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104TH CONGRESS

1ST SESSION H. R. 2249

To amend the Social Security Act to require health maintenance organizations

under the medicare program to disclose to enrollees and potential enrollees certain information on the credentials of physicians providing services

by or through the organization, the financial status of the organization,

and the compensation paid to officers and executives of the organization.

IN THE HOUSE OF REPRESENTATIVES

AUGUST 4, 1995

Mr. SHAW introduced the following bill; which was referred to the Committee

on Ways and Means, 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 the Social Security Act to require health maintenance organizations under the medicare program to disclose to enrollees and potential enrollees certain information on the credentials of physicians providing services

by or through the organization, the financial status of

the organization, and the compensation paid to officers

and executives of the organization.

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

2 This Act may be cited as the ‘‘Medicare Managed

3 Health Care Sunshine Act of 1995’’.

4 SEC. 2. PROVIDING HMO ENROLLEES WITH CERTAIN IN5 FORMATION ON PLANS.

6 Section 1876(c) of the Social Security Act (42 U.S.C.

7 1395mm(c)) is amended by adding at the end the follow8 ing:

9 ‘‘(9)(A) Upon the request of a member enrolled with

10 the organization under this section, or an individual con11 sidering enrollment with the organization under this sec12 tion, the organization shall provide the enrollee or individ13 ual with the following:

14 ‘‘(i) Descriptive information regarding the cre15 dentials of each physician who is authorized by the

16 organization to provide services by or through the

17 organization to enrollees under this section, includ18 ing the medical education and training received by

19 the physician, the physician’s history of medical

20 practice (whether domestic or foreign), and the posi21 tions held by the physician at the time of the re22 quest.

23 ‘‘(ii) An audited financial statement of the or24 ganization for the most recently concluded fiscal

25 year that complies with generally accepted account26 ing principles and includes a balance sheet, income
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1 statement, and statement of changes in financial po2 sition.

3 ‘‘(iii) A statement identifying the salaries, bo4 nuses, and other remuneration paid to the 5 highest5 paid officers or executives of the organization, as

6 well as the other benefits provided to such officers

7 or executives.

8 ‘‘(B) The organization shall include in any brochure,

9 application form, or other promotional or informational

10 material that is distributed by the organization to (or for

11 the use of) individuals eligible to enroll with the organiza12 tion under this section a statement that the information

13 described in subparagraph (A) is available from the orga14 nization upon request.’’.

15 SEC. 3. EFFECTIVE DATE.

16 The amendment made by this Act shall apply with

17 respect to contract years beginning on or after the date

18 that is 6 months after the date of the enactment of this

19 Act.

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