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Union Calendar No. 342

106TH CONGRESS

2D SESSION H. R. 1304

[Report No. 106–625]

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

the antitrust laws apply to negotiations between groups of health care

professionals and health plans and health insurance issuers in the same

manner as such laws apply to collective bargaining by labor organizations

under the National Labor Relations Act.

IN THE HOUSE OF REPRESENTATIVES

MARCH 25, 1999

Mr. CAMPBELL (for himself, Mr. CONYERS, Mr. MILLER of Florida, Mr.

HOEFFEL, Mr. BAKER, Mr. LAFALCE, Mr. COOKSEY, Mr. PALLONE, Mr.

NADLER, Mr. HORN, Mr. FROST, Mr. FILNER, Mr. BOUCHER, Mr.

WEXLER, Mr. SCARBOROUGH, Ms. SCHAKOWSKY, Mr. SHOWS, Mr.

SANDLIN, Mr. TOWNS, Mr. BLAGOJEVICH, Mr. BROWN of Ohio, Mr.

PAUL, Mr. COBURN, Mr. GANSKE, Mr. DELAHUNT, Mr. ROHRABACHER,

Mr. MCCOLLUM, and Mr. KLINK) introduced the following bill; which was

referred to the Committee on the Judiciary

MAY 18, 2000

Additional sponsors: Mr. NETHERCUTT, Ms. KILPATRICK, Ms. JACKSON-LEE

of Texas, Mr. DAVIS of Virginia, Ms. LOFGREN, Mr. NORWOOD, Mr.

SMITH of Texas, Ms. WOOLSEY, Mr. BONIOR, Mr. ANDREWS, Mr.

WHITFIELD, Mr. WAMP, Mr. DOOLITTLE, Mr. GOODE, Mr. KILDEE, Mr.

BARR of Georgia, Mr. DICKEY, Mr. BACHUS, Mr. LEACH, Mr. PICKERING, Mr. RAHALL, Mr. PORTER, Mr. SMITH of Michigan, Mr. THORNBERRY, Mr. DEAL of Georgia, Mr. BAIRD, Mrs. MCCARTHY of New York,

Mr. DIAZ-BALART, Mr. GEORGE MILLER of California, Mr. KOLBE, Mr.

ACKERMAN, Mr. MCGOVERN, Mr. WALSH, Mr. MCHUGH, Mr. FLETCHER, Mr. HANSEN, Mr. WELDON of Pennsylvania, Mr. RILEY, Ms. BALDWIN, Mr. THOMPSON of Mississippi, Mr. CANADY of Florida, Mr. RADANOVICH, Ms. DELAURO, Mr. MICA, Mr. PASCRELL, Mr. BERMAN, Mr.

LUCAS of Oklahoma, Mr. WELDON of Florida, Mr. BARTON of Texas, Ms.

PELOSI, Mrs. TAUSCHER, Mr. MANZULLO, Ms. HOOLEY of Oregon, Mr.

FARR of California, Mr. WEINER, Ms. STABENOW, Mr. FORD, Mr.
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THOMPSON of California, Mr. MALONEY of Connecticut, Mr. FORBES,

Mr. OWENS, Mr. SMITH of New Jersey, Mr. BOEHLERT, Mr. COOK, Mr.

MCNULTY, Ms. RIVERS, Mr. PETERSON of Minnesota, Mr. INSLEE, Mr.

OSE, Mr. GRAHAM, Mr. TURNER, Mr. ROTHMAN, Mr. DICKS, Mr. GARY

MILLER of California, Mr. HOLT, Mr. LOBIONDO, Mrs. MORELLA, Ms.

BERKLEY, Mr. PASTOR, Mr. GILMAN, Mr. BARCIA, Mr. WU, Mr. FRANKS

of New Jersey, Mrs. KELLY, Mr. LAMPSON, Mr. TIAHRT, Mr. SNYDER,

Mr. SHAW, Mr. ABERCROMBIE, Mr. MORAN of Virginia, Ms. MCCARTHY

of Missouri, Mr. PRICE of North Carolina, Mr. ISAKSON, Mr. MASCARA,

Mr. SCOTT, Mr. KENNEDY of Rhode Island, Ms. LEE, Mr. LEWIS of California, Mr. KIND, Ms. KAPTUR, Mr. WICKER, Mr. HOLDEN, Mr.

GILCHREST, Ms. ESHOO, Mr. DUNCAN, Mr. CLAY, Mr. TANCREDO, Mr.

