```

[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4274 Introduced in House (IH)]

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Care Quality Improvement Act 
Amendments of 1994''.

SEC. 2. STANDARDS FOR PROFESSIONAL REVIEW ACTIONS.

    Section 412(a) of the Health Care Quality Improvement Act of 1986 
(42 U.S.C. 11112(a)) is amended in the matter after and below paragraph 
(4) by adding at the end the following sentences: ``A motion for a 
summary judgment that such standards have been met shall be granted 
unless, considering the evidence in the light most favorable to the 
opposing party, a reasonable finder of fact could conclude that the 
presumption has been so rebutted. The decision on such a motion may be 
appealed as of right, without regard to whether the motion is granted 
or denied, and the courts of appeals (other than the United States 
Court of Appeals for the Federal Circuit) have jurisdiction of appeals 
from such decisions of the district courts.''.

SEC. 3. REQUIRING REPORTS ON MEDICAL MALPRACTICE DATA.

    (a) In General.--Section 421 of the Health Care Quality Improvement 
Act of 1986 (42 U.S.C. 11131) is amended--
            (1) by striking subsections (a) and (b);
            (2) by redesignating subsections (c) and (d) as subsections 
        (d) and (e), respectively; and
            (3) by inserting before subsection (d) (as so redesignated) 
        the following subsections:
    ``(a) In General.--
            ``(1) Requirement of reporting.--Subject to the subsequent 
        provisions of this subsection, each person or entity which 
        makes payment under a policy of insurance, self-insurance, or 
        otherwise in settlement (or partial settlement) of, or in 
        satisfaction of a judgment in, a medical malpractice action or 
        claim shall report, in accordance with section 424, information 
        respecting the payment and circumstances thereof.
            ``(2) Payments by practitioners.--The persons to whom the 
        requirement of paragraph (1) applies include a physician or 
        other licensed health care practitioner who makes a payment 
        described in such paragraph and whose acts or omissions are the 
        basis of the action or claim involved. The preceding sentence 
        is subject to paragraph (3).
            ``(3) Refund of fees.--With respect to a physician or other 
        licensed health care practitioner whose acts or omissions are 
        the basis of an action or claim described in paragraph (1), the 
        requirement of such paragraph shall not apply to a payment 
        described in such paragraph if--
                    ``(A) the payment is made by the physician or 
                practitioner as a refund of fees for the health 
                services involved, and
                    ``(B) the payment does not exceed the amount of the 
                original charge for the health services.
            ``(4) Definition of entity and person.--For purposes of 
        this section, the term `entity' includes the Federal 
        Government, any State or local government, and any insurance 
        company or other private entity; and the term `person' includes 
        Federal officers and employees.
    ``(b) Information To Be Reported.--The information to be reported 
under subsection (a) by a person or entity regarding a payment and an 
action or claim includes the following:
            ``(1)(A) The name of each physician or other licensed 
        health care practitioner whose acts or omissions were the basis 
        of the action or claim; and (to the extent authorized under 
        title II of the Social Security Act) the social security 
        account number assigned to the physician or practitioner.
            ``(B) If the physician or practitioner could not be 
        identified for purposes of subparagraph (A)--
                    ``(i) a statement of such fact and an explanation 
                of the inability to make the identification, and
                    ``(ii) the name of the hospital or other health 
                services organization (as defined in section 431) for 
                whose benefit the payment was made.
            ``(2) The amount of the payment.
            ``(3) The name (if known) of any hospital or other health 
        services organization with which the physician or practitioner 
        is affiliated or associated.
            ``(4)(A) A statement describing the acts or omissions and 
        injuries or illnesses upon which the action or claim was based.
            ``(B) A statement by the physician or practitioner 
        regarding the action or claim, if the physician or practitioner 
        elects to make such a statement.
            ``(C) If the payment was made without the consent of the 
        physician or practitioner, a statement specifying such fact and 
        the reasons underlying the decision to make the payment without 
        such consent.
            ``(5) Such other information as the Secretary determines is 
        required for appropriate interpretation of information reported 
        under this section.
