I 

114TH CONGRESS 

2D SESSION H. R. 4589 

To amend title XVIII of the Social Security Act to repeal the cap on 

the Medicare Advantage star rating bonuses, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 23, 2016 

Mr. MACARTHUR introduced the following bill; which was referred to the Committee on the Judiciary, and in addition to the Committees on Energy 

and Commerce and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions 

as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to repeal 

the cap on the Medicare Advantage star rating bonuses, 

and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Excellence in Medicare 

5 Act’’. 


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1 TITLE I—MEDICARE ADVANTAGE 

2 SEC. 101. REPEALING CAP ON MEDICARE ADVANTAGE STAR 

3 RATING BONUSES. 

4 (a) IN GENERAL.—Section 1853(n)(4) of the Social 

5 Security Act (42 U.S.C. 1395w–23(n)(4)) is amended by 

6 striking ‘‘(determined taking into account subsection (o))’’ 

7 and inserting ‘‘determined before application of subsection 

8 (o))’’. 

9 (b) EFFECTIVE DATE.—The amendment made by 

10 subsection (a) shall apply beginning with respect to 2017. 

11 TITLE II—HEALTH ACT 

12 SEC. 201. SHORT TITLE. 

13 This title may be cited as the ‘‘Medical Malpractice 

14 Reform Act of 2015’’. 

15 SEC. 202. FINDINGS AND PURPOSE. 

16 (a) FINDINGS.— 

17 (1) EFFECT ON HEALTH CARE ACCESS AND

18 COSTS.—Congress finds that our current civil justice 

19 system is adversely affecting patient access to health 

20 care services, better patient care, and cost-efficient 

21 health care, in that the health care liability system 

22 is a costly and ineffective mechanism for resolving 

23 claims of health care liability and compensating in24 jured patients, and is a deterrent to the sharing of 

25 information among health care professionals which 


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1 impedes efforts to improve patient safety and quality 

2 of care. 

3 (2) EFFECT ON INTERSTATE COMMERCE.— 

4 Congress finds that the health care liability litigation 

5 systems existing throughout the United States are 

6 activities that affect interstate commerce by contrib7 uting to the high costs of health care and premiums 

8 for health care liability insurance purchased by 

9 health care system providers. 

10 (3) EFFECT ON FEDERAL SPENDING.—Con11 gress finds that the health care liability litigation 

12 systems existing throughout the United States have 

13 a significant effect on the amount, distribution, and 

14 use of Federal funds because of— 

15 (A) the large number of individuals who 

16 receive health care benefits under programs op17 erated or financed by the Federal Government; 

18 (B) the large number of individuals who 

19 benefit because of the exclusion from Federal 

20 taxes of the amounts spent to provide them 

21 with health insurance benefits; and 

22 (C) the large number of health care pro23 viders who provide items or services for which 

24 the Federal Government makes payments. 


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1 (b) PURPOSE.—It is the purpose of this title to imple2 ment reasonable, comprehensive, and effective health care 

3 liability reforms designed to— 

4 (1) improve the availability of health care serv5 ices in cases in which health care liability actions 

6 have been shown to be a factor in the decreased 

7 availability of services; 

8 (2) reduce the incidence of ‘‘defensive medi9 cine’’ and lower the cost of health care liability in10 surance, all of which contribute to the escalation of 

11 health care costs; 

12 (3) ensure that persons with meritorious health 

13 care injury claims receive fair and adequate com14 pensation, including reasonable noneconomic dam15 ages; 

16 (4) improve the fairness and cost-effectiveness 

17 of our current health care liability system to resolve 

18 disputes over, and provide compensation for, health 

19 care liability by reducing uncertainty in the amount 

20 of compensation provided to injured individuals; and 

21 (5) provide an increased sharing of information 

22 in the health care system which will reduce unin23 tended injury and improve patient care. 


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1 SEC. 203. ENCOURAGING SPEEDY RESOLUTION OF CLAIMS. 