NEY, Mr. MCINTOSH, Mr. JONES of North Carolina, Mr. BRADY of

Pennsylvania, Mr. CLYBURN, Mr. SAXTON, Mr. MATSUI, Ms. DANNER,

Mr. MCINTYRE, Mrs. CLAYTON, Ms. MCKINNEY, Mr. ISTOOK, Mr. HILL

of Montana, Mr. BISHOP, Mr. RODRIGUEZ, Mrs. MALONEY of New York,

Mr. WYNN, Mr. LUCAS of Kentucky, Mr. CUMMINGS, Mr. RYUN of Kansas, Mr. UDALL of New Mexico, Mr. VITTER, Mr. GORDON, Mr. PICKETT, Mr. WATKINS, Mr. VISCLOSKY, Mrs. LOWEY, Mr. WELLER, Mrs.

ROUKEMA, Mr. MORAN of Kansas, Mrs. EMERSON, Mr. FATTAH, Mr.

GIBBONS, Mr. UPTON, Mrs. CUBIN, Mr. MENENDEZ, Mr. PHELPS, Mr.

KUYKENDALL, Mr. DIXON, Mr. UDALL of Colorado, Mr. GILLMOR, Mr.

WISE, Mr. PAYNE, Mr. DEFAZIO, Mr. SAWYER, Mr. RANGEL, Mr.

SHIMKUS, Mr. METCALF, Mr. HALL of Ohio, Mr. SKELTON, Mr. CALVERT, Mr. KANJORSKI, Mr. BORSKI, Mr. LATOURETTE, Mr. ENGEL, Mr.

POMBO, Mr. CAMP, Mrs. WILSON, Mr. KUCINICH, Mr. TRAFICANT, Mr.

HEFLEY, Mr. ADERHOLT, Ms. DEGETTE, Mr. GUTIERREZ, Mr. DOYLE,

Mr. HILLIARD, Mr. EVANS, Mr. CRAMER, Mr. MURTHA, Mr. SANDERS,

Mr. EVERETT, Mr. HINOJOSA, Mr. MCDERMOTT, Mr. GALLEGLY, Mrs.

JONES of Ohio, Mrs. NAPOLITANO, Mr. STENHOLM, Mr. BACA, Ms. CARSON, Mr. BOSWELL, Mr. DINGELL, Mr. MEEKS of New York, Mr. PETRI,

Mr. STRICKLAND, Mr. COYNE, Mr. HASTINGS of Florida, Mr. LEWIS of

Georgia, and Mr. ENGLISH

Deleted sponsors: Mr. COBURN (added March 25, 1999; deleted October 14,

1999), and Mr. DELAHUNT (added March 25, 1999; deleted March 1, 2000)

MAY 18, 2000

Reported with an amendment, committed to the Committee of the Whole

House on the State of the Union, and ordered to be printed

[Strike out all after the enacting clause and insert the part printed in italic]

[For text of introduced bill, see copy of bill as introduced on March 25, 1999]

A BILL

To ensure and foster continued patient safety and quality
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of care by making the antitrust laws apply to negotiations between groups of health care professionals and

health plans and health insurance issuers in the same

manner as such laws apply to collective bargaining by

labor organizations under the National Labor Relations

Act.

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 2000’’.

6 SEC. 2. APPLICATION OF THE ANTITRUST LAWS TO HEALTH

7 CARE PROFESSIONALS NEGOTIATING WITH

8 HEALTH PLANS.

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

10 are engaged in negotiations with a health plan regarding

11 the terms of any contract under which the professionals pro12 vide health care items or services for which benefits are pro13 vided under such plan shall, in connection with such nego14 tiations, be entitled to the same treatment under the anti15 trust laws as the treatment to which bargaining units which

16 are recognized under the National Labor Relations Act are

17 entitled in connection with such collective bargaining. Such

18 a professional shall, only in connection with such negotia19 tions, be treated as an employee engaged in concerted activi20 ties and shall not be regarded as having the status of an
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1 employer, independent contractor, managerial employee, or

2 supervisor.

3 (b) PROTECTION FOR GOOD FAITH ACTIONS.—Actions

4 taken in good faith reliance on subsection (a) shall not be

5 the subject under the antitrust laws of criminal sanctions

6 nor of any civil damages, fees, or penalties beyond actual

7 damages incurred.

8 (c) LIMITATION.—

9 (1) NO NEW RIGHT FOR COLLECTIVE CESSATION

10 OF SERVICE.—The exemption provided in subsection

11 (a) shall not confer any new right to participate in

12 any collective cessation of service to patients not al13 ready permitted by existing law.

