185 
‘‘(C) The health care professional that pro-
vides the items or services involved in the de-
nial. 
‘‘(D) The institution at which the items or 
services (or treatment) involved in the denial 
are provided. 
‘‘(E) The manufacturer of any drug or 
other item that is included in the items or serv-
ices involved in the denial. 
‘‘(F) Any other party determined under 
any regulations to have a substantial interest in 
the denial involved. 
‘‘(8) DEFINITIONS.—For purposes of this sub-
section: 
‘‘(A) ENROLLEE.—The term ‘enrollee’ 
means, with respect to health insurance cov-
erage offered by a health insurance issuer, an 
individual enrolled with the issuer to receive 
such coverage. 
‘‘(B) HEALTH CARE PROFESSIONAL.—The 
term ‘health care professional’ means an indi-
vidual who is licensed, accredited, or certified 
under State law to provide specified health care 
services and who is operating within the scope 
of such licensure, accreditation, or certification. 
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‘‘SEC. 2800. ENFORCEMENT. 
‘‘(a) IN GENERAL.—Subject to subsection (b), with 
respect to specific individual health insurance coverage the 
primary State for such coverage has sole jurisdiction to 
enforce the primary State’s covered laws in the primary 
State and any secondary State. 
‘‘(b) SECONDARY STATE’S AUTHORITY.—Nothing in 
subsection (a) shall be construed to affect the authority 
of a secondary State to enforce its laws as set forth in 
the exception specified in section 2796(b)(1). 
‘‘(c) COURT INTERPRETATION.—In reviewing action 
initiated by the applicable secondary State authority, the 
court of competent jurisdiction shall apply the covered 
laws of the primary State. 
‘‘(d) NOTICE OF COMPLIANCE FAILURE.—In the case 
of individual health insurance coverage offered in a sec-
ondary State that fails to comply with the covered laws 
of the primary State, the applicable State authority of the 
secondary State may notify the applicable State authority 
of the primary State.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to individual health insurance 
coverage offered, issued, or sold after the date that is one 
year after the date of the enactment of this Act. 
(c) GAO ONGOING STUDY AND REPORTS.— 
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(1) STUDY.—The Comptroller General of the 
United States shall conduct an ongoing study con-
cerning the effect of the amendment made by sub-
section (a) on— 
(A) the number of uninsured and under-in-
sured; 
(B) the availability and cost of health in-
surance policies for individuals with pre-existing 
medical conditions; 
(C) the availability and cost of health in-
surance policies generally; 
(D) the elimination or reduction of dif-
ferent types of benefits under health insurance 
policies offered in different States; and 
(E) cases of fraud or abuse relating to 
health insurance coverage offered under such 
amendment and the resolution of such cases. 
(2) ANNUAL REPORTS.—The Comptroller Gen-
eral shall submit to Congress an annual report, after 
the end of each of the 5 years following the effective 
date of the amendment made by subsection (a), on 
the ongoing study conducted under paragraph (1). 
(d) SEVERABILITY.—If any provision of the section 
or the application of such provision to any person or cir-
cumstance is held to be unconstitutional, the remainder 
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of this section and the application of the provisions of such 
to any other person or circumstance shall not be affected. 
TITLE IV—LAWSUIT ABUSE 
REFORMS 
SEC. 401. CHANGE IN BURDEN OF PROOF BASED ON COM-
PLIANCE WITH CLINICAL PRACTICE GUIDE-
LINES. 
(a) SELECTION AND ISSUANCE OF CLINICAL PRAC-
TICES GUIDELINES.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the 
‘‘Secretary’’) shall provide for the selection and 
issuance of clinical practice guidelines for treatment 
of medical conditions (each in this subsection re-
ferred to as a ‘‘guideline’’) in accordance with para-
graphs (2) and (3). 
(2) DEVELOPMENT PROCESS.—Not later than 
90 days after the date of enactment of this title, the 
Secretary shall enter into a contract with a qualified 
physician consensus-building organization (such as 
the Physician Consortium for Performance Improve-
ment), in concert and agreement with physician spe-
cialty organizations, to develop guidelines. The con-
tract shall require that the organization submit 
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guidelines to the agency not later than 18 months 
after the date of the enactment of this title. 
(3) ISSUANCE.— 
(A) IN GENERAL.—Not later than 2 years 
after the date of the enactment of this title, the 
Secretary shall, after notice and opportunity for 
public comment, make a rule that provides for 
the issuance of the guidelines submitted under 
paragraph (2). 
(B) LIMITATION.—The Secretary may not 
make a rule that includes guidelines other than 
those submitted under paragraph (2). 
