II 

111TH CONGRESS 

2D SESSION S. 2997 

To amend title XVIII of the Social Security Act to provide for the update 

under the Medicare physician fee schedule for years beginning with 

2010 and to sunset the application of the sustainable growth rate formula, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 4, 2010 

Mr. WICKER introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for the update under the Medicare physician fee schedule 

for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for 

other purposes. 

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

3 TITLE I—PHYSICIAN PAYMENT 

4 UPDATE COMMISSION 

5 SECTION 1. SHORT TITLE. 

6 This title may be cited as the ‘‘Physician Payment 

7 Update Commission Act’’. 

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1 SEC. 2. ESTABLISHMENT OF PHYSICIAN PAYMENT UPDATE 

2 COMMISSION. 

3 (a) MEDICARE PHYSICIAN FEE SCHEDULE UPDATE

4 AND SUNSET OF MEDICARE SUSTAINABLE GROWTH RATE

5 FORMULA.— 

6 (1) UPDATE FOR 2010 AND 2011.—Section 

7 1848(d)(10) of the Social Security Act (42 U.S.C. 

8 1395w–4(d)(10)) is amended to read as follows: 

9 ‘‘(10) UPDATE FOR 2010 AND 2011.— 

10 ‘‘(A) IN GENERAL.—The update to the sin11 gle conversion factor established in paragraph 

12 (1)(C) for 2010 and 2011 shall be 0 percent. 

13 ‘‘(B) NO EFFECT ON COMPUTATION OF

14 CONVERSION FACTOR FOR 2012 AND SUBSE15 QUENT YEARS.—The conversion factor under 

16 this subsection shall be computed under para17 graph (1)(A) for 2012 and subsequent years as 

18 if subparagraph (A) had never applied.’’. 

19 (2) SUNSET OF MEDICARE SUSTAINABLE

20 GROWTH RATE FORMULA.—Effective January 1, 

21 2012, subsection (f) of section 1848 of the Social 

22 Security Act (42 U.S.C. 1395w–4) is repealed. 

23 (b) ESTABLISHMENT OF PHYSICIAN PAYMENT UP24 DATE COMMISSION.— 

25 (1) IN GENERAL.—There is established a com26 mission to be known as the ‘‘Physician Payment Upmstockstill on DSKH9S0YB1PROD with BILLS

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1 date Commission’’ (referred to in this section as the 

2 ‘‘Commission’’). 

3 (2) MEMBERSHIP.— 

4 (A) COMPOSITION.—The Commission shall 

5 be composed of 17 members appointed by the 

6 Comptroller General of the United States, upon 

7 the recommendation of the majority and minor8 ity leaders of the Senate and the Speaker and 

9 minority leader of the House of Representa10 tives. 

11 (B) DATE OF APPOINTMENTS.—Members 

12 of the Commission shall be appointed not later 

13 than 2 months after the date of enactment of 

14 this Act. 

15 (3) QUALIFICATIONS.— 

16 (A) IN GENERAL.—The membership of the 

17 Commission shall include individuals with na18 tional recognition for their expertise in health 

19 finance and economics, actuarial science, inte20 grated delivery systems, allopathic and osteo21 pathic medicine and other areas of health serv22 ices, and other related fields, who provide a mix 

23 of different professionals, broad geographic rep24 resentation, and a balance between urban and 

25 rural representatives. 

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1 (B) INCLUSION.—The members of the 

2 Commission shall include (but not be limited to) 

3 physicians and other health professionals, em4 ployers, third-party payers, individuals skilled 

5 in the conduct and interpretation of biomedical, 

6 health services, and health economics research 

7 and technology assessment. Such membership 

8 shall also include representatives of consumers 

9 and the elderly. 

10 (C) MAJORITY PHYSICIANS AND OTHER

11 HEALTH PROFESSIONALS.—Individuals who are 

12 physicians or other health professionals shall 

13 constitute a majority of the membership of the 

14 Commission. 

15 (4) TERM; VACANCIES.— 

16 (A) TERM.—A member shall be appointed 

17 for the life of the Commission. 

18 (B) VACANCIES.—A vacancy on the Com19 mission— 

20 (i) shall not affect the powers of the 

21 Commission; and 

22 (ii) shall be filled in the same manner 

23 as the original appointment was made. 

24 (5) MEETINGS.—The Commission shall meet at 

25 the call of the Chairperson. 

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1 (6) QUORUM.—A majority of the members of 

2 the Commission shall constitute a quorum, but a 

3 lesser number of members may hold hearings. 

4 (7) CHAIRPERSON.—The Comptroller General 

5 shall designate a member of the Commission, at the 

6 time of the appointment of the member, as Chair7 person. 

8 (c) DUTIES.— 

9 (1) STUDY.—The Commission shall conduct a 

10 study of all matters relating to payment rates under 

11 the Medicare physician fee schedule under section 

12 1848 of the Social Security Act (42 U.S.C. 1395w– 

13 4). 

14 (2) RECOMMENDATIONS.—The Commission 

15 shall develop recommendations on the establishment 

16 of a new physician payment system under the Medi17 care program that would appropriately reimburse 

18 physicians by keeping pace with increases in medical 

19 practice costs and providing stable, positive Medicare 

20 updates. 

21 (3) REPORT.—Not later than December 1, 

22 2010, the Commission shall submit to the appro23 priate Committees of Congress and the Medicare 

24 Payment Advisory Commission— 

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1 (A) a detailed statement of the findings 

2 and conclusions of the Commission; 

3 (B) the recommendations of the Commis4 sion for such legislation and administrative ac5 tions as the Commission considers appropriate 

6 (including proposed legislative language to carry 

7 out such recommendations); and 

8 (C) a long-term CBO cost estimate regard9 ing such recommendations (as described under 

10 subsection (i)). 

11 (d) POWERS.— 

12 (1) HEARINGS.—The Commission may hold 

13 such hearings, meet and act at such times and 

14 places, take such testimony, and receive such evi15 dence as the Commission considers advisable to 

16 carry out this section. 

17 (2) INFORMATION FROM FEDERAL AGENCIES.— 

18 (A) IN GENERAL.—The Commission may 

19 secure directly from a Federal agency such in20 formation as the Commission considers nec21 essary to carry out this section. 

22 (B) PROVISION OF INFORMATION.—On re23 quest of the Chairperson of the Commission, 

24 the head of the agency shall provide the infor25 mation to the Commission. 

