[House Report 106-709]
[From the U.S. Government Publishing Office]



106th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     106-709

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 PROVIDING FOR THE CONSIDERATION OF H.R. 1304, THE QUALITY HEALTH-CARE 
                         COALITION ACT OF 2000

                                _______
                                

   June 28, 2000.--Referred to the House Calendar and ordered to be 
                                printed

                                _______
                                

     Mr. Goss, from the Committee on Rules, submitted the following

                              R E P O R T

                       [To accompany H. Res. 542]

    The Committee on Rules, having had under consideration 
House Resolution 542, by a non-record vote, report the same to 
the House with the recommendation that the resolution be 
adopted.

                summary of provisions of the resolution

    The resolution provides for the consideration of H.R. 1304, 
the Quality Health-Care Coalition Act of 2000, under a 
structured rule. The rule provides one hour of general debate 
divided equally between the chairman and ranking minority 
member of the Committee on the Judiciary.
    The rule waives all points of order against consideration 
of the bill. The rule makes in order the committee amendment in 
the nature of a substitute now printed in the bill as an 
original bill for the purpose of amendment, which shall be 
considered as read. The rule also waives all points of order 
against the amendment in the nature of a substitute.
    The rule makes in order only those amendments printed in 
this report. The amendments made in order may be offered only 
in the order printed in this report, may be offered only by a 
Member designated in this report, shall be considered as read, 
shall be debatable for the time specified in this report 
equally divided and controlled by the proponent and an 
opponent, shall not be subject to amendment, and shall not be 
subject to a demand for a division of the question in the House 
or in the Committee of the Whole. All points of order are 
waived against the amendments printed in this report.
    The Chairman of the Committee of the Whole may postpone 
votes during consideration of the bill, and reduce voting time 
to five minutes on a postponed question if the vote follows a 
fifteen minute vote. Finally, the rule provides one motion to 
recommit with or without instructions.

           summary of amendments made in order under the rule

    1. Ballenger: Provides that the exemption included in the 
bill not apply to: (1) negotiations between health 
professionals and health plans relating to fees, payments, 
reimbursements, or other compensation arrangements; or (2) 
negotiations with a health plan that would allow health 
professionals to balance bill patients of a health plan. The 
exemption would also not apply to a health professional if they 
had not submitted and received approval from the Sec. of HHS on 
a plan to reduce medical errors. Health professionals availing 
themselves of the exemption would also be required to notify 
patients and prospective patients of their participation in 
exempt negotiations. The exemption would not apply to health 
professional who engaged in boycotts of health plans. (20 
minutes)
    2. Stearns: Exempts groups of health care professionals 
engaged in negotiations with health plans from federal 
antitrust laws if the FTC or the Department of Justice has 
certified that such negotiations would promote competition and 
enhance the quality of patient care. Groups representing fewer 
than 20% of the health care professionals in a specialty in a 
market area would get an antitrust exemption without having to 
obtain approval from the FTC or DOJ. Finally, the amendment 
clarifies that the bill does not create any legal right for 
such groups of health care professionals to engage in boycotts, 
coercive behavior or engage in a collective cessation of 
service to patients. (10 minutes)
    3. Cox: Provides that a physician may not be forced to join 
a union as a condition of employment by a health plan. (10 
minutes)
    4. Terry: Prevents doctors, or any health care professional 
covered in the bill, from using the bill language to negotiate 
fees. (10 minutes)
    5. Coburn: Exempts discussions regarding requiring abortion 
coverage from collective bargaining negotiations. (20 minutes)
    6. Davis (IL): Sense of Congress that medical decisions 
regarding treatment should be made by the physician or health 
care professional and the patient. (10 minutes)

            text of amendments made in order under the rule

  1. An Amendment To Be Offered by Representative Ballenger of North 
           Carolina, or a Designee, Debatable for 20 Minutes

  Page 3, line 9, strike ``Any'' and insert ``Except as 
provided in paragraph (3) of subsection (c), any''.
  Page 4, after line 20 insert the following:
          (3) Application.--The exemption provided in 
        subsection (a) shall not apply to the following:
                  (A) Any negotiations with a health plan 
                regarding or relating to fees, payments, or 
                reimbursement, including the methodology of 
                such fees, payments, or reimbursement between 
                health care professionals and health plans.
                  (B) Any negotiations with a health plan to 
                permit health care professionals to balance 
                bill patients.
                  (C) Any health care professional who has not 
                submitted to and received approval from the 
                Secretary of Health and Human Services for a 
                plan that specifies policies and procedures to 
                identify and reduce the incidence of medical 
                errors.
                  (D) Any health care professional who has not 
                disclosed to patients and prospective patients 
                information regarding the professional's 
                participation in such negotiations.
                  (E) Any acts by health care professionals to 
                engage in boycotts.
                              ----------                              


2. An Amendment To Be Offered by Representative Stearns of Florida, or 
                  a Designee, Debatable for 10 Minutes