(C) DISSEMINATION.—The Secretary shall 
post such guidelines on the public Internet Web 
page of the Department of Health and Human 
Services. 
(4) MAINTENANCE.—Not later than 4 years 
after the date of enactment of this title, and every 
2 years thereafter, the Secretary shall review the 
guidelines and shall, as necessary, enter into con-
tracts similar to the contract described in paragraph 
(2), and issue guidelines in a manner similar to the 
issuance of guidelines under paragraph (3). 
(b) USE.— 
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(1) USE BY DEFENDANT TO CHANGE THE BUR-
DEN OF PROOF.—If a defendant in a health care 
lawsuit relating to treatment of an individual estab-
lishes by a preponderance of the evidence that the 
treatment was provided in a manner consistent with 
an applicable guideline issued under subsection (a), 
the defendant may not be held liable unless the 
plaintiff establishes the liability of the defendant by 
clear and convincing evidence. 
(2) LIMITATION
ON
INTRODUCTION
AS
EVI-
DENCE AGAINST A DEFENDANT.—Guidelines issued 
under subsection (a) may not be introduced as evi-
dence of negligence or deviation in the standard of 
care in any health care lawsuit unless they have pre-
viously been introduced by the defendant. 
(3) NO PRESUMPTION OF NEGLIGENCE AGAINST 
A DEFENDANT.—There shall be no presumption of 
negligence with respect to treatment if a health care 
provider provides the treatment in a manner incon-
sistent with such guidelines. 
(c) 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 
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health care provider’s compliance with a guideline 
issued under subsection (a); or 
(2) applying additional guidelines or limitations 
on liability that are in addition to, but not in lieu 
of, the guidelines issued under subsection (a). 
SEC. 402. STATE GRANTS TO CREATE EXPERT PANELS AND 
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. 
‘‘(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. 
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‘‘(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.—If, in any health care liabil-
ity action against a health care provider, the health 
care provider alleges, in any response to the claim-
ant’s filing, that the health care provider adhered to 
an applicable practice guideline in the provision of 
health care items or services to the claimant, then 
further proceedings on the health care liability ac-
tion shall be suspended prior to discovery pro-
ceedings, until the completion of a review of the ac-
tion by an independent expert panel in accordance 
with this subsection. 
‘‘(2) COMPOSITION.— 
‘‘(A) IN GENERAL.—The members of each 
expert panel under this subsection shall be ap-
pointed by the head of the State agency respon-
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sible for health. Each expert panel shall be 
composed of no fewer than 3 members and not 
more than 5 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 one 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 
‘‘(II) not otherwise have a con-
flict of interest with such a party. 
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‘‘(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 
‘‘(II) by a health care profes-
sional other than a physician, at least 
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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 
expert on the expert panel shall have expertise 
described in subparagraph (D)(i) in pediatrics. 
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‘‘(F) NO
CIVIL
LIABILITY
FOR
MEM-
BERS.—No civil action shall be brought in any 
court against any member of an expert panel 
for any act done, failure to act, or statement or 
opinion made, within the scope of individual’s 
as a member of the expert panel. 
‘‘(3) DETERMINATION.— 
‘‘(A) IN GENERAL.—After a review under 
paragraph (1), an expert panel shall make a de-
termination as to the liability of the parties in-
volved and compensation. 
‘‘(B) CONSIDERATIONS IN MAKING DETER-
MINATIONS.—In making a determination under 
this subsection as to the liability of parties in-
volved and compensation, the following shall 
apply: 
‘‘(i) TREATMENT OF CLINICAL PRAC-
TICE GUIDELINES.—An expert panel shall 
acknowledge the ability of physicians to de-
part from the recommendations in clinical 
practice guidelines, when appropriate, in 
the care of individual patients. 
‘‘(ii) LIMITATION.—An expert panel 
shall not make a finding of negligence 
from the mere fact that a treatment or 
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procedure was unsuccessful or failed to 
bring the best result. 
‘‘(4) EARLY OFFER.—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. 
‘‘(2) REQUIREMENTS.—In establishing an ad-
ministrative health care tribunal under this section, 
a State shall— 
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‘‘(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; and 
‘‘(D) allow the admission into evidence of 
the recommendation made by the expert panel 
under subsection (d). 
‘‘(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, 
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). 
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‘‘(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. 
‘‘(4) TREATMENT OF CERTAIN EXPERT PANEL 
AND
ADMINISTRATIVE
HEALTH
CARE
TRIBUNAL 
FINDINGS.— 
‘‘(A) WORK PRODUCT.—No finding by an 
expert panel under subsection (d) or adminis-
trative health care tribunal under subsection (e) 
that the defendant applicable eligible profes-
sional breached the standard of care as set 
forth under the prescribed practice guidelines 
shall constitute negligence per se or conclusive 
evidence of liability. 
