        parties before the commencement of the action.
            (2) Each State shall disclose to residents of the State the 
        availability and procedures for resolution of consumer 
        grievances regarding the provision of (or failure to provide) 
        health care services, including such mediation.
            (3) Each State shall provide that such mediation may begin 
        before or after, at the option of the claimant, the 
        commencement of a medical malpractice action.
            (4) The Attorney General, in consultation with the 
        Secretary of Health and Human Services, shall, by regulation, 
        develop requirements with respect to such mediation to ensure 
        that it is carried out in a manner that--
                    (A) is affordable for the parties involved;
                    (B) encourages timely resolution of claims;
                    (C) encourages the consistent and fair resolution 
                of claims; and
                    (D) provides for reasonably convenient access to 
                dispute resolution.
    (c) Further Redress and Admissibility.--Any party dissatisfied with 
a determination reached with respect to a medical malpractice claim as 
a result of an alternative dispute resolution method applied under this 
section shall not be bound by such determination. The results of any 
alternative dispute resolution method applied under this section, and 
all statements, offers, and communications made during the application 
of such method, shall be inadmissible for purposes of adjudicating the 
claim.

SEC. 105. LIMITATION ON PUNITIVE DAMAGES.

    (a) In General.--Punitive damages may not be awarded in a medical 
malpractice action, except upon proof of--
            (1) gross negligence;
            (2) reckless indifference to life; or
            (3) an intentional act, such as voluntary intoxication or 
        impairment by a physician, sexual abuse or misconduct, assault 
        and battery, or falsification of records.
    (b) Allocation.--In such a case, the award of punitive damages 
shall be allocated 50 percent to the claimant and 50 percent to a 
trustee appointed by the court, to be used by such trustee in the 
manner specified in subsection (d). The court shall appoint the 
Secretary of Health and Human Services as such trustee.
    (c) Exception.--This section shall not apply with respect to an 
action if the applicable State law provides (or has been construed to 
provide) for damages in such an action that are only punitive or 
exemplary in nature.
    (d) Trust Fund.--
            (1) In general.--This subsection applies to amounts 
        allocated to the Secretary of Health and Human Services as 
        trustee under subsection (b).
            (2) Availability.--Such amounts shall be available for use 
        by the Secretary of Health and Human Services under paragraph 
        (3) and shall remain so available until expended.
            (3) Use.--
                    (A) Subject to subparagraph (B), the Secretary of 
                Health and Human Services, acting through the Director 
                of the Agency for Healthcare Research and Quality, 
                shall use the amounts to which this subsection applies 
                for activities to reduce medical errors and improve 
                patient safety.
                    (B) The Secretary of Health and Human Services may 
                not use any part of such amounts to establish or 
                maintain any system that requires mandatory reporting 
                of medical errors.
                    (C) The Secretary of Health and Human Services 
                shall promulgate regulations to establish programs and 
                procedures for carrying out this paragraph.
            (4) Investment.--
                    (A) The Secretary of Health and Human Services 
                shall invest the amounts to which this subsection 
                applies in such amounts as such Secretary determines 
                are not required to meet current withdrawals. Such 
                investments may be made only in interest-bearing 
                obligations of the United States. For such purpose, 
                such obligations may be acquired on original issue at 
                the issue price, or by purchase of outstanding 
                obligations at the market price.
                    (B) Any obligation acquired by the Secretary in 
                such Secretary's capacity as trustee of such amounts 
                may be sold by the Secretary at the market price.

