[Congressional Record (Bound Edition), Volume 145 (1999), Part 11]
[Senate]
[Pages 15884-15889]
[From the U.S. Government Publishing Office, www.gpo.gov]




                          AMENDMENTS SUBMITTED

                                 ______
                                 

                  PATIENTS' BILL OF RIGHTS ACT OF 1999

                                 ______
                                 

                 SNOWE (AND OTHERS) AMENDMENT NO. 1241

  Ms. SNOWE (for herself, Mr. Abraham, Mr. Fitzgerald, Mr. Crapo, Ms. 
Collins, Mr. Jeffords, Mr. Murkowski, and Mr. DeWine) proposed an 
amendment to amendment No. 1239 proposed by Mr. Dodd to the bill (S. 
1344) to amend the Public Health Service Act, the Employee Retirement 
Income Security Act of 1974, and the Internal Revenue Code of 1986 to 
protect consumers in managed care plans and other health coverage; as 
follows:

       Strike section 152 of the bill, and insert the following:

     WOMEN'S HEALTH AND CANCER RIGHTS.

       (a) Short Title.--This section may be cited as the 
     ``Women's Health and Cancer Rights Act of 1999''.
       (b) Findings.--Congress finds that--
       (1) the offering and operation of health plans affect 
     commerce among the States;
       (2) health care providers located in a State serve patients 
     who reside in the State and patients who reside in other 
     States; and
       (3) in order to provide for uniform treatment of health 
     care providers and patients among the States, it is necessary 
     to cover health plans operating in 1 State as well as health 
     plans operating among the several States.
       (c) Amendments to ERISA.--
       (1) In general.--Subpart B of part 7 of subtitle B of title 
     I of the Employee Retirement Income Security Act of 1974, as 
     amended by section 301, is further amended by adding at the 
     end the following:

     ``SEC. 715. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR 
                   MASTECTOMIES AND LYMPH NODE DISSECTIONS FOR THE 
                   TREATMENT OF BREAST CANCER AND COVERAGE FOR 
                   SECONDARY CONSULTATIONS.

       ``(a) Inpatient Care.--
       ``(1) In general.--A group health plan, and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan, that provides medical 
     and surgical benefits shall ensure that inpatient coverage 
     with respect to the treatment of breast cancer is provided 
     for a period of time as is determined by the attending 
     physician, in consultation with the patient, to be medically 
     necessary and appropriate following--
       ``(A) a mastectomy;
       ``(B) a lumpectomy; or
       ``(C) a lymph node dissection for the treatment of breast 
     cancer.
       ``(2) Exception.--Nothing in this section shall be 
     construed as requiring the provision of inpatient coverage if 
     the attending physician and patient determine that a shorter 
     period of hospital stay is medically appropriate.
       ``(b) Prohibition on Certain Modifications.--In 
     implementing the requirements of this section, a group health 
     plan, and a health insurance issuer providing health 
     insurance coverage in connection with a group health plan, 
     may not modify the terms and conditions of coverage based on 
     the determination by a participant or beneficiary to request 
     less than the minimum coverage required under subsection (a).
       ``(c) Notice.--A group health plan, and a health insurance 
     issuer providing health insurance coverage in connection with 
     a group health plan shall provide notice to each participant 
     and beneficiary under such plan regarding the coverage 
     required by this section in accordance with regulations 
     promulgated by the Secretary. Such notice shall be in writing 
     and prominently positioned in any literature or 
     correspondence made available or distributed by the plan or 
     issuer and shall be transmitted--

[[Page 15885]]

       ``(1) in the next mailing made by the plan or issuer to the 
     participant or beneficiary;
       ``(2) as part of any yearly informational packet sent to 
     the participant or beneficiary; or
       ``(3) not later than January 1, 2000;
     whichever is earlier.
       ``(d) Secondary Consultations.--
       ``(1) In general.--A group health plan, and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan, that provides coverage 
     with respect to medical and surgical services provided in 
     relation to the diagnosis and treatment of cancer shall 
     ensure that full coverage is provided for secondary 
     consultations by specialists in the appropriate medical 
     fields (including pathology, radiology, and oncology) to 
     confirm or refute such diagnosis. Such plan or issuer shall 
     ensure that full coverage is provided for such secondary 
     consultation whether such consultation is based on a positive 
     or negative initial diagnosis. In any case in which the 
     attending physician certifies in writing that services 
     necessary for such a secondary consultation are not 
     sufficiently available from specialists operating under the 
     plan with respect to whose services coverage is otherwise 
     provided under such plan or by such issuer, such plan or 
     issuer shall ensure that coverage is provided with respect to 
     the services necessary for the secondary consultation with 
     any other specialist selected by the attending physician for 
     such purpose at no additional cost to the individual beyond 
     that which the individual would have paid if the specialist 
     was participating in the network of the plan.
       ``(2) Exception.--Nothing in paragraph (1) shall be 
     construed as requiring the provision of secondary 
     consultations where the patient determines not to seek such a 
     consultation.
       ``(e) Prohibition on Penalties or Incentives.--A group 
     health plan, and a health insurance issuer providing health 
     insurance coverage in connection with a group health plan, 
     may not--
       ``(1) penalize or otherwise reduce or limit the 
     reimbursement of a provider or specialist because the 
     provider or specialist provided care to a participant or 
     beneficiary in accordance with this section;
       ``(2) provide financial or other incentives to a physician 
     or specialist to induce the physician or specialist to keep 
     the length of inpatient stays of patients following a 
     mastectomy, lumpectomy, or a lymph node dissection for the 
     treatment of breast cancer below certain limits or to limit 
     referrals for secondary consultations; or
       ``(3) provide financial or other incentives to a physician 
     or specialist to induce the physician or specialist to 
     refrain from referring a participant or beneficiary for a 
     secondary consultation that would otherwise be covered by the 
     plan or coverage involved under subsection (d).''.
       (2) Clerical amendment.--The table of contents in section 1 
     of the Employee Retirement Income Security Act of 1974 is 
     amended by inserting after the item relating to section 714 
     the following new item:

``Sec. 715. Required coverage for minimum hospital stay for 
              mastectomies and lymph node dissections for the treatment 
              of breast cancer and coverage for secondary 
              consultations.''.
       (d) Amendments to PHSA Relating to the Group Market.--
     Subpart 2 of part A of title XXVII of the Public Health 
     Service Act, as amended by section 201, is further amended by 
     adding at the end the following new section:

     ``SEC. 2708. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR 
                   MASTECTOMIES AND LYMPH NODE DISSECTIONS FOR THE 
                   TREATMENT OF BREAST CANCER AND COVERAGE FOR 
                   SECONDARY CONSULTATIONS.

