I

103D CONGRESS

2D SESSION H. R. 4274

To modify certain provisions of the Health Care Quality Improvement Act

of 1986.

IN THE HOUSE OF REPRESENTATIVES

APRIL 21, 1994

Mr. WYDEN (for himself and Mr. Klug) introduced the following bill; which

was referred to the Committee on Energy and Commerce

A BILL

To modify certain provisions of the Health Care Quality

Improvement Act of 1986.

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 ‘‘Health Care Quality

5 Improvement Act Amendments of 1994’’.

6 SEC. 2. STANDARDS FOR PROFESSIONAL REVIEW ACTIONS.

7 Section 412(a) of the Health Care Quality Improve8 ment Act of 1986 (42 U.S.C. 11112(a)) is amended in

9 the matter after and below paragraph (4) by adding at

10 the end the following sentences: ‘‘A motion for a summary
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1 judgment that such standards have been met shall be

2 granted unless, considering the evidence in the light most

3 favorable to the opposing party, a reasonable finder of fact

4 could conclude that the presumption has been so rebutted.

5 The decision on such a motion may be appealed as of

6 right, without regard to whether the motion is granted or

7 denied, and the courts of appeals (other than the United

8 States Court of Appeals for the Federal Circuit) have ju9 risdiction of appeals from such decisions of the district

10 courts.’’.

11 SEC. 3. REQUIRING REPORTS ON MEDICAL MALPRACTICE

12 DATA.

13 (a) IN GENERAL.—Section 421 of the Health Care

14 Quality Improvement Act of 1986 (42 U.S.C. 11131) is

15 amended—

16 (1) by striking subsections (a) and (b);

17 (2) by redesignating subsections (c) and (d) as

18 subsections (d) and (e), respectively; and

19 (3) by inserting before subsection (d) (as so re20 designated) the following subsections:

21 ‘‘(a) IN GENERAL.—

22 ‘‘(1) REQUIREMENT OF REPORTING.—Subject

23 to the subsequent provisions of this subsection, each

24 person or entity which makes payment under a pol25 icy of insurance, self-insurance, or otherwise in set-
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1 tlement (or partial settlement) of, or in satisfaction

2 of a judgment in, a medical malpractice action or

3 claim shall report, in accordance with section 424,

4 information respecting the payment and cir5 cumstances thereof.

6 ‘‘(2) PAYMENTS BY PRACTITIONERS.—The per7 sons to whom the requirement of paragraph (1)

8 applies include a physician or other licensed health

9 care practitioner who makes a payment described in

10 such paragraph and whose acts or omissions are the

11 basis of the action or claim involved. The preceding

12 sentence is subject to paragraph (3).

13 ‘‘(3) REFUND OF FEES.—With respect to a

14 physician or other licensed health care practitioner

15 whose acts or omissions are the basis of an action

16 or claim described in paragraph (1), the requirement

17 of such paragraph shall not apply to a payment de18 scribed in such paragraph if—

19 ‘‘(A) the payment is made by the physician

20 or practitioner as a refund of fees for the health

21 services involved, and

22 ‘‘(B) the payment does not exceed the

23 amount of the original charge for the health

24 services.
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1 ‘‘(4) DEFINITION OF ENTITY AND PERSON.—

2 For purposes of this section, the term ‘entity’ in3 cludes the Federal Government, any State or local

4 government, and any insurance company or other

5 private entity; and the term ‘person’ includes Fed6 eral officers and employees.

7 ‘‘(b) INFORMATION TO BE REPORTED.—The infor8 mation to be reported under subsection (a) by a person

9 or entity regarding a payment and an action or claim in10 cludes the following:

11 ‘‘(1)(A) The name of each physician or other li12 censed health care practitioner whose acts or omis13 sions were the basis of the action or claim; and (to

14 the extent authorized under title II of the Social Se15 curity Act) the social security account number as16 signed to the physician or practitioner.

17 ‘‘(B) If the physician or practitioner could not

18 be identified for purposes of subparagraph (A)—

19 ‘‘(i) a statement of such fact and an expla20 nation of the inability to make the identifica21 tion, and

22 ‘‘(ii) the name of the hospital or other

23 health services organization (as defined in sec24 tion 431) for whose benefit the payment was

25 made.
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1 ‘‘(2) The amount of the payment.