‘‘(B) FINDING
RELATING
TO
CLINICAL 
PRACTICE
GUIDELINES.—If an administrative 
health care tribunal did not make a finding 
under subsection (e) that there was an applica-
ble clinical practice guideline that the defendant 
adhered to, with respect to the State court pro-
ceeding under paragraph (1) the State court 
may issue summary judgment in favor of the 
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defendant health care professional unless the 
claimant is able to show otherwise by clear and 
convincing evidence. If an administrative health 
care tribunal made a finding under subsection 
(e) that there was an applicable clinical practice 
guideline that the defendant adhered to, with 
respect to a State court proceeding under para-
graph (1) the State court shall issue summary 
judgment in favor of the applicable health care 
professional unless the claimant is able to show 
otherwise by clear and convincing evidence. 
‘‘(C) FINDING RELATING TO STANDARD OF 
CARE.—Any finding an expert panel or adminis-
trative health care tribunal under subsection (d) 
or (e), respectively, that the defendant did not 
breach the standard of care as set forth under 
the prescribed clinical practice guidelines or 
that the defendant’s failure to conform to the 
required standard was neither the cause in fact 
nor the proximate cause of the plaintiff’s injury 
or that the plaintiff did not incur any damages 
as a result shall be given deference by the State 
court involved and shall entitle the defendant to 
summary judgment unless the plaintiff is able 
to show by clear and convincing evidence that 
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the expert panel or health care tribunal, respec-
tively, was in error and that there is a genuine 
issue as to a material fact in the case. 
‘‘(g) DEFINITION.—In this section, the term ‘health 
care provider’ means any person or entity required by 
State or Federal laws or regulations to be licensed, reg-
istered, or certified to provide health care services, and 
being either so licensed, registered, or certified, or exempt-
ed from such requirement by other statute or regulation. 
‘‘(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. 403. PAYMENT OF DAMAGES AND RECOVERY OF 
COSTS IN HEALTH CARE LAWSUITS. 
(a) AUTHORIZATION OF PAYMENT OF FUTURE DAM-
AGES TO CLAIMANTS IN HEALTH CARE LAWSUITS.—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 judg-
ment, the court shall, at the request of any party, enter 
a judgment ordering that the future damages be paid by 
periodic payments, in accordance with the Uniform Peri-
odic Payment of Judgments Act promulgated by the Na-
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tional Conference of Commissioners on Uniform State 
Laws. 
(b) RECOVERY OF COSTS; PAYMENT OF AWARD.— 
In any health care lawsuit, the court may supervise the 
arrangements for payment of damages to protect against 
conflicts of interest that may have the effect of reducing 
the amount of damages awarded that are actually paid 
to claimants. In particular, in any health care lawsuit in 
which the attorney for a party claims a financial stake 
in the outcome by virtue of a contingent fee, the court 
shall have the power to restrict the payment of a claim-
ant’s damage recovery to such attorney, and to redirect 
such damages to the claimant based upon the interests 
of justice and principles of equity. 
(c) 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. 
(d) STATUTE OF LIMITATIONS.—Except in the case 
of a State law that provides for a shorter period of time, 
the time for the commencement of a health care lawsuit 
shall be no more than 3 years after the date of manifesta-
tion of injury or 1 year after the claimant discovers, or 
through the use of reasonable diligence should have discov-
ered, the injury, whichever occurs first. In no event shall 
the time for commencement of a health care lawsuit exceed 
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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. 
Except in the case of a State law that provides for a short-
er period of time, actions by a minor shall be commenced 
within 3 years from the date of the alleged manifestation 
of injury except that actions by a minor under the full 
age of 6 years shall be commenced within 3 years of mani-
festation of injury 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. 
(e) 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 
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-
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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. 
(f) APOLOGIES.—In any health care lawsuit, if a 
claimant receives any expression of regret for any act per-
taining to conduct giving rise to the health care lawsuit, 
such expression of regret, notwithstanding any applicable 
rule of evidence may not be admitted into evidence in the 
health care lawsuit. 
SEC. 404. DEFINITIONS. 
In this title: 
(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-
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serted or such an action is brought, whether de-
ceased, incompetent, or a minor. 
