# H.R. 3962/Division A/Title II/Subtitle F
## SUBTITLE F — RELATION TO OTHER REQUIREMENTS; MISCELLANEOUS
### Sec. 251. Relation to Other Requirements.

    (a) Coverage Not Offered Through Exchange.—
          (1) IN GENERAL.—
             In the case of health insurance coverage not offered through the Health Insurance Exchange (whether or not offered in connection with an employment-based health plan), and in the case of employment-based health plans, the requirements of this title do not supercede any requirements applicable under titles XXII and XXVII of the Public Health Service Act, parts 6 and 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974, or State law, except insofar as such requirements prevent the application of a requirement of this division, as determined by the Commissioner.
          (2) CONSTRUCTION.—
             Nothing in paragraphs (1) or (2) shall be construed as affecting the application of section 514 of the Employee Retirement Income Security Act of 1974.
    (b) Coverage Offered through Exchange.—
          (1) IN GENERAL.—
             In the case of health insurance coverage offered through the Health Insurance Exchange—
                (A) the requirements of this title do not supercede any requirements (including requirements relating to genetic information nondiscrimination and mental health parity) applicable under title XXVII of the Public Health Service Act or under State law, except insofar as such requirements prevent the application of a requirement of this division, as determined by the Commissioner; and
                (B) individual rights and remedies under State laws shall apply.
          (2) CONSTRUCTION.—
             In the case of coverage described in paragraph (1), nothing in such paragraph shall be construed as preventing the application of rights and remedies under State laws to health insurance issuers generally with respect to any requirement referred to in paragraph (1)(A). The previous sentence shall not be construed as providing for the applicability of rights or remedies under State laws with respect to requirements applicable to employers or other plan sponsors in connection with arrangements which are treated as group health plans under section 802(a)(1) of the Employee Retirement Income Security Act of 1974.

### Sec. 252. Prohibiting Discrimination in Health Care.

    (a) In General.—
       Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.
    (b) Implementation.—
       To implement the requirement set forth in subsection (a), the Secretary of Health and Human Services shall, not later than 18 months after the date of the enactment of this Act, promulgate such regulations as are necessary or appropriate to insure that all health care and related services (including insurance coverage and public health activities) covered by this Act are provided (whether directly or through contractual, licensing, or other arrangements) without regard to personal characteristics extraneous to the provision of high quality health care or related services.

### Sec. 253. Whistleblower Protection.

    (a) Retaliation Prohibited.—
       No employer may discharge any employee or otherwise discriminate against any employee with respect to his compensation, terms, conditions, or other privileges of employment because the employee (or any person acting pursuant to a request of the employee)—
          (1) provided, caused to be provided, or is about to provide or cause to be provided to the employer, the Federal Government, or the attorney general of a State information relating to any violation of, or any act or omission the employee reasonably believes to be a violation of any provision of this Act or any order, rule, or regulation promulgated under this Act;
          (2) testified or is about to testify in a proceeding concerning such violation;
          (3) assisted or participated or is about to assist or participate in such a proceeding; or
          (4) objected to, or refused to participate in, any activity, policy, practice, or assigned task that the employee (or other such person) reasonably believed to be in violation of any provision of this Act or any order, rule, or regulation promulgated under this Act.
    (b) Enforcement Action.—
       An employee covered by this section who alleges discrimination by an employer in violation of subsection (a) may bring an action governed by the rules, procedures, legal burdens of proof, and remedies set forth in section 40(b) of the Consumer Product Safety Act (15 U.S.C. 2087(b)).
    (c) Employer Defined.—
       As used in this section, the term “employer” means any person (including one or more individuals, partnerships, associations, corporations, trusts, professional membership organization including a certification, disciplinary, or other professional body, unincorporated organizations, nongovernmental organizations, or trustees) engaged in profit or nonprofit business or industry whose activities are governed by this Act, and any agent, contractor, subcontractor, grantee, or consultant of such person.
    (d) Rule of Construction.—
       The rule of construction set forth in section 20109(h) of title 49, United States Code, shall also apply to this section.

### Sec. 254. Construction Regarding Collective Bargaining.

    Nothing in this division shall be construed to alter or supersede any statutory or other obligation to engage in collective bargaining over the terms or conditions of employment related to health care. Any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by this division shall not be treated as a termination of such collective bargaining agreement.

### Sec. 255. Severability.

    If any provision of this Act, or any application of such provision to any person or circumstance, is held to be unconstitutional, the remainder of the provisions of this Act and the application of the provision to any other person or circumstance shall not be affected.

