177 
(1) improve the availability of health care serv-
ices in cases in which health care liability actions 
have been shown to be a factor in the decreased 
availability of services; 
(2) reduce the incidence of ‘‘defensive medi-
cine’’ and lower the cost of health care liability in-
surance, all of which contribute to the escalation of 
health care costs; 
(3) ensure that persons with meritorious health 
care injury claims receive fair and adequate com-
pensation, including reasonable noneconomic dam-
ages; 
(4) improve the fairness and cost-effectiveness 
of our current health care liability system to resolve 
disputes over, and provide compensation for, health 
care liability by reducing uncertainty in the amount 
of compensation provided to injured individuals; and 
(5) provide an increased sharing of information 
in the health care system which will reduce unin-
tended injury and improve patient care. 
SEC. 503. ENCOURAGING SPEEDY RESOLUTION OF CLAIMS. 
The time for the commencement of a health care law-
suit shall be 3 years after the date of manifestation of 
injury or 1 year after the claimant discovers, or through 
the use of reasonable diligence should have discovered, the 
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injury, whichever occurs first. In no event shall the time 
for commencement of a health care lawsuit exceed 3 years 
after the date of manifestation of injury unless tolled for 
any of the following— 
(1) upon proof of fraud; 
(2) intentional concealment; or 
(3) the presence of a foreign body, which has no 
therapeutic or diagnostic purpose or effect, in the 
person of the injured person. Actions by a minor 
shall be commenced within 3 years from the date of 
the alleged manifestation of injury except that ac-
tions by a minor under the full age of 6 years shall 
be commenced within 3 years of manifestation of in-
jury or prior to the minor’s 8th birthday, whichever 
provides a longer period. Such time limitation shall 
be tolled for minors for any period during which a 
parent or guardian and a health care provider or 
health care organization have committed fraud or 
collusion in the failure to bring an action on behalf 
of the injured minor. 
SEC. 504. COMPENSATING PATIENT INJURY. 
(a) UNLIMITED AMOUNT OF DAMAGES FOR ACTUAL 
ECONOMIC LOSSES IN HEALTH CARE LAWSUITS.—In any 
health care lawsuit, nothing in this title shall limit a claim-
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ant’s recovery of the full amount of the available economic 
damages, notwithstanding the limitation in subsection (b). 
(b) ADDITIONAL NONECONOMIC DAMAGES.—In any 
health care lawsuit, the amount of noneconomic damages, 
if available, may be as much as $250,000, regardless of 
the number of parties against whom the action is brought 
or the number of separate claims or actions brought with 
respect to the same injury. 
(c) NO DISCOUNT OF AWARD FOR NONECONOMIC 
DAMAGES.—For purposes of applying the limitation in 
subsection (b), future noneconomic damages shall not be 
discounted to present value. The jury shall not be in-
formed about the maximum award for noneconomic dam-
ages. An award for noneconomic damages in excess of 
$250,000 shall be reduced either before the entry of judg-
ment, or by amendment of the judgment after entry of 
judgment, and such reduction shall be made before ac-
counting for any other reduction in damages required by 
law. If separate awards are rendered for past and future 
noneconomic damages and the combined awards exceed 
$250,000, the future noneconomic damages shall be re-
duced first. 
(d) FAIR SHARE RULE.—In any health care lawsuit, 
each party shall be liable for that party’s several share 
of any damages only and not for the share of any other 
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person. Each party shall be liable only for the amount of 
damages allocated to such party in direct proportion to 
such party’s percentage of responsibility. Whenever a 
judgment of liability is rendered as to any party, a sepa-
rate judgment shall be rendered against each such party 
for the amount allocated to such party. For purposes of 
this section, the trier of fact shall determine the propor-
tion of responsibility of each party for the claimant’s 
harm. 
SEC. 505. MAXIMIZING PATIENT RECOVERY. 
(a) COURT SUPERVISION OF SHARE OF DAMAGES 
ACTUALLY PAID TO CLAIMANTS.—In any health care law-
suit, the court shall supervise the arrangements for pay-
ment of damages to protect against conflicts of interest 
that may have the effect of reducing the amount of dam-
ages awarded that are actually paid to claimants. In par-
ticular, in any health care lawsuit in which the attorney 
for a party claims a financial stake in the outcome by vir-
tue of a contingent fee, the court shall have the power 
to restrict the payment of a claimant’s damage recovery 
to such attorney, and to redirect such damages to the 
claimant based upon the interests of justice and principles 
of equity. In no event shall the total of all contingent fees 
for representing all claimants in a health care lawsuit ex-
ceed the following limits: 
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(1) 40 percent of the first $50,000 recovered by 
the claimant(s). 
(2) 331⁄3 percent of the next $50,000 recovered 
by the claimant(s). 
(3) 25 percent of the next $500,000 recovered 
by the claimant(s). 
(4) 15 percent of any amount by which the re-
covery by the claimant(s) is in excess of $600,000. 
(b) APPLICABILITY.—The limitations in this section 
shall apply whether the recovery is by judgment, settle-
ment, mediation, arbitration, or any other form of alter-
native dispute resolution. In a health care lawsuit involv-
ing a minor or incompetent person, a court retains the 
authority to authorize or approve a fee that is less than 
the maximum permitted under this section. The require-
ment for court supervision in the first two sentences of 
subsection (a) applies only in civil actions. 
SEC. 506. ADDITIONAL HEALTH BENEFITS. 
In any health care lawsuit involving injury or wrong-
ful death, any party may introduce evidence of collateral 
source benefits. If a party elects to introduce such evi-
dence, any opposing party may introduce evidence of any 
amount paid or contributed or reasonably likely to be paid 
or contributed in the future by or on behalf of the oppos-
ing party to secure the right to such collateral source bene-
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fits. No provider of collateral source benefits shall recover 
any amount against the claimant or receive any lien or 
credit against the claimant’s recovery or be equitably or 
legally subrogated to the right of the claimant in a health 
care lawsuit involving injury or wrongful death. This sec-
tion shall apply to any health care lawsuit that is settled 
as well as a health care lawsuit that is resolved by a fact 
finder. This section shall not apply to section 1862(b) (42 
U.S.C. 1395y(b)) or section 1902(a)(25) (42 U.S.C. 
1396a(a)(25)) of the Social Security Act. 
SEC. 507. PUNITIVE DAMAGES. 