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1 (3) POSTAL SERVICES.—The Commission may 

2 use the United States mails in the same manner and 

3 under the same conditions as other agencies of the 

4 Federal Government. 

5 (e) COMMISSION PERSONNEL MATTERS.— 

6 (1) COMPENSATION OF MEMBERS.— 

7 (A) IN GENERAL.—Members of the Com8 mission shall serve without compensation in ad9 dition to the compensation received for the serv10 ices of the member as an officer or employee of 

11 the Federal Government. 

12 (B) TRAVEL EXPENSES.—A member of the 

13 Commission shall be allowed travel expenses, in14 cluding per diem in lieu of subsistence, at rates 

15 authorized for an employee of an agency under 

16 subchapter I of chapter 57 of title 5, United 

17 States Code, while away from the home or reg18 ular place of business of the member in the per19 formance of the duties of the Commission. 

20 (2) STAFF AND SUPPORT SERVICES.— 

21 (A) EXECUTIVE DIRECTOR.—The Chair22 person shall appoint an executive director of the 

23 Commission. 

24 (B) STAFF.—With the approval of the 

25 Commission, the executive director may appoint 

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1 such personnel as the executive director con2 siders appropriate. 

3 (C) APPLICABILITY OF CIVIL SERVICE

4 LAWS.—The staff of the Commission shall be 

5 appointed without regard to the provisions of 

6 title 5, United States Code, governing appoint7 ments in the competitive service, and shall be 

8 paid without regard to the provisions of chapter 

9 51 and subchapter III of chapter 53 of such 

10 title (relating to classification and General 

11 Schedule pay rates). 

12 (D) EXPERTS AND CONSULTANTS.—With 

13 the approval of the Commission, the executive 

14 director may procure temporary and intermit15 tent services under section 3109(b) of title 5, 

16 United States Code. 

17 (f) TERMINATION OF COMMISSION.—The Commis18 sion shall terminate 30 days after the date on which the 

19 Commission submits its report under subsection (c)(3). 

20 (g) REVIEW AND RESPONSE TO RECOMMENDATIONS

21 BY THE MEDICARE PAYMENT ADVISORY COMMISSION.— 

22 (1) IN GENERAL.—Not later than February 1, 

23 2011, the Medicare Payment Advisory Commission 

24 shall— 

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1 (A) review the recommendations included 

2 in the report submitted under subsection (c)(3); 

3 (B) examine the budget consequences of 

4 such recommendations, directly or through con5 sultation with appropriate expert entities; and 

6 (C) submit to the appropriate Committees 

7 of Congress a report on such review. 

8 (2) CONTENTS OF REPORT ON REVIEW OF COM9 MISSION RECOMMENDATIONS.—The report sub10 mitted under paragraph (1)(C) shall include— 

11 (A) if the Medicare Payment Advisory 

12 Commission supports the recommendations of 

13 the Commission, the reasons for such support; 

14 or 

15 (B) if the Medicare Payment Advisory 

16 Commission does not support such rec17 ommendations, the recommendations of the 

18 Medicare Payment Advisory Commission, to19 gether with an explanation as to why the Medi20 care Payment Advisory Commission does not 

21 support the recommendations of the Commis22 sion. 

23 (h) AUTHORIZATION OF APPROPRIATIONS.—There 

24 are authorized to be appropriated such sums as may be 

25 necessary for the Commission to carry out this section. 

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1 Such appropriation shall be payable from the Federal Sup2 plementary Medical Insurance Trust Fund under section 

3 1841 of the Social Security Act (42 U.S.C. 1395t). 

4 (i) LONG-TERM CBO COST ESTIMATE.— 

5 (1) PREPARATION AND SUBMISSION.—When 

6 the Commission submits a written request to the Di7 rector of the Congressional Budget Office for a long8 term CBO cost estimate of recommended legislation 

9 or administrative actions (as described under sub10 section (c)(3)), the Director shall prepare the esti11 mate and have it published in the Congressional 

12 Record as expeditiously as possible. 

13 (2) CONTENT.—A long-term CBO cost estimate 

14 shall include— 

15 (A) an estimate of the cost of each provi16 sion (if practicable) or group of provisions of 

17 the recommended legislation or administrative 

18 actions for first fiscal year it would take effect 

19 and for each of the 49 fiscal years thereafter; 

20 and 

21 (B) a statement of any estimated future 

22 costs not reflected by the estimate described in 

23 subparagraph (A). 

24 (3) FORM.—To the extent that a long-term 

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1 cable, the Director of the Congressional Budget Of2 fice may instead present the estimate in terms of 

3 percentages of gross domestic product, with rounding to the nearest 1 4 ⁄10 of 1 percent of gross domestic 

5 product. 

6 (4) LIMITATIONS ON DISCRETIONARY SPEND7 ING.—A long-term CBO cost estimate shall only 

8 consider the effects of provisions affecting revenues 

9 and direct spending (as defined by the Balanced 

10 Budget and Emergency Deficit Control Act of 

11 1985), and shall not assume that any changes in 

12 outlays will result from limitations on, or reductions 

13 in, annual appropriations. 

14 (j) EXPEDITED CONSIDERATION OF COMMISSION

15 RECOMMENDATIONS.— 

16 (1) INTRODUCTION.— 

17 (A) IN GENERAL.—The proposed legisla18 tive language contained in the report submitted 

19 pursuant to subsection (c)(3) (referred to in 

20 this subsection as the ‘‘Commission bill’’) shall 

21 be introduced within the first 10 calendar days 

22 of the 112th Congress (or on the first session 

23 day thereafter) in the House of Representatives 

24 and in the Senate by the majority leader of 

25 each House of Congress, for himself, the minormstockstill on DSKH9S0YB1PROD with BILLS

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1 ity leader of each House of Congress, for him2 self, or any member of the House designated by 

3 the majority leader or minority leader. If the 

4 Commission bill is not introduced in accordance 

5 with the preceding sentence in either House of 

6 Congress, then any Member of that House may 

7 introduce the Commission bill on any day there8 after. Upon introduction, the Commission bill 

9 shall be referred to the appropriate committees 

10 under subparagraph (B). 

11 (B) COMMITTEE CONSIDERATION.—A 

12 Commission bill introduced in either House of 

13 Congress shall be jointly referred to the com14 mittee or committees of jurisdiction, which shall 

15 report the bill without any revision and with a 

16 favorable recommendation, an unfavorable rec17 ommendation, or without recommendation, not 

18 later than 10 calendar days after the date of in19 troduction of the bill in that House. If any com20 mittee fails to report the bill within that period, 

21 that committee shall be automatically dis22 charged from consideration of the bill, and the 

23 bill shall be placed on the appropriate calendar. 