SEC. 106. REDUCTION IN PREMIUMS PAID BY PHYSICIANS FOR MEDICAL 
              MALPRACTICE INSURANCE COVERAGE.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, each medical malpractice liability insurance 
company shall--
            (1) develop a reasonable estimate of the annual amount of 
        financial savings that will be achieved by the company as a 
        result of this title;
            (2) develop and implement a plan to annually dedicate at 
        least 50 percent of such annual savings to reduce the amount of 
        premiums that the company charges physicians for medical 
        malpractice liability coverage; and
            (3) submit to the Secretary of Health and Human Services 
        (hereinafter referred to in this section as the ``Secretary'') 
        a written certification that the company has complied with 
        paragraphs (1) and (2).
    (b) Reports.--Not later than one year after the date of the 
enactment of this Act and annually thereafter, each medical malpractice 
liability insurance company shall submit to the Secretary a report that 
identifies the percentage by which the company has reduced medical 
malpractice coverage premiums relative to the date of the enactment of 
this Act.
    (c) Enforcement.--A medical malpractice liability insurance company 
that violates a provision of this section is liable to the United 
States for a civil penalty in an amount assessed by the Secretary, not 
to exceed $11,000 for each such violation. The provisions of paragraphs 
(3) through (5) of section 303(g) of the Federal Food, Drug, and 
Cosmetic Act apply to such a civil penalty to the same extent and in 
the same manner as such paragraphs apply to a civil penalty under such 
section.
    (d) Definition.--For purposes of this section, the term ``medical 
malpractice liability insurance company'' means an entity in the 
business of providing an insurance policy under which the entity makes 
payment in settlement (or partial settlement) of, or in satisfaction of 
a judgment in, a medical malpractice action or claim.

SEC. 107. DEFINITIONS.

    In this title, the following definitions apply:
            (1) Alternative dispute resolution method.--The term 
        ``alternative dispute resolution method'' means a method that 
        provides for the resolution of medical malpractice claims in a 
        manner other than through medical malpractice actions.
            (2) Claimant.--The term ``claimant'' means any person who 
        alleges a medical malpractice claim, and any person on whose 
        behalf such a claim is alleged, including the decedent in the 
        case of an action brought through or on behalf of an estate.
            (3) Health care professional.--The term ``health care 
        professional'' means any individual who provides health care 
        services in a State and who is required by the laws or 
        regulations of the State to be licensed or certified by the 
        State to provide such services in the State.
            (4) Health care provider.--The term ``health care 
        provider'' means any organization or institution that is 
        engaged in the delivery of health care services in a State and 
        that is required by the laws or regulations of the State to be 
        licensed or certified by the State to engage in the delivery of 
        such services in the State.
            (5) Injury.--The term ``injury'' means any illness, 
        disease, or other harm that is the subject of a medical 
        malpractice action or a medical malpractice claim.
            (6) Mandatory.--The term ``mandatory'' means required to be 
        used by the parties to attempt to resolve a medical malpractice 
        claim notwithstanding any other provision of an agreement, 
        State law, or Federal law.
            (7) Mediation.--The term ``mediation'' means a settlement 
        process coordinated by a neutral third party and without the 
        ultimate rendering of a formal opinion as to factual or legal 
        findings.
            (8) Medical malpractice action.--The term ``medical 
        malpractice action'' means an action in any State or Federal 
court against a physician, or other health professional, who is 
licensed in accordance with the requirements of the State involved 
that--
                    (A) arises under the law of the State involved;
                    (B) alleges the failure of such physician or other 
                health professional to adhere to the relevant 
                professional standard of care for the service and 
                specialty involved;
                    (C) alleges death or injury proximately caused by 
                such failure; and
                    (D) seeks monetary damages, whether compensatory or 
                punitive, as relief for such death or injury.
            (9) Medical malpractice claim.--The term ``medical 
        malpractice claim'' means a claim forming the basis of a 
        medical malpractice action.
            (10) State.--The term ``State'' means each of the several 
        States, the District of Columbia, the Commonwealth of Puerto 
        Rico, American Samoa, Guam, the Commonwealth of the Northern 
        Mariana Islands, the Virgin Islands, and any other territory or 
        possession of the United States.

SEC. 108. APPLICABILITY.

    (a) In General.--Except as provided in section 104, this title 
shall apply with respect to any medical malpractice action brought on 
or after the date of the enactment of this Act.
    (b) Federal Court Jurisdiction Not Established on Federal Question 
Grounds.--Nothing in this title shall be construed to establish any 
jurisdiction in the district courts of the United States over medical 
malpractice actions on the basis of section 1331 or 1337 of title 28, 
United States Code.

