Table of Contents
TITLE 
I—BASIC 
REFORMS 
TO 
EXPAND 
ACCESS 
TO
HEALTH INSURANCE COVERAGE AND TO ENSURE UNI-
VERSAL COVERAGE
Subtitle A—Universal Access
Page
Sec. 1001. Access for each individual .....................................................
Sec. 1002. Promotion of coverage through expanded tax deductibility ..
Sec. 1003. Low-income assistance with qualified health plan premiums
Sec. 1004. Expanded access to employer plans ......................................
Subtitle B—Qualified General Access Plans in the Small
Employer and Individual Marketplace
PART I—STANDARDS FOR GENERAL ACCESS PLANS
SUBPART A—ESTABLISHMENT AND APPLICATION OF STANDARDS
Sec. 1101. Qualified general access plans ...............................................
Sec. 1102. Establishment of standards ...................................................
Sec. 1103. Application of interim requirements ......................................
SUBPART B—STANDARDS
Sec. 1111. Guaranteed eligibility, availability, and renewability ............
Sec. 1112. Nondiscrimination based on health status ............................
Sec. 1113. Benefits offered .....................................................................
Sec. 1114. Financial solvency requirements ...........................................
Sec. 1115. Enrollment .............................................................................
Sec. 1116. Rating limitations ..................................................................
Sec. 1117. Risk adjustment ....................................................................
Sec. 1118. Collection and provision of standardized information ...........
Sec. 1119. Quality assurance ..................................................................
Sec. 1120. Mediation procedures relating to malpractice claims ............
Sec. 1121. Service to designated underserved areas ...............................
Sec. 1122. Additional requirements ........................................................
PART II—INDIVIDUAL AND SMALL EMPLOYER PURCHASING GROUPS
Sec. 1141. Establishment and organization ............................................
Sec. 1142. Agreements with qualified general access plans ....................
Sec. 1143. Provision of information ........................................................
Sec. 1144. Enrolling eligible employees and eligible individuals in
qualified general access plans through a purchasing
group .............................................................................
Sec. 1145. Restriction on charges ...........................................................
PART III—CONSUMER PROTECTION AND MARKET REFORMS
Sec. 1161. Requirement for provision of information by brokers ...........
Sec. 1162. Prohibition of improper incentives ........................................
Sec. 1163. Prohibition of sale of duplicate coverage or sale to certain
populations ....................................................................
Subtitle C—Qualified Health Plans in the Large Employer
Marketplace
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PART I—REQUIREMENTS ON LARGE EMPLOYER PLANS
Sec. 1201. Standards applied to large employer plans ...........................
Sec. 1202. Establishment of standards applicable to large employer
plans ..............................................................................
Sec. 1203. Offer of different benefit packages required .........................
Sec. 1204. Enrollment in large employer plans in satisfaction of enroll-
ment requirement ..........................................................
Sec. 1205. Development of large or multiple employer purchasing
groups ............................................................................
Sec. 1207. Corrective actions ..................................................................
PART II—AMENDMENTS TO ERISA
Sec. 1221. Limitation on coverage of group health plans under title I
of ERISA ......................................................................
PART III—REVISION OF COBRA CONTINUATION COVERAGE REQUIREMENTS
Sec. 1231. Amendments to the Employee Retirement Income Security
Act of 1974 ...................................................................
Sec. 1232. Amendment to Public Health Service Act ............................
Sec. 1233. Additional revisions ...............................................................
Subtitle D—Benefits; Benefits Commission
PART I—BENEFITS
Sec. 1301. Offering of benefit packages .................................................
PART II—BENEFITS COMMISSION
Sec. 1311. Establishment ........................................................................
Sec. 1312. Duties ....................................................................................
Sec. 1313. Operation of the Commission ................................................
103
Sec. 1314. Congressional consideration of Commission proposals ..........
107
Sec. 1315. Implementation ......................................................................
114
Subtitle E—State and Federal Responsibilities in Relation to
Qualified Health Plans
PART I—STATE RESPONSIBILITIES
SUBPART A—GENERAL RESPONSIBILITIES
Sec. 1401. Establishment of State insurance market reform programs
114
Sec. 1402. Certification of insured health plans .....................................
