1.This Act may be cited as the
Quality Health Care Coalition Act of
2011
.
2.Application of
the Federal antitrust laws to health care professionals negotiating with health
plans
(a)Any health care professionals who are engaged in
negotiations with a health plan regarding the terms of any contract under which
the professionals provide health care items or services for which benefits are
provided under such plan shall, in connection with such negotiations, be exempt
from the Federal antitrust laws.
(b)
(1)No new right for
collective cessation of serviceThe exemption provided in
subsection (a) shall not confer any new right to participate in any collective
cessation of service to patients not already permitted by existing law.
(2)No change in
National Labor Relations ActThis section applies only to health
care professionals excluded from the National Labor Relations Act. Nothing in
this section shall be construed as changing or amending any provision of the
National Labor Relations Act, or as affecting the status of any group of
persons under that Act.
(c)No application
to Federal programsNothing in this section shall apply to
negotiations between health care professionals and health plans pertaining to
benefits provided under any of the following:
(1)The Medicare
Program under title XVIII of the Social Security
Act (42
U.S.C. 1395 et seq.).
(2)The Medicaid
program under title XIX of the Social Security
Act (42
U.S.C. 1396 et seq.).
(3)The SCHIP program
under title XXI of the Social Security
Act (42
U.S.C. 1397aa et seq.).
(4)Chapter 55 of
title 10, United States Code (relating to medical and dental care for members
of the uniformed services).
(5)Chapter 17 of
title 38, United States Code (relating to Veterans’ medical care).
(6)Chapter 89 of
title 5, United States Code (relating to the Federal employees’ health benefits
program).
(7)The
Indian Health Care Improvement Act
(25 U.S.C. 1601 et
seq.).
3.In this Act, the following definitions shall
apply:
(1)The term antitrust laws—
(A)has the meaning
given it in subsection (a) of the first section of the
Clayton Act (15 U.S.C. 12(a)), except
that such term includes section 5 of the Federal
Trade Commission Act (15 U.S.C. 45) to the extent such section
applies to unfair methods of competition; and
(B)includes any State
law similar to the laws referred to in subparagraph (A).
(2)The term group health plan means an employee
welfare benefit plan to the extent that the plan provides medical care
(including items and services paid for as medical care) to employees or their
dependents (as defined under the terms of the plan) directly or through
insurance, reimbursement, or otherwise.
(3)Group health
plan, health insurance issuerThe terms group health
plan and health insurance issuer include a third-party
administrator or other person acting for or on behalf of such plan or
issuer.
(4)The term health care services means any
services for which payment may be made under a health plan, including services
related to the delivery or administration of such services.
(5)The term health care professional means
any individual or entity that provides health care items or services,
treatment, assistance with activities of daily living, or medications to
patients and who, to the extent required by State or Federal law, possesses
specialized training that confers expertise in the provision of such items or
services, treatment, assistance, or medications.
(6)Health insurance
coverageThe term health insurance coverage means
benefits consisting of medical care (provided directly, through insurance or
reimbursement, or otherwise and including items and services paid for as
medical care) under any hospital or medical service policy or certificate,
hospital or medical service plan contract, or health maintenance organization
contract offered by a health insurance issuer.
(7)The term health insurance issuer means an
insurance company, insurance service, or insurance organization (including a
health maintenance organization) that is licensed to engage in the business of
insurance in a State and that is subject to State law regulating insurance.
Such term does not include a group health plan.
(8)Health
maintenance organizationThe term health maintenance
organization means—
(A)a federally
qualified health maintenance organization (as defined in section 1301(a) of the
Public Health Service Act (42 U.S.C.
300e(a));
(B)an organization
recognized under State law as a health maintenance organization; or
(C)a similar
organization regulated under State law for solvency in the same manner and to
the same extent as such a health maintenance organization.
(9)The term health plan means a group health plan
or a health insurance issuer that is offering health insurance coverage.
(10)The term medical care means amounts paid
for—
(A)the diagnosis,
cure, mitigation, treatment, or prevention of disease, or amounts paid for the
purpose of affecting any structure or function of the body; and
(B)transportation
primarily for and essential to receiving items and services referred to in
subparagraph (A).
(11)The
term person includes a State or unit of local government.
(12)The
term State includes the several States, the District of Columbia,
Puerto Rico, the Virgin Islands of the United States, Guam, American Samoa, and
the Commonwealth of the Northern Mariana Islands.
4.This Act shall take
effect on on the date of the enactment of this Act and shall not apply with
respect to conduct occurring before such date.