I 

112TH CONGRESS 

1ST SESSION H. R. 1409 

To ensure and foster continued patient safety and quality of care by clarifying 

the application of the antitrust laws to negotiations between groups 

of health care professionals and health plans and health care insurance 

issuers. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 7, 2011 

Mr. CONYERS (for himself, Mr. PAUL, and Mr. MILLER of Florida) introduced 

the following bill; which was referred to the Committee on the Judiciary 

A BILL 

To ensure and foster continued patient safety and quality 

of care by clarifying the application of the antitrust 

laws to negotiations between groups of health care professionals and health plans and health care insurance 

issuers. 

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 ‘‘Quality Health Care 

5 Coalition Act of 2011’’. 


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1 SEC. 2. APPLICATION OF THE FEDERAL ANTITRUST LAWS 

2 TO HEALTH CARE PROFESSIONALS NEGOTI3 ATING WITH HEALTH PLANS. 

4 (a) IN GENERAL.—Any health care professionals who 

5 are engaged in negotiations with a health plan regarding 

6 the terms of any contract under which the professionals 

7 provide health care items or services for which benefits 

8 are provided under such plan shall, in connection with 

9 such negotiations, be exempt from the Federal antitrust 

10 laws. 

11 (b) LIMITATION.— 

12 (1) NO NEW RIGHT FOR COLLECTIVE CES13 SATION OF SERVICE.—The exemption provided in 

14 subsection (a) shall not confer any new right to par15 ticipate in any collective cessation of service to pa16 tients not already permitted by existing law. 

17 (2) NO CHANGE IN NATIONAL LABOR RELA18 TIONS ACT.—This section applies only to health care 

19 professionals excluded from the National Labor Re20 lations Act. Nothing in this section shall be con21 strued as changing or amending any provision of the 

22 National Labor Relations Act, or as affecting the 

23 status of any group of persons under that Act. 

24 (c) NO APPLICATION TO FEDERAL PROGRAMS.— 

25 Nothing in this section shall apply to negotiations between 


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1 health care professionals and health plans pertaining to 

2 benefits provided under any of the following: 

3 (1) The Medicare Program under title XVIII of 

4 the Social Security Act (42 U.S.C. 1395 et seq.). 

5 (2) The Medicaid program under title XIX of 

6 the Social Security Act (42 U.S.C. 1396 et seq.). 

7 (3) The SCHIP program under title XXI of the 

8 Social Security Act (42 U.S.C. 1397aa et seq.). 

9 (4) Chapter 55 of title 10, United States Code 

10 (relating to medical and dental care for members of 

11 the uniformed services). 

12 (5) Chapter 17 of title 38, United States Code 

13 (relating to Veterans’ medical care). 

14 (6) Chapter 89 of title 5, United States Code 

15 (relating to the Federal employees’ health benefits 

16 program). 

17 (7) The Indian Health Care Improvement Act 

18 (25 U.S.C. 1601 et seq.). 

19 SEC. 3. DEFINITIONS. 

20 In this Act, the following definitions shall apply: 

21 (1) ANTITRUST LAWS.—The term ‘‘antitrust 

22 laws’’— 

23 (A) has the meaning given it in subsection 

24 (a) of the first section of the Clayton Act (15 

25 U.S.C. 12(a)), except that such term includes 


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1 section 5 of the Federal Trade Commission Act 

2 (15 U.S.C. 45) to the extent such section ap3 plies to unfair methods of competition; and 

4 (B) includes any State law similar to the 

5 laws referred to in subparagraph (A). 

6 (2) GROUP HEALTH PLAN.—The term ‘‘group 

7 health plan’’ means an employee welfare benefit plan 

8 to the extent that the plan provides medical care (in9 cluding items and services paid for as medical care) 

10 to employees or their dependents (as defined under 

11 the terms of the plan) directly or through insurance, 

12 reimbursement, or otherwise. 

13 (3) GROUP HEALTH PLAN, HEALTH INSURANCE

14 ISSUER.—The terms ‘‘group health plan’’ and 

15 ‘‘health insurance issuer’’ include a third-party ad16 ministrator or other person acting for or on behalf 

17 of such plan or issuer. 

18 (4) HEALTH CARE SERVICES.—The term 

19 ‘‘health care services’’ means any services for which 

20 payment may be made under a health plan, includ21 ing services related to the delivery or administration 

22 of such services. 

23 (5) HEALTH CARE PROFESSIONAL.—The term 

24 ‘‘health care professional’’ means any individual or 

25 entity that provides health care items or services, 


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1 treatment, assistance with activities of daily living, 

2 or medications to patients and who, to the extent re3 quired by State or Federal law, possesses specialized 

4 training that confers expertise in the provision of 

5 such items or services, treatment, assistance, or 

6 medications. 

7 (6) HEALTH INSURANCE COVERAGE.—The term 

8 ‘‘health insurance coverage’’ means benefits con9 sisting of medical care (provided directly, through 

10 insurance or reimbursement, or otherwise and in11 cluding items and services paid for as medical care) 

12 under any hospital or medical service policy or cer13 tificate, hospital or medical service plan contract, or 

14 health maintenance organization contract offered by 

15 a health insurance issuer. 

16 (7) HEALTH INSURANCE ISSUER.—The term 

17 ‘‘health insurance issuer’’ means an insurance com18 pany, insurance service, or insurance organization 

19 (including a health maintenance organization) that 

20 is licensed to engage in the business of insurance in 

21 a State and that is subject to State law regulating 

22 insurance. Such term does not include a group 

23 health plan. 


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1 (8) HEALTH MAINTENANCE ORGANIZATION.— 

2 The term ‘‘health maintenance organization’’ 

3 means— 

4 (A) a federally qualified health mainte5 nance organization (as defined in section 

6 1301(a) of the Public Health Service Act (42 

7 U.S.C. 300e(a)); 

8 (B) an organization recognized under State 

9 law as a health maintenance organization; or 

10 (C) a similar organization regulated under 

11 State law for solvency in the same manner and 

12 to the same extent as such a health mainte13 nance organization. 

14 (9) HEALTH PLAN.—The term ‘‘health plan’’ 

15 means a group health plan or a health insurance 

16 issuer that is offering health insurance coverage. 

17 (10) MEDICAL CARE.—The term ‘‘medical 

18 care’’ means amounts paid for— 

19 (A) the diagnosis, cure, mitigation, treat20 ment, or prevention of disease, or amounts paid 

21 for the purpose of affecting any structure or 

22 function of the body; and 

23 (B) transportation primarily for and essen24 tial to receiving items and services referred to 

25 in subparagraph (A). 


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1 (11) PERSON.—The term ‘‘person’’ includes a 

2 State or unit of local government. 

3 (12) STATE.—The term ‘‘State’’ includes the 

4 several States, the District of Columbia, Puerto 

5 Rico, the Virgin Islands of the United States, Guam, 

6 American Samoa, and the Commonwealth of the 

7 Northern Mariana Islands. 

8 SEC. 4. EFFECTIVE DATE. 

9 This Act shall take effect on on the date of the enact10 ment of this Act and shall not apply with respect to con11 duct occurring before such date. 

Æ 


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