             TITLE II--MEDICAL MALPRACTICE INSURANCE REFORM

SEC. 201. PROHIBITION ON ANTICOMPETITIVE ACTIVITIES BY MEDICAL 
              MALPRACTICE INSURERS.

    Notwithstanding any other provision of law, nothing in the Act of 
March 9, 1945 (15 U.S.C. 1011 et seq., commonly known as the 
``McCarran-Ferguson Act'') shall be construed to permit commercial 
insurers to engage in any form of price fixing, bid rigging, or market 
allocations in connection with the conduct of the business of providing 
medical malpractice insurance. This section does not apply to the 
information-gathering and rate-setting activities of any State 
commissions of insurance, or any other State regulatory body with 
authority to set insurance rates.

SEC. 202. MEDICAL MALPRACTICE INSURANCE PRICE COMPARISON.

    (a) Internet Site.--Not later than 90 days after the date of the 
enactment of this Act, and after consultation with the medical 
malpractice insurance industry, the Secretary of Health and Human 
Services shall establish an interactive internet site which shall 
enable any health care provider licensed in the United States to obtain 
a quote from each medical malpractice insurer licensed to write the 
type of coverage sought by the provider.
    (b) Online Forms.--
            (1) In general.--The internet site shall enable health care 
        providers to complete an online form that shall capture a 
        comprehensive set of information sufficient to generate a quote 
        for each insurer. The Secretary shall develop transmission 
        software components which allow such information to be 
        formatted for delivery to each medical malpractice insurer 
        based on the requirements of the computer system of the 
        insurer.
            (2) Protection of confidentiality of information 
        disclosed.--All information provided by a health care provider 
        for purposes of generating a quote through the internet site 
        shall be used only for that purpose.
    (c) Integration of Rating Criteria.--The Secretary shall integrate 
the rating criteria of each insurer into its online form after 
consultation with each insurer. The Secretary shall integrate such 
criteria using one of the following methods:
            (1) Developing a customized interface with the insurer's 
        own rating engine.
            (2) Accessing a third-party rating engine of the insurer's 
        choice.
            (3) Loading the carrier's rating information into a rating 
        engine operated by the Secretary.
            (4) Any other method agreed on between the Secretary and 
        the insurer.
    (d) Presentation of Quotes.--After a health care provider has 
answered all the questions appearing on the online form, such provider 
will be presented with quotes from each medical malpractice insurer 
licensed to write the coverage requested by the provider.
    (e) Accuracy of Quotes.--Quotes provided at the internet site shall 
at all times be accurate. Whenever any insurer changes its rates, such 
rate changes shall be implemented at the internet site by the 
Secretary, in consultation with the insurer, as soon as practicable, 
but in no event later than 10 days after such changes take effect. 
During any period during which an insurer has changed its rates but the 
Secretary has not yet implemented such changed rates on the internet 
site, quotes for that insurer shall not be obtainable at the internet 
site.
    (f) User-Friendly Features.--The Secretary shall design the 
internet site to incorporate user-friendly formats and self-help 
guidance materials, and shall develop a user-friendly internet user-
interface.
    (g) Contact Information.--The internet site shall also provide 
contact information, including address and telephone number, for each 
medical malpractice insurer for which a provider obtains a quote at the 
site.
    (h) Report.--Not later than December 31, 2004, the Secretary shall 
submit a report to the Congress on the development, implementation and 
effects of the internet site. Such report shall be based on--
            (1) the Secretary's consultation with health care 
        providers, medical malpractice insurers, State insurance 
        commissioners, and other interested parties; and
            (2) the Secretary's analysis of other information available 
        to the Secretary.
The report shall describe the Secretary's views concerning the extent 
to which this section has contributed to increasing the availability of 
medical malpractice insurance, and the effect this section has had on 
the cost of medical malpractice insurance.

 TITLE III--ENHANCING PATIENT ACCESS TO CARE THROUGH DIRECT ASSISTANCE

SEC. 301. GRANTS AND CONTRACTS REGARDING HEALTH PROVIDER SHORTAGES.