(3) FEDERAL TAX BENEFIT.—A claimant shall 
be treated as receiving a Federal tax benefit with re-
spect to payment for items or services if— 
(A) such payment is compensation by in-
surance— 
(i) which constitutes medical care, and 
(ii) with respect to the payment of 
premiums for which the claimant, or the 
employer of the claimant, was allowed an 
exclusion from gross income, a deduction, 
or a credit for Federal income tax pur-
poses, 
(B) a deduction was allowed with respect 
to such payment for Federal income tax pur-
poses, or 
(C) such payment was from an Archer 
MSA (as defined in section 220(d) of the Inter-
nal Revenue Code of 1986), a health savings 
account (as defined in section 223(d) of such 
Code), a flexible spending arrangement (as de-
fined in section 106(c)(2) of such Code), or a 
health reimbursement arrangement which is 
treated as employer-provided coverage under an 
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accident or health plan for purposes of section 
106 of such Code. 
(4) 
HEALTH
CARE
LAWSUIT.—The 
term 
‘‘health care lawsuit’’ means any health care liability 
claim concerning the provision of health care goods 
or services brought in a Federal court or in a State 
court or pursuant to an alternative dispute resolu-
tion system, if such claim concerns items or services 
for which coverage is provided under title XVIII, 
XIX, or XXI of the Social Security Act or for which 
the claimant receives a Federal tax benefit, against 
a health care provider, a health care organization, 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, plaintiffs, defendants, 
or other parties, or the number of claims or causes 
of action, in which the claimant alleges 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 Govern-
ment; or which is grounded in antitrust. 
(5) HEALTH
CARE
LIABILITY
ACTION.—The 
term ‘‘health care liability action’’ means a civil ac-
tion brought in a State or Federal court or pursuant 
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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. 
(8) 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 
care services, and being either so licensed, reg-
istered, or certified, or exempted from such require-
ment by other statute or regulation. 
(9) 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. 
(10) 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 
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U.S.C. 321(g)(1) and (h)) and section 351(a) of the 
Public Health Service Act (42 U.S.C. 262(a)), re-
spectively, including any component or raw material 
used therein, but excluding health care services. 
(11) MEDICAL TREATMENT.—The term ‘‘med-
ical treatment’’ means the provision of any goods or 
services by a health care provider or by any indi-
vidual working under the supervision of a health 
care provider, that relates to the diagnosis, preven-
tion, or treatment of any human disease or impair-
ment, or the assessment or care of the health of 
human beings. 
(12) 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 
overhead costs or charges for legal services are not 
deductible disbursements or costs for such purpose. 
(13) 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 
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any other territory or possession of the United 
States, or any political subdivision thereof. 
SEC. 405. 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 
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. 
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SEC. 406. APPLICABILITY; EFFECTIVE DATE. 
This title shall apply to any health care lawsuit 
brought in a Federal or State court, or subject to an alter-
native 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 limitations provisions 
in effect at the time the injury occurred. 
TITLE V—WELLNESS AND 
PREVENTION 
SEC. 501. PROVIDING FINANCIAL INCENTIVES FOR TREAT-
MENT COMPLIANCE. 
(a) LIMITATION
ON EXCEPTION
FOR WELLNESS 
PROGRAMS UNDER HIPAA DISCRIMINATION RULES.— 
(1) EMPLOYEE RETIREMENT INCOME SECURITY 
ACT OF 1974 AMENDMENT.—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-
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tion (or lack of participation) in a standards-based 
wellness program.’’. 
(2) PHSA AMENDMENT.—Section 2702(b)(2) 
of the Public Health Service Act (42 U.S.C. 300gg– 
1(b)(2)) is amended by adding after and below sub-
paragraph (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.’’. 
(3) IRC AMENDMENT.—Section 9802(b)(2) of 
the Internal Revenue Code of 1986 is amended by 
adding after and below subparagraph (B) the fol-
lowing: 
‘‘In applying subparagraph (B), a group health plan 
may vary premiums and cost-sharing by up to 50 
percent of the value of the benefits under the plan 
based on participation (or lack of participation) in a 
standards-based wellness program.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to plan years beginning more 
than 1 year after the date of the enactment of this Act. 
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TITLE VI—TRANSPARENCY AND 
INSURANCE REFORM MEASURES 
SEC. 601. 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 
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. 
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‘‘(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 Web site or Web por-
tal accessible by the requesting plan, plan spon-
sor, 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-
quest made under such subsection, including, subject 
to subsection (c), protected health information, for 
the 36-month period preceding the date of the report 
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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. 
‘‘(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 
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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 
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 
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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 
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.’. 
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‘‘(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) 
unless a certification has been provided in accord-
ance with paragraph (2). 
‘‘(d) REQUEST FOR ADDITIONAL INFORMATION.— 
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‘‘(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-
questing plan, plan sponsor, or plan administrator 
agrees to a request for additional time. 
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‘‘(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 the provisions of this section, but not 
in lieu of such provisions. 
