[Congressional Record Volume 141, Number 130 (Saturday, August 5, 1995)]
[Extensions of Remarks]
[Page E1665]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


           MEDICARE MANAGED HEALTH CARE SUNSHINE ACT OF 1995

                                 ______


                         HON. E. CLAY SHAW, JR.

                               of florida

                    in the house of representatives

                         Friday, August 4, 1995
  Mr. SHAW. Mr. Speaker, I rise today to introduce timely legislation 
that will require health maintenance organizations under the Medicare 
Program to disclose certain information to individuals who subscribe to 
an HMO, or who are a prospective subscriber to an HMO. I believe that 
an HMO subscriber under the Medicare Program has the right to know the 
medical education and professional background of the physicians who 
will provide health services to that subscriber. I also believe that it 
is important for a subscriber to know the financial structure of the 
corporation in which he or she is placing so much trust.
  Specifically, my bill requires that, upon request by a subscriber or 
a prospective subscriber, an HMO shall provide descriptive information 
on each physician within the HMO. This information includes the medical 
education and training received by the physician, the physicians' 
history of medical practice--including foreign practice, and the 
position each physician currently holds.
  My bill also requires that an HMO provide recent audited financial 
statements to subscribers and prospective subscribers. Furthermore, any 
promotional material--marketing and advertising brochures, et cetera--
must state that the above information is available.
  This information must be out in the open. In fact, I have titled this 
legislation the Medicare Managed Health Care Sunshine Act of 1995 to 
represent that it is time for these health care providers, who receive 
Federal dollars and ask for the trust of the Nation's seniors, to be 
candid about their operation.
  I urge my colleagues to support this legislation and ask that this 
bill and these remarks be inserted into the Record.
                                H.R. --

       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 ``Medicare Managed Health Care 
     Sunshine Act of 1995''.
     SEC. 2. PROVIDING HMO ENROLLEES WITH CERTAIN INFORMATION ON 
                   PLANS.

       Section 1875(c) of the Social Security Act (42 U.S.C. 
     1395mm(c)) is amended by adding at the end the following:
       ``(9)(A) Upon the request of a member enrolled with the 
     organization under this section, or an individual considering 
     enrollment with the organization under this section, the 
     organization shall provide the enrollee or individual with 
     the following:
       ``(i) Descriptive information regarding the credentials of 
     each physician who is authorized by the organization to 
     provide services by or through the organization to enrollees 
     under this section, including the medical education and 
     training received by the physician, the physician's history 
     of medical practice (whether domestic or foreign), and the 
     positions held by the physician at the time of the request.
       ``(ii) An audited financial statement of the organization 
     for the most recently concluded fiscal year that complies 
     with generally accepted accounting principles and includes a 
     balance sheet, income statement, and statement of changes in 
     financial position.
       ``(iii) A statement identifying the salaries, bonuses, and 
     other remuneration paid to the 5 highest-paid officers or 
     executives of the organization, as well as the other benefits 
     provided to such officers or executives.
       ``(B) The organization shall include in any brochure, 
     application form, or other promotional or informational 
     material that is distributed by the organization to (or for 
     the use of) individuals eligible to enroll with the 
     organization under this section a statement that the 
     information described in subparagraph (A) is available from 
     the organization upon request.''.

     SECTION 3. EFFECTIVE DATE.

       The amendment made by this Act shall apply with respect to 
     contract years beginning on or after the date that is 6 
     months after the date of the enactment of this Act.
     

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