2 The time for the commencement of a health care law3 suit shall be 3 years after the date of manifestation of 

4 injury or 1 year after the claimant discovers, or through 

5 the use of reasonable diligence should have discovered, the 

6 injury, whichever occurs first. In no event shall the time 

7 for commencement of a health care lawsuit exceed 3 years 

8 after the date of manifestation of injury unless tolled for 

9 any of the following— 

10 (1) upon proof of fraud; 

11 (2) intentional concealment; or 

12 (3) the presence of a foreign body, which has no 

13 therapeutic or diagnostic purpose or effect, in the 

14 person of the injured person. 

15 Actions by a minor shall be commenced within 3 years 

16 from the date of the alleged manifestation of injury except 

17 that actions by a minor under the full age of 6 years shall 

18 be commenced within 3 years of manifestation of injury 

19 or prior to the minor’s 8th birthday, whichever provides 

20 a longer period. Such time limitation shall be tolled for 

21 minors for any period during which a parent or guardian 

22 and a health care provider or health care organization 

23 have committed fraud or collusion in the failure to bring 

24 an action on behalf of the injured minor. 


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1 SEC. 204. COMPENSATING PATIENT INJURY. 

2 (a) UNLIMITED AMOUNT OF DAMAGES FOR ACTUAL

3 ECONOMIC LOSSES IN HEALTH CARE LAWSUITS.—In any 

4 health care lawsuit, nothing in this title shall limit a claim5 ant’s recovery of the full amount of the available economic 

6 damages, notwithstanding the limitation in subsection (b). 

7 (b) ADDITIONAL NONECONOMIC DAMAGES.—In any 

8 health care lawsuit, the amount of noneconomic damages, 

9 if available, may be as much as $250,000, regardless of 

10 the number of parties against whom the action is brought 

11 or the number of separate claims or actions brought with 

12 respect to the same injury. 

13 (c) NO DISCOUNT OF AWARD FOR NONECONOMIC

14 DAMAGES.—For purposes of applying the limitation in 

15 subsection (b), future noneconomic damages shall not be 

16 discounted to present value. The jury shall not be in17 formed about the maximum award for noneconomic dam18 ages. An award for noneconomic damages in excess of 

19 $250,000 shall be reduced either before the entry of judg20 ment, or by amendment of the judgment after entry of 

21 judgment, and such reduction shall be made before ac22 counting for any other reduction in damages required by 

23 law. If separate awards are rendered for past and future 

24 noneconomic damages and the combined awards exceed 

25 $250,000, the future noneconomic damages shall be re26 duced first. 


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1 (d) FAIR SHARE RULE.—In any health care lawsuit, 

2 each party shall be liable for that party’s several share 

3 of any damages only and not for the share of any other 

4 person. Each party shall be liable only for the amount of 

5 damages allocated to such party in direct proportion to 

6 such party’s percentage of responsibility. Whenever a 

7 judgment of liability is rendered as to any party, a sepa8 rate judgment shall be rendered against each such party 

9 for the amount allocated to such party. For purposes of 

10 this section, the trier of fact shall determine the propor11 tion of responsibility of each party for the claimant’s 

12 harm. 

13 SEC. 205. MAXIMIZING PATIENT RECOVERY. 

14 (a) COURT SUPERVISION OF SHARE OF DAMAGES

15 ACTUALLY PAID TO CLAIMANTS.—In any health care law16 suit, the court shall supervise the arrangements for pay17 ment of damages to protect against conflicts of interest 

18 that may have the effect of reducing the amount of dam19 ages awarded that are actually paid to claimants. In par20 ticular, in any health care lawsuit in which the attorney 

21 for a party claims a financial stake in the outcome by vir22 tue of a contingent fee, the court shall have the power 

23 to restrict the payment of a claimant’s damage recovery 

24 to such attorney, and to redirect such damages to the 

25 claimant based upon the interests of justice and principles 


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1 of equity. In no event shall the total of all contingent fees 

2 for representing all claimants in a health care lawsuit ex3 ceed the following limits: 

4 (1) Forty percent of the first $50,000 recovered 

5 by the claimant(s). 

6 (2) Thirty-three and one-third percent of the 

7 next $50,000 recovered by the claimant(s). 

8 (3) Twenty-five percent of the next $500,000 

9 recovered by the claimant(s). 

10 (4) Fifteen percent of any amount by which the 

11 recovery by the claimant(s) is in excess of $600,000. 