24 (2) EXPEDITED PROCEDURE.— 

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1 (A) IN THE HOUSE OF REPRESENTA2 TIVES.— 

3 (i) IN GENERAL.—Not later than 5 

4 days of session after the date on which a 

5 Commission bill is reported or discharged 

6 from all committees to which it was re7 ferred, the majority leader of the House of 

8 Representatives or the majority leader’s 

9 designee shall move to proceed to the con10 sideration of the Commission bill. It shall 

11 also be in order for any Member of the 

12 House of Representatives to move to pro13 ceed to the consideration of the Commis14 sion bill at any time after the conclusion of 

15 such 5-day period. 

16 (ii) MOTION TO PROCEED.—A motion 

17 to proceed to the consideration of the Com18 mission bill is highly privileged in the 

19 House of Representatives and is not debat20 able. The motion is not subject to amend21 ment or to a motion to postpone consider22 ation of the Commission bill. A motion to 

23 proceed to the consideration of other busi24 ness shall not be in order. A motion to re25 consider the vote by which the motion to 

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1 proceed is agreed to or not agreed to shall 

2 not be in order. If the motion to proceed 

3 is agreed to, the House of Representatives 

4 shall immediately proceed to consideration 

5 of the Commission bill without intervening 

6 motion, order, or other business, and the 

7 Commission bill shall remain the unfin8 ished business of the House of Representa9 tives until disposed of. 

10 (iii) LIMITS ON DEBATE.—Debate in 

11 the House of Representatives on a Com12 mission bill under this paragraph shall not 

13 exceed a total of 100 hours, which shall be 

14 divided equally between those favoring and 

15 those opposing the bill. A motion further 

16 to limit debate is in order and shall not be 

17 debatable. It shall not be in order to move 

18 to recommit a Commission bill under this 

19 paragraph or to move to reconsider the 

20 vote by which the bill is agreed to or dis21 agreed to. 

22 (iv) APPEALS.—Appeals from deci23 sions of the chair relating to the applica24 tion of the Rules of the House of Rep25 resentatives to the procedure relating to a 

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1 Commission bill shall be decided without 

2 debate. 

3 (v) APPLICATION OF HOUSE RULES.— 

4 Except to the extent specifically provided 

5 in this paragraph, consideration of a Com6 mission bill shall be governed by the Rules 

7 of the House of Representatives. It shall 

8 not be in order in the House of Represent9 atives to consider any Commission bill in10 troduced pursuant to the provisions of this 

11 subsection under a suspension of the rules 

12 or under a special rule. 

13 (vi) NO AMENDMENTS.—No amend14 ment to the Commission bill shall be in 

15 order in the House of Representatives. 

16 (vii) VOTE ON FINAL PASSAGE.—In 

17 the House of Representatives, immediately 

18 following the conclusion of consideration of 

19 the Commission bill, the vote on final pas20 sage of the Commission bill shall occur 

21 without any intervening action or motion, 

requiring an affirmative vote of 3 22 ⁄5 of the 

23 Members, duly chosen and sworn. If the 

24 Commission bill is passed, the Clerk of the 

25 House of Representatives shall cause the 

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1 bill to be transmitted to the Senate before 

2 the close of the next day of session of the 

3 House. 

4 (B) IN THE SENATE.— 

5 (i) IN GENERAL.—Not later than 5 

6 days of session after the date on which a 

7 Commission bill is reported or discharged 

8 from all committees to which it was re9 ferred, the majority leader of the Senate or 

10 the majority leader’s designee shall move 

11 to proceed to the consideration of the Com12 mission bill. It shall also be in order for 

13 any Member of the Senate to move to pro14 ceed to the consideration of the Commis15 sion bill at any time after the conclusion of 

16 such 5-day period. 

17 (ii) MOTION TO PROCEED.—A motion 

18 to proceed to the consideration of the Com19 mission bill is privileged in the Senate and 

20 is not debatable. The motion is not subject 

21 to amendment or to a motion to postpone 

22 consideration of the Commission bill. A 

23 motion to proceed to consideration of the 

24 Commission bill may be made even though 

25 a previous motion to the same effect has 

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1 been disagreed to. A motion to proceed to 

2 the consideration of other business shall 

3 not be in order. A motion to reconsider the 

4 vote by which the motion to proceed is 

5 agreed to or not agreed to shall not be in 

6 order. If the motion to proceed is agreed 

7 to, the Senate shall immediately proceed to 

8 consideration of the Commission bill with9 out intervening motion, order, or other 

10 business, and the Commission bill shall re11 main the unfinished business of the Senate 

12 until disposed of. 

13 (iii) LIMITS ON DEBATE.—In the Sen14 ate, consideration of the Commission bill 

15 and on all debatable motions and appeals 

16 in connection therewith shall not exceed a 

17 total of 100 hours, which shall be divided 

18 equally between those favoring and those 

19 opposing the Commission bill. A motion 

20 further to limit debate on the Commission 

21 bill is in order and is not debatable. Any 

22 debatable motion or appeal is debatable for 

23 not to exceed 1 hour, to be divided equally 

24 between those favoring and those opposing 

25 the motion or appeal. All time used for 

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1 consideration of the Commission bill, in2 cluding time used for quorum calls and 

3 voting, shall be counted against the total 

4 100 hours of consideration. 

5 (iv) NO AMENDMENTS.—No amend6 ment to the Commission bill shall be in 

7 order in the Senate. 

8 (v) MOTION TO RECOMMIT.—A motion 

9 to recommit a Commission bill shall not be 

10 in order under this paragraph. 

11 (vi) VOTE ON FINAL PASSAGE.—In 

12 the Senate, immediately following the con13 clusion of consideration of the Commission 

14 bill and a request to establish the presence 

15 of a quorum, the vote on final passage of 

16 the Commission bill shall occur and shall 

require an affirmative vote of 3 17 ⁄5 of the 

18 Members, duly chosen and sworn. 

19 (vii) OTHER MOTIONS NOT IN

20 ORDER.—A motion to postpone or a mo21 tion to proceed to the consideration of 

22 other business is not in order in the Sen23 ate. A motion to reconsider the vote by 

24 which the Commission bill is agreed to or 

25 not agreed to is not in order in the Senate. 

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1 (viii) CONSIDERATION OF THE HOUSE

2 BILL.— 

3 (I) IN GENERAL.—If the Senate 

4 has received the House companion bill 

5 to the Commission bill introduced in 

6 the Senate prior to the vote required 

7 under clause (vi) and the House com8 panion bill is identical to the Commis9 sion bill introduced in the Senate, 

10 then the Senate shall consider, and 

11 the vote under clause (vi) shall occur 

12 on, the House companion bill. 