2 ‘‘(3) The name (if known) of any hospital or

3 other health services organization with which the

4 physician or practitioner is affiliated or associated.

5 ‘‘(4)(A) A statement describing the acts or

6 omissions and injuries or illnesses upon which the

7 action or claim was based.

8 ‘‘(B) A statement by the physician or practi9 tioner regarding the action or claim, if the physician

10 or practitioner elects to make such a statement.

11 ‘‘(C) If the payment was made without the con12 sent of the physician or practitioner, a statement

13 specifying such fact and the reasons underlying the

14 decision to make the payment without such consent.

15 ‘‘(5) Such other information as the Secretary

16 determines is required for appropriate interpretation

17 of information reported under this section.

18 ‘‘(c) CERTAIN REPORTING CRITERIA; NOTICE TO

19 PRACTITIONERS.—

20 ‘‘(1) REPORTING CRITERIA.—In establishing

21 criteria under section 424(a) for reports under this

22 section, the Secretary shall establish criteria regard23 ing statements under subsection (b)(4). Such criteria

24 shall include—
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1 ‘‘(A) criteria regarding the length of each

2 of the statements,

3 ‘‘(B) criteria regarding the notice required

4 by paragraph (2) of this subsection, and

5 ‘‘(C) such other criteria as the Secretary

6 determines to be appropriate.

7 ‘‘(2) NOTICE OF OPPORTUNITY TO MAKE

8 STATEMENT.—In the case of an entity that prepares

9 a report under subsection (a)(1) regarding a pay10 ment and an action or claim, the entity shall notify

11 any physician or practitioner identified under sub12 section (b)(1)(A) of the opportunity to make a state13 ment under subsection (b)(4)(B). Criteria under

14 paragraph (1)(B) of this subsection shall include cri15 teria regarding the date by which the reporting en16 tity is to provide the notice and the date by which

17 the physician or practitioner is to submit the state18 ment to the entity.’’.

19 (b) DEFINITION OF HEALTH SERVICES ORGANIZA20 TION.—Section 431 of the Health Care Quality Improve21 ment Act of 1986 (42 U.S.C. 11151) is amended—

22 (1) by redesignating paragraphs (5) through

23 (14) as paragraphs (6) through (15), respectively;

24 and
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1 (2) by inserting after paragraph (4) the follow2 ing paragraph:

3 ‘‘(5) The term ‘health services organization’

4 means an entity that, directly or through contracts,

5 provides health services. Such term includes hos6 pitals; health maintenance organizations and other

7 health plans; and health care entities (as defined in

8 paragraph (4)).’’.

9 (c) CONFORMING AMENDMENTS.—

10 (1) IN GENERAL.—The Health Care Quality

11 Improvement Act of 1986 (42 U.S.C. 11101 et seq.)

12 is amended—

13 (A) in section 411(a)(1), in the matter pre14 ceding subparagraph (A), by striking ‘‘431(9)’’

15 and inserting ‘‘431(10)’’;

16 (B) in section 421(d) (as redesignated by

17 subsection (a)(2) of this section), by inserting

18 ‘‘person or’’ before ‘‘entity’’;

19 (C) in section 422(a)(2)(A), by inserting

20 before the comma at the end the following: ‘‘,

21 and (to the extent authorized under title II of

22 the Social Security Act) the social security ac23 count number assigned to the physician’’; and

24 (D) in section 423(a)(3)(A), by inserting

25 before the comma at the end the following: ‘‘,
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1 and (to the extent authorized under title II of

2 the Social Security Act) the social security ac3 count number assigned to the physician or

4 practitioner’’.

5 (2) APPLICABILITY OF REQUIREMENTS TO FED6 ERAL ENTITIES.—

7 (A) Section 432 of the Health Care Qual8 ity Improvement Act of 1986 (42 U.S.C.

9 11152) is amended—

10 (i) by striking subsection (b); and

11 (ii) by redesignating subsection (c) as

12 subsection (b).

13 (B) Section 423 of the Health Care Qual14 ity Improvement Act of 1986 (42 U.S.C.