    ``(c) Certain Reporting Criteria; Notice to Practitioners.--
            ``(1) Reporting criteria.--In establishing criteria under 
        section 424(a) for reports under this section, the Secretary 
        shall establish criteria regarding statements under subsection 
        (b)(4). Such criteria shall include--
                    ``(A) criteria regarding the length of each of the 
                statements,
                    ``(B) criteria regarding the notice required by 
                paragraph (2) of this subsection, and
                    ``(C) such other criteria as the Secretary 
                determines to be appropriate.
            ``(2) Notice of opportunity to make statement.--In the case 
        of an entity that prepares a report under subsection (a)(1) 
        regarding a payment and an action or claim, the entity shall 
        notify any physician or practitioner identified under 
        subsection (b)(1)(A) of the opportunity to make a statement 
        under subsection (b)(4)(B). Criteria under paragraph (1)(B) of 
        this subsection shall include criteria regarding the date by 
        which the reporting entity is to provide the notice and the 
        date by which the physician or practitioner is to submit the 
        statement to the entity.''.
    (b) Definition of Health Services Organization.--Section 431 of the 
Health Care Quality Improvement Act of 1986 (42 U.S.C. 11151) is 
amended--
            (1) by redesignating paragraphs (5) through (14) as 
        paragraphs (6) through (15), respectively; and
            (2) by inserting after paragraph (4) the following 
        paragraph:
            ``(5) The term `health services organization' means an 
        entity that, directly or through contracts, provides health 
        services. Such term includes hospitals; health maintenance 
        organizations and other health plans; and health care entities 
        (as defined in paragraph (4)).''.
    (c) Conforming Amendments.--
            (1) In general.--The Health Care Quality Improvement Act of 
        1986 (42 U.S.C. 11101 et seq.) is amended--
                    (A) in section 411(a)(1), in the matter preceding 
                subparagraph (A), by striking ``431(9)'' and inserting 
                ``431(10)'';
                    (B) in section 421(d) (as redesignated by 
                subsection (a)(2) of this section), by inserting 
                ``person or'' before ``entity'';
                    (C) in section 422(a)(2)(A), by inserting before 
                the comma at the end the following: ``, and (to the 
                extent authorized under title II of the Social Security 
                Act) the social security account number assigned to the 
                physician''; and
                    (D) in section 423(a)(3)(A), by inserting before 
                the comma at the end the following: ``, and (to the 
                extent authorized under title II of the Social Security 
                Act) the social security account number assigned to the 
                physician or practitioner''.
            (2) Applicability of requirements to federal entities.--
                    (A) Section 432 of the Health Care Quality 
                Improvement Act of 1986 (42 U.S.C. 11152) is amended--
                            (i) by striking subsection (b); and
                            (ii) by redesignating subsection (c) as 
                        subsection (b).
                    (B) Section 423 of the Health Care Quality 
                Improvement Act of 1986 (42 U.S.C. 11133) is amended by 
                adding at the end the following subsection:
    ``(e) Applicability to Federal Facilities and Physicians.--
            ``(1) In general.--Subsection (a) applies to Federal health 
        facilities (including hospitals) and actions by such facilities 
        regarding the competence or professional conduct of Federal 
        physicians to the same extent and in the same manner as such 
        subsection applies to health care entities and professional 
        review actions.
            ``(2) Relevant board of medical examiners.--For purposes of 
        paragraph (1), the Board of Medical Examiners to which a 
        Federal health facility is to report is the Board of Medical 
        Examiners of the State within which the facility is located.''.
                    (C) Section 425 of the Health Care Quality 
                Improvement Act of 1986 (42 U.S.C. 11135) is amended by 
                adding at the end the following subsection:
    ``(d) Applicability to Federal Hospitals.--This section applies to 
Federal hospitals to the same extent and in the same manner as such 
subsection applies to other hospitals.''.

SEC. 4. REPORTING OF SANCTIONS TAKEN BY BOARDS OF MEDICAL EXAMINERS.

    Section 422(a)(1)(A) of the Health Care Quality Improvement Act of 
1986 (42 U.S.C. 11132(a)(1)(A)) is amended by striking ``which revokes 
or suspends'' and inserting ``which denies, revokes, or suspends''.

SEC. 5. DUTY TO OBTAIN INFORMATION.

    Part B of the Health Care Quality Improvement Act of 1986 (42 
U.S.C. 11131 et seq.) is amended by inserting after section 425 the 
following section:

``SEC. 425A. DUTY OF BOARDS OF MEDICAL EXAMINERS TO OBTAIN INFORMATION.