13 (II) PROCEDURE AFTER VOTE ON

14 SENATE BILL.—If the Senate votes, 

15 pursuant to clause (vi), on the bill in16 troduced in the Senate, the Senate bill 

17 shall be held pending receipt of the 

18 House message on the bill. Upon re19 ceipt of the House companion bill, if 

20 the House bill is identical to the Sen21 ate bill, the House bill shall be 

22 deemed to be considered, read for the 

23 third time, and the vote on passage of 

24 the Senate bill shall be considered to 

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1 be the vote on the bill received from 

2 the House. 

3 (C) NO SUSPENSION.—No motion to sus4 pend the application of this paragraph shall be 

5 in order in the Senate or in the House of Rep6 resentatives. 

7 TITLE II—MEDICAL CARE 

8 ACCESS PROTECTION 

9 SEC. 101. SHORT TITLE. 

10 This title may be cited as the ‘‘Medical Care Access 

11 Protection Act of 2009’’ or the ‘‘MCAP Act’’. 

12 SEC. 102. FINDINGS AND PURPOSE. 

13 (a) FINDINGS.— 

14 (1) EFFECT ON HEALTH CARE ACCESS AND

15 COSTS.—Congress finds that our current civil justice 

16 system is adversely affecting patient access to health 

17 care services, better patient care, and cost-efficient 

18 health care, in that the health care liability system 

19 is a costly and ineffective mechanism for resolving 

20 claims of health care liability and compensating in21 jured patients, and is a deterrent to the sharing of 

22 information among health care professionals which 

23 impedes efforts to improve patient safety and quality 

24 of care. 

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1 (2) EFFECT ON INTERSTATE COMMERCE.— 

2 Congress finds that the health care and insurance 

3 industries are industries affecting interstate com4 merce and the health care liability litigation systems 

5 existing throughout the United States are activities 

6 that affect interstate commerce by contributing to 

7 the high costs of health care and premiums for 

8 health care liability insurance purchased by health 

9 care system providers. 

10 (3) EFFECT ON FEDERAL SPENDING.—Con11 gress finds that the health care liability litigation 

12 systems existing throughout the United States have 

13 a significant effect on the amount, distribution, and 

14 use of Federal funds because of— 

15 (A) the large number of individuals who 

16 receive health care benefits under programs op17 erated or financed by the Federal Government; 

18 (B) the large number of individuals who 

19 benefit because of the exclusion from Federal 

20 taxes of the amounts spent to provide them 

21 with health insurance benefits; and 

22 (C) the large number of health care pro23 viders who provide items or services for which 

24 the Federal Government makes payments. 

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1 (b) PURPOSE.—It is the purpose of this title to imple2 ment reasonable, comprehensive, and effective health care 

3 liability reforms designed to— 

4 (1) improve the availability of health care serv5 ices in cases in which health care liability actions 

6 have been shown to be a factor in the decreased 

7 availability of services; 

8 (2) reduce the incidence of ‘‘defensive medi9 cine’’ and lower the cost of health care liability in10 surance, all of which contribute to the escalation of 

11 health care costs; 

12 (3) ensure that persons with meritorious health 

13 care injury claims receive fair and adequate com14 pensation, including reasonable noneconomic dam15 ages; 

16 (4) improve the fairness and cost-effectiveness 

17 of our current health care liability system to resolve 

18 disputes over, and provide compensation for, health 

19 care liability by reducing uncertainty in the amount 

20 of compensation provided to injured individuals; and 

21 (5) provide an increased sharing of information 

22 in the health care system which will reduce unin23 tended injury and improve patient care. 

24 SEC. 103. DEFINITIONS. 

25 In this title: 

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1 (1) ALTERNATIVE DISPUTE RESOLUTION SYS2 TEM; ADR.—The term ‘‘alternative dispute resolution 

3 system’’ or ‘‘ADR’’ means a system that provides 

4 for the resolution of health care lawsuits in a man5 ner other than through a civil action brought in a 

6 State or Federal court. 

7 (2) CLAIMANT.—The term ‘‘claimant’’ means 

8 any person who brings a health care lawsuit, includ9 ing a person who asserts or claims a right to legal 

10 or equitable contribution, indemnity or subrogation, 

11 arising out of a health care liability claim or action, 

12 and any person on whose behalf such a claim is as13 serted or such an action is brought, whether de14 ceased, incompetent, or a minor. 

15 (3) COLLATERAL SOURCE BENEFITS.—The 

16 term ‘‘collateral source benefits’’ means any amount 

17 paid or reasonably likely to be paid in the future to 

18 or on behalf of the claimant, or any service, product 

19 or other benefit provided or reasonably likely to be 

20 provided in the future to or on behalf of the claim21 ant, as a result of the injury or wrongful death, pur22 suant to— 

23 (A) any State or Federal health, sickness, 

24 income-disability, accident, or workers’ com25 pensation law; 

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1 (B) any health, sickness, income-disability, 

2 or accident insurance that provides health bene3 fits or income-disability coverage; 

4 (C) any contract or agreement of any 

5 group, organization, partnership, or corporation 

6 to provide, pay for, or reimburse the cost of 

7 medical, hospital, dental, or income disability 

8 benefits; and 

9 (D) any other publicly or privately funded 

10 program. 

11 (4) COMPENSATORY DAMAGES.—The term 

12 ‘‘compensatory damages’’ means objectively 

13 verifiable monetary losses incurred as a result of the 

14 provision of, use of, or payment for (or failure to 

15 provide, use, or pay for) health care services or med16 ical products, such as past and future medical ex17 penses, loss of past and future earnings, cost of ob18 taining domestic services, loss of employment, and 

19 loss of business or employment opportunities, dam20 ages for physical and emotional pain, suffering, in21 convenience, physical impairment, mental anguish, 

22 disfigurement, loss of enjoyment of life, loss of soci23 ety and companionship, loss of consortium (other 

24 than loss of domestic service), hedonic damages, in25 jury to reputation, and all other nonpecuniary losses 

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1 of any kind or nature. Such term includes economic 

2 damages and noneconomic damages, as such terms 

3 are defined in this section. 

4 (5) CONTINGENT FEE.—The term ‘‘contingent 

5 fee’’ includes all compensation to any person or per6 sons which is payable only if a recovery is effected 

7 on behalf of one or more claimants. 

