I

104TH CONGRESS

1ST SESSION H. R. 1084

To amend title 5, United States Code, to make the Federal Employees

Health Benefits Program available to the general public, and for other

purposes.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 28, 1995

Mrs. SCHROEDER introduced the following bill; which was referred to the

Committee on Government Reform and Oversight and, in addition, to the

Committee on Commerce, 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 5, United States Code, to make the Federal

Employees Health Benefits Program available to the general public, 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 ‘‘Federal Employees

5 Health Benefits Access Act’’.
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1 SEC. 2. PROVISIONS TO MAKE FEHBP AVAILABLE TO THE

2 GENERAL PUBLIC.

3 (a) IN GENERAL.—Chapter 89 of title 5, United

4 States Code, is amended by adding at the end the follow5 ing:

6 ‘‘§ 8915. Provisions to require that benefits be ex7 tended to the general public

8 ‘‘(a) A contract may not be made or a plan approved

9 unless the carrier agrees to offer to the general public,

10 throughout each term for which the contract or approval

11 remains effective, the same benefits (subject to the same

12 maximums, limitations, exclusions, and other similar

13 terms or conditions) as would be offered under such con14 tract or plan to employees and annuitants and their family

15 members.

16 ‘‘(b)(1) Premiums for coverage under this section

17 shall be established in conformance with such require18 ments as the Office of Personnel Management shall by

19 regulation prescribe, including provisions to ensure con20 formance with generally accepted standards and practices

21 associated with community rating.

22 ‘‘(2) In no event shall the enactment of this section

23 result in—

24 ‘‘(A) any increase in the level of individual or

25 Government contributions required under section
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1 8906 or any other provision of this chapter, includ2 ing copayments or deductibles;

3 ‘‘(B) any decrease in the types of benefits of4 fered under this chapter; or

5 ‘‘(C) any other change that would adversely af6 fect the coverage afforded under this chapter to em7 ployees and annuitants and their family members.

8 ‘‘(c) Benefits under this section shall, with respect

9 to an individual who is entitled to benefits under part A

10 of title XVIII of the Social Security Act, be offered (for

11 use in coordination with those Social Security benefits) to

12 the same extent and in the same manner as if coverage

13 were under the preceding provisions of this chapter, rather

14 than under this section.

15 ‘‘(d)(1) A carrier may file an application with the Of16 fice setting forth reasons why it, or a plan provided by

17 such carrier, should be excluded from the requirements of

18 this section.

19 ‘‘(2) In reviewing any such application, the Office

20 may consider such factors as—

21 ‘‘(A) any bona fide enrollment restrictions

22 which would make the application of this section in23 appropriate, including those common to plans which

24 are limited to individuals having a past or current
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1 employment relationship with a particular agency or

2 other authority of the Government;

3 ‘‘(B) whether compliance with this section

4 would jeopardize the financial solvency of the plan or

5 carrier, or otherwise compromise its ability to offer

6 health benefits under the preceding provisions of this

7 chapter; and

8 ‘‘(C) the anticipated duration of the requested

9 exclusion, and what efforts the plan or carrier pro10 poses to take in order to be able to comply with this

11 section.

12 ‘‘(e) Except as the Office may by regulation pre13 scribe, any reference to this chapter (or any requirement

14 of this chapter), made in any provision of law, shall not

15 be considered to include this section (or any requirement

16 of this section).’’.

17 (b) CONFORMING AMENDMENT.—The table of sec18 tions for chapter 89 of title 5, United States Code, is

19 amended by adding at the end the following:

‘‘8915. Provisions to require that benefits be extended to the general public.’’.

20 SEC. 3. STANDARDIZED CLAIMS PROCESSING.

21 Section 8902 of title 5, United States Code, is

22 amended by adding at the end the following:

23 ‘‘(o) A claim for payment or reimbursement under

24 this chapter (whether electronic or otherwise) shall be sub25 mitted on such a standard form or in such a standard
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1 manner as may be required by the Office in relation to

2 health benefit plans. Each contract under this chapter

3 shall include appropriate provisions to carry out the pre4 ceding sentence.’’.

5 SEC. 4. ADVANCE DIRECTIVES.

6 Section 8907 of title 5, United States Code, is

7 amended by adding at the end the following:

8 ‘‘(c) The Office shall—

9 ‘‘(1) prepare information relating to the use of

10 advance directives regarding the type or intensity of

11 care which an individual desires in the event that

12 such individual becomes unable to communicate by

13 reason of incapacity due to illness or injury; and

14 ‘‘(2) require, as a condition for approval of any

15 contract under section 8902, that appropriate provi16 sions be included so that such information may be

17 made available to enrollees of the plan involved.’’.

18 SEC. 5. DEMONSTRATION PROJECT TO EXAMINE THE FEA19 SIBILITY OF OFFERING FEHBP ENROLLEES

20 THE OPTION OF USING ARBITRATION IN21 STEAD OF LITIGATION TO RESOLVE MEDICAL

22 MALPRACTICE CLAIMS.

23 (a) IN GENERAL.—The Office of Personnel Manage24 ment shall conduct a demonstration project to assess the

25 feasibility and desirability of offering the use of arbitra-
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1 tion, instead of litigation, to resolve medical malpractice

2 claims arising out of covered health care services.

3 (b) DEFINITION.—For the purpose of this section,

4 the term ‘‘covered health care services’’ means any care,

5 treatment, or other service for which the individual who

6 receives such service has coverage under chapter 89 of title

7 5, United States Code.

8 (c) PROJECT REQUIREMENTS.—

9 (1) IN GENERAL.—The demonstration project

10 shall be conducted as a demonstration project under

11 section 4703 of title 5, United States Code.

12 (2) PLAN DESIGN.—In developing a plan for

13 such project under section 4703 of title 5, United

14 States Code, the Office shall include (in addition to

15 any information otherwise required)—

16 (A) suggestions for incentives that may be

17 offered in order to obtain the voluntary partici18 pation of enrollees, such as reductions in pre19 miums, copayments, or deductibles;

20 (B) the criteria for identifying the types of

21 health benefit plans which are appropriate for

22 inclusion, and the procedures and conditions in

23 accordance with which any such plan may par24 ticipate;
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1 (C) the general framework for arbitration,

2 including (to the extent the Office considers ap3 propriate) methods for the selection of arbitra4 tors, length of hearings, and limitations on

5 damages; and

6 (D) the effect of an award resulting from

7 the arbitration process, and the extent to which

8 review of such an award may be obtained.

9 (d) EVALUATION.—The evaluation required under

10 section 4703(h) of title 5, United States Code, with re11 spect to the demonstration project shall include data and

12 analysis relating to matters such as—

13 (1) the number of claims brought for arbitra14 tion;

15 (2) how those claims were disposed of (whether

16 by settlement, hearing, or otherwise), and the per17 centage of the total number of claims represented by

18 each;

19 (3) the average dollar amount of those awards

20 or settlements;

21 (4) the various costs involved in connection with

22 those claims; and

23 (5) the advantages and disadvantages of arbi24 tration, relative to other methods of dispute resolu-
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1 tion, and the extent to which arbitration should con2 tinue to be used under chapter 89 of such title.

3 SEC. 6. APPLICABILITY.

4 The amendments made by this Act shall apply with

5 respect to contract terms beginning after the end of the

6 6-month period beginning on the date of the enactment

7 of this Act.

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