12 (b) APPLICABILITY.—The limitations in this section 

13 shall apply whether the recovery is by judgment, settle14 ment, mediation, arbitration, or any other form of alter15 native dispute resolution. In a health care lawsuit involv16 ing a minor or incompetent person, a court retains the 

17 authority to authorize or approve a fee that is less than 

18 the maximum permitted under this section. The require19 ment for court supervision in the first two sentences of 

20 subsection (a) applies only in civil actions. 

21 SEC. 206. ADDITIONAL BENEFITS. 

22 In any health care lawsuit involving injury or wrong23 ful death, any party may introduce evidence of collateral 

24 source benefits. If a party elects to introduce such evi25 dence, any opposing party may introduce evidence of any 


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1 amount paid or contributed or reasonably likely to be paid 

2 or contributed in the future by or on behalf of the oppos3 ing party to secure the right to such collateral source bene4 fits. No provider of collateral source benefits shall recover 

5 any amount against the claimant or receive any lien or 

6 credit against the claimant’s recovery or be equitably or 

7 legally subrogated to the right of the claimant in a health 

8 care lawsuit involving injury or wrongful death. This sec9 tion shall apply to any health care lawsuit that is settled 

10 as well as a health care lawsuit that is resolved by a fact 

11 finder. This section shall not apply to section 1862(b) (42 

12 U.S.C. 1395y(b)) or section 1902(a)(25) (42 U.S.C. 

13 1396a(a)(25)) of the Social Security Act. 

14 SEC. 207. PUNITIVE DAMAGES. 

15 (a) IN GENERAL.—Punitive damages may, if other16 wise permitted by applicable State or Federal law, be 

17 awarded against any person in a health care lawsuit only 

18 if it is proven by clear and convincing evidence that such 

19 person acted with malicious intent to injure the claimant, 

20 or that such person deliberately failed to avoid unneces21 sary injury that such person knew the claimant was sub22 stantially certain to suffer. In any health care lawsuit 

23 where no judgment for compensatory damages is rendered 

24 against such person, no punitive damages may be awarded 

25 with respect to the claim in such lawsuit. No demand for 


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1 punitive damages shall be included in a health care lawsuit 

2 as initially filed. A court may allow a claimant to file an 

3 amended pleading for punitive damages only upon a mo4 tion by the claimant and after a finding by the court, upon 

5 review of supporting and opposing affidavits or after a 

6 hearing, after weighing the evidence, that the claimant has 

7 established by a substantial probability that the claimant 

8 will prevail on the claim for punitive damages. At the re9 quest of any party in a health care lawsuit, the trier of 

10 fact shall consider in a separate proceeding— 

11 (1) whether punitive damages are to be award12 ed and the amount of such award; and 

13 (2) the amount of punitive damages following a 

14 determination of punitive liability. 

15 If a separate proceeding is requested, evidence relevant 

16 only to the claim for punitive damages, as determined by 

17 applicable State law, shall be inadmissible in any pro18 ceeding to determine whether compensatory damages are 

19 to be awarded. 

20 (b) DETERMINING AMOUNT OF PUNITIVE DAM21 AGES.— 

22 (1) FACTORS CONSIDERED.—In determining 

23 the amount of punitive damages, if awarded, in a 

24 health care lawsuit, the trier of fact shall consider 

25 only the following: 


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1 (A) The severity of the harm caused by the 

2 conduct of such party. 

3 (B) The duration of the conduct or any 

4 concealment of it by such party. 

5 (C) The profitability of the conduct to such 

6 party. 

7 (D) The number of products sold or med8 ical procedures rendered for compensation, as 

9 the case may be, by such party, of the kind 

10 causing the harm complained of by the claim11 ant. 

12 (E) Any criminal penalties imposed on 

13 such party, as a result of the conduct com14 plained of by the claimant. 

15 (F) The amount of any civil fines assessed 

16 against such party as a result of the conduct 

17 complained of by the claimant. 

18 (2) MAXIMUM AWARD.—The amount of punitive 

19 damages, if awarded, in a health care lawsuit may 

20 be as much as $250,000 or as much as two times 

21 the amount of economic damages awarded, which22 ever is greater. The jury shall not be informed of 

23 this limitation. 