117
Sec. 1403. Establishment of health care coverage areas ........................
117
Sec. 1404. Procedures for purchasing groups .........................................
118
Sec. 1405. Preparation of information concerning plans and purchas-
ing groups .....................................................................
118
Sec. 1406. Risk adjustment program ......................................................
119
Sec. 1407. Development of binding arbitration process ..........................
120
Sec. 1408. Specification of annual general enrollment period ................
120
SUBPART B—WAIVER OF REQUIREMENTS
Sec. 1421. Alternate State systems allowed ............................................
121
Sec. 1422. State opt-out ..........................................................................
123
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Sec. 1423. Waiver of certain medicaid requirements ..............................
123
SUBPART C—PREEMPTION OF CERTAIN STATE LAWS
Sec. 1431. Preemption from State benefit mandates .............................
123
Sec. 1432. Preemption of State law restrictions on network plans ........
124
PART II—FEDERAL RESPONSIBILITIES
Sec. 1441. Federal role with respect to multi-State employer plans ......
126
Sec. 1442. Federal role in the case of a default by a State ...................
127
Sec. 1443. Establishment of residency rules ...........................................
127
Sec. 1444. Rules determining separate employer status .........................
127
Subtitle F—Universal Coverage
Sec. 1501. Requirement of coverage .......................................................
128
Subtitle G—Definitions
Sec. 1601. Definitions .............................................................................
128
TITLE II—TAX AND ENFORCEMENT PROVISIONS
Sec. 2000. Amendment of 1986 Code .....................................................
136
Subtitle A—General Tax Provisions
Sec. 2001. Certain employer health plan contributions included in in-
come ..............................................................................
137
Sec. 2002. Deductions for costs of qualified health plans ......................
147
Sec. 2003. Medical savings accounts .......................................................
152
Sec. 2004. Eliminating commonality of interest or geographic location
requirement for tax exempt trust status .......................
172
Sec. 2005. Revision of COBRA continuation coverage requirements .....
172
Subtitle B—Provisions Relating to Acceleration of Death
Benefits
Sec. 2101. Tax treatment of payments under life insurance contracts
for terminally ill individuals ..........................................
175
Sec. 2102. Tax treatment of companies issuing qualified terminal ill-
ness riders .....................................................................
176
Subtitle C—Long-Term Care Tax Provisions
PART I—GENERAL PROVISIONS
Sec. 2201. Qualified long-term care services treated as medical care ....
177
Sec. 2202. Treatment of long-term care insurance or plans ..................
182
Sec. 2203. Effective dates .......................................................................
191
PART II—CONSUMER PROTECTION PROVISIONS
Sec. 2301. Policy requirements ...............................................................
192
Sec. 2302. Additional requirements for issuers of long-term care insur-
ance policies ..................................................................
201
Sec. 2303. Coordination with State requirements ..................................
206
Sec. 2304. Uniform language and definitions .........................................
207
Sec. 2305. Effective dates .......................................................................
207
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Subtitle D—Enforcement Provisions
PART I—GENERAL PROVISIONS
Sec. 2401. Universal coverage .................................................................
207
Sec. 2402. Role of employers and large employer plans .........................
217
Sec. 2403. Enforcement before State certification programs or stand-
ards in place ..................................................................
221
Sec. 2404. Disclosure of information regarding reconciliation of assist-
ance ...............................................................................
223
PART II—OTHER ENFORCEMENT PROVISIONS
Sec. 2411. Conforming ERISA changes regarding enforcement of em-
ployer failures ................................................................
224
Sec. 2412. Equitable relief regarding insurers failing to comply with
qualified health plan standards .....................................
226
TITLE III—QUALITY ASSURANCE AND SIMPLIFICATION
Subtitle A—Quality Assurance
PART I—STANDARDS AND MEASUREMENTS OF QUALITY
Sec. 3001. Standards for quality assurance and performance measures
programs .......................................................................
