[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 596 Introduced in House (IH)]







108th CONGRESS
  1st Session
                                H. R. 596

To amend title I of the Employee Retirement Income Security Act of 1974 
     to exclude from preemption State causes of action to enforce 
  determinations under group health plans based on medical necessity.


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                    IN THE HOUSE OF REPRESENTATIVES

                            February 5, 2003

 Mr. Norwood introduced the following bill; which was referred to the 
                Committee on Education and the Workforce

_______________________________________________________________________

                                 A BILL


 
To amend title I of the Employee Retirement Income Security Act of 1974 
     to exclude from preemption State causes of action to enforce 
  determinations under group health plans based on medical necessity.

    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 ``ERISA Clarification Act of 2003''.

SEC. 2. EXCLUSION FROM ERISA PREEMPTION OF STATE CAUSES OF ACTION TO 
              ENFORCE GROUP HEALTH PLAN DETERMINATIONS BASED ON MEDICAL 
              NECESSITY.

    Section 514(b) of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1144(b)) is amended--
            (1) by redesignating paragraph (9) as paragraph (10); and
            (2) by inserting after paragraph (8) the following new 
        paragraph:
    ``(9) Subsection (a) of this section shall not be construed to 
preclude any State cause of action to enforce a determination under a 
group health plan (as defined in section 733(a)) regarding the 
existence or extent of coverage of any item or service under the plan 
to the extent that the determination is of whether or not the item or 
service is medically necessary or appropriate or is based on the 
application of substantially equivalent terms.''.

SEC. 3. EFFECTIVE DATE.

    The amendments made by this Act shall apply with respect to plan 
determinations made on or after the date of the enactment of this Act.
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