To establish Medicare performance-based quality measures, to establish an affirmative defense in medical malpractice actions based on compliance with best practices guidelines, and to provide grants to States for administrative health care tribunals.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Care OverUse Reform Today Act 
(HealthCOURT Act) of 2009''.

SEC. 2. ESTABLISHMENT OF PERFORMANCE-BASED QUALITY MEASURES.

    Not later than January 1, 2010, the Secretary of Health and Human 
Services shall submit to Congress a proposal for a formalized process 
for the development of performance-based quality measures that could be 
applied to physicians' services under the Medicare program under title 
XVIII of the Social Security Act. Such proposal shall be in concert and 
agreement with the Physician Consortium for Performance Improvement and 
shall only utilize measures agreed upon by each physician specialty 
organization.

SEC. 3. AFFIRMATIVE DEFENSE BASED ON COMPLIANCE WITH BEST PRACTICE 
              GUIDELINES.

    (a) Selection and Issuance of Best Practices Guidelines.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary'') shall 
        provide for the selection and issuance of best practice 
        guidelines (each in this subsection referred to as a 
        ``guideline'') in accordance with paragraphs (2) and (3).
            (2) Development process.--Not later than 90 days after the 
        date of the enactment of this Act, the Secretary shall enter 
        into a contract with a qualified physician consensus-building 
        organization (such as the Physician Consortium for Performance 
        Improvement), in concert and agreement with physician specialty 
        organizations, to develop guidelines for treatment of medical 
        conditions for application under subsection (b). Under the 
        contract, the organization shall take into consideration any 
        endorsed performance-based quality measures described in 
        section 2. Under the contract and not later than 18 months 
        after the date of the enactment of this Act, the organization 
        shall submit best practice guidelines for issuance as 
        guidelines under paragraph (3).
            (3) Issuance.--
                    (A) In general.--Not later than 2 years after the 
                date of the enactment of this Act, the Secretary shall 
                issue, by regulation, after notice and opportunity for 
                public comment, guidelines that have been recommended 
                under paragraph (2) for application under subsection 
                (b).
                    (B) Limitation.--The Secretary may not issue 
                guidelines unless they have been approved or endorsed 
                by qualified physician consensus-building organization 
                involved and physician specialty organizations.
                    (C) Dissemination.--The Secretary shall broadly 
                disseminate the guidelines so issued.
    (b) Limitation on Damages.--
            (1) Limitation on noneconomic damages.--In any health care 
        lawsuit, no noneconomic damages may awarded with respect to 
        treatment that is within a guideline issued under subsection 
        (a).
            (2) Limitation on punitive damages.--In any health care 
        lawsuit, no punitive damages may be awarded against a health 
        care practitioner based on a claim that such treatment caused 
        the claimant harm if--
                    (A) such treatment was subject to the quality 
                review by a qualified physician consensus-building 
                organization;
                    (B) such treatment was approved in a guideline that 
                underwent full review by such organization, public 
                comment, approval by the Secretary, and dissemination 
                as described in subparagraph (a); and
                    (C) such medical treatment is generally recognized 
                among qualified experts (including medical providers 
                and relevant physician specialty organizations) as 
                safe, effective, and appropriate.
    (c) Use.--
            (1) Introduction as evidence.--Guidelines under subsection 
        (a) may not be introduced as evidence of negligence or 
        deviation in the standard of care in any civil action unless 
        they have previously been introduced by the defendant.
            (2) No presumption of negligence.--There would be no 
        presumption of negligence if a participating physician does not 
        adhere to such guidelines.
    (d) Construction.--Nothing in this section shall be construed as 
preventing a State from--
            (1) replacing their current medical malpractice rules with 
        rules that rely, as a defense, upon a health care provider's 
        compliance with a guideline issued under subsection (a); or
            (2) applying additional guidelines or safe-harbors that are 
        in addition to, but not in lieu of, the guidelines issued under 
        subsection (a).

SEC. 4. STATE GRANTS TO CREATE ADMINISTRATIVE HEALTH CARE TRIBUNALS.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.) is amended by adding at the end the following:

``SEC. 399T. STATE GRANTS TO CREATE ADMINISTRATIVE HEALTH CARE 
              TRIBUNALS.