15 11133) is amended by adding at the end the

16 following subsection:

17 ‘‘(e) APPLICABILITY TO FEDERAL FACILITIES AND

18 PHYSICIANS.—

19 ‘‘(1) IN GENERAL.—Subsection (a) applies to

20 Federal health facilities (including hospitals) and ac21 tions by such facilities regarding the competence or

22 professional conduct of Federal physicians to the

23 same extent and in the same manner as such sub24 section applies to health care entities and profes25 sional review actions.
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1 ‘‘(2) RELEVANT BOARD OF MEDICAL EXAMIN2 ERS.—For purposes of paragraph (1), the Board of

3 Medical Examiners to which a Federal health facility

4 is to report is the Board of Medical Examiners of

5 the State within which the facility is located.’’.

6 (C) Section 425 of the Health Care Qual7 ity Improvement Act of 1986 (42 U.S.C.

8 11135) is amended by adding at the end the

9 following subsection:

10 ‘‘(d) APPLICABILITY TO FEDERAL HOSPITALS.—

11 This section applies to Federal hospitals to the same ex12 tent and in the same manner as such subsection applies

13 to other hospitals.’’.

14 SEC. 4. REPORTING OF SANCTIONS TAKEN BY BOARDS OF

15 MEDICAL EXAMINERS.

16 Section 422(a)(1)(A) of the Health Care Quality Im17 provement Act of 1986 (42 U.S.C. 11132(a)(1)(A)) is

18 amended by striking ‘‘which revokes or suspends’’ and in19 serting ‘‘which denies, revokes, or suspends’’.

20 SEC. 5. DUTY TO OBTAIN INFORMATION.

21 Part B of the Health Care Quality Improvement Act

22 of 1986 (42 U.S.C. 11131 et seq.) is amended by inserting

23 after section 425 the following section:
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1 ‘‘SEC. 425A. DUTY OF BOARDS OF MEDICAL EXAMINERS TO

2 OBTAIN INFORMATION.

3 ‘‘(a) IN GENERAL.—Effective 2 years after the date

4 of the enactment of the Health Care Quality Improvement

5 Act Amendments of 1994, it is the duty of each Board

6 of Medical Examiners to request from the Secretary (or

7 the agency designated under section 424(b)) information

8 reported under this part concerning a physician—

9 ‘‘(1) at the time the physician submits the ini10 tial application for a physician’s license in the State

11 involved, and

12 ‘‘(2) at each time the physician submits an ap13 plication to continue in effect the license, subject to

14 subsection (d).

15 A Board of Medical Examiners may request information

16 reported under this part concerning a physician at other

17 times.

18 ‘‘(b) FAILURE TO OBTAIN INFORMATION.—With re19 spect to an action for mandamus or other cause of action

20 against a Board of Medical Examiners, a Board which

21 does not request information respecting a physician as re22 quired under subsection (a) is presumed to have knowl23 edge of any information reported under this part to the

24 Secretary with respect to the physician.

25 ‘‘(c) RELIANCE ON INFORMATION PROVIDED.—With

26 respect to a cause of action against a Board of Medical
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1 Examiners, each Board of Medical Examiners may rely

2 upon information provided to the Board under this title,

3 unless the Board has knowledge that the information pro4 vided was false.

5 ‘‘(d) STATE OPTION REGARDING CONTINUATION OF

6 LICENSES.—

7 ‘‘(1) ESTABLISHMENT OF ELECTRONIC SYSTEM

8 FOR TRANSMISSION OF DATA.—After consultation

9 with the States, the Secretary shall establish a sys10 tem for electronically transmitting information under

11 this part to States that elect to install equipment

12 necessary for participation in the system. The sys13 tem shall possess the capability to receive trans14 missions of data from such States.

15 ‘‘(2) STATE OPTION REGARDING ELECTRONIC

16 SYSTEM.—With respect to compliance with sub17 section (a)(2) (relating to applications to continue in

18 effect physicians’ licenses), if a State is participating

19 in the system under paragraph (1) and provides the

20 Board of Medical Examiners of the State with ac21 cess to the system, the Board may elect, in lieu of

22 complying with subsection (a)(2), to comply with

23 paragraph (3) of this subsection.
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1 ‘‘(3) DESCRIPTION OF OPTION.—For purposes

2 of paragraph (2), a Board of Medical Examiners is

3 complying with this paragraph if—

4 ‘‘(A) through the system under paragraph

5 (1), the Board annually transmits to the Sec6 retary (or the agency designated under section

7 424(b)) data identifying all individuals who

8 hold a valid physician’s license issued by the

9 Board, without regard to whether the licenses

10 are expiring, and

11 ‘‘(B) after receiving from the Secretary (or

12 such agency) a list of physicians under para13 graph (4)(B), the Board complies with para14 graph (5).