    ``(a) In General.--Effective 2 years after the date of the 
enactment of the Health Care Quality Improvement Act Amendments of 
1994, it is the duty of each Board of Medical Examiners to request from 
the Secretary (or the agency designated under section 424(b)) 
information reported under this part concerning a physician--
            ``(1) at the time the physician submits the initial 
        application for a physician's license in the State involved, 
        and
            ``(2) at each time the physician submits an application to 
        continue in effect the license, subject to subsection (d).
A Board of Medical Examiners may request information reported under 
this part concerning a physician at other times.
    ``(b) Failure To Obtain Information.--With respect to an action for 
mandamus or other cause of action against a Board of Medical Examiners, 
a Board which does not request information respecting a physician as 
required under subsection (a) is presumed to have knowledge of any 
information reported under this part to the Secretary with respect to 
the physician.
    ``(c) Reliance on Information Provided.--With respect to a cause of 
action against a Board of Medical Examiners, each Board of Medical 
Examiners may rely upon information provided to the Board under this 
title, unless the Board has knowledge that the information provided was 
false.
    ``(d) State Option Regarding Continuation of Licenses.--
            ``(1) Establishment of electronic system for transmission 
        of data.--After consultation with the States, the Secretary 
        shall establish a system for electronically transmitting 
        information under this part to States that elect to install 
        equipment necessary for participation in the system. The system 
        shall possess the capability to receive transmissions of data 
        from such States.
            ``(2) State option regarding electronic system.--With 
        respect to compliance with subsection (a)(2) (relating to 
        applications to continue in effect physicians' licenses), if a 
        State is participating in the system under paragraph (1) and 
        provides the Board of Medical Examiners of the State with 
        access to the system, the Board may elect, in lieu of complying 
        with subsection (a)(2), to comply with paragraph (3) of this 
        subsection.
            ``(3) Description of option.--For purposes of paragraph 
        (2), a Board of Medical Examiners is complying with this 
        paragraph if--
                    ``(A) through the system under paragraph (1), the 
                Board annually transmits to the Secretary (or the 
                agency designated under section 424(b)) data 
                identifying all individuals who hold a valid 
                physician's license issued by the Board, without regard 
                to whether the licenses are expiring, and
                    ``(B) after receiving from the Secretary (or such 
                agency) a list of physicians under paragraph (4)(B), 
                the Board complies with paragraph (5).
            ``(4) Identification by secretary of relevant physicians.--
        After receiving data under paragraph (3)(A) from a Board of 
        Medical Examiners, the Secretary (or the agency designated 
        under section 424(b)) shall--
                    ``(A) from among the physicians identified through 
                the data, determine which of such physicians has been 
                the subject of information reported under this part, 
                and the State in which the incidents involved occurred, 
                and
                    ``(B) provide to the Board, through the system 
                under paragraph (1), a list of the physicians who have 
                been such subjects, which list specifies for each 
                physician the States in which the incidents involved 
                occurred.
            ``(5) Request by state of information on relevant 
        physicians.--For purposes of paragraph (3)(B), a Board of 
        Medical Examiners of a State is complying with this paragraph 
        if, after receiving the list of physicians under paragraph 
        (4)(B), the Board promptly--
                    (A) identifies which of the physicians has had, for 
                purposes of paragraph (4), an incident in another 
                State, and
                    (B) requests from the Secretary (or the agency) 
                information reported under this part concerning each of 
                the physicians so identified.''.

SEC. 6. ADDITIONAL PROVISIONS REGARDING ACCESS TO INFORMATION; 
              MISCELLANEOUS PROVISIONS.

    (a) Access to Information.--Section 427(a) of the Health Care 
Quality Improvement Act of 1986 (42 U.S.C. 11137(a)) is amended to read 
as follows:
    ``(a) Access Regarding Licensing, Employment, and Clinical 
Privileges.--The Secretary (or the agency designated under section 
424(b)) shall, upon request, provide information reported under this 
part concerning a physician or other licensed health care practitioner 
to--
            ``(1) State licensing boards, and
            ``(2) hospitals and other health services organizations--
                    ``(A) that have entered (or may be entering) into 
                an employment or affiliation relationship with the 
                physician or practitioner, or
                    ``(B) to which the physician or practitioner has 
                applied for clinical privileges or appointment to the 
                medical staff.''.