  Page 3, line 17, insert before the period the following: ``, 
but only if such health care professionals have received prior 
approval for such negotiations from the Federal Trade 
Commission or the Assistant Attorney General pursuant to 
subsection (i).''.
  Page 6, after line 21, insert the following new subsection 
(and redesignate the succeeding subsection accordingly):
  (i) Prior Approval.--
          (1) In general.--Health care professionals who seek 
        to engage in negotiations with a health plan as 
        provided in subsection (a) must obtain approval from 
        the Commission or the Assistant Attorney General prior 
        to commencing such negotiations. The Commission or the 
        Assistant Attorney General shall grant such approval if 
        the Commission or Assistant Attorney General has 
        determined that recognition under subsection (a) of the 
        group of health care professionals for the purpose of 
        engaging in collective negotiations with the health 
        plan will promote competition and enhance the quality 
        of patient care. The approval that is granted under 
        this subsection may be limited in time or scope to 
        ensure that these criteria are met. The Commission and 
        the Assistant Attorney General shall make a 
        determination regarding a request for approval under 
        this paragraph within 30 days after the date it is 
        received, if the request contains the information 
        specified in regulations issued under paragraph (2). 
        Failure by the Commission or Assistant Attorney General 
        to make such determination within such 30-day period 
        will be deemed to be an approval of the request by the 
        Commission or the Assistant Attorney General.
          (2) Regulations.--The Commission, in consultation 
        with the Assistant Attorney General, shall publish 
        regulations implementing this subsection within six 
        months of the effective date of this Act. Such 
        regulations shall include the following:
                  (A) A description of the information that 
                must be submitted by health care professionals 
                who seek to obtain approval to engage in 
                collective negotiations.
                  (B) Provisions for the opportunity for the 
                public to submit comments to the Commission or 
                the Assistant Attorney General for 
                consideration in reviewing any request for 
                approval by health care professionals to engage 
                in collective negotiations under this section.
                  (C) Provision for a filing fee in an amount 
                reasonable and necessary to cover the costs of 
                the Commission and the Assistant Attorney 
                General to implement this subsection. On an 
                annual basis, this fee shall be updated to 
                reflect any increases or decreases determined 
                to be necessary to cover such costs.
          (3) Coordination.--The Commission and the Assistant 
        Attorney General shall coordinate so that an 
        application is reviewed under this subsection by either 
        the Commission or the Assistant Attorney General, but 
        not both.
          (4) Exemption for small groups.--
                  (A) In general.--Notwithstanding any other 
                provision of this subsection (other than 
                subparagraph (B)), no prior approval is 
                required under this subsection in the case of a 
                group of health care professionals who are 
                acting collectively with respect to a 
                negotiation if such group constitutes less than 
                20 percent of the health care professionals in 
                a specialty (or subspecialty) in the market 
                area involved, as determined under regulations 
                of the Commission.
                  (B) Oversight.--The Commission shall 
                establish a process under which, if it receives 
                a bona fide request that alleges that the 
                negotiations of a group described in 
                subparagraph (A) has not promoted competition 
                or has not enhanced the quality of patient 
                care, the Commission will review the request 
                and may take such action as the Commission 
                determines to be appropriate. Such action may 
                include ordering that the results of the 
                negotiations be vitiated and that the exemption 
                under subparagraph (A) not apply to such group 
                for such period as the Commission may specify.
  Page 8, after line 8, insert the following:
          (4) Commission.--The term ``Commission'' means the 
        Federal Trade Commission.
          (5) Assistant attorney general.--The term ``Assistant 
        Attorney General'' means the Assistant Attorney General 
        in charge of the Antitrust Division of the Department 
        of Justice.
                              ----------                              


3. An Amendment To Be Offered by Representative Cox of California, or a 
                   Designee, Debatable for 10 Minutes

  Page 4, after line 20, insert the following new paragraph:
          (3) Physicians' right to choose whether to join a 
        labor organization.--Nothing in this Act shall impair 
        the right of any health care professional to refrain 
        from self-organizing, from forming, joining or 
        assisting a labor organization (including an 
        organization of other health care professionals), from 
        bargaining collectively, or from engaging in concerted 
        activities, and no agreement with a health care plan 
        may require membership by a health care professional 
        (who under existing law prior to the enactment of this 
        Act would not have been treated as an employee) in a 
        labor organization, including any organization of other 
        health care professionals, as a condition of 
        employment.
                              ----------                              


4. An Amendment To Be Offered by Representative Terry of Nebraska, or a 
                   Designee, Debatable for 10 Minutes

  Page 4, after line 20, insert the following:
          (3) No negotiation over fees.--The exemption provided 
        in subsection (a) shall not apply to negotiations over 
        fees.
                              ----------                              


5. An Amendment To Be Offered by Representative Coburn of Oklahoma, or 
                  a Designee, Debatable for 20 Minutes

  Page 6, after line 10, insert the following new subsection 
(and redesignate the succeeding subsections accordingly):
  (h) Exemption of Abortion and Abortion Services.--Nothing in 
this section shall apply to negotiations specifically relating 
to requiring a health plan to cover abortion or abortion 
services.
                              ----------                              


6. An Amendment To Be Offered by Representative Davis of Illinois, or a 
                   Designee, Debatable for 10 Minutes

  Add at the end the following new subsection:
  (j) Sense of Congress.--It is the sense of Congress that 
decisions regarding medical care and treatment should be made 
by the physician or health care professional in consultation 
with the patient.