‘‘(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 VII—QUALITY 
SEC. 701. PROHIBITION ON CERTAIN USES OF DATA OB-
TAINED FROM COMPARATIVE EFFECTIVE-
NESS RESEARCH OR FROM PATIENT-CEN-
TERED OUTCOMES RESEARCH; ACCOUNTING 
FOR PERSONALIZED MEDICINE AND DIF-
FERENCES 
IN 
PATIENT 
TREATMENT 
RE-
SPONSE. 
(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 or pa-
tient-centered outcomes research, including such re-
search that is conducted or supported using funds 
appropriated under the American Recovery and Re-
investment Act of 2009 (Public Law 111–5), to deny 
coverage of an item or service under a Federal 
health care program (as defined in section 1128B(f) 
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of the Social Security Act (42 U.S.C. 1320a–7b(f))); 
and 
(2) shall ensure that comparative effectiveness 
research and patient-centered outcomes research 
conducted or supported by the Federal Government 
accounts for factors contributing to differences 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 indirect 
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 (21 U.S.C. 301 et seq.) 
or the Public Health Service Act (42 U.S.C. 201 et seq.). 
SEC. 
702. 
ESTABLISHMENT 
OF 
PERFORMANCE-BASED 
QUALITY MEASURES. 
Not later than January 1, 2016, the Secretary of 
Health and Human Services shall submit to Congress a 
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proposal for a formalized process for the development of 
performance-based quality measures that could be applied 
to physicians’ services under the Medicare program under 
title XVIII of the Social Security Act (42 U.S.C. 1395 
et seq.). Such proposal shall be in concert and agreement 
with the Physician Consortium for Performance Improve-
ment and shall only utilize measures agreed upon by each 
physician specialty organization. 
TITLE VIII—STATE 
TRANSPARENCY PLAN PORTAL 
SEC. 801. 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 Web 
site (referred to in this section as a ‘‘plan portal’’) for 
the purposes 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) PROHIBITIONS.— 
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(1) DIRECT ENROLLMENT.—A plan portal may 
not directly enroll individuals in health insurance 
plans or under a State Medicaid plan or a State 
children’s health insurance plan. 
(2) CONFLICTS OF INTEREST.— 
(A) 
COMPANIES.—A 
health 
insurance 
issuer offering a health insurance plan through 
a plan portal may not— 
(i) be the private entity developing 
and maintaining a plan portal under this 
section; or 
(ii) have an ownership interest in such 
private entity or in the plan portal. 
(B) 
INDIVIDUALS.—An 
individual 
em-
ployed by a health insurance issuer offering a 
health insurance plan through a plan portal 
may not serve as a director or officer for— 
(i) the private entity developing and 
maintaining a plan portal under this sec-
tion; or 
(ii) the plan portal. 
(c) CONSTRUCTION.—Nothing in this section shall be 
construed to prohibit health insurance brokers and agents 
from— 
(1) utilizing the plan portal for any purpose; or 
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(2) marketing or offering health insurance 
products. 
(d) STATE DEFINED.—In this section, the term 
‘‘State’’ has the meaning given such term for purposes of 
title XIX of the Social Security Act. 
(e) HEALTH INSURANCE PLANS.—For purposes of 
this section, the term ‘‘health insurance plan’’ does not 
include coverage of excepted benefits, as defined in section 
2791(c) of the Public Health Service Act (42 U.S.C. 
300gg–91(c)). 
TITLE IX—PATIENT FREEDOM 
OF CHOICE 
SEC. 901. GUARANTEEING FREEDOM OF CHOICE AND CON-
TRACTING FOR PATIENTS UNDER MEDICARE. 
(a) IN GENERAL.—Section 1802 of the Social Secu-
rity Act (42 U.S.C. 1395a) is amended to read as follows: 
‘‘FREEDOM OF CHOICE AND CONTRACTING BY PATIENT 
GUARANTEED 
‘‘SEC. 1802. (a) BASIC FREEDOM OF CHOICE.—Any 
individual entitled to insurance benefits under this title 
may obtain health services from any institution, agency, 
or person qualified to participate under this title if such 
institution, agency, or person undertakes to provide that 
individual such services. 
‘‘(b) FREEDOM TO CONTRACT BY MEDICARE BENE-
FICIARIES.— 
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‘‘(1) IN GENERAL.—Subject to the provisions of 
this subsection, nothing in this title shall prohibit a 
Medicare beneficiary from entering into a contract 
with an eligible professional (whether or not the pro-
fessional is a participating or non-participating phy-
sician or practitioner) for any item or service cov-
ered under this title. 