15 ‘‘(4) IDENTIFICATION BY SECRETARY OF REL16 EVANT PHYSICIANS.—After receiving data under

17 paragraph (3)(A) from a Board of Medical Examin18 ers, the Secretary (or the agency designated under

19 section 424(b)) shall—

20 ‘‘(A) from among the physicians identified

21 through the data, determine which of such phy22 sicians has been the subject of information re23 ported under this part, and the State in which

24 the incidents involved occurred, and
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1 ‘‘(B) provide to the Board, through the

2 system under paragraph (1), a list of the physi3 cians who have been such subjects, which list

4 specifies for each physician the States in which

5 the incidents involved occurred.

6 ‘‘(5) REQUEST BY STATE OF INFORMATION ON

7 RELEVANT PHYSICIANS.—For purposes of paragraph

8 (3)(B), a Board of Medical Examiners of a State is

9 complying with this paragraph if, after receiving the

10 list of physicians under paragraph (4)(B), the Board

11 promptly—

12 (A) identifies which of the physicians has

13 had, for purposes of paragraph (4), an incident

14 in another State, and

15 (B) requests from the Secretary (or the

16 agency) information reported under this part

17 concerning each of the physicians so identi18 fied.’’.

19 SEC. 6. ADDITIONAL PROVISIONS REGARDING ACCESS TO

20 INFORMATION; MISCELLANEOUS PROVI21 SIONS.

22 (a) ACCESS TO INFORMATION.—Section 427(a) of the

23 Health Care Quality Improvement Act of 1986 (42 U.S.C.

24 11137(a)) is amended to read as follows:
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1 ‘‘(a) ACCESS REGARDING LICENSING, EMPLOYMENT,

2 AND CLINICAL PRIVILEGES.—The Secretary (or the agen3 cy designated under section 424(b)) shall, upon request,

4 provide information reported under this part concerning

5 a physician or other licensed health care practitioner to—

6 ‘‘(1) State licensing boards, and

7 ‘‘(2) hospitals and other health services organi8 zations—

9 ‘‘(A) that have entered (or may be enter10 ing) into an employment or affiliation relation11 ship with the physician or practitioner, or

12 ‘‘(B) to which the physician or practitioner

13 has applied for clinical privileges or appoint14 ment to the medical staff.’’.

15 (b) FEES.—Section 427(b)(4) of the Health Care

16 Quality Improvement Act of 1986 (42 U.S.C.

17 11137(b)(4)) is amended to read as follows:

18 ‘‘(4) FEES.—In disclosing information under

19 subsection (a) or section 426, the Secretary may im20 pose fees in amounts reasonably related to the costs

21 of carrying out the duties of the Secretary regarding

22 the information reported under this part (including

23 the functions specified in section 424(b) with respect

24 to the information), except that a fee may not be im25 posed for providing a list under section
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1 425A(d)(4)(B) to any Board of Medical Examiners.

2 Such fees are available to the Secretary (or, in the

3 Secretary’s discretion, to the agency designated

4 under section 424(b)) to cover such costs. Such fees

5 remain available until expended.’’.

6 (c) ADDITIONAL DISCLOSURES OF INFORMATION.—

7 Section 427 of the Health Care Quality Improvement Act

8 of 1986 (42 U.S.C. 11137) is amended by adding at the

9 end the following subsection:

10 ‘‘(e) AVAILABILITY OF INFORMATION TO PUBLIC.—

11 ‘‘(1) IN GENERAL.—Not later than 30 days

12 after the effective date for this subsection under sec13 tion 9 of the Health Care Quality Improvement Act

14 Amendments of 1994, and semiannually thereafter,

15 the Secretary shall publish and make available to the

16 public the following information reported under this

17 part:

18 ‘‘(A) Information reported under section

19 421, excepting the following:

20 ‘‘(i) Information concerning a physi21 cian or other licensed health care practi22 tioner with respect to whom the number of

23 discrete incidents on which information is

24 required to be submitted under such sec25 tion is 1.
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1 ‘‘(ii) The social security account num2 ber of the physician or practitioner.

