Patient Communications Protection Act of 1996

Summary: Patient Communications Protection Act of 1996 - Prohibits an entity offering a health plan from prohibiting or restricting any communication by a health care provider with a patient regarding the patient's physical or mental condition or treatment options.  Mandates a civil monetary penalty.  Allows related State requirements only if they are more protective of such communications than the requirements of this Act.

SECTION 1. SHORT TITLE; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Patient 
Communications Protection Act of 1996''.
    (b) Findings.--Congress finds the following:
            (1) Patients need access to all relevant information to 
        make appropriate decisions, with their physicians, about their 
        health care.
            (2) Restrictions on the ability of physicians to provide 
        full disclosure of all relevant information to patients making 
        health care decisions violate the principles of informed 
        consent and practitioner ethical standards.
            (3) The offering and operation of health plans affect 
        commerce among the States. Health care providers located in one 
        State serve patients who reside in other States as well as that 
        State. 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 one State as well as those 
        operating among the several States.

SEC. 2. PROHIBITION OF INTERFERENCE WITH CERTAIN MEDICAL 
              COMMUNICATIONS.

    (a) In General.--
            (1) Prohibition of certain provisions.--Subject to 
        paragraph (2), an entity offering a health plan (as defined in 
        subsection (d)(2)) may not include any provision that prohibits 
        or restricts any medical communication (as defined in 
        subsection (b)) as part of--
                    (A) a written contract or agreement with a health 
                care provider,
                    (B) a written statement to such a provider, or
                    (C) an oral communication to such a provider.
            (2) Construction.--Nothing in this section shall be 
        construed as preventing an entity from exercising mutually 
        agreed upon terms and conditions not inconsistent with 
        paragraph (1), including terms or conditions requiring a 
        physician to participate in, and cooperate with, all programs, 
        policies, and procedures developed or operated by the person, 
        corporation, partnership, association, or other organization to 
        ensure, review, or improve the quality of health care.
            (3) Nullification.--Any provision described in paragraph 
        (1) is null and void.
    (b) Medical Communication Defined.--In this section, the term 
``medical communication'' means a communication made by a health care 
provider with a patient of the provider (or the guardian or legal 
representative of such patient) with respect to the patient's physical 
or mental condition or treatment options.
    (c) Enforcement Through Imposition of Civil Money Penalty.--
            (1) In general.--Any entity that violates paragraph (1) of 
        subsection (a) shall be subject to a civil money penalty of up 
        to $15,000 for each violation. No such penalty shall be imposed 
        solely on the basis of an oral communication unless the 
        communication is part of a pattern or practice of such 
        communications and the violation is demonstrated by a 
        preponderance of the evidence.
            (2) Procedures.--The provisions of subsections (c) through 
        (l) of section 1128A of the Social Security Act (42 U.S.C. 
        1320a-7a) shall apply to civil money penalties under paragraph 
        (1) in the same manner as they apply to a penalty or proceeding 
        under section 1128A(a) of such Act.
    (d) Definitions.--For purposes of this section:
            (1) Health care provider.--The term ``health care 
        provider'' means anyone licensed under State law to provide 
        health care services, including a practitioner such as a nurse 
        anesthetist or chiropractor who is so licensed.
            (2) Health plan.--The term ``health plan'' means any public 
        or private health plan or arrangement (including an employee 
        welfare benefit plan) which provides, or pays the cost of, 
        health benefits, and includes an organization of health care 
        providers that furnishes health services under a contract or 
        agreement with such a plan.
            (3) Coverage of third party administrators.--In the case of 
        a health plan that is an employee welfare benefit plan (as 
        defined in section 3(1) of the Employee Retirement Income 
        Security Act of 1974), any third party administrator or other 
        person with responsibility for contracts with health care 
        providers under the plan shall be considered, for purposes of 
        this section, to be an entity offering such health plan.
    (e) Non-Preemption of State Law.--A State may establish or enforce 
requirements with respect to the subject matter of this section, but 
only if such requirements are consistent with the Act and are more 
protective of medical communications than the requirements established 
under this section.
    (g) Effective Date.--Subsection (a) shall take effect 180 days 
after the date of the enactment of this Act and shall apply to medical 
communications made on or after such date.