24 (c) NO PUNITIVE DAMAGES FOR PRODUCTS THAT

25 COMPLY WITH FDA STANDARDS.— 


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1 (1) IN GENERAL.— 

2 (A) No punitive damages may be awarded 

3 against the manufacturer or distributor of a 

4 medical product, or a supplier of any compo5 nent or raw material of such medical product, 

6 based on a claim that such product caused the 

7 claimant’s harm where— 

8 (i)(I) such medical product was sub9 ject to premarket approval, clearance, or li10 censure by the Food and Drug Administra11 tion with respect to the safety of the for12 mulation or performance of the aspect of 

13 such medical product which caused the 

14 claimant’s harm or the adequacy of the 

15 packaging or labeling of such medical 

16 product; and 

17 (II) such medical product was so ap18 proved, cleared, or licensed; or 

19 (ii) such medical product is generally 

20 recognized among qualified experts as safe 

21 and effective pursuant to conditions estab22 lished by the Food and Drug Administra23 tion and applicable Food and Drug Admin24 istration regulations, including without 

25 limitation those related to packaging and 


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1 labeling, unless the Food and Drug Admin2 istration has determined that such medical 

3 product was not manufactured or distrib4 uted in substantial compliance with appli5 cable Food and Drug Administration stat6 utes and regulations. 

7 (B) RULE OF CONSTRUCTION.—Subpara8 graph (A) may not be construed as establishing 

9 the obligation of the Food and Drug Adminis10 tration to demonstrate affirmatively that a 

11 manufacturer, distributor, or supplier referred 

12 to in such subparagraph meets any of the con13 ditions described in such subparagraph. 

14 (2) LIABILITY OF HEALTH CARE PROVIDERS.— 

15 A health care provider who prescribes, or who dis16 penses pursuant to a prescription, a medical product 

17 approved, licensed, or cleared by the Food and Drug 

18 Administration shall not be named as a party to a 

19 product liability lawsuit involving such product and 

20 shall not be liable to a claimant in a class action 

21 lawsuit against the manufacturer, distributor, or 

22 seller of such product. Nothing in this paragraph 

23 prevents a court from consolidating cases involving 

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1 ability claims against the manufacturer, distributor, 

2 or product seller of such medical product. 

3 (3) PACKAGING.—In a health care lawsuit for 

4 harm which is alleged to relate to the adequacy of 

5 the packaging or labeling of a drug which is required 

6 to have tamper-resistant packaging under regula7 tions of the Secretary of Health and Human Serv8 ices (including labeling regulations related to such 

9 packaging), the manufacturer or product seller of 

10 the drug shall not be held liable for punitive dam11 ages unless such packaging or labeling is found by 

12 the trier of fact by clear and convincing evidence to 

13 be substantially out of compliance with such regula14 tions. 

15 (4) EXCEPTION.—Paragraph (1) shall not 

16 apply in any health care lawsuit in which— 

17 (A) a person, before or after premarket ap18 proval, clearance, or licensure of such medical 

19 product, knowingly misrepresented to or with20 held from the Food and Drug Administration 

21 information that is required to be submitted 

22 under the Federal Food, Drug, and Cosmetic 

23 Act (21 U.S.C. 301 et seq.) or section 351 of 

24 the Public Health Service Act (42 U.S.C. 262) 


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1 that is material and is causally related to the 

2 harm which the claimant allegedly suffered; or 

3 (B) a person made an illegal payment to 

4 an official of the Food and Drug Administra5 tion for the purpose of either securing or main6 taining approval, clearance, or licensure of such 

7 medical product. 

8 SEC. 208. AUTHORIZATION OF PAYMENT OF FUTURE DAM9 AGES TO CLAIMANTS IN HEALTH CARE LAW10 SUITS. 

11 (a) IN GENERAL.—In any health care lawsuit, if an 

12 award of future damages, without reduction to present 

13 value, equaling or exceeding $50,000 is made against a 

14 party with sufficient insurance or other assets to fund a 

15 periodic payment of such a judgment, the court shall, at 

16 the request of any party, enter a judgment ordering that 

17 the future damages be paid by periodic payments, in ac18 cordance with the Uniform Periodic Payment of Judg19 ments Act promulgated by the National Conference of 

20 Commissioners on Uniform State Laws. 

21 (b) APPLICABILITY.—This section applies to all ac22 tions which have not been first set for trial or retrial be23 fore the effective date of this title. 