    Subpart I of part D of title III of the Public Health Service Act 
(42 U.S.C. 254b et seq.) is amended by adding at the end the following 
section.

``SEC. 330L. HEALTH PROVIDER SHORTAGES RESULTING FROM COSTS OF MEDICAL 
              MALPRACTICE INSURANCE.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, may make awards of 
grants or contracts in accordance with this section for geographic 
areas that, as determined by the Secretary, have a shortage of one or 
more types of health providers as a result of the providers making the 
decision to cease or curtail providing health services in the 
geographic areas because of the costs of maintaining malpractice 
insurance.
    ``(b) Recipients of Awards; Expenditure.--In accordance with such 
criteria as the Secretary may establish:
            ``(1) Awards under subsection (a) may be made to health 
        providers who agree to provide health services (or to continue 
        providing health services, as the case may be) in geographic 
        areas described in such subsection for the period during which 
        payments under the awards are made to the health providers.
            ``(2) Health providers who receive such awards may expend 
        the awards to assist the providers with the costs of 
        maintaining medical malpractice insurance for providing health 
        services in the geographic area for which the award is made.
    ``(c) Definition.--For purposes of this section, the term `health 
providers' means physicians and other health professionals, and 
organizations that provide health services (including hospitals, 
clinics, and group practices), that meet applicable legal requirements 
to provide the health services involved.''.

SEC. 302. HEALTH PROFESSIONAL ASSIGNMENTS TO TRAUMA CENTERS THROUGH 
              NATIONAL HEALTH SERVICE CORPS.

    Section 338H of the Public Health Service Act (42 U.S.C. 254q) is 
amended by adding at the end the following subsection:
    ``(d) Trauma Centers; Separate Authorization Regarding Shortages 
Resulting From Costs of Medical Malpractice Insurance.--
            ``(1) In general.--For the purpose of assigning Corps 
        surgeons, obstetricians/gynecologists, and other health 
        professionals to trauma centers in health professional shortage 
        areas described in paragraph (2), there are authorized to be 
        appropriated such sums as may be necessary for each of the 
        fiscal years 2003 through 2006. Such authorization is in 
        addition to any other authorization of appropriations that is 
        available for such purpose.
            ``(2) Description of areas.--A health professional shortage 
        area referred to in paragraph (1) is such an area in which, as 
        determined by the Secretary, a medical facility in the area has 
        lost its designation as a trauma center or as a particular 
        level of trauma center, or is at significant risk of losing 
        such a designation, as a result of one or more surgeons, 
        obstetricians/gynecologists, or other health professionals 
        making the decision to cease or curtail practicing at the 
        facility because of the costs of maintaining malpractice 
        insurance. For purposes of paragraph (1), (A) the term `trauma 
        center' includes such a medical facility; and (B) the Secretary 
        may adjust the criteria for designation as a health 
        professional shortage area to the extent necessary to make 
        funds appropriated under paragraph (1) available with respect 
        to any medical facility to ensure that the facility does not 
        lose any such designation as a result of such decisions by 
        health professionals.''.

   TITLE IV--INDEPENDENT ADVISORY COMMISSION ON MEDICAL MALPRACTICE 
                               INSURANCE

SEC. 401. ESTABLISHMENT.

    (a) Findings.--The Congress finds as follows:
            (1) The sudden rise in medical malpractice premiums in 
        regions of the United States can threaten patient access to 
        doctors and other health providers.
            (2) Improving patient access to doctors and other health 
        providers is a national priority.
    (b) Establishment.--There is established a national commission to 
be known as the ``Independent Advisory Commission on Medical 
Malpractice Insurance'' (in this title referred to as the 
``Commission'').

SEC. 402. DUTIES.