8 (6) ECONOMIC DAMAGES.—The term ‘‘economic 

9 damages’’ means objectively verifiable monetary 

10 losses incurred as a result of the provision of, use 

11 of, or payment for (or failure to provide, use, or pay 

12 for) health care services or medical products, such as 

13 past and future medical expenses, loss of past and 

14 future earnings, cost of obtaining domestic services, 

15 loss of employment, and loss of business or employ16 ment opportunities. 

17 (7) HEALTH CARE GOODS OR SERVICES.—The 

18 term ‘‘health care goods or services’’ means any 

19 goods or services provided by a health care institu20 tion, provider, or by any individual working under 

21 the supervision of a health care provider, that relates 

22 to the diagnosis, prevention, care, or treatment of 

23 any human disease or impairment, or the assessment 

24 of the health of human beings. 

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1 (8) HEALTH CARE INSTITUTION.—The term 

2 ‘‘health care institution’’ means any entity licensed 

3 under Federal or State law to provide health care 

4 services (including but not limited to ambulatory 

5 surgical centers, assisted living facilities, emergency 

6 medical services providers, hospices, hospitals and 

7 hospital systems, nursing homes, or other entities li8 censed to provide such services). 

9 (9) HEALTH CARE LAWSUIT.—The term 

10 ‘‘health care lawsuit’’ means any health care liability 

11 claim concerning the provision of health care goods 

12 or services affecting interstate commerce, or any 

13 health care liability action concerning the provision 

14 of (or the failure to provide) health care goods or 

15 services affecting interstate commerce, brought in a 

16 State or Federal court or pursuant to an alternative 

17 dispute resolution system, against a health care pro18 vider or a health care institution regardless of the 

19 theory of liability on which the claim is based, or the 

20 number of claimants, plaintiffs, defendants, or other 

21 parties, or the number of claims or causes of action, 

22 in which the claimant alleges a health care liability 

23 claim. 

24 (10) HEALTH CARE LIABILITY ACTION.—The 

25 term ‘‘health care liability action’’ means a civil acmstockstill on DSKH9S0YB1PROD with BILLS

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1 tion brought in a State or Federal Court or pursu2 ant to an alternative dispute resolution system, 

3 against a health care provider or a health care insti4 tution regardless of the theory of liability on which 

5 the claim is based, or the number of plaintiffs, de6 fendants, or other parties, or the number of causes 

7 of action, in which the claimant alleges a health care 

8 liability claim. 

9 (11) HEALTH CARE LIABILITY CLAIM.—The 

10 term ‘‘health care liability claim’’ means a demand 

11 by any person, whether or not pursuant to ADR, 

12 against a health care provider or health care institu13 tion, including third-party claims, cross-claims, 

14 counter-claims, or contribution claims, which are 

15 based upon the provision of, use of, or payment for 

16 (or the failure to provide, use, or pay for) health 

17 care services, regardless of the theory of liability on 

18 which the claim is based, or the number of plaintiffs, 

19 defendants, or other parties, or the number of 

20 causes of action. 

21 (12) HEALTH CARE PROVIDER.— 

22 (A) IN GENERAL.—The term ‘‘health care 

23 provider’’ means any person (including but not 

24 limited to a physician (as defined by section 

25 1861(r) of the Social Security Act (42 U.S.C. 

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1 1395x(r)), registered nurse, dentist, podiatrist, 

2 pharmacist, chiropractor, or optometrist) re3 quired by State or Federal law to be licensed, 

4 registered, or certified to provide health care 

5 services, and being either so licensed, reg6 istered, or certified, or exempted from such re7 quirement by other statute or regulation. 

8 (B) TREATMENT OF CERTAIN PROFES9 SIONAL ASSOCIATIONS.—For purposes of this 

10 title, a professional association that is organized 

11 under State law by an individual physician or 

12 group of physicians, a partnership or limited li13 ability partnership formed by a group of physi14 cians, a nonprofit health corporation certified 

15 under State law, or a company formed by a 

16 group of physicians under State law shall be 

17 treated as a health care provider under sub18 paragraph (A). 

19 (13) MALICIOUS INTENT TO INJURE.—The 

20 term ‘‘malicious intent to injure’’ means inten21 tionally causing or attempting to cause physical in22 jury other than providing health care goods or serv23 ices. 

24 (14) NONECONOMIC DAMAGES.—The term 

25 ‘‘noneconomic damages’’ means damages for physmstockstill on DSKH9S0YB1PROD with BILLS

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1 ical and emotional pain, suffering, inconvenience, 

2 physical impairment, mental anguish, disfigurement, 

3 loss of enjoyment of life, loss of society and compan4 ionship, loss of consortium (other than loss of do5 mestic service), hedonic damages, injury to reputa6 tion, and all other nonpecuniary losses of any kind 

7 or nature. 

8 (15) PUNITIVE DAMAGES.—The term ‘‘punitive 

9 damages’’ means damages awarded, for the purpose 

10 of punishment or deterrence, and not solely for com11 pensatory purposes, against a health care provider 

12 or health care institution. Punitive damages are nei13 ther economic nor noneconomic damages. 

14 (16) RECOVERY.—The term ‘‘recovery’’ means 

15 the net sum recovered after deducting any disburse16 ments or costs incurred in connection with prosecu17 tion or settlement of the claim, including all costs 

18 paid or advanced by any person. Costs of health care 

19 incurred by the plaintiff and the attorneys’ office 

20 overhead costs or charges for legal services are not 

21 deductible disbursements or costs for such purpose. 

22 (17) STATE.—The term ‘‘State’’ means each of 

23 the several States, the District of Columbia, the 

24 Commonwealth of Puerto Rico, the Virgin Islands, 

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1 lands, the Trust Territory of the Pacific Islands, and 

2 any other territory or possession of the United 

3 States, or any political subdivision thereof. 

4 SEC. 104. ENCOURAGING SPEEDY RESOLUTION OF CLAIMS. 

5 (a) IN GENERAL.—Except as otherwise provided for 

6 in this section, the time for the commencement of a health 

7 care lawsuit shall be 3 years after the date of manifesta8 tion of injury or 1 year after the claimant discovers, or 

9 through the use of reasonable diligence should have discov10 ered, the injury, whichever occurs first. 

11 (b) GENERAL EXCEPTION.—The time for the com12 mencement of a health care lawsuit shall not exceed 3 

13 years after the date of manifestation of injury unless the 

14 tolling of time was delayed as a result of— 

15 (1) fraud; 

16 (2) intentional concealment; or 

17 (3) the presence of a foreign body, which has no 

18 therapeutic or diagnostic purpose or effect, in the 

19 person of the injured person. 