       ``(a) Inpatient Care.--
       ``(1) In general.--A group health plan, and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan, that provides medical 
     and surgical benefits shall ensure that inpatient coverage 
     with respect to the treatment of breast cancer is provided 
     for a period of time as is determined by the attending 
     physician, in consultation with the patient, to be medically 
     necessary and appropriate following--
       ``(A) a mastectomy;
       ``(B) a lumpectomy; or
       ``(C) a lymph node dissection for the treatment of breast 
     cancer.
       ``(2) Exception.--Nothing in this section shall be 
     construed as requiring the provision of inpatient coverage if 
     the attending physician and patient determine that a shorter 
     period of hospital stay is medically appropriate.
       ``(b) Prohibition on Certain Modifications.--In 
     implementing the requirements of this section, a group health 
     plan, and a health insurance issuer providing health 
     insurance coverage in connection with a group health plan, 
     may not modify the terms and conditions of coverage based on 
     the determination by a participant or beneficiary to request 
     less than the minimum coverage required under subsection (a).
       ``(c) Notice.--A group health plan, and a health insurance 
     issuer providing health insurance coverage in connection with 
     a group health plan shall provide notice to each participant 
     and beneficiary under such plan regarding the coverage 
     required by this section in accordance with regulations 
     promulgated by the Secretary. Such notice shall be in writing 
     and prominently positioned in any literature or 
     correspondence made available or distributed by the plan or 
     issuer and shall be transmitted--
       ``(1) in the next mailing made by the plan or issuer to the 
     participant or beneficiary;
       ``(2) as part of any yearly informational packet sent to 
     the participant or beneficiary; or
       ``(3) not later than January 1, 2000;
     whichever is earlier.
       ``(d) Secondary Consultations.--
       ``(1) In general.--A group health plan, and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan that provides coverage 
     with respect to medical and surgical services provided in 
     relation to the diagnosis and treatment of cancer shall 
     ensure that full coverage is provided for secondary 
     consultations by specialists in the appropriate medical 
     fields (including pathology, radiology, and oncology) to 
     confirm or refute such diagnosis. Such plan or issuer shall 
     ensure that full coverage is provided for such secondary 
     consultation whether such consultation is based on a positive 
     or negative initial diagnosis. In any case in which the 
     attending physician certifies in writing that services 
     necessary for such a secondary consultation are not 
     sufficiently available from specialists operating under the 
     plan with respect to whose services coverage is otherwise 
     provided under such plan or by such issuer, such plan or 
     issuer shall ensure that coverage is provided with respect to 
     the services necessary for the secondary consultation with 
     any other specialist selected by the attending physician for 
     such purpose at no additional cost to the individual beyond 
     that which the individual would have paid if the specialist 
     was participating in the network of the plan.
       ``(2) Exception.--Nothing in paragraph (1) shall be 
     construed as requiring the provision of secondary 
     consultations where the patient determines not to seek such a 
     consultation.
       ``(e) Prohibition on Penalties or Incentives.--A group 
     health plan, and a health insurance issuer providing health 
     insurance coverage in connection with a group health plan, 
     may not--
       ``(1) penalize or otherwise reduce or limit the 
     reimbursement of a provider or specialist because the 
     provider or specialist provided care to a participant or 
     beneficiary in accordance with this section;
       ``(2) provide financial or other incentives to a physician 
     or specialist to induce the physician or specialist to keep 
     the length of inpatient stays of patients following a 
     mastectomy, lumpectomy, or a lymph node dissection for the 
     treatment of breast cancer below certain limits or to limit 
     referrals for secondary consultations; or
       ``(3) provide financial or other incentives to a physician 
     or specialist to induce the physician or specialist to 
     refrain from referring a participant or beneficiary for a 
     secondary consultation that would otherwise be covered by the 
     plan or coverage involved under subsection (d).''.
       (e) Amendments to PHSA Relating to the Individual Market.--
     Subpart 2 of part B of title XXVII of the Public Health 
     Service Act, as amended by section 202, is further amended by 
     adding at the end the following new section:

     ``SEC. 2754. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR 
                   MASTECTOMIES AND LYMPH NODE DISSECTIONS FOR THE 
                   TREATMENT OF BREAST CANCER AND SECONDARY 
                   CONSULTATIONS.

       ``The provisions of section 2708 shall apply to health 
     insurance coverage offered by a health insurance issuer in 
     the individual market in the same manner as they apply to 
     health insurance coverage offered by a health insurance 
     issuer in connection with a group health plan in the small or 
     large group market.''.
       (f) Amendments to the IRC.--
       (1) In general.--Subchapter B of chapter 100 of the 
     Internal Revenue Code of 1986, as amended by section 401, is 
     further amended--
       (A) in the table of sections, by inserting after the item 
     relating to section 9813 the following new item:

``Sec. 9814. Required coverage for minimum hospital stay for 
              mastectomies and lymph node dissections for the treatment 
              of breast cancer and coverage for secondary 
              consultations.''; and
       (B) by inserting after section 9813 the following:

     ``SEC. 9814. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR 
                   MASTECTOMIES AND LYMPH NODE DISSECTIONS FOR THE 
                   TREATMENT OF BREAST CANCER AND COVERAGE FOR 
                   SECONDARY CONSULTATIONS.