    (a) In General.--The Commission shall evaluate the causes and scope 
of the recent and dramatic increases in medical malpractice insurance 
premiums and formulate additional proposals to reduce such medical 
malpractice premiums and make recommendations to avoid any dramatic 
increases in medical malpractice premiums in the future, in light of 
proposals for tort reform regarding medical malpractice.
    (b) Considerations.--In formulating proposals under this section, 
the Commission shall, at a minimum, consider the following:
            (1) Alternatives to the current medical malpractice tort 
        system that would ensure adequate compensation for patients, 
        preserve access to providers, and improve health care safety 
        and quality.
            (2) Modifications of, and alternatives to, the existing 
        State and Federal regulations and oversight that affect, or 
        could affect, medical malpractice lines of insurance.
            (3) State and Federal reforms that would distribute the 
        risk of medical malpractice more equitably among health care 
        providers.
            (4) State and Federal reforms that would more evenly 
        distribute the risk of medical malpractice across various 
        categories of providers.
            (5) The effect of a Federal medical malpractice reinsurance 
        program administered by the Department of Health and Human 
        Services.
            (6) The effect of a Federal medical malpractice insurance 
        program, administered by the Department of Health and Human 
        Services, to provide medical malpractice insurance based on 
        customary coverage terms and liability amounts in States where 
        such insurance is unavailable or is unavailable at reasonable 
        and customary terms.
            (7) Programs that would reduce medical errors and increase 
        patient safety, including new innovations in technology and 
        management.
            (8) The effect of State policies under which--
                    (A) any health care professional licensed by the 
                State has standing in any State administrative 
                proceeding to challenge a proposed rate increase in 
                medical malpractice insurance; and
                    (B) a provider of medical malpractice insurance in 
                the State may not implement a rate increase in such 
                insurance unless the provider, at minimum, first 
                submits to the appropriate State agency a description 
                of the rate increase and a substantial justification 
                for the rate increase.

SEC. 403. REPORT.

    (a) In General.--The Commission shall transmit to Congress--
            (1) an initial report not later than 180 days after the 
        date of the initial meeting of the Commission; and
            (2) a report not less than each year thereafter until the 
        Commission terminates.
    (b) Contents.--Each report transmitted under this section shall 
contain a detailed statement of the findings and conclusions of the 
Commission, including proposals for addressing the current dramatic 
increases in medical malpractice insurance rates and recommendations 
for avoiding any such dramatic increases in the future.
    (c) Voting and Reporting Requirements.--With respect to each 
proposal or recommendation contained in the report submitted under 
subsection (a), each member of the Commission shall vote on the 
proposal or recommendation, and the Commission shall include, by 
member, the results of that vote in the report.

SEC. 404. MEMBERSHIP.

    (a) Number and Appointment.--The Commission shall be composed of 15 
members appointed by the Comptroller General of the United States.
    (b) Membership.--
            (1) In general.--The membership of the Commission shall 
        include individuals with national recognition for their 
        expertise in health finance and economics, actuarial science, 
        medical malpractice insurance, insurance regulation, health 
        care law, health care policy, health care access, allopathic 
        and osteopathic physicians, other providers of health care 
        services, patient advocacy, and other related fields, who 
        provide a mix of different professionals, broad geographic 
        representations, and a balance between urban and rural 
        representatives.
            (2) Inclusion.--The membership of the Commission shall 
        include the following:
                    (A) Two individuals with expertise in health 
                finance and economics, including one with expertise in 
                consumer protections in the area of health finance and 
                economics.
                    (B) Two individuals with expertise in medical 
                malpractice insurance, representing both commercial 
                insurance carriers and physician-sponsored insurance 
                carriers.
                    (C) An individual with expertise in State insurance 
                regulation and State insurance markets.
                    (D) An individual representing physicians.
                    (E) An individual with expertise in issues 
                affecting hospitals, nursing homes, nurses, and other 
                providers.
                    (F) Two individuals representing patient interests.
                    (G) Two individuals with expertise in health care 
                law or health care policy.
                    (H) An individual with expertise in representing 
                patients in malpractice lawsuits.
            (3) Majority.--The total number of individuals who are 
        directly involved with the provision or management of 
        malpractice insurance, representing physicians or other 
        providers, or representing physicians or other providers in 
        malpractice lawsuits, shall not constitute a majority of the 
        membership of the Commission.
            (4) Ethical disclosure.--The Comptroller General of the 
        United States shall establish a system for public disclosure by 
        members of the Commission of financial or other potential 
        conflicts of interest relating to such members.
    (c) Terms.--
            (1) In general.--The terms of the members of the Commission 
        shall be for 3 years except that the Comptroller General of the 
        United States shall designate staggered terms for the members 
        first appointed.
            (2) Vacancies.--Any member appointed to fill a vacancy 
        occurring before the expiration of the term for which the 
        member's predecessor was appointed shall be appointed only for 
        the remainder of that term. A member may serve after the 
        expiration of that member's term until a successor has taken 
        office. A vacancy in the Commission shall be filled in the 
        manner in which the original appointment was made.
            (3) Compensation.--Members of the Commission shall be 
        compensated in accordance with section 1805(c)(4) of the Social 
        Security Act.
            (4) Chairman; vice chairman.--The Comptroller General of 
        the United States shall designate at the time of appointment a 
        member of the Commission as Chairman and a member as Vice 
        Chairman. In the case of vacancy of the Chairmanship or Vice 
        Chairmanship, the Comptroller General may designate another 
        member for the remainder of that member's term.
            (5) Meetings.--
                    (A) In general.--The Commission shall meet at the 
                call of the Chairman.
                    (B) Initial meeting.--The Commission shall hold an 
                initial meeting not later than the date that is 1 year 
after the date of the enactment of this title, or the date that is 3 
months after the appointment of all the members of the Commission, 
whichever occurs earlier.