    ``(a) In General.--The Secretary may award grants to States for the 
development, implementation, and evaluation of administrative health 
care tribunals that comply with this section, for the resolution of 
disputes concerning injuries allegedly caused by health care providers.
    ``(b) Conditions for Demonstration Grants.--To be eligible to 
receive a grant under this section, a State shall submit to the 
Secretary an application at such time, in such manner, and containing 
such information as may be required by the Secretary. A grant shall be 
awarded under this section on such terms and conditions as the 
Secretary determines appropriate.
    ``(c) Representation by Counsel.--A State that receives a grant 
under this section may not preclude any party to a dispute before an 
administrative health care tribunal operated under such grant from 
obtaining legal representation during any review by the expert panel 
under subsection (d), the administrative health care tribunal under 
subsection (e), or a State court under subsection (f).
    ``(d) Expert Panel Review and Early Offer Guidelines.--
            ``(1) In general.--Prior to the submission of any dispute 
        concerning injuries allegedly caused by health care providers 
        to an administrative health care tribunal under this section, 
        such allegations shall first be reviewed by an expert panel.
            ``(2) Composition.--
                    ``(A) In general.--The members of each expert panel 
                under this subsection shall be appointed by the head of 
                the State agency responsible for health. Each expert 
                panel shall be composed of no fewer than 3 members and 
                not more than 7 members. At least one-half of such 
                members shall be medical experts (either physicians or 
                health care professionals).
                    ``(B) Licensure and expertise.--Each physician or 
                health care professional appointed to an expert panel 
                under subparagraph (A) shall--
                            ``(i) be appropriately credentialed or 
                        licensed in 1 or more States to deliver health 
                        care services; and
                            ``(ii) typically treat the condition, make 
                        the diagnosis, or provide the type of treatment 
                        that is under review.
                    ``(C) Independence.--
                            ``(i) In general.--Subject to clause (ii), 
                        each individual appointed to an expert panel 
                        under this paragraph shall--
                                    ``(I) not have a material familial, 
                                financial, or professional relationship 
                                with a party involved in the dispute 
                                reviewed by the panel; and
                                    ``(II) not otherwise have a 
                                conflict of interest with such a party.
                            ``(ii) Exception.--Nothing in clause (i) 
                        shall be construed to prohibit an individual 
                        who has staff privileges at an institution 
                        where the treatment involved in the dispute was 
                        provided from serving as a member of an expert 
                        panel merely on the basis of such affiliation, 
                        if the affiliation is disclosed to the parties 
                        and neither party objects.
                    ``(D) Practicing health care professional in same 
                field.--
                            ``(i) In general.--In a dispute before an 
                        expert panel that involves treatment, or the 
                        provision of items or services--
                                    ``(I) by a physician, the medical 
                                experts on the expert panel shall be 
                                practicing physicians (allopathic or 
                                osteopathic) of the same or similar 
                                specialty as a physician who typically 
                                treats the condition, makes the 
                                diagnosis, or provides the type of 
                                treatment under review; or
                                    ``(II) by a health care 
                                professional other than a physician, at 
                                least two medical experts on the expert 
                                panel shall be practicing physicians 
                                (allopathic or osteopathic) of the same 
                                or similar specialty as the health care 
                                professional who typically treats the 
                                condition, makes the diagnosis, or 
                                provides the type of treatment under 
                                review, and, if determined appropriate 
                                by the State agency, an additional 
                                medical expert shall be a practicing 
                                health care professional (other than 
                                such a physician) of such a same or 
                                similar specialty.
                            ``(ii) Practicing defined.--In this 
                        paragraph, the term `practicing' means, with 
                        respect to an individual who is a physician or 
                        other health care professional, that the 
                        individual provides health care services to 
                        individual patients on average at least 2 days 
                        a week.
                    ``(E) Pediatric expertise.--In the case of dispute 
                relating to a child, at least 1 medical expert on the 
                expert panel shall have expertise described in 
                subparagraph (D)(i) in pediatrics.
            ``(3) Determination.--After a review under paragraph (1), 
        an expert panel shall make a determination as to the liability 
        of the parties involved and compensation.
            ``(4) Acceptance.--If the parties to a dispute before an 
        expert panel under this subsection accept the determination of 
        the expert panel concerning liability and compensation, such 
        compensation shall be paid to the claimant and the claimant 
        shall agree to forgo any further action against the health care 
        providers involved.
            ``(5) Failure to accept.--If any party decides not to 
        accept the expert panel's determination, the matter shall be 
        referred to an administrative health care tribunal created 
        pursuant to this section.
    ``(e) Administrative Health Care Tribunals.--
            ``(1) In general.--Upon the failure of any party to accept 
        the determination of an expert panel under subsection (d), the 
        parties shall have the right to request a hearing concerning 
        the liability or compensation involved by an administrative 
        health care tribunal established by the State involved.
            ``(2) Requirements.--In establishing an administrative 
        health care tribunal under this section, a State shall--
                    ``(A) ensure that such tribunals are presided over 
                by special judges with health care expertise;
                    ``(B) provide authority to such judges to make 
                binding rulings, rendered in written decisions, on 
                standards of care, causation, compensation, and related 
                issues with reliance on independent expert witnesses 
                commissioned by the tribunal;
                    ``(C) establish gross negligence as the legal 
                standard for the tribunal;
                    ``(D) allow the admission into evidence of the 
                recommendation made by the expert panel under 
                subsection (d); and
                    ``(E) provide for an appeals process to allow for 
                review of decisions by State courts.
    ``(f) Review by State Court After Exhaustion of Administrative 
Remedies.--
            ``(1) Right to file.--If any party to a dispute before a 
        health care tribunal under subsection (e) is not satisfied with 
        the determinations of the tribunal, the party shall have the 
        right to file their claim in a State court of competent 
        jurisdiction.
            ``(2) Forfeit of awards.--Any party filing an action in a 
        State court in accordance with paragraph (1) shall forfeit any 
        compensation award made under subsection (e).
            ``(3) Admissibility.--The determinations of the expert 
        panel and the administrative health care tribunal pursuant to 
        subsections (d) and (e) with respect to a State court 
        proceeding under paragraph (1) shall be admissible into 
        evidence in any such State court proceeding.
    ``(g) Definition.--In this section, the term `health care provider' 
has the meaning given such term for purposes of part A of title VII.
    ``(h) Authorization of Appropriations.--There are authorized to be 
appropriated for any fiscal year such sums as may be necessary for 
purposes of making grants to States under this section.''.