       ``(a) Inpatient Care.--
       ``(1) In general.--A group health plan that provides 
     medical and surgical benefits shall ensure that inpatient 
     coverage with respect to the treatment of breast cancer is 
     provided for a period of time as is determined by the 
     attending physician, in consultation with the patient, to be 
     medically necessary and appropriate following--
       ``(A) a mastectomy;
       ``(B) a lumpectomy; or
       ``(C) a lymph node dissection for the treatment of breast 
     cancer.

[[Page 15886]]

       ``(2) Exception.--Nothing in this section shall be 
     construed as requiring the provision of inpatient coverage if 
     the attending physician and patient determine that a shorter 
     period of hospital stay is medically appropriate.
       ``(b) Prohibition on Certain Modifications.--In 
     implementing the requirements of this section, a group health 
     plan may not modify the terms and conditions of coverage 
     based on the determination by a participant or beneficiary to 
     request less than the minimum coverage required under 
     subsection (a).
       ``(c) Notice.--A group health plan shall provide notice to 
     each participant and beneficiary under such plan regarding 
     the coverage required by this section in accordance with 
     regulations promulgated by the Secretary. Such notice shall 
     be in writing and prominently positioned in any literature or 
     correspondence made available or distributed by the plan and 
     shall be transmitted--
       ``(1) in the next mailing made by the plan to the 
     participant or beneficiary;
       ``(2) as part of any yearly informational packet sent to 
     the participant or beneficiary; or
       ``(3) not later than January 1, 2000;
     whichever is earlier.
       ``(d) Secondary Consultations.--
       ``(1) In general.--A group health plan that provides 
     coverage with respect to medical and surgical services 
     provided in relation to the diagnosis and treatment of cancer 
     shall ensure that full coverage is provided for secondary 
     consultations by specialists in the appropriate medical 
     fields (including pathology, radiology, and oncology) to 
     confirm or refute such diagnosis. Such plan or issuer shall 
     ensure that full coverage is provided for such secondary 
     consultation whether such consultation is based on a positive 
     or negative initial diagnosis. In any case in which the 
     attending physician certifies in writing that services 
     necessary for such a secondary consultation are not 
     sufficiently available from specialists operating under the 
     plan with respect to whose services coverage is otherwise 
     provided under such plan or by such issuer, such plan or 
     issuer shall ensure that coverage is provided with respect to 
     the services necessary for the secondary consultation with 
     any other specialist selected by the attending physician for 
     such purpose at no additional cost to the individual beyond 
     that which the individual would have paid if the specialist 
     was participating in the network of the plan.
       ``(2) Exception.--Nothing in paragraph (1) shall be 
     construed as requiring the provision of secondary 
     consultations where the patient determines not to seek such a 
     consultation.
       ``(e) Prohibition on Penalties.--A group health plan may 
     not--
       ``(1) penalize or otherwise reduce or limit the 
     reimbursement of a provider or specialist because the 
     provider or specialist provided care to a participant or 
     beneficiary in accordance with this section;
       ``(2) provide financial or other incentives to a physician 
     or specialist to induce the physician or specialist to keep 
     the length of inpatient stays of patients following a 
     mastectomy, lumpectomy, or a lymph node dissection for the 
     treatment of breast cancer below certain limits or to limit 
     referrals for secondary consultations; or
       ``(3) provide financial or other incentives to a physician 
     or specialist to induce the physician or specialist to 
     refrain from referring a participant or beneficiary for a 
     secondary consultation that would otherwise be covered by the 
     plan involved under subsection (d).''.
       (2) Clerical amendment.--The table of contents for chapter 
     100 of such Code is amended by inserting after the item 
     relating to section 9813 the following new item:

``Sec. 9814. Required coverage for minimum hospital stay for 
              mastectomies and lymph node dissections for the treatment 
              of breast cancer and coverage for secondary 
              consultations.''.
                                 ______
                                 

                KENNEDY (AND OTHERS) AMENDMENT NO. 1242

  Mr. DASCHLE (for Mr. Kennedy (for himself, Mr. Reid, Mr. Durbin, Mr. 
Wellstone, Mr. Wyden, Mr. Reed, Mrs. Murray, Mr. Daschle, Mr. Chafee, 
and Mrs. Feinstein)) proposed an amendment to amendment No. 1239 to the 
bill, S. 1344, supra; as follows:

       At the appropriate place, insert the following:

     SEC. __. APPLICATION TO ALL HEALTH PLANS.

       (a) ERISA.--Subpart C of part 7 of subtitle B of title I of 
     the Employee Retirement Income Security Act of 1974, as added 
     by section 101(a)(2) of this Act, is amended by adding at the 
     end the following:

     ``SEC. 730A. APPLICATION OF PROVISIONS.