20 (c) MINORS.—An action by a minor shall be com21 menced within 3 years from the date of the alleged mani22 festation of injury except that if such minor is under the 

23 full age of 6 years, such action shall be commenced within 

24 3 years of the manifestation of injury, or prior to the 

25 eighth birthday of the minor, whichever provides a longer 

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1 period. Such time limitation shall be tolled for minors for 

2 any period during which a parent or guardian and a health 

3 care provider or health care institution have committed 

4 fraud or collusion in the failure to bring an action on be5 half of the injured minor. 

6 (d) RULE 11 SANCTIONS.—Whenever a Federal or 

7 State court determines (whether by motion of the parties 

8 or whether on the motion of the court) that there has been 

9 a violation of Rule 11 of the Federal Rules of Civil Proce10 dure (or a similar violation of applicable State court rules) 

11 in a health care liability action to which this title applies, 

12 the court shall impose upon the attorneys, law firms, or 

13 pro se litigants that have violated Rule 11 or are respon14 sible for the violation, an appropriate sanction, which shall 

15 include an order to pay the other party or parties for the 

16 reasonable expenses incurred as a direct result of the filing 

17 of the pleading, motion, or other paper that is the subject 

18 of the violation, including a reasonable attorneys’ fee. 

19 Such sanction shall be sufficient to deter repetition of such 

20 conduct or comparable conduct by others similarly situ21 ated, and to compensate the party or parties injured by 

22 such conduct. 

23 SEC. 105. COMPENSATING PATIENT INJURY. 

24 (a) UNLIMITED AMOUNT OF DAMAGES FOR ACTUAL

25 ECONOMIC LOSSES IN HEALTH CARE LAWSUITS.—In any 

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1 health care lawsuit, nothing in this title shall limit the re2 covery by a claimant of the full amount of the available 

3 economic damages, notwithstanding the limitation con4 tained in subsection (b). 

5 (b) ADDITIONAL NONECONOMIC DAMAGES.— 

6 (1) HEALTH CARE PROVIDERS.—In any health 

7 care lawsuit where final judgment is rendered 

8 against a health care provider, the amount of non9 economic damages recovered from the provider, if 

10 otherwise available under applicable Federal or State 

11 law, may be as much as $250,000, regardless of the 

12 number of parties other than a health care institu13 tion against whom the action is brought or the num14 ber of separate claims or actions brought with re15 spect to the same occurrence. 

16 (2) HEALTH CARE INSTITUTIONS.— 

17 (A) SINGLE INSTITUTION.—In any health 

18 care lawsuit where final judgment is rendered 

19 against a single health care institution, the 

20 amount of noneconomic damages recovered 

21 from the institution, if otherwise available 

22 under applicable Federal or State law, may be 

23 as much as $250,000, regardless of the number 

24 of parties against whom the action is brought 

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1 or the number of separate claims or actions 

2 brought with respect to the same occurrence. 

3 (B) MULTIPLE INSTITUTIONS.—In any 

4 health care lawsuit where final judgment is ren5 dered against more than one health care insti6 tution, the amount of noneconomic damages re7 covered from each institution, if otherwise avail8 able under applicable Federal or State law, may 

9 be as much as $250,000, regardless of the 

10 number of parties against whom the action is 

11 brought or the number of separate claims or ac12 tions brought with respect to the same occur13 rence, except that the total amount recovered 

14 from all such institutions in such lawsuit shall 

15 not exceed $500,000. 

16 (c) NO DISCOUNT OF AWARD FOR NONECONOMIC

17 DAMAGES.—In any health care lawsuit— 

18 (1) an award for future noneconomic damages 

19 shall not be discounted to present value; 

20 (2) the jury shall not be informed about the 

21 maximum award for noneconomic damages under 

22 subsection (b); 

23 (3) an award for noneconomic damages in ex24 cess of the limitations provided for in subsection (b) 

25 shall be reduced either before the entry of judgment, 

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1 or by amendment of the judgment after entry of 

2 judgment, and such reduction shall be made before 

3 accounting for any other reduction in damages re4 quired by law; and 

5 (4) if separate awards are rendered for past 

6 and future noneconomic damages and the combined 

7 awards exceed the limitations described in subsection 

8 (b), the future noneconomic damages shall be re9 duced first. 

10 (d) FAIR SHARE RULE.—In any health care lawsuit, 

11 each party shall be liable for that party’s several share 

12 of any damages only and not for the share of any other 

13 person. Each party shall be liable only for the amount of 

14 damages allocated to such party in direct proportion to 

15 such party’s percentage of responsibility. A separate judg16 ment shall be rendered against each such party for the 

17 amount allocated to such party. For purposes of this sec18 tion, the trier of fact shall determine the proportion of 

19 responsibility of each party for the claimant’s harm. 

20 SEC. 106. MAXIMIZING PATIENT RECOVERY. 

21 (a) COURT SUPERVISION OF SHARE OF DAMAGES

22 ACTUALLY PAID TO CLAIMANTS.— 

23 (1) IN GENERAL.—In any health care lawsuit, 

24 the court shall supervise the arrangements for pay25 ment of damages to protect against conflicts of inmstockstill on DSKH9S0YB1PROD with BILLS

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1 terest that may have the effect of reducing the 

2 amount of damages awarded that are actually paid 

3 to claimants. 

4 (2) CONTINGENCY FEES.— 

5 (A) IN GENERAL.—In any health care law6 suit in which the attorney for a party claims a 

7 financial stake in the outcome by virtue of a 

8 contingent fee, the court shall have the power 

9 to restrict the payment of a claimant’s damage 

10 recovery to such attorney, and to redirect such 

11 damages to the claimant based upon the inter12 ests of justice and principles of equity. 

13 (B) LIMITATION.—The total of all contin14 gent fees for representing all claimants in a 

15 health care lawsuit shall not exceed the fol16 lowing limits: 

17 (i) 40 percent of the first $50,000 re18 covered by the claimant(s). 

(ii) 331 19 ⁄3 percent of the next $50,000 

20 recovered by the claimant(s). 

21 (iii) 25 percent of the next $500,000 

22 recovered by the claimant(s). 

23 (iv) 15 percent of any amount by 

24 which the recovery by the claimant(s) is in 

25 excess of $600,000. 

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1 (b) APPLICABILITY.— 

2 (1) IN GENERAL.—The limitations in subsection 

3 (a) shall apply whether the recovery is by judgment, 

4 settlement, mediation, arbitration, or any other form 

5 of alternative dispute resolution. 