SEC. 5. SENSE OF CONGRESS REGARDING HEALTH INSURER LIABILITY.

    It is the sense of Congress that a health insurance issuer should 
be liable for damages for harm caused when it makes a decision as to 
what care is medically necessary and appropriate.

Summary: Health Care OverUse Reform Today Act of 2009 - Directs the Secretary of Health and Human Services (HHS) to propose to Congress a formalized process for the development of performance-based quality measures that could be applied to physicians' services under title XVIII (Medicare) of the Social Security Act. Requires the proposal: (1) to be in concert and agreement with the Physician Consortium for Performance Improvement. And (2) utilize only measures agreed upon by each physician specialty organization. Directs the Secretary to: (1) provide for the selection and issuance of best practice guidelines for treatment of medical conditions. And (2) contract with a qualified physician consensus-building organization , in concert and agreement with physician specialty organizations, to develop such guidelines. Prohibits the award of any noneconomic damages in any health care lawsuit with respect to treatment that is within an issued guideline. Prohibits the award of punitive damages against a health care practitioner in such a lawsuit based on a claim that medical treatment caused the claimant harm if the treatment: (1) was subject to quality review by a qualified physician consensus-building organization. (2) was approved in a guideline that underwent full review by such organization, public comment, the Secretary's approval, and dissemination. And (3) is generally recognized among qualified experts as safe, effective, and appropriate. Amends the Public Health Service Act to authorize the Secretary to award grants to states for the development, implementation, and evaluation of administrative health care tribunals for the resolution of disputes concerning injuries allegedly caused by health care providers. Expresses the sense of Congress that a health insurance issuer should be liable for damages for a harm caused when it makes a decision as to what care is medically necessary and appropriate.