(a) IN GENERAL.—Punitive damages may, if other-
wise permitted by applicable State or Federal law, be 
awarded against any person in a health care lawsuit only 
if it is proven by clear and convincing evidence that such 
person acted with malicious intent to injure the claimant, 
or that such person deliberately failed to avoid unneces-
sary injury that such person knew the claimant was sub-
stantially certain to suffer. In any health care lawsuit 
where no judgment for compensatory damages is rendered 
against such person, no punitive damages may be awarded 
with respect to the claim in such lawsuit. No demand for 
punitive damages shall be included in a health care lawsuit 
as initially filed. A court may allow a claimant to file an 
amended pleading for punitive damages only upon a mo-
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tion by the claimant and after a finding by the court, upon 
review of supporting and opposing affidavits or after a 
hearing, after weighing the evidence, that the claimant has 
established by a substantial probability that the claimant 
will prevail on the claim for punitive damages. At the re-
quest of any party in a health care lawsuit, the trier of 
fact shall consider in a separate proceeding— 
(1) whether punitive damages are to be award-
ed and the amount of such award; and 
(2) the amount of punitive damages following a 
determination of punitive liability. 
If a separate proceeding is requested, evidence relevant 
only to the claim for punitive damages, as determined by 
applicable State law, shall be inadmissible in any pro-
ceeding to determine whether compensatory damages are 
to be awarded. 
(b) DETERMINING AMOUNT
OF PUNITIVE DAM-
AGES.— 
(1) FACTORS
CONSIDERED.—In determining 
the amount of punitive damages, if awarded, in a 
health care lawsuit, the trier of fact shall consider 
only the following— 
(A) the severity of the harm caused by the 
conduct of such party; 
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(B) the duration of the conduct or any 
concealment of it by such party; 
(C) the profitability of the conduct to such 
party; 
(D) the number of products sold or med-
ical procedures rendered for compensation, as 
the case may be, by such party, of the kind 
causing the harm complained of by the claim-
ant; 
(E) any criminal penalties imposed on such 
party, as a result of the conduct complained of 
by the claimant; and 
(F) the amount of any civil fines assessed 
against such party as a result of the conduct 
complained of by the claimant. 
(2) MAXIMUM AWARD.—The amount of punitive 
damages, if awarded, in a health care lawsuit may 
be as much as $250,000 or as much as two times 
the amount of economic damages awarded, which-
ever is greater. The jury shall not be informed of 
this limitation. 
(c) NO PUNITIVE DAMAGES FOR PRODUCTS THAT 
COMPLY WITH FDA STANDARDS.— 
(1) IN GENERAL.— 
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(A) No punitive damages may be awarded 
against the manufacturer or distributor of a 
medical product, or a supplier of any compo-
nent or raw material of such medical product, 
based on a claim that such product caused the 
claimant’s harm where— 
(i)(I) such medical product was sub-
ject to premarket approval, clearance, or li-
censure by the Food and Drug Administra-
tion with respect to the safety of the for-
mulation or performance of the aspect of 
such medical product which caused the 
claimant’s harm or the adequacy of the 
packaging or labeling of such medical 
product; and 
(II) such medical product was so ap-
proved, cleared, or licensed; or 
(ii) such medical product is generally 
recognized among qualified experts as safe 
and effective pursuant to conditions estab-
lished by the Food and Drug Administra-
tion and applicable Food and Drug Admin-
istration regulations, including without 
limitation those related to packaging and 
labeling, unless the Food and Drug Admin-
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istration has determined that such medical 
product was not manufactured or distrib-
uted in substantial compliance with appli-
cable Food and Drug Administration stat-
utes and regulations. 
(B) RULE OF CONSTRUCTION.—Subpara-
graph (A) may not be construed as establishing 
the obligation of the Food and Drug Adminis-
tration to demonstrate affirmatively that a 
manufacturer, distributor, or supplier referred 
to in such subparagraph meets any of the con-
ditions described in such subparagraph. 
(2) LIABILITY OF HEALTH CARE PROVIDERS.— 
A health care provider who prescribes, or who dis-
penses pursuant to a prescription, a medical product 
approved, licensed, or cleared by the Food and Drug 
Administration shall not be named as a party to a 
product liability lawsuit involving such product and 
shall not be liable to a claimant in a class action 
lawsuit against the manufacturer, distributor, or 
seller of such product. Nothing in this paragraph 
prevents a court from consolidating cases involving 
health care providers and cases involving products li-
ability claims against the manufacturer, distributor, 
or product seller of such medical product. 
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(3) PACKAGING.—In a health care lawsuit for 
harm which is alleged to relate to the adequacy of 
the packaging or labeling of a drug which is required 
to have tamper-resistant packaging under regula-
tions of the Secretary of Health and Human Serv-
ices (including labeling regulations related to such 
packaging), the manufacturer or product seller of 
the drug shall not be held liable for punitive dam-
ages unless such packaging or labeling is found by 
the trier of fact by clear and convincing evidence to 
be substantially out of compliance with such regula-
tions. 
(4) EXCEPTION.—Paragraph (1) shall not 
apply in any health care lawsuit in which— 
(A) a person, before or after premarket ap-
proval, clearance, or licensure of such medical 
product, knowingly misrepresented to or with-
held from the Food and Drug Administration 
information that is required to be submitted 
under the Federal Food, Drug, and Cosmetic 
Act (21 U.S.C. 301 et seq.) or section 351 of 
the Public Health Service Act (42 U.S.C. 262) 
that is material and is causally related to the 
harm which the claimant allegedly suffered; or 
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(B) a person made an illegal payment to 
an official of the Food and Drug Administra-
tion for the purpose of either securing or main-
taining approval, clearance, or licensure of such 
medical product. 
SEC. 508. AUTHORIZATION OF PAYMENT OF FUTURE DAM-
AGES TO CLAIMANTS IN HEALTH CARE LAW-
SUITS. 
(a) IN GENERAL.—In any health care lawsuit, if an 
award of future damages, without reduction to present 
value, equaling or exceeding $50,000 is made against a 
party with sufficient insurance or other assets to fund a 
periodic payment of such a judgment, the court shall, at 
the request of any party, enter a judgment ordering that 
the future damages be paid by periodic payments. In any 
health care lawsuit, the court may be guided by the Uni-
form Periodic Payment of Judgments Act promulgated by 
the National Conference of Commissioners on Uniform 
State Laws. 
(b) APPLICABILITY.—This section applies to all ac-
tions which have not been first set for trial or retrial be-
fore the effective date of this title. 
SEC. 509. DEFINITIONS. 
In this title: 
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(1) ALTERNATIVE DISPUTE RESOLUTION SYS-
TEM; ADR.—The term ‘‘alternative dispute resolution 
system’’ or ‘‘ADR’’ means a system that provides 
for the resolution of health care lawsuits in a man-
ner other than through a civil action brought in a 
State or Federal court. 