    (b) Fees.--Section 427(b)(4) of the Health Care Quality Improvement 
Act of 1986 (42 U.S.C. 11137(b)(4)) is amended to read as follows:
            ``(4) Fees.--In disclosing information under subsection (a) 
        or section 426, the Secretary may impose fees in amounts 
        reasonably related to the costs of carrying out the duties of 
        the Secretary regarding the information reported under this 
        part (including the functions specified in section 424(b) with 
        respect to the information), except that a fee may not be 
        imposed for providing a list under section 425A(d)(4)(B) to any 
        Board of Medical Examiners. Such fees are available to the 
        Secretary (or, in the Secretary's discretion, to the agency 
        designated under section 424(b)) to cover such costs. Such fees 
        remain available until expended.''.
    (c) Additional Disclosures of Information.--Section 427 of the 
Health Care Quality Improvement Act of 1986 (42 U.S.C. 11137) is 
amended by adding at the end the following subsection:
    ``(e) Availability of Information to Public.--
            ``(1) In general.--Not later than 30 days after the 
        effective date for this subsection under section 9 of the 
        Health Care Quality Improvement Act Amendments of 1994, and 
        semiannually thereafter, the Secretary shall publish and make 
        available to the public the following information reported 
        under this part:
                    ``(A) Information reported under section 421, 
                excepting the following:
                            ``(i) Information concerning a physician or 
                        other licensed health care practitioner with 
                        respect to whom the number of discrete 
                        incidents on which information is required to 
                        be submitted under such section is 1.
                            ``(ii) The social security account number 
                        of the physician or practitioner.
                            ``(iii) Information disclosing the identity 
                        of any patient involved in such an incident.
                            ``(iv) With respect to information that the 
                        Secretary requires under section 421(b)(5)--
                                    ``(I) the home address of the 
                                physician or practitioner, and
                                    ``(II) the number assigned to the 
                                physician or practitioner by the Drug 
                                Enforcement Administration.
                            ``(v) Information not required to be 
                        reported under such section.
                    ``(B) Information reported under section 422(a).
                    ``(C) Information reported under section 423(b).
            ``(2) Dissemination; fees.--The Secretary shall disseminate 
        each publication under paragraph (1) to public libraries 
        without charge. In providing the publication to other entities, 
        the Secretary may impose a fee reasonably related to the costs 
        of the Secretary in carrying out this subsection. Such fees are 
        available to the Secretary (or, in the Secretary's discretion, 
        to the agency designated under section 424(b)) to cover such 
        costs. Such fees remain available until expended.''
    (d) Conforming Amendments.--Section 427 of the Health Care Quality 
Improvement Act of 1986 (42 U.S.C. 11137) is amended--
            (1) in subsection (b)(1), in the first sentence, by 
        striking ``Information reported'' and inserting the following: 
        ``Except for information disclosed under subsection (e), 
        information reported''; and
            (2) in the heading for the section, by striking 
        ``miscellaneous provisions'' and inserting the following: 
        ``additional provisions regarding access to information; 
        miscellaneous provisions''.

SEC. 7. OTHER MATTERS.

    The Health Care Quality Improvement Act of 1986 (42 U.S.C. 11101 et 
seq.) is amended--
            (1) by redesignating part C as part D; and
            (2) by inserting after part B the following part:

  ``PART C--OTHER MATTERS REGARDING IMPROVEMENT OF HEALTH CARE QUALITY

``SEC. 428. PROHIBITION AGAINST SETTLEMENT WITHOUT CONSENT OF 
              PRACTITIONER.

    ``(a) Prohibition.--With respect to a physician or other licensed 
health care practitioner whose acts or omissions are the basis of a 
medical malpractice action or claim, an entity may not make a payment 
described in section 421(a)(1) without the written consent of the 
physician or practitioner, subject to subsection (b).
