I

106TH CONGRESS

1ST SESSION H. R. 2043

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 unrestricted medical advice.

IN THE HOUSE OF REPRESENTATIVES

JUNE 8, 1999

Mrs. KELLY 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 unrestricted

medical advice.

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 Unre5 stricted Medical Advice Act of 1999’’.
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1 SEC. 2. PATIENT ACCESS TO UNRESTRICTED MEDICAL AD2 VICE.

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

4 B of title I of the Employee Retirement Income Security

5 Act of 1974 is amended by adding at the end the following

6 new section:

7 ‘‘SEC. 714. PATIENT ACCESS TO UNRESTRICTED MEDICAL

8 ADVICE.

9 ‘‘(a) IN GENERAL.—In the case of any health care

10 professional acting within the lawful scope of practice in

11 the course of carrying out a contractual employment ar12 rangement or other direct contractual arrangement be13 tween such professional and a group health plan or a

14 health insurance issuer offering health insurance coverage

15 in connection with a group health plan, the plan or issuer

16 with which such contractual employment arrangement or

17 other direct contractual arrangement is maintained by the

18 professional may not impose on such professional under

19 such arrangement any prohibition or restriction with re20 spect to advice, provided to a participant or beneficiary

21 under the plan who is a patient, about the health status

22 of the participant or beneficiary or the medical care or

23 treatment for the condition or disease of the participant

24 or beneficiary, regardless of whether benefits for such care

25 or treatment are provided under the plan or health insur26 ance coverage offered in connection with the plan.
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1 ‘‘(b) HEALTH CARE PROFESSIONAL DEFINED.—For

2 purposes of this section, the term ‘health care professional’

3 means a physician (as defined in section 1861(r) of the

4 Social Security Act) or other health care professional if

5 coverage for the professional’s services is provided under

6 the group health plan for the services of the professional.

7 Such term includes a podiatrist, optometrist, chiropractor,

8 psychologist, dentist, physician assistant, physical or occu9 pational therapist and therapy assistant, speech-language

10 pathologist, audiologist, registered or licensed practical

11 nurse (including nurse practitioner, clinical nurse spe12 cialist, certified registered nurse anesthetist, and certified

13 nurse-midwife), licensed certified social worker, registered

14 respiratory therapist, and certified respiratory therapy

15 technician.’’.

16 (b) CONFORMING AMENDMENT.—The table of con17 tents in section 1 of such Act is amended by adding at

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

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

‘‘Sec. 714. Patient access to unrestricted medical advice.’’.

20 SEC. 3. EFFECTIVE DATE AND RELATED RULES.

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

22 Act shall apply with respect to plan years beginning on

23 or after January 1 of the second calendar year following

24 the date of the enactment of this Act, except that the Sec25 retary of Labor may issue regulations before such date
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1 under such amendments. The Secretary shall first issue

2 regulations necessary to carry out the amendments made

3 by this Act before the effective date thereof.

4 (b) LIMITATION ON ENFORCEMENT ACTIONS.—No

5 enforcement action shall be taken, pursuant to the amend6 ments made by this Act, against a group health plan or

7 health insurance issuer with respect to a violation of a re8 quirement imposed by such amendments before the date

9 of issuance of regulations issued in connection with such

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

11 in good faith with such requirement.

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