‘‘(2) SUBMISSION OF CLAIMS.—Any Medicare 
beneficiary that enters into a contract under this 
section with an eligible professional shall be per-
mitted to submit a claim for payment under this 
title for services furnished by such professional, and 
such payment shall be made in the amount that 
would otherwise apply to such professional under 
this title except that where such professional is con-
sidered to be non-participating, payment shall be 
paid as if the professional were participating. Pay-
ment made under this title for any item or service 
provided under the contract shall not render the pro-
fessional a participating or non-participating physi-
cian or practitioner, and as such, requirements of 
this title that may otherwise apply to a participating 
or non-participating physician or practitioner would 
not apply with respect to any items or services fur-
nished under the contract. 
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‘‘(3) BENEFICIARY PROTECTIONS.— 
‘‘(A) IN
GENERAL.—Paragraph (1) shall 
not apply to any contract unless— 
‘‘(i) the contract is in writing, is 
signed by the Medicare beneficiary and the 
eligible professional, and establishes all 
terms of the contract (including specific 
payment for items and services covered by 
the contract) before any item or service is 
provided pursuant to the contract, and the 
beneficiary shall be held harmless for any 
subsequent payment charged for an item 
or service in excess of the amount estab-
lished under the contract during the period 
the contract is in effect; 
‘‘(ii) the contract contains the items 
described in subparagraph (B); and 
‘‘(iii) the contract is not entered into 
at a time when the Medicare beneficiary is 
facing an emergency medical condition or 
urgent health care situation. 
‘‘(B) ITEMS REQUIRED TO BE INCLUDED 
IN CONTRACT.—Any contract to provide items 
and services to which paragraph (1) applies 
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shall clearly indicate to the Medicare beneficiary 
that by signing such contract the beneficiary— 
‘‘(i) agrees to be responsible for pay-
ment to such eligible professional for such 
items or services under the terms of and 
amounts established under the contract; 
‘‘(ii) agrees to be responsible for sub-
mitting claims under this title to the Sec-
retary, and to any other supplemental in-
surance plan that may provide supple-
mental insurance, for such items or serv-
ices furnished under the contract if such 
items or services are covered by this title, 
unless otherwise provided in the contract 
under subparagraph (C)(i); and 
‘‘(iii) acknowledges that no limits or 
other payment incentives that may other-
wise apply under this title (such as the 
limits under subsection (g) of section 1848 
or incentives under subsections (a)(5), (m), 
(q), and (p) of such section) shall apply to 
amounts that may be charged, or paid to 
a beneficiary for, such items or services. 
Such contract shall also clearly indicate whether 
the eligible professional is excluded from par-
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ticipation under the Medicare program under 
section 1128. 
‘‘(C) BENEFICIARY
ELECTIONS
UNDER 
THE
CONTRACT.—Any Medicare beneficiary 
that enters into a contract under this section 
may elect to negotiate, as a term of the con-
tract, a provision under which— 
‘‘(i) the eligible professional shall file 
claims on behalf of the beneficiary with the 
Secretary and any supplemental insurance 
plan for items or services furnished under 
the contract if such items or services are 
covered under this title or under the plan; 
and 
‘‘(ii) the beneficiary assigns payment 
to the eligible professional for any claims 
filed by, or on behalf of, the beneficiary 
with the Secretary and any supplemental 
insurance plan for items or services fur-
nished under the contract. 
‘‘(D) EXCLUSION OF DUAL ELIGIBLE INDI-
VIDUALS.—Paragraph (1) shall not apply to 
any contract if a beneficiary who is eligible for 
medical assistance under title XIX is a party to 
the contract. 
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‘‘(4) LIMITATION
ON
ACTUAL
CHARGE
AND 
CLAIM
SUBMISSION
REQUIREMENT
NOT
APPLICA-
BLE.—Section 1848(g) shall not apply with respect 
to any item or service provided to a Medicare bene-
ficiary under a contract described in paragraph (1). 
‘‘(5) CONSTRUCTION.—Nothing in this section 
shall be construed— 
‘‘(A) to prohibit any eligible professional 
from maintaining an election and acting as a 
participating or non-participating physician or 
practitioner with respect to any patient not cov-
ered under a contract established under this 
section; and 
‘‘(B) as changing the items and services 
for which an eligible professional may bill under 
this title. 
‘‘(6) DEFINITIONS.—In this subsection: 
‘‘(A) MEDICARE BENEFICIARY.—The term 
‘Medicare beneficiary’ means an individual who 
is entitled to benefits under part A or enrolled 
under part B. 
‘‘(B) ELIGIBLE PROFESSIONAL.—The term 
‘eligible professional’ has the meaning given 
such term in section 1848(k)(3)(B). 