6 (2) MINORS.—In a health care lawsuit involving 

7 a minor or incompetent person, a court retains the 

8 authority to authorize or approve a fee that is less 

9 than the maximum permitted under this section. 

10 (c) EXPERT WITNESSES.— 

11 (1) REQUIREMENT.—No individual shall be 

12 qualified to testify as an expert witness concerning 

13 issues of negligence in any health care lawsuit 

14 against a defendant unless such individual— 

15 (A) except as required under paragraph 

16 (2), is a health care professional who— 

17 (i) is appropriately credentialed or li18 censed in 1 or more States to deliver 

19 health care services; and 

20 (ii) typically treats the diagnosis or 

21 condition or provides the type of treatment 

22 under review; and 

23 (B) can demonstrate by competent evi24 dence that, as a result of training, education, 

25 knowledge, and experience in the evaluation, dimstockstill on DSKH9S0YB1PROD with BILLS

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1 agnosis, and treatment of the disease or injury 

2 which is the subject matter of the lawsuit 

3 against the defendant, the individual was sub4 stantially familiar with applicable standards of 

5 care and practice as they relate to the act or 

6 omission which is the subject of the lawsuit on 

7 the date of the incident. 

8 (2) PHYSICIAN REVIEW.—In a health care law9 suit, if the claim of the plaintiff involved treatment 

10 that is recommended or provided by a physician 

11 (allopathic or osteopathic), an individual shall not be 

12 qualified to be an expert witness under this sub13 section with respect to issues of negligence con14 cerning such treatment unless such individual is a 

15 physician. 

16 (3) SPECIALTIES AND SUBSPECIALTIES.—With 

17 respect to a lawsuit described in paragraph (1), a 

18 court shall not permit an expert in one medical spe19 cialty or subspecialty to testify against a defendant 

20 in another medical specialty or subspecialty unless, 

21 in addition to a showing of substantial familiarity in 

22 accordance with paragraph (1)(B), there is a show23 ing that the standards of care and practice in the 

24 two specialty or subspecialty fields are similar. 

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1 (4) LIMITATION.—The limitations in this sub2 section shall not apply to expert witnesses testifying 

3 as to the degree or permanency of medical or phys4 ical impairment. 

5 SEC. 107. ADDITIONAL HEALTH BENEFITS. 

6 (a) IN GENERAL.—The amount of any damages re7 ceived by a claimant in any health care lawsuit shall be 

8 reduced by the court by the amount of any collateral 

9 source benefits to which the claimant is entitled, less any 

10 insurance premiums or other payments made by the claim11 ant (or by the spouse, parent, child, or legal guardian of 

12 the claimant) to obtain or secure such benefits. 

13 (b) PRESERVATION OF CURRENT LAW.—Where a 

14 payor of collateral source benefits has a right of recovery 

15 by reimbursement or subrogation and such right is per16 mitted under Federal or State law, subsection (a) shall 

17 not apply. 

18 (c) APPLICATION OF PROVISION.—This section shall 

19 apply to any health care lawsuit that is settled or resolved 

20 by a fact finder. 

21 SEC. 108. PUNITIVE DAMAGES. 

22 (a) PUNITIVE DAMAGES PERMITTED.— 

23 (1) IN GENERAL.—Punitive damages may, if 

24 otherwise available under applicable State or Federal 

25 law, be awarded against any person in a health care 

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1 lawsuit only if it is proven by clear and convincing 

2 evidence that such person acted with malicious in3 tent to injure the claimant, or that such person de4 liberately failed to avoid unnecessary injury that 

5 such person knew the claimant was substantially 

6 certain to suffer. 

7 (2) FILING OF LAWSUIT.—No demand for puni8 tive damages shall be included in a health care law9 suit as initially filed. A court may allow a claimant 

10 to file an amended pleading for punitive damages 

11 only upon a motion by the claimant and after a find12 ing by the court, upon review of supporting and op13 posing affidavits or after a hearing, after weighing 

14 the evidence, that the claimant has established by a 

15 substantial probability that the claimant will prevail 

16 on the claim for punitive damages. 

17 (3) SEPARATE PROCEEDING.—At the request of 

18 any party in a health care lawsuit, the trier of fact 

19 shall consider in a separate proceeding— 

20 (A) whether punitive damages are to be 

21 awarded and the amount of such award; and 

22 (B) the amount of punitive damages fol23 lowing a determination of punitive liability. 

24 If a separate proceeding is requested, evidence rel25 evant only to the claim for punitive damages, as demstockstill on DSKH9S0YB1PROD with BILLS

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1 termined by applicable State law, shall be inadmis2 sible in any proceeding to determine whether com3 pensatory damages are to be awarded. 

4 (4) LIMITATION WHERE NO COMPENSATORY

5 DAMAGES ARE AWARDED.—In any health care law6 suit where no judgment for compensatory damages 

7 is rendered against a person, no punitive damages 

8 may be awarded with respect to the claim in such 

9 lawsuit against such person. 

10 (b) DETERMINING AMOUNT OF PUNITIVE DAM11 AGES.— 

12 (1) FACTORS CONSIDERED.—In determining 

13 the amount of punitive damages under this section, 

14 the trier of fact shall consider only the following: 

15 (A) the severity of the harm caused by the 

16 conduct of such party; 

17 (B) the duration of the conduct or any 

18 concealment of it by such party; 

19 (C) the profitability of the conduct to such 

20 party; 

21 (D) the number of products sold or med22 ical procedures rendered for compensation, as 

23 the case may be, by such party, of the kind 

24 causing the harm complained of by the claim25 ant; 

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1 (E) any criminal penalties imposed on such 

2 party, as a result of the conduct complained of 

3 by the claimant; and 

4 (F) the amount of any civil fines assessed 

5 against such party as a result of the conduct 

6 complained of by the claimant. 

7 (2) MAXIMUM AWARD.—The amount of punitive 

8 damages awarded in a health care lawsuit may not 

9 exceed an amount equal to two times the amount of 

10 economic damages awarded in the lawsuit or 

11 $250,000, whichever is greater. The jury shall not 

12 be informed of the limitation under the preceding 

13 sentence. 

14 (c) LIABILITY OF HEALTH CARE PROVIDERS.— 

15 (1) IN GENERAL.—A health care provider who 

16 prescribes, or who dispenses pursuant to a prescrip17 tion, a drug, biological product, or medical device 

18 approved by the Food and Drug Administration, for 

19 an approved indication of the drug, biological prod20 uct, or medical device, shall not be named as a party 

21 to a product liability lawsuit invoking such drug, bi22 ological product, or medical device and shall not be 

23 liable to a claimant in a class action lawsuit against 

24 the manufacturer, distributor, or product seller of 

25 such drug, biological product, or medical device. 