3 ‘‘(iii) Information disclosing the iden4 tity of any patient involved in such an inci5 dent.

6 ‘‘(iv) With respect to information that

7 the Secretary requires under section

8 421(b)(5)—

9 ‘‘(I) the home address of the phy10 sician or practitioner, and

11 ‘‘(II) the number assigned to the

12 physician or practitioner by the Drug

13 Enforcement Administration.

14 ‘‘(v) Information not required to be

15 reported under such section.

16 ‘‘(B) Information reported under section

17 422(a).

18 ‘‘(C) Information reported under section

19 423(b).

20 ‘‘(2) DISSEMINATION; FEES.—The Secretary

21 shall disseminate each publication under paragraph

22 (1) to public libraries without charge. In providing

23 the publication to other entities, the Secretary may

24 impose a fee reasonably related to the costs of the

25 Secretary in carrying out this subsection. Such fees
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1 are available to the Secretary (or, in the Secretary’s

2 discretion, to the agency designated under section

3 424(b)) to cover such costs. Such fees remain avail4 able until expended.’’

5 (d) CONFORMING AMENDMENTS.—Section 427 of the

6 Health Care Quality Improvement Act of 1986 (42 U.S.C.

7 11137) is amended—

8 (1) in subsection (b)(1), in the first sentence,

9 by striking ‘‘Information reported’’ and inserting the

10 following: ‘‘Except for information disclosed under

11 subsection (e), information reported’’; and

12 (2) in the heading for the section, by striking

13 ‘‘MISCELLANEOUS PROVISIONS’’ and inserting

14 the following: ‘‘ADDITIONAL PROVISIONS RE15 GARDING ACCESS TO INFORMATION; MIS16 CELLANEOUS PROVISIONS’’.

17 SEC. 7. OTHER MATTERS.

18 The Health Care Quality Improvement Act of 1986

19 (42 U.S.C. 11101 et seq.) is amended—

20 (1) by redesignating part C as part D; and

21 (2) by inserting after part B the following part:
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1 ‘‘PART C—OTHER MATTERS REGARDING

2 IMPROVEMENT OF HEALTH CARE QUALITY

3 ‘‘SEC. 428. PROHIBITION AGAINST SETTLEMENT WITHOUT

4 CONSENT OF PRACTITIONER.

5 ‘‘(a) PROHIBITION.—With respect to a physician or

6 other licensed health care practitioner whose acts or omis7 sions are the basis of a medical malpractice action or

8 claim, an entity may not make a payment described in

9 section 421(a)(1) without the written consent of the physi10 cian or practitioner, subject to subsection (b).

11 ‘‘(b) EXCEPTIONS.—Subsection (a) shall not apply

12 with respect to a payment by an entity regarding an action

13 or claim, subject to subsection (c)—

14 ‘‘(1) if the payment is made in satisfaction of

15 a judgment in a court of competent jurisdiction,

16 ‘‘(2) if, with respect to the action or claim, the

17 physician or other licensed health care practitioner

18 involved enters a process of alternative dispute reso19 lution, and the process has been concluded or any of

20 the individuals involved has terminated participation

21 in the process,

22 ‘‘(3)(A) the entity delivers directly, or makes a

23 reasonable effort to deliver through the mail, a writ24 ten notice to the physician or practitioner involved

25 providing the information specified in subsection (c),

26 and
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1 ‘‘(B) a 30-day period elapses, at the conclusion

2 of which the entity has a reasonable belief that the

3 physician or practitioner does not object to the pay4 ment.