    ``(b) Exceptions.--Subsection (a) shall not apply with respect to a 
payment by an entity regarding an action or claim, subject to 
subsection (c)--
            ``(1) if the payment is made in satisfaction of a judgment 
        in a court of competent jurisdiction,
            ``(2) if, with respect to the action or claim, the 
        physician or other licensed health care practitioner involved 
        enters a process of alternative dispute resolution, and the 
        process has been concluded or any of the individuals involved 
        has terminated participation in the process,
            ``(3)(A) the entity delivers directly, or makes a 
        reasonable effort to deliver through the mail, a written notice 
        to the physician or practitioner involved providing the 
        information specified in subsection (c), and
            ``(B) a 30-day period elapses, at the conclusion of which 
        the entity has a reasonable belief that the physician or 
        practitioner does not object to the payment.
    ``(c) Criteria Regarding Notice.--For purposes of subsection (b)(3) 
regarding a written notice to a physician or practitioner--
            ``(1) the notice shall be considered to have been delivered 
        if the notice was delivered to the home or business address of 
        the physician or practitioner, and to the attorney (if any) 
        representing the physician or practitioner in the action or 
        claim involved,
            ``(2) the notice shall be considered to have been delivered 
        directly if the notice was delivered personally by the entity 
        involved or by an agent of the entity,
            ``(3) the entity shall be considered to have made a 
        reasonable effort to deliver the notice through the mail if the 
        entity provided the notice through certified mail, with return 
        receipt requested,
            ``(4) the information specified in this paragraph for the 
        notice is that the entity intends to make the payment involved; 
        that the physician or practitioner has a legal right to 
        prohibit the payment; and that such right expires in 30 days, 
        with a specification of the date on which the right expires, 
        and
            ``(5) the 30-day period begins on the date on which the 
        notice is delivered directly to the physician or practitioner, 
        or on the seventh day after the date on which the notice is 
        posted, as the case may be.
    ``(d) Civil Money Penalty.--Any entity that makes a payment in 
violation of subsection (a) shall be subject to a civil money penalty 
of not more than $10,000 for each such payment involved. Such penalty 
shall be imposed and collected in the same manner as civil money 
penalties under subsection (a) of section 1128A of the Social Security 
Act are imposed and collected under that section.

``SEC. 429. EMPLOYMENT TERMINATION OF PHYSICIAN.

    ``(a) Requirement of Adequate Notice and Hearing.--
            ``(1) In general.--A health services organization may not 
        terminate the employment of a physician, and may not terminate 
        a contract with a physician for the provision of health 
        services, unless adequate notice and hearing procedures have 
        been afforded the physician involved.
            ``(2) Applicability.--Section 412(a)(3) applies in lieu of 
        paragraph (1) in the case of an employment termination that is 
        a professional review action. (With respect to the preceding 
        sentence, paragraph (1) does apply to an employment termination 
        that is an action described in subparagraph (A) of section 
        431(10) or in the other subparagraphs of such section.)
    ``(b) Safe Harbor.--
            ``(1) In general.--A health services organization is deemed 
        to have met the adequate notice and hearing requirement of 
        subsection (a) with respect to the employment of, or a contract 
        of, a physician if the conditions described in paragraphs (2) 
        through (4) are met (or are waived voluntarily by the 
        physician).
            ``(2) Notice of proposed action.--Conditions under 
        paragraph (1) are that the physician involved has been given 
        notice stating--
                    ``(A)(i) that the health services organization 
                proposes to take action to terminate the employment or 
                contract,
                    ``(ii) reasons for the proposed action,
                    ``(B)(i) that the physician has the right to 
                request a hearing on the proposed action,
                    ``(ii) any time limit (of not less than 30 days) 
                within which to request such a hearing, and
                    ``(C) a summary of the rights in the hearing under 
                paragraph (4).
            ``(3) Notice of hearing.--Conditions under paragraph (1) 
        are that, if a hearing is requested on a timely basis under 
        paragraph (2)(B), the physician involved must be given notice 
        stating--
                    ``(A) the place, time, and date, of the hearing, 
                which date shall not be less than 30 days after the 
                date of the notice, and
                    ``(B) a list of the witnesses (if any) expected to 
                testify at the hearing on behalf of the health services 
                organization.