       ``(a) Application to Group Health Plans.--The provisions of 
     this subpart, and sections 714 and 503, shall apply to group 
     health plans and health insurance issuers offering health 
     insurance coverage in connection with a group health plan.
       ``(b) Treatment of Multiple Coverage Options.--In the case 
     of a group health plan that provides benefits under 2 or more 
     coverage options, the requirements of this subpart, other 
     than section 722, shall apply separately with respect to each 
     coverage option.
       ``(c) Plan Satisfaction of Certain Requirements.--
       ``(1) Satisfaction of certain requirements through 
     insurance.--For purposes of subsection (a), insofar as a 
     group health plan provides benefits in the form of health 
     insurance coverage through a health insurance issuer, the 
     plan shall be treated as meeting the following requirements 
     of this Act with respect to such benefits and not be 
     considered as failing to meet such requirements because of a 
     failure of the issuer to meet such requirements so long as 
     the plan sponsor or its representatives did not cause such 
     failure by the issuer:
       ``(A) section 721 (relating to access to emergency care).
       ``(B) Section 722 (relating to choice of coverage options), 
     but only insofar as the plan is meeting such requirement 
     through an agreement with the issuer to offer the option to 
     purchase point-of-service coverage under such section.
       ``(C) Section 723, 724 and 725 (relating to access to 
     specialty care).
       ``(D) Section 726) (relating to continuity in case of 
     termination of provider (or, issuer in connection with health 
     insurance coverage) contract) but only insofar as a 
     replacement issuer assumes the obligation for continuity of 
     care.
       ``(E) Section 727 (relating to patient-provider 
     communications).
       ``(F) Section 728 (relating to prescription drugs).
       ``(G) Section 729 (relating to self-payment for certain 
     services).
       ``(2) Information.--With respect to information required to 
     be provided or made available under section 714, in the case 
     of a group health plan that provides benefits in the form of 
     health insurance coverage through a health insurance issuer, 
     the Secretary shall determine the circumstances under which 
     the plan is not required to provide or make available the 
     information (and is not liable for the issuer's failure to 
     provide or make available the information), if the issuer is 
     obligated to provide and make available (or provides and 
     makes available) such information.
       ``(3) Grievance and internal appeals.--With respect to the 
     grievance system and internal appeals process required to be 
     established under section 503, in the case of a group health 
     plan that provides benefits in the form of health insurance 
     coverage through a health insurance issuer, the Secretary 
     shall determine the circumstances under which the plan is not 
     required to provide for such system and process (and is not 
     liable for the issuer's failure to provide for such system 
     and process), if the issuer is obligated to provide for (and 
     provides for) such system and process.
       ``(4) External appeals.--Pursuant to rules of the 
     Secretary, insofar as a group health plan enters into a 
     contract with a qualified external appeal entity for the 
     conduct of external appeal activities in accordance with 
     section 503, the plan shall be treated as meeting the 
     requirement of such section and is not liable for the 
     entity's failure to meet any requirements under such section.
       ``(5) Application to prohibitions.--Pursuant to rules of 
     the Secretary, if a health insurance issuer offers health 
     insurance coverage in connection with a group health plan and 
     takes an action in violation of section 727, the group health 
     plan shall not be liable for such violation unless the plan 
     caused such violation.
       ``(6) Construction.--Nothing in this subsection shall be 
     construed to affect or modify the responsibilities of the 
     fiduciaries of a group health plan under part 4 of subtitle 
     B.
       ``(d) Conforming Regulations.--The Secretary may issue 
     regulations to coordinate the requirements on group health 
     plans under this section with the requirements imposed under 
     the other provisions of this title.''.
       (b) Application to Group Market Under Public Health Service 
     Act.--Subpart 2 of part A of title XXVII of the Public Health 
     Service Act (42 U.S.C. 300gg-4 et seq.), as amended by 
     section 203(a)(1)(B), is further amended by adding at the end 
     the following new section:

     ``SEC. 2708. PATIENT PROTECTION STANDARDS.

       ``(a) In General.--Each group health plan shall comply with 
     the following patient protection requirements, and each 
     health insurance issuer shall comply with such patient 
     protection requirements with respect to group health 
     insurance coverage it offers, and such requirements shall be 
     deemed to be incorporated into this subsection:
       ``(1) The requirements of subpart C of part 7 of subtitle B 
     of title I of the Employee Retirement Income Security Act of 
     1974.
       ``(2) The requirements of section 714 of the Employee 
     Retirement Income Security Act of 1974.
       ``(3) The requirements of subsections (b) through (g) of 
     section 503 of the Employee Retirement Income Security Act of 
     1974.
       ``(b) Notice.--A group health plan shall comply with the 
     notice requirement under section 104(b)(1) of the Employee 
     Retirement Income Security Act of 1974 with respect to the 
     requirements referred to in subsection (a) and a health 
     insurance issuer shall comply with such notice requirement as 
     if such section applied to such issuer and such issuer were a 
     group health plan.''.

[[Page 15887]]

       (c) Application to Individual Market Under Public Health 
     Service Act.--Subpart 3 of part B of title XXVII of the 
     Public Health Service Act (42 U.S.C. 300gg-51 et seq.), as 
     amended by section 203(b)(2), is further amended by adding at 
     the end the following new section:

     ``SEC. 2754. PATIENT PROTECTION STANDARDS.

       ``(a) In General.--Each health insurance issuer shall 
     comply with the following patient protection requirements 
     with respect to individual health insurance coverage it 
     offers, and such requirements shall be deemed to be 
     incorporated into this subsection:
       ``(1) The requirements of subpart C of part 7 of subtitle B 
     of title I of the Employee Retirement Income Security Act of 
     1974.
       ``(2) The requirements of section 714 of the Employee 
     Retirement Income Security Act of 1974.
       ``(3) The requirements of section 503 of the Employee 
     Retirement Income Security Act of 1974.
       ``(b) Notice.--A health insurance issuer under this part 
     shall comply with the notice requirement under section 
     104(b)(1) of the Employee Retirement Income Security Act of 
     1974 with respect to the requirements of such subtitle as if 
     such section applied to such issuer and such issuer were a 
     group health plan.
       ``(c) Nonapplication of Certain Provision.--Section 2763(a) 
     shall not apply to the provisions of this section.''.
       (d) Application to Group Health Plans Under the Internal 
     Revenue Code of 1986.--
       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. Standard relating to patients' bill of rights.''; and
       (2) by inserting after section 9812 the following:

     ``SEC. 9813. STANDARD RELATING TO PATIENTS' BILL OF RIGHTS.