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1 (2) MEDICAL PRODUCT.—The term ‘‘medical 

2 product’’ means a drug or device intended for hu3 mans. The terms ‘‘drug’’ and ‘‘device’’ have the 

4 meanings given such terms in sections 201(g)(1) and 

5 201(h) of the Federal Food, Drug and Cosmetic Act 

6 (21 U.S.C. 321), respectively, including any compo7 nent or raw material used therein, but excluding 

8 health care services. 

9 SEC. 109. AUTHORIZATION OF PAYMENT OF FUTURE DAM10 AGES TO CLAIMANTS IN HEALTH CARE LAW11 SUITS. 

12 (a) IN GENERAL.—In any health care lawsuit, if an 

13 award of future damages, without reduction to present 

14 value, equaling or exceeding $50,000 is made against a 

15 party with sufficient insurance or other assets to fund a 

16 periodic payment of such a judgment, the court shall, at 

17 the request of any party, enter a judgment ordering that 

18 the future damages be paid by periodic payments in ac19 cordance with the Uniform Periodic Payment of Judg20 ments Act promulgated by the National Conference of 

21 Commissioners on Uniform State Laws. 

22 (b) APPLICABILITY.—This section applies to all ac23 tions which have not been first set for trial or retrial be24 fore the effective date of this title. 

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1 SEC. 110. EFFECT ON OTHER LAWS. 

2 (a) GENERAL VACCINE INJURY.— 

3 (1) IN GENERAL.—To the extent that title XXI 

4 of the Public Health Service Act establishes a Fed5 eral rule of law applicable to a civil action brought 

6 for a vaccine-related injury or death— 

7 (A) this title shall not affect the applica8 tion of the rule of law to such an action; and 

9 (B) any rule of law prescribed by this title 

10 in conflict with a rule of law under title XXI 

11 shall not apply to such action. 

12 (2) EXCEPTION.—If there is an aspect of a civil 

13 action brought for a vaccine-related injury or death 

14 to which a Federal rule of law under title XXI of 

15 the Public Health Service Act does not apply, then 

16 this title or otherwise applicable law (as determined 

17 under this title) will apply to such aspect of such ac18 tion. 

19 (b) SMALLPOX VACCINE INJURY.— 

20 (1) IN GENERAL.—To the extent that part C of 

21 title II of the Public Health Service Act establishes 

22 a Federal rule of law applicable to a civil action 

23 brought for a smallpox vaccine-related injury or 

24 death— 

25 (A) this title shall not affect the applica26 tion of the rule of law to such an action; and 

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1 (B) any rule of law prescribed by this title 

2 in conflict with a rule of law of such part C 

3 shall not apply to such action. 

4 (2) EXCEPTION.—If there is an aspect of a civil 

5 action brought for a smallpox vaccine-related injury 

6 or death to which a Federal rule of law under part 

7 C of title II of the Public Health Service Act does 

8 not apply, then this title or otherwise applicable law 

9 (as determined under this title) will apply to such 

10 aspect of such action. 

11 (c) OTHER FEDERAL LAW.—Except as provided in 

12 this section, nothing in this title shall be deemed to affect 

13 any defense available, or any limitation on liability that 

14 applies to, a defendant in a health care lawsuit or action 

15 under any other provision of Federal law. 

16 SEC. 111. STATE FLEXIBILITY AND PROTECTION OF 

17 STATES’ RIGHTS. 

18 (a) HEALTH CARE LAWSUITS.—The provisions gov19 erning health care lawsuits set forth in this title shall pre20 empt, subject to subsections (b) and (c), State law to the 

21 extent that State law prevents the application of any pro22 visions of law established by or under this title. The provi23 sions governing health care lawsuits set forth in this title 

24 supersede chapter 171 of title 28, United States Code, to 

25 the extent that such chapter— 

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1 (1) provides for a greater amount of damages 

2 or contingent fees, a longer period in which a health 

3 care lawsuit may be commenced, or a reduced appli4 cability or scope of periodic payment of future dam5 ages, than provided in this title; or 

6 (2) prohibits the introduction of evidence re7 garding collateral source benefits. 

8 (b) PREEMPTION OF CERTAIN STATE LAWS.—No 

9 provision of this title shall be construed to preempt any 

10 State law (whether effective before, on, or after the date 

11 of the enactment of this Act) that specifies a particular 

12 monetary amount of compensatory or punitive damages 

13 (or the total amount of damages) that may be awarded 

14 in a health care lawsuit, regardless of whether such mone15 tary amount is greater or lesser than is provided for under 

16 this title, notwithstanding section 105(a). 

17 (c) PROTECTION OF STATE’S RIGHTS AND OTHER

18 LAWS.— 

19 (1) IN GENERAL.—Any issue that is not gov20 erned by a provision of law established by or under 

21 this title (including the State standards of neg22 ligence) shall be governed by otherwise applicable 

23 Federal or State law. 

24 (2) RULE OF CONSTRUCTION.—Nothing in this 

25 title shall be construed to— 

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1 (A) preempt or supersede any Federal or 

2 State law that imposes greater procedural or 

3 substantive protections (such as a shorter stat4 ute of limitations) for a health care provider or 

5 health care institution from liability, loss, or 

6 damages than those provided by this title; 

7 (B) preempt or supercede any State law 

8 that permits and provides for the enforcement 

9 of any arbitration agreement related to a health 

10 care liability claim whether enacted prior to or 

11 after the date of enactment of this Act; 

12 (C) create a cause of action that is not 

13 otherwise available under Federal or State law; 

14 or 

15 (D) affect the scope of preemption of any 

16 other Federal law. 

17 SEC. 112. APPLICABILITY; EFFECTIVE DATE. 

18 This title shall apply to any health care lawsuit 

19 brought in a Federal or State court, or subject to an alter20 native dispute resolution system, that is initiated on or 

21 after the date of the enactment of this Act, except that 

22 any health care lawsuit arising from an injury occurring 

23 prior to the date of enactment of this Act shall be gov24 erned by the applicable statute of limitations provisions 

25 in effect at the time the injury occurred. 

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1 TITLE III—RESCISSION OF 

2 UNUSED STIMULUS FUNDS 

3 SEC. 201. RESCISSION IN ARRA. 

4 Effective as of October 1, 2010, any unobligated bal5 ances available on such date of funds made available by 

6 division A of the American Recovery and Reinvestment 

7 Act of 2009 (Public Law 111–5) are rescinded. 

Æ 

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