228
Sec. 3002. National health data system ..................................................
229
Sec. 3003. Measures of quality of care of specialized centers of care ....
233
Sec. 3004. Clinical evaluations ................................................................
234
Sec. 3005. Report and recommendations on achieving universal cov-
erage ..............................................................................
237
Sec. 3006. Monitoring reinsurance market .............................................
238
Sec. 3007. Authorization of appropriations ............................................
239
PART II—AGENCY FOR HEALTH CARE POLICY AND RESEARCH
Sec. 3101. Agency for Health Care Policy and Research .......................
239
PART III—NATIONAL FUND FOR MEDICAL RESEARCH
Sec. 3201. National Fund for Medical Research ....................................
241
Subtitle B—Administrative Simplification
Sec. 3301. Establishment of health care data interchange system .........
248
Sec. 3302. Development of proposed regulations by Panel ....................
249
Sec. 3303. Promulgation and implementation of proposed regulations
by OMB .........................................................................
251
Sec. 3304. Selection and establishment of data and transaction stand-
ards, conventions, and requirements for the data inter-
change system ...............................................................
252
Sec. 3305. Standards for operation of a uniform working file ...............
260
Sec. 3306. Code sets for system ..............................................................
261
Sec. 3307. Establishment of unique identifiers ......................................
262
Sec. 3308. Privacy and confidentiality standards ...................................
263
Sec. 3309. Transfer of information between health plans ......................
265
Sec. 3310. Fines and penalties for failure to comply .............................
266
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Sec. 3311. Oversight of uniform working file, health care information
clearinghouses, and value-added networks ....................
269
Sec. 3312. Annual reports to Congress ...................................................
270
Sec. 3313. Health Care Data Panel ........................................................
270
Sec. 3314. National Health Informatics Commission .............................
273
Sec. 3315. Definitions .............................................................................
281
TITLE IV—JUDICIAL REFORMS
Subtitle A—Medical Liability Reform
Sec. 4001. Definitions .............................................................................
283
PART I—MEDIATION AND ALTERNATIVE DISPUTE RESOLUTION
Sec. 4011. Mediation ...............................................................................
286
Sec. 4012. Failure of mediation ..............................................................
288
Sec. 4013. Alternative dispute resolution ................................................
288
Sec. 4014. Court actions .........................................................................
291
PART II—LIABILITY REFORM
Sec. 4021. Applicability ...........................................................................
292
Sec. 4022. Limitation on amount of attorney’s contingency fees ...........
294
Sec. 4023. Reform of damages ................................................................
295
Sec. 4024. Reform of procedures ............................................................
298
Sec. 4025. Practice guidelines .................................................................
300
Sec. 4026. Drugs and devices .................................................................
302
Sec. 4027. Report ....................................................................................
307
Subtitle B—Anti-Fraud and Abuse Control Program
PART I—ALL-PAYER FRAUD AND ABUSE CONTROL PROGRAM
Sec. 4101. All-payer fraud and abuse control program ..........................
308
Sec. 4102. Application of Federal health anti-fraud and abuse sanc-
tions to all fraud and abuse against any health care
plan ...............................................................................
319
Sec. 4103. Reporting of fraudulent actions under medicare ..................
322
PART II—REVISIONS TO CURRENT SANCTIONS FOR FRAUD AND ABUSE
Sec. 4111. Mandatory exclusion from participation in medicare and
State health care programs ...........................................
323
Sec. 4112. Establishment of minimum period of exclusion for certain
individuals and entities subject to permissive exclusion
from medicare and State health care programs ...........
325
Sec. 4113. Civil monetary penalties ........................................................
326
Sec. 4114. Actions subject to criminal penalties .....................................
327
Sec. 4115. Sanctions against practitioners and persons for failure to
comply with statutory obligations .................................
328
Sec. 4116. Intermediate sanctions for medicare health maintenance or-
ganizations ....................................................................
329
Sec. 4117. Effective date ........................................................................
334
PART III—ADMINISTRATIVE AND MISCELLANEOUS PROVISIONS