### Sec. 256. Treatment of Hawaii Prepaid Health Care Act.

    (a) In General.—
       Subject to this section—
          (1) nothing in this division (or an amendment made by this division) shall be construed to modify or limit the application of the exemption for the Hawaii Prepaid Health Care Act (Haw. Rev. Stat. §§ 393–1 et seq.) as provided for under section 514(b)(5) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1144(b)(5)), and such exemption shall also apply with respect to the provisions of this division; and
          (2) for purposes of this division (and the amendments made by this division), coverage provided pursuant to the Hawaii Prepaid Health Care Act shall be treated as a qualified health benefits plan providing acceptable coverage so long as the Secretary of Labor determines that such coverage for employees (taking into account the benefits and the cost to employees for such benefits) is substantially equivalent to or greater than the coverage provided for employees pursuant to the essential benefits package.
    (b) Coordination with State law of Hawaii.—
       The Commissioner shall, based on ongoing consultation with the appropriate officials of the State of Hawaii, make adjustments to rules and regulations of the Commissioner under this division as may be necessary, as determined by the Commissioner, to most effectively coordinate the provisions of this division with the provisions of the Hawaii Prepaid Health Care Act, taking into account any changes made from time to time to the Hawaii Prepaid Health Care Act and related laws of such State.

### Sec. 257. Actions by State Attorneys General.

    Any State attorney general may bring a civil action in the name of such State as parens patriae on behalf of natural persons residing in such State, in any district court of the United States or State court having jurisdiction of the defendant to secure monetary or equitable relief for violation of any provisions of this title or regulations issued thereunder. Nothing in this section shall be construed as affecting the application of section 514 of the Employee Retirement Income Security Act of 1974.

### Sec. 258. Application of State and Federal Laws Regarding Abortion.

    (a) No Preemption of State Laws Regarding Abortion.—
       Nothing in this Act shall be construed to preempt or otherwise have any effect on State laws regarding the prohibition of (or requirement of) coverage, funding, or procedural requirements on abortions, including parental notification or consent for the performance of an abortion on a minor.
    (b) No Effect on Federal Laws Regarding Abortion.—
          (1) IN GENERAL.—
             Nothing in this Act shall be construed to have any effect on Federal laws regarding—
                (A) conscience protection;
                (B) willingness or refusal to provide abortion; and
                (C) discrimination on the basis of the willingness or refusal to provide, pay for, cover, or refer for abortion or to provide or participate in training to provide abortion.
    (c) No Effect on Federal Civil Rights Law.—
       Nothing in this section shall alter the rights and obligations of employees and employers under title VII of the Civil Rights Act of 1964.

### Sec. 259. Nondiscrimination on Abortion and Respect for Rights of Conscience.

    (a) Nondiscrimination.—
       A Federal agency or program, and any State or local government that receives Federal financial assistance under this Act (or an amendment made by this Act), may not—
          (1) subject any individual or institutional health care entity to discrimination; or
          (2) require any health plan created or regulated under this Act (or an amendment made by this Act) to subject any individual or institutional health care entity to discrimination,
       on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions.
    (b) Definition.—
       In this section, the term “health care entity” includes an individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan.
    (c) Administration.—
       The Office for Civil Rights of the Department of Health and Human Services is designated to receive complaints of discrimination based on this section, and coordinate the investigation of such complaints.

### Sec. 260. Authority of Federal Trade Commission.

    Section 6 of the Federal Trade Commission Act (15 U.S.C. 46) is amended by striking “and prepare reports” and all that follows and inserting the following: “and prepare reports, and to share information under clauses (f) and (k), relating to insurance. Notwithstanding section 4, the Commission’s authority shall include the authority to conduct studies and prepare reports, and to share information under clauses (f) and (k), relating to insurance, without regard to whether the subject of such studies, reports, or information is for-profit or not-for-profit.”.

### Sec. 261. Construction Regarding Standard of Care.

    (a) In General.—
       The development, recognition, or implementation of any guideline or other standard under a provision described in subsection (b) shall not be construed to establish the standard of care or duty of care owed by health care providers to their patients in any medical malpractice action or claim (as defined in section 431(7) of the Health Care Quality Improvement Act of 1986 (42 U.S.C. 11151(7)).
    (b) Provisions Described.—
       The provisions described in this subsection are the following:
          (1) Section 324 (relating to modernized payment initiatives and delivery system reform under the public health option).
          (2) The amendments made by section 1151 (relating to reducing potentially preventable hospital readmissions).
          (3) The amendments made by section 1751 (relating to health care acquired conditions).
          (4) Section 3131 of the Public Health Service Act (relating to the Task Force on Clinical Preventive Services), added by section 2301.
          (5) Part D of title IX of the Public Health Service Act (relating to implementation of best practices in the delivery of health care), added by section 2401.
    (c) Savings Clause for State Medical Malpractice Laws.—
       Nothing in this Act or the amendments made by this Act shall be construed to modify or impair State law governing legal standards or procedures used in medical malpractice cases, including the authority of a State to make or implement such law.