24 SEC. 209. DEFINITIONS. 

25 In this title: 


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1 (1) ALTERNATIVE DISPUTE RESOLUTION SYS2 TEM; ADR.—The term ‘‘alternative dispute resolution 

3 system’’ or ‘‘ADR’’ means a system that provides 

4 for the resolution of health care lawsuits in a man5 ner other than through a civil action brought in a 

6 State or Federal court. 

7 (2) CLAIMANT.—The term ‘‘claimant’’ means 

8 any person who brings a health care lawsuit, includ9 ing a person who asserts or claims a right to legal 

10 or equitable contribution, indemnity, or subrogation, 

11 arising out of a health care liability claim or action, 

12 and any person on whose behalf such a claim is as13 serted or such an action is brought, whether de14 ceased, incompetent, or a minor. 

15 (3) COLLATERAL SOURCE BENEFITS.—The 

16 term ‘‘collateral source benefits’’ means any amount 

17 paid or reasonably likely to be paid in the future to 

18 or on behalf of the claimant, or any service, product, 

19 or other benefit provided or reasonably likely to be 

20 provided in the future to or on behalf of the claim21 ant, as a result of the injury or wrongful death, pur22 suant to— 

23 (A) any State or Federal health, sickness, 

24 income-disability, accident, or workers’ com25 pensation law; 


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1 (B) any health, sickness, income-disability, 

2 or accident insurance that provides health bene3 fits or income-disability coverage; 

4 (C) any contract or agreement of any 

5 group, organization, partnership, or corporation 

6 to provide, pay for, or reimburse the cost of 

7 medical, hospital, dental, or income-disability 

8 benefits; and 

9 (D) any other publicly or privately funded 

10 program. 

11 (4) COMPENSATORY DAMAGES.—The term 

12 ‘‘compensatory damages’’ means objectively 

13 verifiable monetary losses incurred as a result of the 

14 provision of, use of, or payment for (or failure to 

15 provide, use, or pay for) health care services or med16 ical products, such as past and future medical ex17 penses, loss of past and future earnings, cost of ob18 taining domestic services, loss of employment, and 

19 loss of business or employment opportunities, dam20 ages for physical and emotional pain, suffering, in21 convenience, physical impairment, mental anguish, 

22 disfigurement, loss of enjoyment of life, loss of soci23 ety and companionship, loss of consortium (other 

24 than loss of domestic service), hedonic damages, in25 jury to reputation, and all other nonpecuniary losses 


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1 of any kind or nature. The term ‘‘compensatory 

2 damages’’ includes economic damages and non3 economic damages, as such terms are defined in this 

4 section. 

5 (5) CONTINGENT FEE.—The term ‘‘contingent 

6 fee’’ includes all compensation to any person or per7 sons which is payable only if a recovery is effected 

8 on behalf of one or more claimants. 

9 (6) ECONOMIC DAMAGES.—The term ‘‘economic 

10 damages’’ means objectively verifiable monetary 

11 losses incurred as a result of the provision of, use 

12 of, or payment for (or failure to provide, use, or pay 

13 for) health care services or medical products, such as 

14 past and future medical expenses, loss of past and 

15 future earnings, cost of obtaining domestic services, 

16 loss of employment, and loss of business or employ17 ment opportunities. 

18 (7) HEALTH CARE LAWSUIT.—The term 

19 ‘‘health care lawsuit’’ means any health care liability 

20 claim concerning the provision of health care goods 

21 or services or any medical product affecting inter22 state commerce, or any health care liability action 

23 concerning the provision of health care goods or 

24 services or any medical product affecting interstate 

25 commerce, brought in a State or Federal court or 


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1 pursuant to an alternative dispute resolution system, 

2 against a health care provider, a health care organi3 zation, or the manufacturer, distributor, supplier, 

4 marketer, promoter, or seller of a medical product, 

5 regardless of the theory of liability on which the 

6 claim is based, or the number of claimants, plain7 tiffs, defendants, or other parties, or the number of 

8 claims or causes of action, in which the claimant al9 leges a health care liability claim. Such term does 

10 not include a claim or action which is based on 

11 criminal liability; which seeks civil fines or penalties 

12 paid to Federal, State, or local government; or which 

13 is grounded in antitrust. 