(2) CLAIMANT.—The term ‘‘claimant’’ means 
any person who brings a health care lawsuit, includ-
ing a person who asserts or claims a right to legal 
or equitable contribution, indemnity or subrogation, 
arising out of a health care liability claim or action, 
and any person on whose behalf such a claim is as-
serted or such an action is brought, whether de-
ceased, incompetent, or a minor. 
(3) COLLATERAL
SOURCE
BENEFITS.—The 
term ‘‘collateral source benefits’’ means any amount 
paid or reasonably likely to be paid in the future to 
or on behalf of the claimant, or any service, product 
or other benefit provided or reasonably likely to be 
provided in the future to or on behalf of the claim-
ant, as a result of the injury or wrongful death, pur-
suant to— 
(A) any State or Federal health, sickness, 
income-disability, accident, or workers’ com-
pensation law; 
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(B) any health, sickness, income-disability, 
or accident insurance that provides health bene-
fits or income-disability coverage; 
(C) any contract or agreement of any 
group, organization, partnership, or corporation 
to provide, pay for, or reimburse the cost of 
medical, hospital, dental, or income disability 
benefits; and 
(D) any other publicly or privately funded 
program. 
(4) 
COMPENSATORY
DAMAGES.—The 
term 
‘‘compensatory 
damages’’ 
means 
objectively 
verifiable monetary losses incurred as a result of the 
provision of, use of, or payment for (or failure to 
provide, use, or pay for) health care services or med-
ical products, such as past and future medical ex-
penses, loss of past and future earnings, cost of ob-
taining domestic services, loss of employment, and 
loss of business or employment opportunities, dam-
ages for physical and emotional pain, suffering, in-
convenience, physical impairment, mental anguish, 
disfigurement, loss of enjoyment of life, loss of soci-
ety and companionship, loss of consortium (other 
than loss of domestic service), hedonic damages, in-
jury to reputation, and all other nonpecuniary losses 
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of any kind or nature. The term ‘‘compensatory 
damages’’ includes economic damages and non-
economic damages, as such terms are defined in this 
section. 
(5) CONTINGENT FEE.—The term ‘‘contingent 
fee’’ includes all compensation to any person or per-
sons which is payable only if a recovery is effected 
on behalf of one or more claimants. 
(6) ECONOMIC DAMAGES.—The term ‘‘economic 
damages’’ means objectively verifiable monetary 
losses incurred as a result of the provision of, use 
of, or payment for (or failure to provide, use, or pay 
for) health care services or medical products, such as 
past and future medical expenses, loss of past and 
future earnings, cost of obtaining domestic services, 
loss of employment, and loss of business or employ-
ment opportunities. 
(7) 
HEALTH
CARE
LAWSUIT.—The 
term 
‘‘health care lawsuit’’ means any health care liability 
claim concerning the provision of health care goods 
or services or any medical product affecting inter-
state commerce, or any health care liability action 
concerning the provision of health care goods or 
services or any medical product affecting interstate 
commerce, brought in a State or Federal court or 
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pursuant to an alternative dispute resolution system, 
against a health care provider, a health care organi-
zation, or the manufacturer, distributor, supplier, 
marketer, promoter, or seller of a medical product, 
regardless of the theory of liability on which the 
claim is based, or the number of claimants, plain-
tiffs, defendants, or other parties, or the number of 
claims or causes of action, in which the claimant al-
leges a health care liability claim. Such term does 
not include a claim or action which is based on 
criminal liability; which seeks civil fines or penalties 
paid to Federal, State, or local government; or which 
is grounded in antitrust. 
(8) HEALTH
CARE
LIABILITY
ACTION.—The 
term ‘‘health care liability action’’ means a civil ac-
tion brought in a State or Federal Court or pursu-
ant to an alternative dispute resolution system, 
against a health care provider, a health care organi-
zation, or the manufacturer, distributor, supplier, 
marketer, promoter, or seller of a medical product, 
regardless of the theory of liability on which the 
claim is based, or the number of plaintiffs, defend-
ants, or other parties, or the number of causes of ac-
tion, in which the claimant alleges a health care li-
ability claim. 
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(9) HEALTH
CARE
LIABILITY
CLAIM.—The 
term ‘‘health care liability claim’’ means a demand 
by any person, whether or not pursuant to ADR, 
against a health care provider, health care organiza-
tion, or the manufacturer, distributor, supplier, mar-
keter, promoter, or seller of a medical product, in-
cluding, but not limited to, third-party claims, cross- 
claims, counter-claims, or contribution claims, which 
are based upon the provision of, use of, or payment 
for (or the failure to provide, use, or pay for) health 
care services or medical products, regardless of the 
theory of liability on which the claim is based, or the 
number of plaintiffs, defendants, or other parties, or 
the number of causes of action. 
(10) HEALTH CARE ORGANIZATION.—The term 
‘‘health care organization’’ means any person or en-
tity which is obligated to provide or pay for health 
benefits under any health plan, including any person 
or entity acting under a contract or arrangement 
with a health care organization to provide or admin-
ister any health benefit. 
(11) HEALTH
CARE
PROVIDER.—The term 
‘‘health care provider’’ means any person or entity 
required by State or Federal laws or regulations to 
be licensed, registered, or certified to provide health 
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care services, and being either so licensed, reg-
istered, or certified, or exempted from such require-
ment by other statute or regulation. 
(12) HEALTH CARE GOODS OR SERVICES.—The 
term ‘‘health care goods or services’’ means any 
goods or services provided by a health care organiza-
tion, provider, or by any individual working under 
the supervision of a health care provider, that relates 
to the diagnosis, prevention, or treatment of any 
human disease or impairment, or the assessment or 
care of the health of human beings. 
(13) MALICIOUS
INTENT
TO
INJURE.—The 
term ‘‘malicious intent to injure’’ means inten-
tionally causing or attempting to cause physical in-
jury other than providing health care goods or serv-
ices. 
(14) MEDICAL PRODUCT.—The term ‘‘medical 
product’’ means a drug, device, or biological product 
intended for humans, and the terms ‘‘drug’’, ‘‘de-
vice’’, and ‘‘biological product’’ have the meanings 
given such terms in sections 201(g)(1) and 201(h) 
of the Federal Food, Drug and Cosmetic Act (21 
U.S.C. 321) and section 351(a) of the Public Health 
Service Act (42 U.S.C. 262(a)), respectively, includ-
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ing any component or raw material used therein, but 
excluding health care services. 
(15) 
NONECONOMIC
DAMAGES.—The 
term 
‘‘noneconomic damages’’ means damages for phys-
ical and emotional pain, suffering, inconvenience, 
physical impairment, mental anguish, disfigurement, 
loss of enjoyment of life, loss of society and compan-
ionship, loss of consortium (other than loss of do-
mestic service), hedonic damages, injury to reputa-
tion, and all other nonpecuniary losses of any kind 
or nature. 