            ``(4) Conduct of hearing and notice.--Conditions under 
        paragraph (1) are that, if a hearing is requested on a timely 
        basis under paragraph (2)(B)--
                    ``(A) subject to subparagraph (B), the hearing 
                shall be held (as determined by the health services 
                organization)--
                            ``(i) before an arbitrator mutually 
                        acceptable to the physician involved and the 
                        health services organization,
                            ``(ii) before a hearing officer who is 
                        appointed by the organization and who is not in 
                        direct economic competition with the physician, 
                        or
                            ``(iii) before a panel of individuals who 
                        are appointed by the organization and are not 
                        in direct economic competition with the 
                        physician,
                    ``(B) the right to the hearing may be forfeited if 
                the physician fails, without good cause, to appear,
                    ``(C) in the hearing the physician has the right--
                            ``(i) to representation by an attorney or 
                        other person of the physician's choice,
                            ``(ii) to have a record made of the 
                        proceedings, copies of which may be obtained by 
                        the physician upon payment of any reasonable 
                        charges associated with the preparation 
                        thereof,
                            ``(iii) to call, examine, and cross-examine 
                        witnesses,
                            ``(iv) to present evidence determined to be 
                        relevant by the hearing officer, regardless of 
                        its admissibility in a court of law, and
                            ``(v) to submit a written statement at the 
                        close of the hearing, and
                    ``(D) upon completion of the hearing, the physician 
                has the right--
                            ``(i) to receive the written recommendation 
                        of the arbitrator, officer, or panel, including 
                        a statement of the basis for the 
                        recommendations, and
                            ``(ii) to receive a written decision of the 
                        health services organization, including a 
                        statement of the basis for the decision.
    ``(c) Rule of Construction.--A health services organization's 
failure to meet the conditions described in paragraphs (2) through (4) 
of subsection (b) shall not, in itself, constitute failure to meet the 
standards of subsection (a).''.

SEC. 8. DEFINITIONS.

    Section 431(6) of the Health Care Quality Improvement Act of 1986, 
as redesignated by section 3(b)(1) of this Act, is amended by inserting 
before the period the following: ``(except that such term means an 
institution described in such paragraph (1) (without regard to such 
paragraph (7)) if, under applicable State or local law, the institution 
is permitted to operate without being licensed or otherwise approved as 
a hospital)''.

SEC. 9. EFFECTIVE DATES.

    (a) Incorporation of Text of Amendments.--The amendments described 
in this Act are made upon the date of the enactment of this Act.
    (b) Substantive Effect.--Except as provided in subsection (c)(1) 
and subsection (d), and except as otherwise provided in this Act--
            (1) the amendments made by this Act take effect upon the 
        expiration of the 1-year period beginning on the date of the 
        enactment of this Act; and
            (2) prior to the expiration of such period, the Health Care 
        Quality Improvement Act of 1986, as in effect on the day before 
        such date of enactment, continues in effect.
    (c) Regulations.--
            (1) In general.--With respect to the amendments made by 
        this Act, the Secretary of Health and Human Services may issue 
        regulations pursuant to such amendments before the expiration 
        of the period specified in subsection (b), and may otherwise 
        take appropriate action before the expiration of such period to 
        prepare for the responsibilities of the Secretary pursuant to 
        the amendments.
            (2) Absence of final rule.--The final rule for purposes of 
        paragraph (1) may not take effect before the expiration of the 
        period specified in subsection (b), and the absence of such a 
        rule upon such expiration does not affect the provisions of 
        subsection (b).
    (d) Transitional Provisions Regarding Malpractice Payments by 
Persons.--With respect to the reporting of information under section 
421 of the Health Care Quality Improvement Act of 1986, the following 
applies:
            (1) The requirement of reporting by persons under section 
        421(a)(1) of such Act (as amended by section 3(a) of this Act) 
        takes effect 180 days after the date of the enactment of this 
        Act.
            (2) The requirement of reporting by persons applies to 
        payments under such section 421(a)(1) made before, on, or after 
        such date of enactment.
            (3)(A) The information received by the Secretary of Health 
        and Human Services on or before August 27, 1993, pursuant to 
        regulations requiring reports from persons (in addition to 
        reports from entities) shall be maintained in the same manner 
        as the information was maintained prior to such date, and shall 
        be available in accordance with the regulations in effect under 
        such Act prior to such date (which regulations remain in effect 
        unless a provision of this Act takes effect pursuant to this 
        section and requires otherwise).
            (B) Subparagraph (A) takes effect on the date of the 
        enactment of this Act.

                                 <all>

HR 4274 1H----2
```