       ``A group health plan shall comply with the following 
     requirements (as in effect as of the date of the enactment of 
     such Act), and such requirements shall be deemed to be 
     incorporated into this section:
       ``(1) The requirements of subpart C of part 7 of subtitle B 
     of title I of the Employee Retirement Income Security Act of 
     1974.
       ``(2) The requirements of section 714 of the Employee 
     Retirement Income Security Act of 1974.
       ``(3) The requirements of section 503 of the Employee 
     Retirement Income Security Act of 1974.''.
       (e) Conforming Amendment.--Section 2721(b)(2)(A) of the 
     Public Health Service Act (42 U.S.C. 300gg-21(b)(2)(A)) is 
     amended by inserting ``(other than section 2708)'' after 
     ``requirements of such subparts''.
       (f) No Impact on Social Security Trust Fund.--
       (1) In general.--Nothing in the amendments made by this 
     section shall be construed to alter or amend the Social 
     Security Act (or any regulation promulgated under that Act).
       (2) Transfers.--
       (A) Estimate of secretary.--The Secretary of the Treasury 
     shall annually estimate the impact that the enactment of this 
     section has on the income and balances of the trust funds 
     established under section 201 of the Social Security Act (42 
     U.S.C. 401).
       (B) Transfer of funds.--If, under subparagraph (A), the 
     Secretary of the Treasury estimates that the enactment of 
     this section has a negative impact on the income and balances 
     of the trust funds established under section 201 of the 
     Social Security Act (42 U.S.C. 401), the Secretary shall 
     transfer, not less frequently than quarterly, from the 
     general revenues of the Federal Government an amount 
     sufficient so as to ensure that the income and balances of 
     such trust funds are not reduced as a result of the enactment 
     of such section.
       (g) Information Requirements.--
       (1) Information from group health plans.--Section 1862(b) 
     of the Social Security Act (42 U.S.C. 1395y(b)) is amended by 
     adding at the end the following:
       ``(7) Information from group health plans.--
       ``(A) Provision of information by group health plans.--The 
     administrator of a group health plan subject to the 
     requirements of paragraph (1) shall provide to the Secretary 
     such of the information elements described in subparagraph 
     (C) as the Secretary specifies, and in such manner and at 
     such times as the Secretary may specify (but not more 
     frequently than 4 times per year), with respect to each 
     individual covered under the plan who is entitled to any 
     benefits under this title.
       ``(B) Provision of information by employers and employee 
     organizations.--An employer (or employee organization) that 
     maintains or participates in a group health plan subject to 
     the requirements of paragraph (1) shall provide to the 
     administrator of the plan such of the information elements 
     required to be provided under subparagraph (A), and in such 
     manner and at such times as the Secretary may specify, at a 
     frequency consistent with that required under subparagraph 
     (A) with respect to each individual described in subparagraph 
     (A) who is covered under the plan by reason of employment 
     with that employer or membership in the organization.
       ``(C) Information elements.--The information elements 
     described in this subparagraph are the following:
       ``(i) Elements concerning the individual.--

       ``(I) The individual's name.
       ``(II) The individual's date of birth.
       ``(III) The individual's sex.
       ``(IV) The individual's social security insurance number.
       ``(V) The number assigned by the Secretary to the 
     individual for claims under this title.
       ``(VI) The family relationship of the individual to the 
     person who has or had current or employment status with the 
     employer.

       ``(ii) Elements concerning the family member with current 
     or former employment status.--

       ``(I) The name of the person in the individual's family who 
     has current or former employment status with the employer.
       ``(II) That person's social security insurance number.
       ``(III) The number or other identifier assigned by the plan 
     to that person.
       ``(IV) The periods of coverage for that person under the 
     plan.

       ``(V) The employment status of that person (current or 
     former) during those periods of coverage.
       ``(VI) The classes (of that person's family members) 
     covered under the plan.

       ``(iii) Plan elements.--

       ``(I) The items and services covered under the plan.
       ``(II) The name and address to which claims under the plan 
     are to be sent.

       ``(iv) Elements concerning the employer.--

       ``(I) The employer's name.
       ``(II) The employer's address.
       ``(III) The employer identification number of the employer.

       ``(D) Use of identifiers.--The administrator of a group 
     health plan shall utilize a unique identifier for the plan in 
     providing information under subparagraph (A) and in other 
     transactions, as may be specified by the Secretary, related 
     to the provisions of this subsection. The Secretary may 
     provide to the administrator the unique identifier described 
     in the preceding sentence.
       ``(E) Penalty for noncompliance.--Any entity that knowingly 
     and willfully fails to comply with a requirement imposed by 
     the previous subparagraphs shall be subject to a civil money 
     penalty not to exceed $1,000 for each incident of such 
     failure. The provisions of section 1128A (other than 
     subsections (a) and (b)) shall apply to a civil money penalty 
     under the previous sentence in the same manner as those 
     provisions apply to a penalty or proceeding under section 
     1128A(a).''
       (2) Effective date.--The amendment made by paragraph (1) 
     shall take effect 180 days after the date of the enactment of 
     this Act.
       (h) Modification to Foreign Tax Credit Carryback and 
     Carryover Periods.--
       (1) In general.--Section 904(c) of the Internal Revenue 
     Code of 1986 (relating to limitation on credit) is amended--
       (A) by striking ``in the second preceding taxable year,'', 
     and
       (B) by striking ``or fifth'' and inserting ``fifth, sixth, 
     or seventh''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall apply to credits arising in taxable years beginning 
     after December 31, 2001.
       (i) Limitations on Welfare Benefit Funds of 10 or More 
     Employer Plans.--
       (1) Benefits to which exception applies.--Section 
     419A(f)(6)(A) of the Internal Revenue Code of 1986 (relating 
     to exception for 10 or more employer plans) is amended to 
     read as follows:
       ``(A) In general.--This subpart shall not apply to a 
     welfare benefit fund which is part of a 10 or more employer 
     plan if the only benefits provided through the fund are 1 or 
     more of the following:
       ``(i) Medical benefits.
       ``(ii) Disability benefits.
       ``(iii) Group term life insurance benefits which do not 
     provide for any cash surrender value or other money that can 
     be paid, assigned, borrowed, or pledged for collateral for a 
     loan.