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‘‘(C) EMERGENCY MEDICAL CONDITION.— 
The term ‘emergency medical condition’ means 
a medical condition manifesting itself by acute 
symptoms of sufficient severity (including se-
vere pain) such that a prudent layperson, with 
an average knowledge of health and medicine, 
could reasonably expect the absence of imme-
diate medical attention to result in— 
‘‘(i) serious jeopardy to the health of 
the individual or, in the case of a pregnant 
woman, the health of the woman or her 
unborn child; 
‘‘(ii) serious impairment to bodily 
functions; or 
‘‘(iii) serious dysfunction of any bodily 
organ or part. 
‘‘(D) URGENT
HEALTH
CARE
SITUA-
TION.—The term ‘urgent health care situation’ 
means services furnished to an individual who 
requires services to be furnished within 12 
hours in order to avoid the likely onset of an 
emergency medical condition.’’. 
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SEC. 
902. 
PREEMPTION 
OF 
STATE 
LAWS 
LIMITING 
CHARGES 
FOR 
ELIGIBLE 
PROFESSIONAL 
SERVICES. 
(a) IN GENERAL.—No State may impose a limit on 
the amount of charges for services, furnished by an eligible 
professional (as defined in subsection (k)(3)(B) of section 
1848 of the Social Security Act, 42 U.S.C. 1395w–4), for 
which payment is made under such section, and any such 
limit is hereby preempted. 
(b) STATE.—In this section, the term ‘‘State’’ in-
cludes the District of Columbia, Puerto Rico, the Virgin 
Islands, Guam, and American Samoa. 
SEC. 903. HEALTH CARE PROVIDER LICENSURE CANNOT BE 
CONDITIONED 
ON 
PARTICIPATION 
IN 
A 
HEALTH PLAN. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services and any State (as a condition of receiving 
Federal financial participation under title XIX of the So-
cial Security Act) may not require any health care pro-
vider to participate in any health plan as a condition of 
licensure of the provider in any State. 
(b) DEFINITIONS.—In this section: 
(1) HEALTH PLAN.—The term ‘‘health plan’’ 
has the meaning given such term in section 1171(5) 
of the Social Security Act (42 U.S.C. 1320d(5)). 
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233 
(2) HEALTH
CARE
PROVIDER.—The term 
‘‘health care provider’’ means any person or entity 
that is required by State or Federal laws or regula-
tions to be licensed, registered, or certified to pro-
vide health care services and is so licensed, reg-
istered, or certified, or exempted from such require-
ment by other statute or regulation. 
(3) STATE.—The term ‘‘State’’ has the mean-
ing given such term for purposes of title XIX of the 
Social Security Act. 
SEC. 904. 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.— 
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‘‘(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-
vided to an individual enrolled under part B of 
title XVIII 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-
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smartinez on DSK4TPTVN1PROD with BILLS
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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-
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 
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smartinez on DSK4TPTVN1PROD with BILLS
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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 
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. 
SEC. 905. RIGHT OF CONTRACT WITH HEALTH CARE PRO-
VIDERS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall not preclude an enrollee, partici-
pant, or beneficiary in a health benefits plan from entering 
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into any contract or arrangement for health care with any 
health care provider. 
(b) HEALTH BENEFITS PLAN DEFINED.— 
(1) IN GENERAL.—In this section, subject to 
paragraph (2), the term ‘‘health benefits plan’’ 
means any of the following: 
(A) Group health plan (as defined in sec-
tion 2791 of the Public Health Service Act). 
(B) Health insurance coverage (as defined 
in section 2791 of such Act). 
(C) A health benefits plan under chapter 
89 of title 5, United States Code. 
(2) EXCLUSION OF MEDICAID AND TRICARE.— 
Such term does not include a health plan partici-
pating in— 
(A) the Medicaid program under title XIX 
of the Social Security Act; or 
(B) the TRICARE program under chapter 
55 of title 10, United States Code. 
(c) HEALTH CARE PROVIDER DEFINED.—In this 
section, the term ‘‘health care provider’’ means— 
(1) a physician, as defined in paragraphs (1), 
(2), (3), and (4) of section 1861(r) of the Social Se-
curity Act (42 U.S.C. 1395x(r)); and 
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(2) a health care practitioner described in sec-
tion 1842(b)(18)(C) of such Act (42 U.S.C. 
1395u(b)(18)(C)). 
TITLE X—QUALITY HEALTH 
CARE COALITION 
SEC. 1001. QUALITY HEALTH CARE COALITION. 
(a) APPLICATION
OF
THE FEDERAL ANTITRUST 
LAWS TO HEALTH CARE PROFESSIONALS NEGOTIATING 
WITH HEALTH PLANS.— 
(1) IN
GENERAL.—Any health care profes-
sionals who are engaged in negotiations with a 
health plan regarding the terms of any contract 
under which the professionals provide health care 
items or services for which benefits are provided 
under such plan shall, in connection with such nego-
tiations, be exempt from the Federal antitrust laws. 