5 ‘‘(c) CRITERIA REGARDING NOTICE.—For purposes

6 of subsection (b)(3) regarding a written notice to a physi7 cian or practitioner—

8 ‘‘(1) the notice shall be considered to have been

9 delivered if the notice was delivered to the home or

10 business address of the physician or practitioner,

11 and to the attorney (if any) representing the physi12 cian or practitioner in the action or claim involved,

13 ‘‘(2) the notice shall be considered to have been

14 delivered directly if the notice was delivered person15 ally by the entity involved or by an agent of the en16 tity,

17 ‘‘(3) the entity shall be considered to have made

18 a reasonable effort to deliver the notice through the

19 mail if the entity provided the notice through cer20 tified mail, with return receipt requested,

21 ‘‘(4) the information specified in this paragraph

22 for the notice is that the entity intends to make the

23 payment involved; that the physician or practitioner

24 has a legal right to prohibit the payment; and that
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1 such right expires in 30 days, with a specification of

2 the date on which the right expires, and

3 ‘‘(5) the 30-day period begins on the date on

4 which the notice is delivered directly to the physician

5 or practitioner, or on the seventh day after the date

6 on which the notice is posted, as the case may be.

7 ‘‘(d) CIVIL MONEY PENALTY.—Any entity that

8 makes a payment in violation of subsection (a) shall be

9 subject to a civil money penalty of not more than $10,000

10 for each such payment involved. Such penalty shall be im11 posed and collected in the same manner as civil money

12 penalties under subsection (a) of section 1128A of the So13 cial Security Act are imposed and collected under that sec14 tion.

15 ‘‘SEC. 429. EMPLOYMENT TERMINATION OF PHYSICIAN.

16 ‘‘(a) REQUIREMENT OF ADEQUATE NOTICE AND

17 HEARING.—

18 ‘‘(1) IN GENERAL.—A health services organiza19 tion may not terminate the employment of a physi20 cian, and may not terminate a contract with a physi21 cian for the provision of health services, unless ade22 quate notice and hearing procedures have been af23 forded the physician involved.

24 ‘‘(2) APPLICABILITY.—Section 412(a)(3) ap25 plies in lieu of paragraph (1) in the case of an em-
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1 ployment termination that is a professional review

2 action. (With respect to the preceding sentence,

3 paragraph (1) does apply to an employment termi4 nation that is an action described in subparagraph

5 (A) of section 431(10) or in the other subpara6 graphs of such section.)

7 ‘‘(b) SAFE HARBOR.—

8 ‘‘(1) IN GENERAL.—A health services organiza9 tion is deemed to have met the adequate notice and

10 hearing requirement of subsection (a) with respect

11 to the employment of, or a contract of, a physician

12 if the conditions described in paragraphs (2)

13 through (4) are met (or are waived voluntarily by

14 the physician).

15 ‘‘(2) NOTICE OF PROPOSED ACTION.—Condi16 tions under paragraph (1) are that the physician in17 volved has been given notice stating—

18 ‘‘(A)(i) that the health services organiza19 tion proposes to take action to terminate the

20 employment or contract,

21 ‘‘(ii) reasons for the proposed action,

22 ‘‘(B)(i) that the physician has the right to

23 request a hearing on the proposed action,
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1 ‘‘(ii) any time limit (of not less than 30

2 days) within which to request such a hearing,

3 and

4 ‘‘(C) a summary of the rights in the hear5 ing under paragraph (4).

6 ‘‘(3) NOTICE OF HEARING.—Conditions under

7 paragraph (1) are that, if a hearing is requested on

8 a timely basis under paragraph (2)(B), the physician

9 involved must be given notice stating—

10 ‘‘(A) the place, time, and date, of the hear11 ing, which date shall not be less than 30 days

12 after the date of the notice, and

13 ‘‘(B) a list of the witnesses (if any) ex14 pected to testify at the hearing on behalf of the

15 health services organization.

16 ‘‘(4) CONDUCT OF HEARING AND NOTICE.—

17 Conditions under paragraph (1) are that, if a hear18 ing is requested on a timely basis under paragraph

19 (2)(B)—

20 ‘‘(A) subject to subparagraph (B), the

21 hearing shall be held (as determined by the

22 health services organization)—

23 ‘‘(i) before an arbitrator mutually ac24 ceptable to the physician involved and the

25 health services organization,
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1 ‘‘(ii) before a hearing officer who is

2 appointed by the organization and who is

3 not in direct economic competition with the

4 physician, or

5 ‘‘(iii) before a panel of individuals who

6 are appointed by the organization and are

7 not in direct economic competition with the

8 physician,

9 ‘‘(B) the right to the hearing may be for10 feited if the physician fails, without good cause,