(16) PUNITIVE DAMAGES.—The term ‘‘punitive 
damages’’ means damages awarded, for the purpose 
of punishment or deterrence, and not solely for com-
pensatory purposes, against a health care provider, 
health care organization, or a manufacturer, dis-
tributor, or supplier of a medical product. Punitive 
damages are neither economic nor noneconomic 
damages. 
(17) RECOVERY.—The term ‘‘recovery’’ means 
the net sum recovered after deducting any disburse-
ments or costs incurred in connection with prosecu-
tion or settlement of the claim, including all costs 
paid or advanced by any person. Costs of health care 
incurred by the plaintiff and the attorneys’ office 
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overhead costs or charges for legal services are not 
deductible disbursements or costs for such purpose. 
(18) STATE.—The term ‘‘State’’ means each of 
the several States, the District of Columbia, the 
Commonwealth of Puerto Rico, the Virgin Islands, 
Guam, American Samoa, the Northern Mariana Is-
lands, the Trust Territory of the Pacific Islands, and 
any other territory or possession of the United 
States, or any political subdivision thereof. 
SEC. 510. EFFECT ON OTHER LAWS. 
(a) VACCINE INJURY.— 
(1) To the extent that title XXI of the Public 
Health Service Act establishes a Federal rule of law 
applicable to a civil action brought for a vaccine-re-
lated injury or death— 
(A) this title does not affect the application 
of the rule of law to such an action; and 
(B) any rule of law prescribed by this title 
in conflict with a rule of law of such title XXI 
shall not apply to such action. 
(2) If there is an aspect of a civil action 
brought for a vaccine-related injury or death to 
which a Federal rule of law under title XXI of the 
Public Health Service Act does not apply, then this 
title or otherwise applicable law (as determined 
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under this title) will apply to such aspect of such ac-
tion. 
(b) OTHER FEDERAL LAW.—Except as provided in 
this section, nothing in this title shall be deemed to affect 
any defense available to a defendant in a health care law-
suit or action under any other provision of Federal law. 
SEC. 
511. 
STATE 
FLEXIBILITY 
AND 
PROTECTION 
OF 
STATES’ RIGHTS. 
(a) HEALTH CARE LAWSUITS.—The provisions gov-
erning health care lawsuits set forth in this title preempt, 
subject to subsections (b) and (c), State law to the extent 
that State law prevents the application of any provisions 
of law established by or under this title. The provisions 
governing health care lawsuits set forth in this title super-
sede chapter 171 of title 28, United States Code, to the 
extent that such chapter— 
(1) provides for a greater amount of damages 
or contingent fees, a longer period in which a health 
care lawsuit may be commenced, or a reduced appli-
cability or scope of periodic payment of future dam-
ages, than provided in this title; or 
(2) prohibits the introduction of evidence re-
garding collateral source benefits, or mandates or 
permits subrogation or a lien on collateral source 
benefits. 
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(b) PROTECTION OF STATES’ RIGHTS AND OTHER 
LAWS.—(1) Any issue that is not governed by any provi-
sion of law established by or under this title (including 
State standards of gross negligence) shall be governed by 
otherwise applicable State or Federal law. 
(2) This title shall not preempt or supersede any 
State or Federal law that imposes greater procedural or 
substantive protections for health care providers and 
health care organizations from liability, loss, or damages 
than those provided by this title or create a cause of ac-
tion. 
(c) STATE FLEXIBILITY.—No provision of this title 
shall be construed to preempt— 
(1) any State law (whether effective before, on, 
or after the date of the enactment of this title) that 
specifies a particular monetary amount of compen-
satory or punitive damages (or the total amount of 
damages) that may be awarded in a health care law-
suit, regardless of whether such monetary amount is 
greater or lesser than is provided for under this title, 
notwithstanding section 404(a); or 
(2) any defense available to a party in a health 
care lawsuit under any other provision of State or 
Federal law. 
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SEC. 512. APPLICABILITY; EFFECTIVE DATE. 
The previous provisions of this title shall apply to any 
health care lawsuit brought in a Federal or State court, 
or subject to an alternative dispute resolution system, that 
is initiated on or after the date of the enactment of this 
title, except that any health care lawsuit arising from an 
injury occurring prior to the date of the enactment of this 
title shall be governed by the applicable statute of limita-
tions provisions in effect at the time the injury occurred. 
SEC. 513. SENSE OF CONGRESS. 
It is the sense of Congress that a health insurer 
should be liable for damages for harm caused when it 
makes a decision as to what care is medically necessary 
and appropriate. 
SEC. 514. STATE GRANTS TO CREATE ADMINISTRATIVE 
HEALTH CARE TRIBUNALS. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 399T. STATE GRANTS TO CREATE ADMINISTRATIVE 
HEALTH CARE TRIBUNALS. 
‘‘(a) IN GENERAL.—The Secretary may award grants 
to States for the development, implementation, and eval-
uation of administrative health care tribunals that comply 
with this section, for the resolution of disputes concerning 
injuries allegedly caused by health care providers. 
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‘‘(b) CONDITIONS FOR DEMONSTRATION GRANTS.— 
To be eligible to receive a grant under this section, a State 
shall submit to the Secretary an application at such time, 
in such manner, and containing such information as may 
be required by the Secretary. A grant shall be awarded 
under this section on such terms and conditions as the 
Secretary determines appropriate. 
‘‘(c) REPRESENTATION BY COUNSEL.—A State that 
receives a grant under this section may not preclude any 
party to a dispute before an administrative health care tri-
bunal operated under such grant from obtaining legal rep-
resentation during any review by the expert panel under 
subsection (d), the administrative health care tribunal 
under subsection (e), or a State court under subsection 
(f). 
‘‘(d) EXPERT PANEL REVIEW AND EARLY OFFER 
GUIDELINES.— 
‘‘(1) IN GENERAL.—Prior to the submission of 
any dispute concerning injuries allegedly caused by 
health care providers to an administrative health 
care tribunal under this section, such allegations 
shall first be reviewed by an expert panel. 
‘‘(2) COMPOSITION.— 
‘‘(A) IN GENERAL.—The members of each 
expert panel under this subsection shall be ap-
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pointed by the head of the State agency respon-
sible for health. Each expert panel shall be 
composed of no fewer than 3 members and not 
more than 7 members. At least one-half of such 
members shall be medical experts (either physi-
cians or health care professionals). 
‘‘(B) LICENSURE AND EXPERTISE.—Each 
physician or health care professional appointed 
to an expert panel under subparagraph (A) 
shall— 
‘‘(i) be appropriately credentialed or 
licensed in 1 or more States to deliver 
health care services; and 
‘‘(ii) typically treat the condition, 
make the diagnosis, or provide the type of 
treatment that is under review. 