SEC. 405. DIRECTOR AND STAFF; EXPERTS AND CONSULTANTS.

    Subject to such review as the Comptroller General of the United 
States deems necessary to assure the efficient administration of the 
Commission, the Commission may--
            (1) employ and fix the compensation of an Executive 
        Director (subject to the approval of the Comptroller General) 
        and such other personnel as may be necessary to carry out its 
        duties (without regard to the provisions of title 5, United 
        States Code, governing appointments in the competitive 
        service);
            (2) seek such assistance and support as may be required in 
        the performance of its duties from appropriate Federal 
        departments and agencies;
            (3) enter into contracts or make other arrangements, as may 
        be necessary for the conduct of the work of the Commission 
        (without regard to section 3709 of the Revised Statutes (41 
        U.S.C. 5));
            (4) make advance, progress, and other payments which relate 
        to the work of the Commission;
            (5) provide transportation and subsistence for persons 
        serving without compensation; and
            (6) prescribe such rules and regulations as it deems 
        necessary with respect to the internal organization and 
        operation of the Commission.

SEC. 406. POWERS.

    (a) Obtaining Official Data.--The Commission may secure directly 
from any department or agency of the United States information 
necessary to enable it to carry out this section. Upon request of the 
Chairman, the head of that department or agency shall furnish that 
information to the Commission on an agreed upon schedule.
    (b) Data Collection.--In order to carry out its functions, the 
Commission shall--
            (1) utilize existing information, both published and 
        unpublished, where possible, collected and assessed either by 
        its own staff or under other arrangements made in accordance 
        with this section;
            (2) carry out, or award grants or contracts for, original 
        research and experimentation, where existing information is 
        inadequate; and
            (3) adopt procedures allowing any interested party to 
        submit information for the Commission's use in making reports 
        and recommendations.
    (c) Access of General Accounting Office to Information.--The 
Comptroller General of the United States shall have unrestricted access 
to all deliberations, records, and nonproprietary data of the 
Commission, immediately upon request.
    (d) Periodic Audit.--The Commission shall be subject to periodic 
audit by the Comptroller General of the United States.

SEC. 407. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There are authorized to be appropriated such sums 
as may be necessary to carry out this title for each of fiscal years 
2004 through 2008.
    (b) Requests for Appropriations.--The Commission shall submit 
requests for appropriations in the same manner as the Comptroller 
General of the United States submits requests for appropriations, but 
amounts appropriated for the Commission shall be separate from amounts 
appropriated for the Comptroller General.
                                 <all>