11 to appear,

12 ‘‘(C) in the hearing the physician has the

13 right—

14 ‘‘(i) to representation by an attorney

15 or other person of the physician’s choice,

16 ‘‘(ii) to have a record made of the

17 proceedings, copies of which may be ob18 tained by the physician upon payment of

19 any reasonable charges associated with the

20 preparation thereof,

21 ‘‘(iii) to call, examine, and cross-ex22 amine witnesses,

23 ‘‘(iv) to present evidence determined

24 to be relevant by the hearing officer, re-
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1 gardless of its admissibility in a court of

2 law, and

3 ‘‘(v) to submit a written statement at

4 the close of the hearing, and

5 ‘‘(D) upon completion of the hearing, the

6 physician has the right—

7 ‘‘(i) to receive the written rec8 ommendation of the arbitrator, officer, or

9 panel, including a statement of the basis

10 for the recommendations, and

11 ‘‘(ii) to receive a written decision of

12 the health services organization, including

13 a statement of the basis for the decision.

14 ‘‘(c) RULE OF CONSTRUCTION.—A health services or15 ganization’s failure to meet the conditions described in

16 paragraphs (2) through (4) of subsection (b) shall not, in

17 itself, constitute failure to meet the standards of sub18 section (a).’’.

19 SEC. 8. DEFINITIONS.

20 Section 431(6) of the Health Care Quality Improve21 ment Act of 1986, as redesignated by section 3(b)(1) of

22 this Act, is amended by inserting before the period the

23 following: ‘‘(except that such term means an institution

24 described in such paragraph (1) (without regard to such

25 paragraph (7)) if, under applicable State or local law, the
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1 institution is permitted to operate without being licensed

2 or otherwise approved as a hospital)’’.

3 SEC. 9. EFFECTIVE DATES.

4 (a) INCORPORATION OF TEXT OF AMENDMENTS.—

5 The amendments described in this Act are made upon the

6 date of the enactment of this Act.

7 (b) SUBSTANTIVE EFFECT.—Except as provided in

8 subsection (c)(1) and subsection (d), and except as other9 wise provided in this Act—

10 (1) the amendments made by this Act take ef11 fect upon the expiration of the 1-year period begin12 ning on the date of the enactment of this Act; and

13 (2) prior to the expiration of such period, the

14 Health Care Quality Improvement Act of 1986, as

15 in effect on the day before such date of enactment,

16 continues in effect.

17 (c) REGULATIONS.—

18 (1) IN GENERAL.—With respect to the amend19 ments made by this Act, the Secretary of Health

20 and Human Services may issue regulations pursuant

21 to such amendments before the expiration of the pe22 riod specified in subsection (b), and may otherwise

23 take appropriate action before the expiration of such

24 period to prepare for the responsibilities of the Sec25 retary pursuant to the amendments.
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1 (2) ABSENCE OF FINAL RULE.—The final rule

2 for purposes of paragraph (1) may not take effect

3 before the expiration of the period specified in sub4 section (b), and the absence of such a rule upon

5 such expiration does not affect the provisions of sub6 section (b).

7 (d) TRANSITIONAL PROVISIONS REGARDING MAL8 PRACTICE PAYMENTS BY PERSONS.—With respect to the

9 reporting of information under section 421 of the Health

10 Care Quality Improvement Act of 1986, the following ap11 plies:

12 (1) The requirement of reporting by persons

13 under section 421(a)(1) of such Act (as amended by

14 section 3(a) of this Act) takes effect 180 days after

15 the date of the enactment of this Act.

16 (2) The requirement of reporting by persons

17 applies to payments under such section 421(a)(1)

18 made before, on, or after such date of enactment.

19 (3)(A) The information received by the Sec20 retary of Health and Human Services on or before

21 August 27, 1993, pursuant to regulations requiring

22 reports from persons (in addition to reports from en23 tities) shall be maintained in the same manner as

24 the information was maintained prior to such date,

25 and shall be available in accordance with the regula-
27

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1 tions in effect under such Act prior to such date

2 (which regulations remain in effect unless a provi3 sion of this Act takes effect pursuant to this section

4 and requires otherwise).

5 (B) Subparagraph (A) takes effect on the date

6 of the enactment of this Act.

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