‘‘(C) INDEPENDENCE.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), each individual appointed to an expert 
panel under this paragraph shall— 
‘‘(I) not have a material familial, 
financial, or professional relationship 
with a party involved in the dispute 
reviewed by the panel; and 
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‘‘(II) not otherwise have a con-
flict of interest with such a party. 
‘‘(ii) EXCEPTION.—Nothing in clause 
(i) shall be construed to prohibit an indi-
vidual who has staff privileges at an insti-
tution where the treatment involved in the 
dispute was provided from serving as a 
member of an expert panel merely on the 
basis of such affiliation, if the affiliation is 
disclosed to the parties and neither party 
objects. 
‘‘(D) PRACTICING HEALTH CARE PROFES-
SIONAL IN SAME FIELD.— 
‘‘(i) IN GENERAL.—In a dispute be-
fore an expert panel that involves treat-
ment, or the provision of items or serv-
ices— 
‘‘(I) by a physician, the medical 
experts on the expert panel shall be 
practicing physicians (allopathic or os-
teopathic) of the same or similar spe-
cialty as a physician who typically 
treats the condition, makes the diag-
nosis, or provides the type of treat-
ment under review; or 
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‘‘(II) by a health care profes-
sional other than a physician, at least 
two medical experts on the expert 
panel shall be practicing physicians 
(allopathic or osteopathic) of the same 
or similar specialty as the health care 
professional who typically treats the 
condition, makes the diagnosis, or 
provides the type of treatment under 
review, and, if determined appropriate 
by the State agency, an additional 
medical expert shall be a practicing 
health care professional (other than 
such a physician) of such a same or 
similar specialty. 
‘‘(ii) PRACTICING DEFINED.—In this 
paragraph, the term ‘practicing’ means, 
with respect to an individual who is a phy-
sician or other health care professional, 
that the individual provides health care 
services to individual patients on average 
at least 2 days a week. 
‘‘(E) PEDIATRIC EXPERTISE.—In the case 
of dispute relating to a child, at least 1 medical 
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expert on the expert panel shall have expertise 
described in subparagraph (D)(i) in pediatrics. 
‘‘(3) DETERMINATION.—After a review under 
paragraph (1), an expert panel shall make a deter-
mination as to the liability of the parties involved 
and compensation. 
‘‘(4) ACCEPTANCE.—If the parties to a dispute 
before an expert panel under this subsection accept 
the determination of the expert panel concerning li-
ability and compensation, such compensation shall 
be paid to the claimant and the claimant shall agree 
to forgo any further action against the health care 
providers involved. 
‘‘(5) FAILURE TO ACCEPT.—If any party de-
cides not to accept the expert panel’s determination, 
the matter shall be referred to an administrative 
health care tribunal created pursuant to this section. 
‘‘(e) ADMINISTRATIVE HEALTH CARE TRIBUNALS.— 
‘‘(1) IN GENERAL.—Upon the failure of any 
party to accept the determination of an expert panel 
under subsection (d), the parties shall have the right 
to request a hearing concerning the liability or com-
pensation involved by an administrative health care 
tribunal established by the State involved. 
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‘‘(2) REQUIREMENTS.—In establishing an ad-
ministrative health care tribunal under this section, 
a State shall— 
‘‘(A) ensure that such tribunals are pre-
sided over by special judges with health care ex-
pertise; 
‘‘(B) provide authority to such judges to 
make binding rulings, rendered in written deci-
sions, on standards of care, causation, com-
pensation, and related issues with reliance on 
independent expert witnesses commissioned by 
the tribunal; 
‘‘(C) establish gross negligence as the legal 
standard for the tribunal; 
‘‘(D) allow the admission into evidence of 
the recommendation made by the expert panel 
under subsection (d); and 
‘‘(E) provide for an appeals process to 
allow for review of decisions by State courts. 
‘‘(f) REVIEW BY STATE COURT AFTER EXHAUSTION 
OF ADMINISTRATIVE REMEDIES.— 
‘‘(1) RIGHT TO FILE.—If any party to a dispute 
before a health care tribunal under subsection (e) is 
not satisfied with the determinations of the tribunal, 
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the party shall have the right to file their claim in 
a State court of competent jurisdiction. 
‘‘(2) FORFEIT OF AWARDS.—Any party filing 
an action in a State court in accordance with para-
graph (1) shall forfeit any compensation award 
made under subsection (e). 
‘‘(3) ADMISSIBILITY.—The determinations of 
the expert panel and the administrative health care 
tribunal pursuant to subsections (d) and (e) with re-
spect to a State court proceeding under paragraph 
(1) shall be admissible into evidence in any such 
State court proceeding. 
‘‘(g) DEFINITION.—In this section, the term ‘health 
care provider’ has the meaning given such term for pur-
poses of part A of title VII. 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated for any fiscal year such 
sums as may be necessary for purposes of making grants 
to States under this section.’’. 
SEC. 515. AFFIRMATIVE DEFENSE BASED ON COMPLIANCE 
WITH BEST PRACTICE GUIDELINES. 
(a) SELECTION AND ISSUANCE OF BEST PRACTICES 
GUIDELINES.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the 
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‘‘Secretary’’) shall provide for the selection and 
issuance of best practice guidelines (each in this sub-
section referred to as a ‘‘guideline’’) in accordance 
with paragraphs (2) and (3). 
(2) DEVELOPMENT PROCESS.—Not later than 
90 days after the date of the enactment of this Act, 
the Secretary shall enter into a contract with a 
qualified physician consensus-building organization 
(such as the Physician Consortium for Performance 
Improvement), in concert and agreement with physi-
cian specialty organizations, to develop guidelines for 
treatment of medical conditions for application 
under subsection (b). Under the contract, the orga-
nization shall take into consideration any endorsed 
performance-based quality measures described in 
section 802. Under the contract and not later than 
18 months after the date of the enactment of this 
Act, the organization shall submit best practice 
guidelines for issuance as guidelines under para-
graph (3). 
(3) ISSUANCE.— 
(A) IN GENERAL.—Not later than 2 years 
after the date of the enactment of this Act, the 
Secretary shall issue, by regulation, after notice 
and opportunity for public comment, guidelines 
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that have been recommended under paragraph 
(2) for application under subsection (b). 
(B) LIMITATION.—The Secretary may not 
issue guidelines unless they have been approved 
or endorsed by qualified physician consensus- 
building organization involved and physician 
specialty organizations. 
(C) DISSEMINATION.—The Secretary shall 
broadly disseminate the guidelines so issued. 