14 (2) NO CHANGE IN NATIONAL LABOR RELATIONS

15 ACT.— This section applies only to health care profes16 sionals excluded from the National Labor Relations

17 Act. Nothing in this section shall be construed as

18 changing or amending any provision of the National

19 Labor Relations Act, or as affecting the status of any

20 group of persons under that Act.

21 (d) 3-YEAR SUNSET.—The exemption provided in sub22 section (a) shall only apply to conduct occurring during

23 the 3-year period beginning on the date of the enactment

24 of this Act and shall continue to apply for 1 year after the
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1 end of such period to contracts entered into before the end

2 of such period.

3 (e) LIMITATION ON EXEMPTION.—Nothing in this sec4 tion shall exempt from the application of the antitrust laws

5 any agreement or otherwise unlawful conspiracy that ex6 cludes, limits the participation or reimbursement of, or oth7 erwise limits the scope of services to be provided by any

8 health care professional or group of health care professionals

9 with respect to the performance of services that are within

10 their scope of practice as defined or permitted by relevant

11 law or regulation.

12 (f) NO EFFECT ON TITLE VI OF CIVIL RIGHTS ACT

13 OF 1964.—Nothing in this section shall be construed to af14 fect the application of title VI of the Civil Rights Act of

15 1964.

16 (g) NO APPLICATION TO FEDERAL PROGRAMS.—Noth17 ing in this section shall apply to negotiations between

18 health care professionals and health plans pertaining to

19 benefits provided under any of the following:

20 (1) The medicare program under title XVIII of

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

22 (2) The medicaid program under title XIX of the

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

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

25 Social Security Act (42 U.S.C. 1397aa et seq.).
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1 (4) Chapter 55 of title 10, United States Code

2 (relating to medical and dental care for members of

3 the uniformed services).

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

5 (relating to Veterans’ medical care).

6 (6) Chapter 89 of title 5, United States Code (re7 lating to the Federal employees’ health benefits pro8 gram).

9 (7) The Indian Health Care Improvement Act

10 (25 U.S.C. 1601 et seq.).

11 (h) GENERAL ACCOUNTING OFFICE STUDY AND RE12 PORT.—The Comptroller General of the United States shall

13 conduct a study on the impact of enactment of this section

14 during the 6-month period beginning with the third year

15 of the 3-year period described in subsection (d). Not later

16 than the end of such 6-month period the Comptroller Gen17 eral shall submit to Congress a report on such study and

18 shall include in the report such recommendations on the

19 extension of this section (and changes that should be made

20 in making such extension) as the Comptroller General

21 deems appropriate.

22 (i) DEFINITIONS.—For purposes of this section:

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

24 laws’’—
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1 (A) has the meaning given it in subsection

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

3 U.S.C. 12(a)), except that such term includes sec4 tion 5 of the Federal Trade Commission Act (15

5 U.S.C. 45) to the extent such section 5 applies to

6 unfair methods of competition, and

7 (B) includes any State law similar to the

8 laws referred to in subparagraph (A).

9 (2) HEALTH PLAN AND RELATED TERMS.—

10 (A) IN GENERAL.—The term ‘‘health plan’’

11 means a group health plan or a health insurance

12 issuer that is offering health insurance coverage.

13 (B) HEALTH INSURANCE COVERAGE;

14 HEALTH INSURANCE ISSUER.—The terms ‘‘health

15 insurance coverage’’ and ‘‘health insurance

16 issuer’’ have the meanings given such terms

17 under paragraphs (1) and (2), respectively, of

18 section 733(b) of the Employee Retirement In19 come Security Act of 1974 (29 U.S.C. 1191b(b)).

20 (C) GROUP HEALTH PLAN.—The term

21 ‘‘group health plan’’ has the meaning given that

22 term in section 733(a)(1) of the Employee Re23 tirement Income Security Act of 1974 (29 U.S.C.

24 1191b(a)(1)).
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1 (3) HEALTH CARE PROFESSIONAL.—The term

2 ‘‘health care professional’’ means an individual who

3 provides health care items or services, treatment, as4 sistance with activities of daily living, or medications

5 to patients and who, to the extent required by State

6 or Federal law, possesses specialized training that

7 confers expertise in the provision of such items or

8 services, treatment, assistance, or medications.

Union Calendar No. 342

106TH CONGRESS

2D SESSION H. R. 1304

[Report No. 106–625]

A BILL

To ensure and foster continued patient safety and

quality of care by making the antitrust lawsapply to negotiations between groups of healthcare professionals and health plans and healthinsurance issuers in the same manner as suchlaws apply to collective bargaining by labor organizations under the National Labor RelationsAct.

MAY 18, 2000

Reported with an amendment, committed to the Committee of the Whole House on the State of the Union,

and ordered to be printed