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106TH CONGRESS

1ST SESSION H. R. 2044

To amend title I of the Employee Retirement Income Security Act of 1974

to provide to participants and beneficiaries of group health plans access

to pediatric care.

IN THE HOUSE OF REPRESENTATIVES

JUNE 8, 1999

Mr. SHERWOOD introduced the following bill; which was referred to the

Committee on Education and the Workforce

A BILL

To amend title I of the Employee Retirement Income Security Act of 1974 to provide to participants and beneficiaries of group health plans access to pediatric care.

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 ‘‘Patient Right to Pedi5 atric Care Act of 1999’’.

6 SEC. 2. PATIENT ACCESS TO PEDIATRIC CARE.

7 (a) IN GENERAL.—Subpart B of part 7 of subtitle

8 B of title I of the Employee Retirement Income Security
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1 Act of 1974 is amended by adding at the end the following

2 new section:

3 ‘‘SEC. 714. PATIENT ACCESS TO PEDIATRIC CARE.

4 ‘‘(a) IN GENERAL.—In any case in which a group

5 health plan (or a health insurance issuer offering health

6 insurance coverage in connection with the plan) provides

7 benefits consisting of routine pediatric care provided by

8 a participating physician who specializes in pediatrics (or

9 consisting of payment for such care) and the plan requires

10 or provides for designation by a participant or beneficiary

11 of a participating primary care provider, the plan (or

12 issuer) shall provide that such a participating physician

13 may be designated, if available, by a parent or guardian

14 of any beneficiary under the plan is who under 18 years

15 of age, as the primary care provider with respect to any

16 such benefits.

17 ‘‘(b) CONSTRUCTION.—Nothing in subsection (a)

18 shall waive any requirements of coverage relating to med19 ical necessity or appropriateness with respect to coverage

20 of pediatric care.

21 ‘‘(c) TREATMENT OF MULTIPLE COVERAGE OP22 TIONS.—In the case of a plan providing benefits under two

23 or more coverage options, the requirements of this section

24 shall apply separately with respect to each coverage op25 tion.’’.
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1 (b) CONFORMING AMENDMENT.—The table of con2 tents in section 1 of such Act is amended by adding at

3 the end of the items relating to subpart B of part 7 of

4 subtitle B of title I of such Act the following new item:

‘‘Sec. 714. Patient access to pediatric care.’’.

5 SEC. 3. EFFECTIVE DATE AND RELATED RULES.

6 (a) IN GENERAL.—The amendments made by this

7 Act shall apply with respect to plan years beginning on

8 or after January 1 of the second calendar year following

9 the date of the enactment of this Act, except that the Sec10 retary of Labor may issue regulations before such date

11 under such amendments. The Secretary shall first issue

12 regulations necessary to carry out the amendments made

13 by this Act before the effective date thereof.

14 (b) LIMITATION ON ENFORCEMENT ACTIONS.—No

15 enforcement action shall be taken, pursuant to the amend16 ments made by this Act, against a group health plan or

17 health insurance issuer with respect to a violation of a re18 quirement imposed by such amendments before the date

19 of issuance of regulations issued in connection with such

20 requirement, if the plan or issuer has sought to comply

21 in good faith with such requirement.

22 (c) SPECIAL RULE FOR COLLECTIVE BARGAINING

23 AGREEMENTS.—In the case of a group health plan main24 tained pursuant to one or more collective bargaining

25 agreements between employee representatives and one or
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1 more employers ratified before the date of the enactment

2 of this Act, the amendments made by this Act shall not

3 apply with respect to plan years beginning before the later

4 of—

5 (1) the date on which the last of the collective

6 bargaining agreements relating to the plan termi7 nates (determined without regard to any extension

8 thereof agreed to after the date of the enactment of

9 this Act); or

10 (2) January 1, 2002.

11 For purposes of this subsection, any plan amendment

12 made pursuant to a collective bargaining agreement relat13 ing to the plan which amends the plan solely to conform

14 to any requirement added by this Act shall not be treated

15 as a termination of such collective bargaining agreement.

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