(b) LIMITATION ON DAMAGES.— 
(1) LIMITATION ON NONECONOMIC DAMAGES.— 
In any health care lawsuit, no noneconomic damages 
may awarded with respect to treatment that is with-
in a guideline issued under subsection (a). 
(2) LIMITATION
ON
PUNITIVE
DAMAGES.—In 
any health care lawsuit, no punitive damages may be 
awarded against a health care practitioner based on 
a claim that such treatment caused the claimant 
harm if— 
(A) such treatment was subject to the 
quality review by a qualified physician con-
sensus-building organization; 
(B) such treatment was approved in a 
guideline that underwent full review by such or-
ganization, public comment, approval by the 
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Secretary, and dissemination as described in 
subparagraph (a); and 
(C) such medical treatment is generally 
recognized among qualified experts (including 
medical providers and relevant physician spe-
cialty organizations) as safe, effective, and ap-
propriate. 
(c) USE.— 
(1) INTRODUCTION AS EVIDENCE.—Guidelines 
under subsection (a) may not be introduced as evi-
dence of negligence or deviation in the standard of 
care in any civil action unless they have previously 
been introduced by the defendant. 
(2) NO PRESUMPTION OF NEGLIGENCE.—There 
would be no presumption of negligence if a partici-
pating physician does not adhere to such guidelines. 
(d) CONSTRUCTION.—Nothing in this section shall be 
construed as preventing a State from— 
(1) replacing their current medical malpractice 
rules with rules that rely, as a defense, upon a 
health care provider’s compliance with a guideline 
issued under subsection (a); or 
(2) applying additional guidelines or safe-har-
bors that are in addition to, but not in lieu of, the 
guidelines issued under subsection (a). 
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SEC. 516. BAD DEBT DEDUCTION FOR DOCTORS TO PAR-
TIALLY OFFSET THE COST OF PROVIDING UN-
COMPENSATED CARE REQUIRED TO BE PRO-
VIDED UNDER AMENDMENTS MADE BY THE 
EMERGENCY 
MEDICAL 
TREATMENT 
AND 
LABOR ACT. 
(a) IN GENERAL.—Section 166 of the Internal Rev-
enue Code of 1986 (relating to bad debts) is amended by 
redesignating subsection (f) as subsection (g) and by in-
serting after subsection (e) the following new subsection: 
‘‘(f) BAD DEBT TREATMENT FOR DOCTORS TO PAR-
TIALLY OFFSET COST OF PROVIDING UNCOMPENSATED 
CARE REQUIRED TO BE PROVIDED.— 
‘‘(1) AMOUNT OF DEDUCTION.— 
‘‘(A) IN GENERAL.—For purposes of sub-
section (a), the basis for determining the 
amount of any deduction for an eligible 
EMTALA debt shall be treated as being equal 
to the Medicare payment amount. 
‘‘(B) MEDICARE PAYMENT AMOUNT.—For 
purposes of subparagraph (A), the Medicare 
payment amount with respect to an eligible 
EMTALA debt is the fee schedule amount es-
tablished under section 1848 of the Social Secu-
rity Act for the physicians’ service (to which 
such debt relates) as if the service were pro-
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vided to an individual enrolled under part B of 
title XVIIII of such Act. 
‘‘(2) ELIGIBLE EMTALA DEBT.—For purposes 
of this section, the term ‘eligible EMTALA debt’ 
means any debt if— 
‘‘(A) such debt arose as a result of physi-
cians’ services— 
‘‘(i) which were performed in an 
EMTALA hospital by a board-certified 
physician (whether as part of medical 
screening or necessary stabilizing treat-
ment and whether as an emergency depart-
ment physician, as an on-call physician, or 
otherwise), and 
‘‘(ii) which were required to be pro-
vided under section 1867 of the Social Se-
curity Act (42 U.S.C. 1395dd), and 
‘‘(B) such debt is owed— 
‘‘(i) to such physician, or 
‘‘(ii) to an entity if— 
‘‘(I) such entity is a corporation 
and the sole shareholder of such cor-
poration is such physician, or 
‘‘(II) such entity is a partnership 
and any deduction under this sub-
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section with respect to such debt is al-
located to such physician or to an en-
tity described in subclause (I). 
‘‘(3) BOARD-CERTIFIED PHYSICIAN.—For pur-
poses of this subsection, the term ‘board-certified 
physician’ means any physician (as defined in sec-
tion 1861(r) of the Social Security Act (42 U.S.C. 
1395x(r)) who is certified by the American Board of 
Emergency Medicine or other appropriate medical 
specialty board for the specialty in which the physi-
cian practices, or who meets comparable require-
ments, as identified by the Secretary of the Treasury 
in consultation with Secretary of Health and Human 
Services. 
‘‘(4) OTHER
DEFINITIONS.—For purposes of 
this subsection— 
‘‘(A) EMTALA 
HOSPITAL.—The term 
‘EMTALA hospital’ means any hospital having 
a hospital emergency department which is re-
quired to comply with section 1867 of the So-
cial Security Act (42 U.S.C. 1395dd) (relating 
to examination and treatment for emergency 
medical conditions and women in labor). 
‘‘(B) PHYSICIANS’ SERVICES.—The term 
‘physicians’ services’ has the meaning given 
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such term in section 1861(q) of the Social Se-
curity Act (42 U.S.C. 1395x(q)).’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to debts arising from services per-
formed in taxable years beginning after the date of the 
enactment of this Act. 
TITLE VI—WELLNESS AND 
PREVENTION 
SEC. 601. PROVIDING FINANCIAL INCENTIVES FOR TREAT-
MENT COMPLIANCE. 
(a) ERISA LIMITATION
ON
EXCEPTION
FOR 
WELLNESS PROGRAMS UNDER HIPAA DISCRIMINATION 
RULES.—Section 702(b)(2) of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1182(b)(2)) is 
amended by adding after and below subparagraph (B) the 
following: 
‘‘In applying subparagraph (B), a group health plan 
(or a health insurance issuer with respect to health 
insurance coverage) may vary premiums and cost- 
sharing by up to 50 percent of the value of the bene-
fits under the plan (or coverage) based on participa-
tion (or lack of participation) in a standards-based 
wellness program.’’. 
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(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to plan years beginning more 
than 1 year after the date of the enactment of this Act. 
TITLE VII—TRANSPARENCY AND 
INSURANCE REFORM MEASURES 
SEC. 701. RECEIPT AND RESPONSE TO REQUESTS FOR 
CLAIM INFORMATION. 
(a) IN GENERAL.—Title XXVII of the Public Health 
Service Act is amended by inserting after section 2713 the 
following new section: 
‘‘SEC. 2714. RECEIPT AND RESPONSE TO REQUESTS FOR 
CLAIM INFORMATION. 