14 (8) HEALTH CARE LIABILITY ACTION.—The 

15 term ‘‘health care liability action’’ means a civil ac16 tion brought in a State or Federal court or pursuant 

17 to an alternative dispute resolution system, against 

18 a health care provider, a health care organization, or 

19 the manufacturer, distributor, supplier, marketer, 

20 promoter, or seller of a medical product, regardless 

21 of the theory of liability on which the claim is based, 

22 or the number of plaintiffs, defendants, or other par23 ties, or the number of causes of action, in which the 

24 claimant alleges a health care liability claim. 


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1 (9) HEALTH CARE LIABILITY CLAIM.—The 

2 term ‘‘health care liability claim’’ means a demand 

3 by any person, whether or not pursuant to ADR, 

4 against a health care provider, health care organiza5 tion, or the manufacturer, distributor, supplier, mar6 keter, promoter, or seller of a medical product, in7 cluding, but not limited to, third-party claims, cross8 claims, counter-claims, or contribution claims, which 

9 are based upon the provision of, use of, or payment 

10 for (or the failure to provide, use, or pay for) health 

11 care services or medical products, regardless of the 

12 theory of liability on which the claim is based, or the 

13 number of plaintiffs, defendants, or other parties, or 

14 the number of causes of action. 

15 (10) HEALTH CARE ORGANIZATION.—The term 

16 ‘‘health care organization’’ means any person or en17 tity which is obligated to provide or pay for health 

18 benefits under any health plan, including any person 

19 or entity acting under a contract or arrangement 

20 with a health care organization to provide or admin21 ister any health benefit. 

22 (11) HEALTH CARE PROVIDER.—The term 

23 ‘‘health care provider’’ means any person or entity 

24 required by State or Federal laws or regulations to 

25 be licensed, registered, or certified to provide health 


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1 care services, and being either so licensed, reg2 istered, or certified, or exempted from such require3 ment by other statute or regulation. 

4 (12) HEALTH CARE GOODS OR SERVICES.—The 

5 term ‘‘health care goods or services’’ means any 

6 goods or services provided by a health care organiza7 tion, provider, or by any individual working under 

8 the supervision of a health care provider, that relates 

9 to the diagnosis, prevention, or treatment of any 

10 human disease or impairment, or the assessment or 

11 care of the health of human beings. 

12 (13) MALICIOUS INTENT TO INJURE.—The 

13 term ‘‘malicious intent to injure’’ means inten14 tionally causing or attempting to cause physical in15 jury other than providing health care goods or serv16 ices. 

17 (14) MEDICAL PRODUCT.—The term ‘‘medical 

18 product’’ means a drug, device, or biological product 

19 intended for humans, and the terms ‘‘drug’’, ‘‘de20 vice’’, and ‘‘biological product’’ have the meanings 

21 given such terms in sections 201(g)(1) and 201(h) 

22 of the Federal Food, Drug, and Cosmetic Act (21 

23 U.S.C. 321(g)(1) and (h)) and section 351(a) of the 

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1 spectively, including any component or raw material 

2 used therein, but excluding health care services. 

3 (15) NONECONOMIC DAMAGES.—The term 

4 ‘‘noneconomic damages’’ means damages for phys5 ical and emotional pain, suffering, inconvenience, 

6 physical impairment, mental anguish, disfigurement, 

7 loss of enjoyment of life, loss of society and compan8 ionship, loss of consortium (other than loss of do9 mestic service), hedonic damages, injury to reputa10 tion, and all other nonpecuniary losses of any kind 

11 or nature. 

12 (16) PUNITIVE DAMAGES.—The term ‘‘punitive 

13 damages’’ means damages awarded, for the purpose 

14 of punishment or deterrence, and not solely for com15 pensatory purposes, against a health care provider, 

16 health care organization, or a manufacturer, dis17 tributor, or supplier of a medical product. Punitive 

18 damages are neither economic nor noneconomic 

19 damages. 