(2) LIMITATION.— 
(A) NO NEW RIGHT FOR COLLECTIVE CES-
SATION OF SERVICE.—The exemption provided 
in paragraph (1) shall not confer any new right 
to participate in any collective cessation of serv-
ice to patients not already permitted by existing 
law. 
(B) NO CHANGE IN NATIONAL LABOR RE-
LATIONS
ACT.—This section applies only to 
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(F) Chapter 89 of title 5, United States 
Code (relating to the Federal employees’ health 
benefits program). 
(G) The Indian Health Care Improvement 
Act (25 U.S.C. 1601 et seq.). 
(b) DEFINITIONS.—In this section, the following defi-
nitions shall apply: 
(1) ANTITRUST
LAWS.—The term ‘‘antitrust 
laws’’— 
(A) has the meaning given it in subsection 
(a) of the first section of the Clayton Act (15 
U.S.C. 12(a)), except that such term includes 
section 5 of the Federal Trade Commission Act 
(15 U.S.C. 45) to the extent such section ap-
plies to unfair methods of competition; and 
(B) includes any State law similar to the 
laws referred to in subparagraph (A). 
(2) GROUP HEALTH PLAN.—The term ‘‘group 
health plan’’ means an employee welfare benefit plan 
to the extent that the plan provides medical care (in-
cluding items and services paid for as medical care) 
to employees or their dependents (as defined under 
the terms of the plan) directly or through insurance, 
reimbursement, or otherwise. 
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(3) GROUP HEALTH PLAN, HEALTH INSURANCE 
ISSUER.—The terms ‘‘group health plan’’ and 
‘‘health insurance issuer’’ include a third-party ad-
ministrator or other person acting for or on behalf 
of such plan or issuer. 
(4) 
HEALTH
CARE
SERVICES.—The 
term 
‘‘health care services’’ means any services for which 
payment may be made under a health plan, includ-
ing services related to the delivery or administration 
of such services. 
(5) HEALTH CARE PROFESSIONAL.—The term 
‘‘health care professional’’ means any individual or 
entity that provides health care items or services, 
treatment, assistance with activities of daily living, 
or medications to patients and who, to the extent re-
quired by State or Federal law, possesses specialized 
training that confers expertise in the provision of 
such items or services, treatment, assistance, or 
medications. 
(6) HEALTH INSURANCE COVERAGE.—The term 
‘‘health insurance coverage’’ means benefits con-
sisting of medical care (provided directly, through 
insurance or reimbursement, or otherwise and in-
cluding items and services paid for as medical care) 
under any hospital or medical service policy or cer-
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tificate, hospital or medical service plan contract, or 
health maintenance organization contract offered by 
a health insurance issuer. 
(7) HEALTH
INSURANCE
ISSUER.—The term 
‘‘health insurance issuer’’ means an insurance com-
pany, insurance service, or insurance organization 
(including a health maintenance organization) that 
is licensed to engage in the business of insurance in 
a State and that is subject to State law regulating 
insurance. Such term does not include a group 
health plan. 
(8) HEALTH MAINTENANCE ORGANIZATION.— 
The 
term 
‘‘health 
maintenance 
organization’’ 
means— 
(A) a federally qualified health mainte-
nance organization (as defined in section 
1301(a) of the Public Health Service Act (42 
U.S.C. 300e(a))); 
(B) an organization recognized under State 
law as a health maintenance organization; or 
(C) a similar organization regulated under 
State law for solvency in the same manner and 
to the same extent as such a health mainte-
nance organization. 
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(9) HEALTH PLAN.—The term ‘‘health plan’’ 
means a group health plan or a health insurance 
issuer that is offering health insurance coverage. 
(10) MEDICAL
CARE.—The term ‘‘medical 
care’’ means amounts paid for— 
(A) the diagnosis, cure, mitigation, treat-
ment, or prevention of disease, or amounts paid 
for the purpose of affecting any structure or 
function of the body; and 
(B) transportation primarily for and essen-
tial to receiving items and services referred to 
in subparagraph (A). 
(11) PERSON.—The term ‘‘person’’ includes a 
State or unit of local government. 
(12) STATE.—The term ‘‘State’’ includes the 
several States, the District of Columbia, Puerto 
Rico, the Virgin Islands of the United States, Guam, 
American Samoa, and the Commonwealth of the 
Northern Mariana Islands. 
(c) EFFECTIVE DATE.—This section shall take effect 
on the date of the enactment of this Act and shall not 
apply with respect to conduct occurring before such date. 
Æ 
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