     The preceding sentence shall not apply to any plan which 
     maintains experience-rating arrangements with respect to 
     individual employers.''
       (2) Limitation on use of amounts for other purposes.--
     Section 4976(b) of such Act (defining disqualified benefit) 
     is amended by adding at the end the following new paragraph:
       ``(5) Special rule for 10 or more employer plans exempted 
     from prefunding limits.--For purposes of paragraph (1)(C), 
     if--
       ``(A) subpart D of part I of subchapter D of chapter 1 does 
     not apply by reason of section 419A(f)(6) to contributions to 
     provide 1 or more welfare benefits through a welfare benefit 
     fund under a 10 or more employer plan, and
       ``(B) any portion of the welfare benefit fund attributable 
     to such contributions is used for a purpose other than that 
     for which the contributions were made,


[[Page 15888]]


     then such portion shall be treated as reverting to the 
     benefit of the employers maintaining the fund.''
       (3) Effective date.--The amendments made by this subsection 
     shall apply to contributions paid or accrued after the date 
     of the enactment of this Act, in taxable years ending after 
     such date.
       (j) Modification of Installment Method and Repeal of 
     Installment Method for Accrual Method Taxpayers.--
       (1) Repeal of installment method for accrual basis 
     taxpayers.--
       (A) In general.--Subsection (a) of section 453 of the 
     Internal Revenue Code of 1986 (relating to installment 
     method) is amended to read as follows:
       ``(a) Use of Installment Method.--
       ``(1) In general.--Except as otherwise provided in this 
     section, income from an installment sale shall be taken into 
     account for purposes of this title under the installment 
     method.
       ``(2) Accrual method taxpayer.--The installment method 
     shall not apply to income from an installment sale if such 
     income would be reported under an accrual method of 
     accounting without regard to this section. The preceding 
     sentence shall not apply to a disposition described in 
     subparagraph (A) or (B) of subsection (l)(2).''
       (B) Conforming amendments.--Sections 453(d)(1), 453(i)(1), 
     and 453(k) of such Act are each amended by striking ``(a)'' 
     each place it appears and inserting ``(a)(1)''.
       (2) Modification of pledge rules.--Paragraph (4) of section 
     453A(d) of such Act (relating to pledges, etc., of 
     installment obligations) is amended by adding at the end the 
     following: ``A payment shall be treated as directly secured 
     by an interest in an installment obligation to the extent an 
     arrangement allows the taxpayer to satisfy all or a portion 
     of the indebtedness with the installment obligation.''
       (3) Effective date.--The amendments made by this subsection 
     shall apply to sales or other dispositions occurring on or 
     after the date of the enactment of this Act.
                                 ______
                                 

                COLLINS (AND OTHERS) AMENDMENT NO. 1243

  Ms. COLLINS (for herself, Mr. Hutchinson, Mr. Jeffords, Mr. Frist, 
Mr. Grams, Mr. Grassley, and Mr. Abraham) proposed an amendment to 
amendment No. 1232 proposed by Mr. Daschle to the bill, S. 1344, supra; 
as follows:

       In the language proposed to be stricken, at the appropriate 
     place, insert the following:

     SEC. __. INCLUSION OF QUALIFIED LONG-TERM CARE INSURANCE 
                   CONTRACTS IN CAFETERIA PLANS, FLEXIBLE SPENDING 
                   ARRANGEMENTS, AND HEALTH FLEXIBLE SPENDING 
                   ACCOUNTS.

       (a) In General.--Section 125(f) of the Internal Revenue 
     Code of 1986 (defining qualified benefits) is amended by 
     striking the last sentence and inserting the following: 
     ``Such term includes any qualified long-term care insurance 
     contract.''
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     1999.

     SEC. __. DEDUCTION FOR PREMIUMS FOR LONG-TERM CARE INSURANCE.

       (a) In General.--Part VII of subchapter B of chapter 1 of 
     the Internal Revenue Code of 1986 (relating to additional 
     itemized deductions) is amended by redesignating section 222 
     as section 223 and by inserting after section 221 the 
     following:

     ``SEC. 222. PREMIUMS FOR LONG-TERM CARE INSURANCE.

       ``(a) In General.--In the case of an eligible individual, 
     there shall be allowed as a deduction an amount equal to 100 
     percent of the amount paid during the taxable year for any 
     coverage for qualified long-term care services (as defined in 
     section 7702B(c)) or any qualified long-term care insurance 
     contract (as defined in section 7702B(b)) which constitutes 
     medical care for the taxpayer, his spouse, and dependents.
       ``(b) Limitations.--
       ``(1) Deduction not available to individuals eligible for 
     employer-subsidized coverage.--
       ``(A) In general.--Except as provided in subparagraph (B), 
     subsection (a) shall not apply to any taxpayer for any 
     calendar month for which the taxpayer is eligible to 
     participate in any plan which includes coverage for qualified 
     long-term care services (as so defined) or is a qualified 
     long-term care insurance contract (as so defined) maintained 
     by any employer (or former employer) of the taxpayer or of 
     the spouse of the taxpayer.
       ``(B) Continuation coverage.--Coverage shall not be treated 
     as subsidized for purposes of this paragraph if--
       ``(i) such coverage is continuation coverage (within the 
     meaning of section 4980B(f)) required to be provided by the 
     employer, and
       ``(ii) the taxpayer or the taxpayer's spouse is required to 
     pay a premium for such coverage in an amount not less than 
     100 percent of the applicable premium (within the meaning of 
     section 4980B(f)(4)) for the period of such coverage.
       ``(2) Limitation on long-term care premiums.--In the case 
     of a qualified long-term care insurance contract (as so 
     defined), only eligible long-term care premiums (as defined 
     in section 213(d)(10)) shall be taken into account under 
     subsection (a)(2).
       ``(c) Special Rules.--For purposes of this section--
       ``(1) Coordination with medical deduction, etc.--Any amount 
     paid by a taxpayer for insurance to which subsection (a) 
     applies shall not be taken into account in computing the 
     amount allowable to the taxpayer as a deduction under section 
     213(a).
       ``(2) Deduction not allowed for self-employment tax 
     purposes.--The deduction allowable by reason of this section 
     shall not be taken into account in determining an 
     individual's net earnings from self-employment (within the 
     meaning of section 1402(a)) for purposes of chapter 2.''
       (b) Conforming Amendments.--
       (1) Subsection (a) of section 62 of the Internal Revenue 
     Code of 1986 is amended by inserting after paragraph (17) the 
     following:
       ``(18) Long-term care insurance costs of certain 
     individuals.--The deduction allowed by section 222.''
       (2) The table of sections for part VII of subchapter B of 
     chapter 1 of such Code is amended by striking the last item 
     and inserting the following:

``Sec. 222. Premiums for long-term care insurance.
``Sec. 223. Cross reference.''
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     1999.

     SEC. __. PATIENT RIGHT TO MEDICAL ADVICE AND CARE.

       (a) In General.--Part 7 of subtitle B of title I of the 
     Employee Retirement Income Security Act of 1974 (29 U.S.C. 
     1181 et seq.) is amended--
       (1) by redesignating subpart C as subpart D; and
       (2) by inserting after subpart B the following:

     ``SEC. 723. PATIENT ACCESS TO OBSTETRIC AND GYNECOLOGICAL 
                   CARE

       (1) General Rights.--
       (A) Waiver of plan referral requirement.--If a group health 
     plan described in paragraph (2) requires a referral to obtain 
     coverage for speciality care, the plan shall waive the 
     referral requirement in the case of a female participant or 
     beneficiary who seeks coverage for obstetrical care or 
     routine gynecological care (such as preventive gynecological 
     care).
       (B) Related routine care.--With respect to a participant or 
     beneficiary described in subparagraph (A), a group health 
     plan described in paragraph (2) may treat the ordering of 
     other care that is related to obstetric or routine 
     gynecologic care, by a physician who specializes in 
     obstetrics and gynecology as the authorization of the primary 
     care provider for such other care.
       (2) Application of Section.--A group health plan described 
     in this paragraph is a group health plan (other than a fully 
     insured group health plan), that--
       (A) provides coverage for obstetric care (such as 
     pregnancy-related services) or routine gynecologic care (such 
     as preventive women's health examinations); and
       (B) requires the designation by a participant or 
     beneficiary of a participating primary care provider who is 
     not a physician who specializes in obstetrics or gynecology.
       (3) Rules of Construction.--Nothing in this subsection 
     shall be construed--
       (A) as waiving any coverage requirement relating to medical 
     necessity or appropriateness with respect to the coverage of 
     obstetric or gynecologic care described in paragraph (1);
       (B) to preclude the plan from requiring that the physician 
     who specializes in obstetrics or gynecology notify the 
     designated primary care provider or the plan of treatment 
     decisions;
       (C) to preclude a group health plan from allowing health 
     care professionals other than physicians to provide routine 
     obstetric or routine gynecologic care; or
       (D) to preclude a group health plan from permitting a 
     physician who specializes in obstetrics and gynecology from 
     being a primary care provider under the plan.
       (4) Application of provisions.--
       (A) In general.--Notwithstanding any other provision of 
     this Act (or an amendment made by this Act), the provisions 
     of this subsection shall only apply to group health plans 
     (other than fully insured group health plans).
       (B) Fully insured group health plan.--In this subsection, 
     the term ``fully insured group health plan'' means a group 
     health plan where benefits under the plan are provided 
     pursuant to the terms of an arrangement between a group 
     health plan and a health insurance issuer and are guaranteed 
     by the health insurance issuer under a contract or policy of 
     insurance.

     ``SEC. 725. TIMELY ACCESS TO SPECIALISTS.

       ``(a) Timely Access.--
       ``(1) In general.--A group health plan (other than a fully 
     insured group health plan) shall ensure that participants and 
     beneficiaries have timely, in accordance with the medical 
     exigencies of the case, access to primary and speciality 
     health care professionals who are appropriate to the 
     condition of the participant or beneficiary, when such care 
     is covered under the plan. Such access may be provided 
     through contractual

[[Page 15889]]

     arrangements with specialized providers outside of the 
     network of the plan.
       ``(2) Rule of construction.--Nothing in paragraph (1) shall 
     be construed--
       ``(A) to require the coverage under a group health plan of 
     particular benefits or services or to prohibit a plan from 
     including providers only to the extent necessary to meet the 
     needs of the plan's participants or beneficiaries or from 
     establishing any measure designed to maintain quality and 
     control costs consistent with the responsibilities of the 
     plan; or
       ``(B) to override any State licensure or scope-of-practice 
     law.
       ``(b) Treatment Plans.--
       ``(1) In general.--Nothing in this section shall be 
     construed to prohibit a group health plan (other than a fully 
     insured group health plan) from requiring that speciality 
     care be provided pursuant to a treatment plan so long as the 
     treatment plan is--
       ``(A) developed by the specialist, in consultation with the 
     case manager or primary care provider, and the participant or 
     beneficiary;
       ``(B) approved by the plan in a timely manner in accordance 
     with the medical exigencies of the case; and
       ``(C) in accordance with the applicable quality assurance 
     and utilization review standards of the plan.
       ``(2) Notification.--Nothing in paragraph (1) shall be 
     construed as prohibiting a plan from requiring the specialist 
     to provide the case manager or primary care provider with 
     regular updates on the specialty care provided, as well as 
     all other necessary medical information.
       ``(c) Referrals.--Nothing in this section shall be 
     construed to prohibit a plan from requiring an authorization 
     by the case manager or primary care provider of the 
     participant or beneficiary in order to obtain coverage for 
     speciality services so long as such authorization is for an 
     adequate number of referrals.
       ``(d) Speciality Care Defined.--For purposes of this 
     subsection, the term `speciality care' means, with respect to 
     a condition, care and treatment provided by a health care 
     practitioner, facility, or center (such as a center of 
     excellence) that has adequate expertise (including age-
     appropriate expertise) through appropriate training and 
     experience.