‘‘(a) REQUIREMENT.— 
‘‘(1) IN GENERAL.—In the case of health insur-
ance coverage offered in connection with a group 
health plan, not later than the 30th day after the 
date a health insurance issuer receives a written re-
quest for a written report of claim information from 
the plan, plan sponsor, or plan administrator, the 
health insurance issuer shall provide the requesting 
party the report, subject to the succeeding provisions 
of this section. 
‘‘(2) EXCEPTION.—The health insurance issuer 
is not obligated to provide a report under this sub-
section regarding a particular employer or group 
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health plan more than twice in any 12-month period 
and is not obligated to provide such a report in the 
case of an employer with fewer than 50 employees. 
‘‘(3) DEADLINE.—A plan, plan sponsor, or plan 
administrator must request a report under this sub-
section before or on the second anniversary of the 
date of termination of coverage under a group health 
plan issued by the health insurance issuer. 
‘‘(b) FORM OF REPORT; INFORMATION TO BE IN-
CLUDED.— 
‘‘(1) IN GENERAL.—A health insurance issuer 
shall provide the report of claim information under 
subsection (a)— 
‘‘(A) in a written report; 
‘‘(B) through an electronic file transmitted 
by secure electronic mail or a file transfer pro-
tocol site; or 
‘‘(C) by making the required information 
available through a secure website or web portal 
accessible by the requesting plan, plan sponsor, 
or plan administrator. 
‘‘(2) INFORMATION TO BE INCLUDED.—A re-
port of claim information provided under subsection 
(a) shall contain all information available to the 
health insurance issuer that is responsive to the re-
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quest made under such subsection, including, subject 
to subsection (c), protected health information, for 
the 36-month period preceding the date of the report 
or the period specified by subparagraphs (D), (E), 
and (F) of paragraph (3), if applicable, or for the 
entire period of coverage, whichever period is short-
er. 
‘‘(3) REQUIRED
INFORMATION.—Subject to 
subsection (c), a report provided under subsection 
(a) shall include the following: 
‘‘(A) Aggregate paid claims experience by 
month, including claims experience for medical, 
dental, and pharmacy benefits, as applicable. 
‘‘(B) Total premium paid by month. 
‘‘(C) Total number of covered employees 
on a monthly basis by coverage tier, including 
whether coverage was for— 
‘‘(i) an employee only; 
‘‘(ii) an employee with dependents 
only; 
‘‘(iii) an employee with a spouse only; 
or 
‘‘(iv) an employee with a spouse and 
dependents. 
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‘‘(D) The total dollar amount of claims 
pending as of the date of the report. 
‘‘(E) A separate description and individual 
claims report for any individual whose total 
paid claims exceed $15,000 during the 12- 
month period preceding the date of the report, 
including the following information related to 
the claims for that individual— 
‘‘(i) a unique identifying number, 
characteristic, or code for the individual; 
‘‘(ii) the amounts paid; 
‘‘(iii) dates of service; and 
‘‘(iv) applicable procedure codes and 
diagnosis codes. 
‘‘(F) For claims that are not part of the 
information described in a previous subpara-
graph, a statement describing precertification 
requests for hospital stays of 5 days or longer 
that were made during the 30-day period pre-
ceding the date of the report. 
‘‘(c) LIMITATIONS ON DISCLOSURE.— 
‘‘(1) IN GENERAL.—A health insurance issuer 
may not disclose protected health information in a 
report of claim information provided under this sec-
tion if the health insurance issuer is prohibited from 
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disclosing that information under another State or 
federal law that imposes more stringent privacy re-
strictions than those imposed under federal law 
under the HIPAA privacy regulations. To withhold 
information in accordance with this subsection, the 
health insurance issuer must— 
‘‘(A) notify the plan, plan sponsor, or plan 
administrator requesting the report that infor-
mation is being withheld; and 
‘‘(B) provide to the plan, plan sponsor, or 
plan administrator a list of categories of claim 
information that the health insurance issuer has 
determined are subject to the more stringent 
privacy restrictions under another State or Fed-
eral law. 
‘‘(2) PROTECTION.—A plan sponsor is entitled 
to receive protected health information under sub-
paragraph (E) and (F) of subsection (b)(3) and sub-
section (d) only after an appropriately authorized 
representative of the plan sponsor makes to the 
health insurance issuer a certification substantially 
similar to the following certification: ‘I hereby certify 
that the plan documents comply with the require-
ments of section 164.504(f)(2) of title 45, Code of 
Federal Regulations, and that the plan sponsor will 
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safeguard and limit the use and disclosure of pro-
tected health information that the plan sponsor may 
receive from the group health plan to perform the 
plan administration functions.’. 
‘‘(3) RESULTS.—A plan sponsor that does not 
provide the certification required by paragraph (2) is 
not entitled to receive the protected health informa-
tion described by subparagraphs (E) and (F) of sub-
section (b)(3) and subsection (d), but is entitled to 
receive a report of claim information that includes 
the information described by subparagraphs (A) 
through (D) of subsection (b)(3). 
‘‘(4) INFORMATION.—In the case of a request 
made under subsection (a) after the date of termi-
nation of coverage, the report must contain all infor-
mation available to the health insurance issuer as of 
the date of the report that is responsive to the re-
quest, including protected health information, and 
including the information described by subsection 
(b)(3), for the period described by subsection (b)(2) 
preceding the date of termination of coverage or for 
the entire policy period, whichever period is shorter. 
Notwithstanding this subsection, the report may not 
include the protected health information described 
by subparagraphs (E) and (F) of subsection (b)(3) 
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unless a certification has been provided in accord-
ance with paragraph (2). 
‘‘(d) REQUEST FOR ADDITIONAL INFORMATION.— 
‘‘(1) REVIEW.—On receipt of the report re-
quired by subsection (a), the plan, plan sponsor, or 
plan administrator may review the report and, not 
later than the 10th day after the date the report is 
received, may make a written request to the health 
insurance issuer for additional information in ac-
cordance with this subsection for specified individ-
uals. 
‘‘(2) REQUEST.—With respect to a request for 
additional information concerning specified individ-
uals for whom claims information has been provided 
under subsection (b)(3)(E), the health insurance 
issuer shall provide additional information on the 
prognosis or recovery if available and, for individuals 
in active case management, the most recent case 
management information, including any future ex-
pected costs and treatment plan, that relate to the 
claims for that individual. 
‘‘(3) RESPONSE.—The health insurance issuer 
must respond to the request for additional informa-
tion under this subsection not later than the 15th 
day after the date of such request unless the re-
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questing plan, plan sponsor, or plan administrator 
agrees to a request for additional time. 