### Sec. 262. Restoring Application of Antitrust Laws to Health Sector Insurers.

    (a) Amendment to McCarran-Ferguson Act.—
       Section 3 of the Act of March 9, 1945 (15 U.S.C. 1013), commonly known as the McCarran-Ferguson Act, is amended by adding at the end the following:
    ``(c)(1) Except as provided in paragraph (2), nothing contained in this Act shall modify, impair, or supersede the operation of any of the antitrust laws with respect to the business of health insurance or the business of medical malpractice insurance.
          ``(2) Paragraph (1) shall not apply to—
                ``(A) collecting, compiling, classifying, or disseminating historical loss data;
                ``(B) determining a loss development factor applicable to historical loss data; or
                ``(C) performing actuarial services if doing so does not involve a restraint of trade.
          ``(3) For purposes of this subsection—
                ``(A) the term ‘antitrust laws’ has the meaning given it in subsection (a) of the first section of the Clayton Act, except that such term includes section 5 of the Federal Trade Commission Act to the extent that such section 5 applies to unfair methods of competition;
                ``(B) the term ‘historical loss data’ means information respecting claims paid, or reserves held for claims reported, by any person engaged in the business of insurance; and
                ``(C) the term ‘loss development factor’ means an adjustment to be made to the aggregate of losses incurred during a prior period of time that have been paid, or for which claims have been received and reserves are being held, in order to estimate the aggregate of the losses incurred during such period that will ultimately be paid.´´.
    (b) Related Provision.—
       For purposes of section 5 of the Federal Trade Commission Act (15 U.S.C. 45) to the extent such section applies to unfair methods of competition, section 3(c) of the McCarran-Ferguson Act shall apply with respect to the business of health insurance, and with respect to the business of medical malpractice insurance, without regard to whether such business is carried on for profit, notwithstanding the definition of “Corporation” contained in section 4 of the Federal Trade Commission Act.
    (c) Related Preservation of Antitrust Laws.—
       Except as provided in subsections (a) and (b), nothing in this Act, or in the amendments made by this Act, shall be construed to modify, impair, or supersede the operation of any of the antitrust laws. For purposes of the preceding sentence, the term “antitrust laws” has the meaning given it in subsection (a) of the first section of the Clayton Act, except that it includes section 5 of the Federal Trade Commission Act to the extent that such section 5 applies to unfair methods of competition.

### Sec. 263. Study and Report on Methods to Increase EHR use by Small Health Care Providers.

    (a) Study.—
       The Secretary of Health and Human Services shall conduct a study of potential methods to increase the use of qualified electronic health records (as defined in section 3000(13) of the Public Health Service Act) by small health care providers. Such study shall consider at least the following methods:
          (1) Providing for higher rates of reimbursement or other incentives for such health care providers to use electronic health records (taking into consideration initiatives by private health insurance companies and incentives provided under Medicare under title XVIII of the Social Security Act, Medicaid under title XIX of such Act, and other programs).
          (2) Promoting low-cost electronic health record software packages that are available for use by such health care providers, including software packages that are available to health care providers through the Veterans Administration and other sources.
          (3) Training and education of such health care providers on the use of electronic health records.
          (4) Providing assistance to such health care providers on the implementation of electronic health records.
    (b) Report.—
       Not later than December 31, 2013, the Secretary of Health and Human Services shall submit to Congress a report containing the results of the study conducted under subsection (a), including recommendations for legislation or administrative action to increase the use of electronic health records by small health care providers that include the use of both public and private funding sources.

### Sec. 264. Performance Assessment and Accountability: Application of GPRA.

    (a) Application of GPRA.—
       Section 306 of title 5, United States Code, and sections 1115, 1116, 1117, and 9703 of title 31 of such Code (originally enacted by the Government Performance and Results Act of 1993, Public Law 103-62) apply to the executive agencies established by this Act, including the Health Choices Administration. Under such section 306, each such executive agency is required to provide for a strategic plan every 3 years.
    (b) Improving Consumer Service and Streamlining Procedures.—
       Every 3 years each such executive agency shall—
          (1)(A) assess the quality of customer service provided, (B) develop a strategy for improving such service, and (C) establish standards for high-quality customer service; and
          (2)(A) identify redundant rules, regulations, and procedures, and (B) develop and implement a plan for eliminating or streamlining such redundancies.

### Sec. 265. Limitation on Abortion Funding.

    (a) In General.—
       No funds authorized or appropriated by this Act (or an amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the result of an act of rape or incest.
    (b) Option to Purchase Separate Supplemental Coverage or Plan.—
       Nothing in this section shall be construed as prohibiting any nonfederal entity (including an individual or a State or local government) from purchasing separate supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes such abortions, so long as—
          (1) such coverage or plan is paid for entirely using only funds not authorized or appropriated by this Act; and
          (2) such coverage or plan is not purchased using—
                (A) individual premium payments required for a Exchange-participating health benefits plan towards which an affordability credit is applied; or
                (B) other nonfederal funds required to receive a federal payment, including a State’s or locality’s contribution of Medicaid matching funds.
    (c) Option to Offer Separate Supplemental Coverage or Plan.—
       Notwithstanding section 303(b), nothing in this section shall restrict any nonfederal QHBP offering entity from offering separate supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes such abortions, so long as—
          (1) premiums for such separate supplemental coverage or plan are paid for entirely with funds not authorized or appropriated by this Act;
          (2) administrative costs and all services offered through such supplemental coverage or plan are paid for using only premiums collected for such coverage or plan; and
          (3) any nonfederal QHBP offering entity that offers an Exchange-participating health benefits plan that includes coverage for abortions for which funding is prohibited under this section also offers an Exchange-participating health benefits plan that is identical in every respect except that it does not cover abortions for which funding is prohibited under this section.