I
107TH CONGRESS
1ST SESSION
H. R. 2342
To amend title XXVII of the Public Health Service Act, the Employee
Retirement Income Security Act of 1974, and the Internal Revenue
Code of 1986 to assure patient access to primary pediatric care through
pediatricians under group health plans and group health insurance cov-
erage.
IN THE HOUSE OF REPRESENTATIVES
JUNE 27, 2001
Ms. GRANGER introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on
Education and the Workforce, and Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee con-
cerned
A BILL
To amend title XXVII of the Public Health Service Act,
the Employee Retirement Income Security Act of 1974,
and the Internal Revenue Code of 1986 to assure patient
access to primary pediatric care through pediatricians
under group health plans and group health insurance
coverage.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Primary Care for Chil-
dren Act of 2001’’.
SEC. 2. PATIENT ACCESS TO PEDIATRIC CARE THROUGH
PEDIATRICIANS.
(a) AMENDMENT
TO PUBLIC HEALTH SERVICE
ACT.—Subpart 2 of part A of title XXVII of the Public
Health Service Act is amended by adding at the end the
following new section:
‘‘SEC. 
2707. 
PATIENT 
ACCESS 
TO 
PEDIATRIC 
CARE
THROUGH PEDIATRICIANS.
‘‘(a) PATIENT ACCESS TO PEDIATRIC CARE.—In any
case in which a group health plan (or a health insurance
issuer offering health insurance coverage in connection
with the plan) provides benefits consisting of primary pe-
diatric care provided by a participating primary care phy-
sician who specializes in pediatrics (or consisting of pay-
ment for such care) and the plan requires or provides for
designation by a participant or beneficiary of a partici-
pating primary care physician with respect to such care,
the plan (or issuer) shall provide that such a participating
physician who specializes in pediatrics may be designated,
if available, by a parent or guardian of any beneficiary
under the plan who is under 18 years of age, as the pri-
mary care physician with respect to any such benefits.
‘‘(b) CONSTRUCTION.—Nothing in subsection (a)
shall waive any requirements of coverage relating to med-
ical necessity or appropriateness with respect to coverage
of pediatric care.’’.
(b) ERISA AMENDMENTS.—
(1) IN GENERAL.—Subpart B of part 7 of sub-
title B of title I of the Employee Retirement Income
Security Act of 1974 is amended by adding at the
end the following new section:
‘‘SEC. 714. PATIENT ACCESS TO PEDIATRIC CARE.
‘‘(a) PATIENT ACCESS TO PEDIATRIC CARE.—In any
case in which a group health plan (or a health insurance
issuer offering health insurance coverage in connection
with the plan) provides benefits consisting of primary pe-
diatric care provided by a participating primary care phy-
sician who specializes in pediatrics (or consisting of pay-
ment for such care) and the plan requires or provides for
designation by a participant or beneficiary of a partici-
pating primary care physician with respect to such care,
the plan (or issuer) shall provide that such a participating
physician who specializes in pediatrics may be designated,
if available, by a parent or guardian of any beneficiary
under the plan who is under 18 years of age, as the pri-
mary care physician with respect to any such benefits.
‘‘(b) CONSTRUCTION.—Nothing in subsection (a)
shall waive any requirements of coverage relating to med-
ical necessity or appropriateness with respect to coverage
of pediatric care.’’.
(2) CLERICAL AMENDMENT.—The table of con-
tents in section 1 of such Act is amended by insert-
ing after the item relating to section 713 the fol-
lowing new item:
‘‘Sec. 714. Patient access to pediatric care.’’.
(c) INTERNAL REVENUE CODE AMENDMENTS.—Sub-
chapter B of chapter 100 of the Internal Revenue Code
of 1986 is amended—
(1) in the table of sections, by inserting after
the item relating to section 9812 the following new
item:
‘‘Sec. 9813. Patient access to pediatric care.’’; and
(2) by inserting after section 9812 the fol-
lowing:
‘‘SEC. 9813. PATIENT ACCESS TO PEDIATRIC CARE.
‘‘(a) PATIENT ACCESS TO PEDIATRIC CARE.—In any
case in which a group health plan provides benefits con-
sisting of primary pediatric care provided by a partici-
pating primary care physician who specializes in pediatrics
(or consisting of payment for such care) and the plan re-
quires or provides for designation by a participant or bene-
ficiary of a participating primary care physician with re-
spect to such care, the plan shall provide that such a par-
ticipating physician who specializes in pediatrics may be
designated, if available, by a parent or guardian of any
beneficiary under the plan is who under 18 years of age,
as the primary care physician with respect to any such
benefits.
‘‘(b) CONSTRUCTION.—Nothing in subsection (a)
shall waive any requirements of coverage relating to med-
ical necessity or appropriateness with respect to coverage
of pediatric care.’’
(d) EFFECTIVE DATE AND RELATED RULES.—
(1) IN GENERAL.—The amendments made by
this section apply with respect to plan years begin-
ning on or after January 1, 2003, except that the
Secretaries of Health and Human Services, of
Labor, and of the Treasury may issue regulations
before such date under such amendments. Such Sec-
retaries shall first issue all regulations necessary to
carry out such amendments before the effective date
thereof.
(2) LIMITATION ON ENFORCEMENT ACTIONS.—
No enforcement action shall be taken, pursuant to
the amendments made by this section, against a
group health plan or health insurance issuer with re-
spect to a violation of a requirement imposed by
such amendments before the date of issuance of reg-
ulations issued in connection with such requirement,
if the plan or issuer has sought to comply in good
faith with such requirement.
(3) SPECIAL
RULE
FOR
COLLECTIVE
BAR-
GAINING
AGREEMENTS.—In the case of a group
health plan maintained pursuant to one or more col-
lective bargaining agreements between employee rep-
resentatives and one or more employers ratified be-
fore the date of the enactment of this Act, the
amendments made by this section shall not apply
with respect to plan years beginning before the later
of—
(1) the date on which the last of the collec-
tive bargaining agreements relating to the plan
terminates (determined without regard to any
extension thereof agreed to after the date of the
enactment of this Act); or
(2) January 1, 2003.
For purposes of this paragraph, any plan amend-
ments made pursuant to a collective bargaining
agreement relating to the plan which amends the
plan solely to conform to any requirement added by
this section shall not be treated as a termination of
such collective bargaining agreement.
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