‘‘(4) LIMITATION.—The health insurance issuer 
is not required to produce the report described by 
this subsection unless a certification has been pro-
vided in accordance with subsection (c)(2). 
‘‘(5) COMPLIANCE
WITH
SECTION
DOES
NOT 
CREATE LIABILITY.—A health insurance issuer that 
releases information, including protected health in-
formation, in accordance with this subsection has 
not violated a standard of care and is not liable for 
civil damages resulting from, and is not subject to 
criminal prosecution for, releasing that information. 
‘‘(e) LIMITATION ON PREEMPTION.—Nothing in this 
section is meant to limit States from enacting additional 
laws in addition to this, but not in lieu of. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) The terms ‘employer’, ‘plan administrator’, 
and ‘plan sponsor’ have the meanings given such 
terms in section 3 of the Employee Retirement In-
come Security Act of 1974. 
‘‘(2) The term ‘HIPAA privacy regulations’ has 
the meaning given such term in section 1180(b)(3) 
of the Social Security Act. 
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‘‘(3) The term ‘protected health information’ 
has the meaning given such term under the HIPAA 
privacy regulations.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the date of the enact-
ment of this Act. 
TITLE VIII—QUALITY 
SEC. 801. PROHIBITION ON CERTAIN USES OF DATA OB-
TAINED FROM COMPARATIVE EFFECTIVE-
NESS RESEARCH; ACCOUNTING FOR PERSON-
ALIZED MEDICINE AND DIFFERENCES IN PA-
TIENT TREATMENT RESPONSE. 
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, the Secretary of Health and Human Serv-
ices— 
(1) shall not use data obtained from the con-
duct of comparative effectiveness research, including 
such research that is conducted or supported using 
funds appropriated under the American Recovery 
and Reinvestment Act of 2009 (Public Law 111–5), 
to deny coverage of an item or service under a Fed-
eral health care program (as defined in section 
1128B(f) of the Social Security Act (42 U.S.C. 
1320a–7b(f))); and 
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(2) shall ensure that comparative effectiveness 
research conducted or supported by the Federal 
Government accounts for factors contributing to dif-
ferences in the treatment response and treatment 
preferences of patients, including patient-reported 
outcomes, genomics and personalized medicine, the 
unique needs of health disparity populations, and in-
direct patient benefits. 
(b) CONSULTATION
AND APPROVAL REQUIRED.— 
Nothing the Federal Coordinating Council for Compara-
tive Effectiveness Research finds can be released in final 
form until after consultation with and approved by rel-
evant physician specialty organizations. 
(c) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed as affecting the authority of the 
Commissioner of Food and Drugs under the Federal 
Food, Drug, and Cosmetic Act or the Public Health Serv-
ice Act. 
SEC. 
802. 
ESTABLISHMENT 
OF 
PERFORMANCE-BASED 
QUALITY MEASURES. 
Not later than January 1, 2010, the Secretary of 
Health and Human Services shall submit to Congress a 
proposal for a formalized process for the development of 
performance-based quality measures that could be applied 
to physicians’ services under the Medicare program. Such 
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proposal shall be in concert and agreement with the Physi-
cian Consortium for Performance Improvement and shall 
only utilize measures agreed upon by each physician spe-
cialty organization. 
TITLE IX—STATE 
TRANSPARENCY PLAN PORTAL 
SEC. 901. PROVIDING INFORMATION ON HEALTH COV-
ERAGE OPTIONS AND HEALTH CARE PRO-
VIDERS. 
(a) STATE-BASED PORTAL.—A State (by itself or 
jointly with other States) may contract with a private enti-
ty to establish a Health Plan and Provider Portal website 
(referred to in this section as a ‘‘plan portal’’) for the pur-
poses of providing standardized information— 
(1) on health insurance plans that have been 
certified to be available for purchase in that State; 
and 
(2) on price and quality information on health 
care providers (including physicians, hospitals, and 
other health care institutions). 
(b) PILOT PROGRAM.— 
(1) IN GENERAL.—Not later than 90 days after 
the date of the enactment of this Act the Secretary 
of Health and Human Services shall work with 
States to establish no later than 2011, consistent 
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with this title, a website that will serve as a pilot 
program for a national portal for information struc-
tured in a manner so individuals may directly link 
to the State plan portal for the State in which they 
reside. 
(2) CONTRACTS WITH STATE.—The Secretary 
shall enter into contracts with States, in a number 
and distribution determined by the Secretary, to de-
velop State plan portals that follow the applicable 
standards and regulations under this section. 
(3) COMMON
STANDARDS
FOR
PLAN
POR-
TALS.— 
(A) IN GENERAL.—In connection with such 
website, the Secretary shall establish standards 
for interoperability and consistency for State 
plan portals so that individuals can access and 
view information in a similar manner on plan 
portals of different States. Such standards shall 
include standard definitions for health insur-
ance plan benefits so that individuals can accu-
rately compare health insurance plans within 
such portals and standards for the inclusion of 
information described in subsection (c). 
(B) CONSULTATION.—The Secretary shall 
consult with a group consisting of a balanced 
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representation of the critical stakeholders (in-
cluding States, health insurance issuers, the 
National Association of Insurance Commis-
sioners, qualified health care provider-based en-
tities (including physicians, hospitals, and other 
health care institutions), and a standards devel-
opment organization) to develop such stand-
ards. 
(C) ISSUANCE.— 
(i) IN GENERAL.—Not later than 6 
months after the date of the enactment of 
this Act, the Secretary shall issue, by regu-
lation, after notice and opportunity for 
public comment, standards that are con-
sistent with the recommendations made by 
the group under subparagraph (B). 
(ii) DISSEMINATION.—The Secretary 
shall broadly disseminate the standards so 
issued. 
(D) REVIEW.—One year after the date of 
establishment of the pilot program under this 
subsection, the Secretary, in consultation with 
stakeholder group described in subparagraph 
(B), shall review the standards established and 
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make such changes in such standards as may 
be appropriate. 
(4) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to the Sec-
retary such amounts as may be necessary for— 
(A) the development and operation of the 
national website under this subsection; and 
(B) contracts with States under paragraph 
(2) to assist in the development and initial op-
eration of plan portals in accordance with 
standards established under paragraph (3) and 
other applicable provisions of this section. 
(c) INFORMATION IN PLAN PORTALS.—The stand-
ards for plan portals under subsection (b)(3) shall include 
the following: 
(1) HEALTH INSURANCE INFORMATION.—Each 
plan portal shall meet the following requirements 
with respect to information on health insurance 
plans: 
(A) The plan portal shall present complete 
information on the costs and benefits of health 
insurance plans (including information on 
monthly premium, copayments, deductibles, and 
covered benefits) in a uniform manner that— 
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