20 (17) RECOVERY.—The term ‘‘recovery’’ means 

21 the net sum recovered after deducting any disburse22 ments or costs incurred in connection with prosecu23 tion or settlement of the claim, including all costs 

24 paid or advanced by any person. Costs of health care 

25 incurred by the plaintiff and the attorneys’ office 


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1 overhead costs or charges for legal services are not 

2 deductible disbursements or costs for such purpose. 

3 (18) STATE.—The term ‘‘State’’ means each of 

4 the several States, the District of Columbia, the 

5 Commonwealth of Puerto Rico, the Virgin Islands, 

6 Guam, American Samoa, the Northern Mariana Is7 lands, the Trust Territory of the Pacific Islands, and 

8 any other territory or possession of the United 

9 States, or any political subdivision thereof. 

10 SEC. 210. EFFECT ON OTHER LAWS. 

11 (a) VACCINE INJURY.— 

12 (1) To the extent that title XXI of the Public 

13 Health Service Act establishes a Federal rule of law 

14 applicable to a civil action brought for a vaccine-re15 lated injury or death— 

16 (A) this title does not affect the application 

17 of the rule of law to such an action; and 

18 (B) any rule of law prescribed by this title 

19 in conflict with a rule of law of such title XXI 

20 shall not apply to such action. 

21 (2) If there is an aspect of a civil action 

22 brought for a vaccine-related injury or death to 

23 which a Federal rule of law under title XXI of the 

24 Public Health Service Act does not apply, then this 

25 title or otherwise applicable law (as determined 


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1 under this title) will apply to such aspect of such ac2 tion. 

3 (b) OTHER FEDERAL LAW.—Except as provided in 

4 this section, nothing in this title shall be deemed to affect 

5 any defense available to a defendant in a health care law6 suit or action under any other provision of Federal law. 

7 SEC. 211. STATE FLEXIBILITY AND PROTECTION OF 

8 STATES’ RIGHTS. 

9 (a) HEALTH CARE LAWSUITS.—The provisions gov10 erning health care lawsuits set forth in this title preempt, 

11 subject to subsections (b) and (c), State law to the extent 

12 that State law prevents the application of any provisions 

13 of law established by or under this title. The provisions 

14 governing health care lawsuits set forth in this title super15 sede chapter 171 of title 28, United States Code, to the 

16 extent that such chapter— 

17 (1) provides for a greater amount of damages 

18 or contingent fees, a longer period in which a health 

19 care lawsuit may be commenced, or a reduced appli20 cability or scope of periodic payment of future dam21 ages, than provided in this title; or 

22 (2) prohibits the introduction of evidence re23 garding collateral source benefits, or mandates or 

24 permits subrogation or a lien on collateral source 

25 benefits. 


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•HR 4589 IH

1 (b) PROTECTION OF STATES’ RIGHTS AND OTHER

2 LAWS.—(1) Any issue that is not governed by any provi3 sion of law established by or under this title (including 

4 State standards of negligence) shall be governed by other5 wise applicable State or Federal law. 

6 (2) This title shall not preempt or supersede any 

7 State or Federal law that imposes greater procedural or 

8 substantive protections for health care providers and 

9 health care organizations from liability, loss, or damages 

10 than those provided by this title or create a cause of ac11 tion. 

12 (c) STATE FLEXIBILITY.—No provision of this title 

13 shall be construed to preempt— 

14 (1) any State law (whether effective before, on, 

15 or after the date of the enactment of this Act) that 

16 specifies a particular monetary amount of compen17 satory or punitive damages (or the total amount of 

18 damages) that may be awarded in a health care law19 suit, regardless of whether such monetary amount is 

20 greater or lesser than is provided for under this title, 

21 notwithstanding section 204(a); or 

22 (2) any defense available to a party in a health 

23 care lawsuit under any other provision of State or 

24 Federal law. 


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•HR 4589 IH

1 SEC. 212. APPLICABILITY; EFFECTIVE DATE. 

2 This title shall apply to any health care lawsuit 

3 brought in a Federal or State court, or subject to an alter4 native dispute resolution system, that is initiated on or 

5 after the date of the enactment of this Act, except that 

6 any health care lawsuit arising from an injury occurring 

7 prior to the date of the enactment of this Act shall be 

8 governed by the applicable statute of limitations provisions 

9 in effect at the time the injury occurred. 

Æ 


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