     SEC.  . PATIENT ACCESS TO EMERGENCY MEDICAL CARE.

       (a) Coverage of Emergency Care.--
       (1) In general.--To the extent that the group health plan 
     (other than a fully insured group health plan) provides 
     coverage for benefits consisting of emergency medical care 
     (as defined in subsection (c)) or emergency ambulance 
     services, except for items or services specifically 
     excluded--
       (A) the plan shall provide coverage for benefits, without 
     requiring preauthorization, for emergency medical screening 
     examinations or emergency ambulance services, to the extent 
     that a prudent layperson, who possesses an average knowledge 
     of health and medicine, would determine such examinations or 
     emergency ambulance services to be necessary to determine 
     whether emergency medical care (as so defined) is necessary; 
     and
       (B) the plan shall provide coverage for benefits, without 
     requiring preauthorization, for additional emergency medical 
     care to stabilize an emergency medical condition following an 
     emergency medical screening examination (if determined 
     necessary under subparagraph (A)), pursuant to the definition 
     of stabilize under section 1867(e)(3) of the Social Security 
     Act (42 U.S.C. 1395dd(e)(3)).
       (2) Reimbursement for care to maintain medical stability.--
       (A) In general.--In the case of services provided to a 
     participant or beneficiary by a nonparticipating provider in 
     order to maintain the medical stability of the participant or 
     beneficiary, the group health plan involved shall provide for 
     reimbursement with respect to such services if--
       (i) coverage for services of the type furnished is 
     available under the group health plan;
       (ii) the services were provided for care related to an 
     emergency medical condition and in an emergency department in 
     order to maintain the medical stability of the participant or 
     beneficiary; and
       (iii) the nonparticipating provider contacted the plan 
     regarding approval for such services.
       (B) Failure to respond.--If a group health plan fails to 
     respond within 1 hours of being contacted in accordance with 
     subparagraph (A)(iii), then the plan shall be liable for the 
     cost of services provided by the nonparticipating provider in 
     order to maintain the stability of the participant or 
     beneficiary.
       (C) Limitation.--The liability of a group health plan to 
     provide reimbursement under subparagraph (A) shall terminate 
     when the plan has contacted the nonparticipating provider to 
     arrange for discharge or transfer.
       (D) Liability of participant.--A participant or beneficiary 
     shall not be liable for the costs of services to which 
     subparagraph (A) in an amount that exceeds the amount of 
     liability that would be incurred if the services were 
     provided by a participating health care provider with prior 
     authorization by the plan.
       (b) In-Network Uniform Costs-Sharing and Out-of-Network 
     Care.--
       (1) In-network uniform cost-sharing.--Nothing in this 
     section shall be construed as preventing a group health plan 
     (other than a fully insured group health plan) from imposing 
     any form of cost-sharing applicable to any participant or 
     beneficiary (including coinsurance, copayments, deductibles, 
     and any other charges) in relation to coverage for benefits 
     described in subsection (a), if such form of cost-sharing is 
     uniformly applied under such plan, with respect to similarly 
     situated participants and beneficiaries, to all benefits 
     consisting of emergency medical care (as defined in 
     subsection (c)) provided to such similarly situated 
     participants and beneficiaries under the plan, and such cost-
     sharing is disclosed in accordance with section 714.
       (2) Out-of-network care.--If a group health plan (other 
     than a fully insured group health plan) provides any benefits 
     with respect to emergency medical care (as defined in 
     subsection (c)), the plan shall cover emergency medical care 
     under the plan in a manner so that, if such care is provided 
     to a participant or beneficiary by a nonparticipating health 
     care provider, the participant or beneficiary is not liable 
     for amounts that exceed the amounts of liability that would 
     be incurred if the services were provided by a participating 
     provider.
       (c) Definition of Emergency Medical Care.--In this section:
       (1) In general.--The term ``emergency medical care'' means, 
     with respect to a participant or beneficiary under a group 
     health plan (other than a fully insured group health plan), 
     covered inpatient and outpatient services that--
       (A) are furnished by any provider, including a 
     nonparticipating provider, that is qualified to furnish such 
     services; and
       (B) are needed to evaluate or stabilize (as such term is 
     defined in section 1867(e)(3) of the Social Security Act (42 
     U.S.C. 1395dd)(e)(3)) an emergency medical condition (as 
     defined in paragraph (2)).
       (2) Emergency medical condition.--The term ``emergency 
     medical condition'' means a medical condition manifesting 
     itself by acute symptoms of sufficient severity (including 
     severe pain) such that a prudent layperson, who possesses an 
     average knowledge of health and medicine, could reasonably 
     expect the absence of immediate medical attention to result 
     in--
       (A) placing the health of the participant or beneficiary 
     (or, with respect to a pregnant woman, the health of the 
     woman or her unborn child) in serious jeopardy,
       (B) serious impairment to bodily functions, or
       (C) serious dysfunction of any bodily organ or part.
       (d) Application of provisions.--
       (1) In general.--Notwithstanding any other provision of 
     this Act (or an amendment made by this Act), the provisions 
     of this section shall only apply to group health plans (other 
     than fully insured group health plans).
       (2) Fully insured group health plan.--In this section, the 
     term ``fully insured group health plan'' means a group health 
     plan where benefits under the plan are provided pursuant to 
     the terms of an arrangement between a group health plan and a 
     health insurance issuer and are guaranteed by the health 
     insurance issuer under a contract or policy of insurance.

                          ____________________