I
103D CONGRESS
2D SESSION
H. R. 4274
To modify certain provisions of the Health Care Quality Improvement Act
of 1986.
IN THE HOUSE OF REPRESENTATIVES
APRIL 21, 1994
Mr. WYDEN (for himself and Mr. Klug) introduced the following bill; which
was referred to the Committee on Energy and Commerce
A BILL
To modify certain provisions of the Health Care Quality
Improvement Act of 1986.
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 ‘‘Health Care Quality
Improvement Act Amendments of 1994’’.
SEC. 2. STANDARDS FOR PROFESSIONAL REVIEW ACTIONS.
Section 412(a) of the Health Care Quality Improve-
ment Act of 1986 (42 U.S.C. 11112(a)) is amended in
the matter after and below paragraph (4) by adding at
the end the following sentences: ‘‘A motion for a summary
judgment that such standards have been met shall be
granted unless, considering the evidence in the light most
favorable to the opposing party, a reasonable finder of fact
could conclude that the presumption has been so rebutted.
The decision on such a motion may be appealed as of
right, without regard to whether the motion is granted or
denied, and the courts of appeals (other than the United
States Court of Appeals for the Federal Circuit) have ju-
risdiction of appeals from such decisions of the district
courts.’’.
SEC. 3. REQUIRING REPORTS ON MEDICAL MALPRACTICE
DATA.
(a) IN GENERAL.—Section 421 of the Health Care
Quality Improvement Act of 1986 (42 U.S.C. 11131) is
amended—
(1) by striking subsections (a) and (b);
(2) by redesignating subsections (c) and (d) as
subsections (d) and (e), respectively; and
(3) by inserting before subsection (d) (as so re-
designated) the following subsections:
‘‘(a) IN GENERAL.—
‘‘(1) REQUIREMENT
OF
REPORTING.—Subject
to the subsequent provisions of this subsection, each
person or entity which makes payment under a pol-
icy of insurance, self-insurance, or otherwise in set-
tlement (or partial settlement) of, or in satisfaction
of a judgment in, a medical malpractice action or
claim shall report, in accordance with section 424,
information 
respecting 
the 
payment 
and 
cir-
cumstances thereof.
‘‘(2) PAYMENTS BY PRACTITIONERS.—The per-
sons to whom the requirement of paragraph (1)
applies include a physician or other licensed health
care practitioner who makes a payment described in
such paragraph and whose acts or omissions are the
basis of the action or claim involved. The preceding
sentence is subject to paragraph (3).
‘‘(3) REFUND
OF
FEES.—With respect to a
physician or other licensed health care practitioner
whose acts or omissions are the basis of an action
or claim described in paragraph (1), the requirement
of such paragraph shall not apply to a payment de-
scribed in such paragraph if—
‘‘(A) the payment is made by the physician
or practitioner as a refund of fees for the health
services involved, and
‘‘(B) the payment does not exceed the
amount of the original charge for the health
services.
‘‘(4) DEFINITION OF ENTITY AND PERSON.—
For purposes of this section, the term ‘entity’ in-
cludes the Federal Government, any State or local
government, and any insurance company or other
private entity; and the term ‘person’ includes Fed-
eral officers and employees.
‘‘(b) INFORMATION TO BE REPORTED.—The infor-
mation to be reported under subsection (a) by a person
or entity regarding a payment and an action or claim in-
cludes the following:
‘‘(1)(A) The name of each physician or other li-
censed health care practitioner whose acts or omis-
sions were the basis of the action or claim; and (to
the extent authorized under title II of the Social Se-
curity Act) the social security account number as-
signed to the physician or practitioner.
‘‘(B) If the physician or practitioner could not
be identified for purposes of subparagraph (A)—
‘‘(i) a statement of such fact and an expla-
nation of the inability to make the identifica-
tion, and
‘‘(ii) the name of the hospital or other
health services organization (as defined in sec-
tion 431) for whose benefit the payment was
made.
‘‘(2) The amount of the payment.
‘‘(3) The name (if known) of any hospital or
other health services organization with which the
physician or practitioner is affiliated or associated.
‘‘(4)(A) A statement describing the acts or
omissions and injuries or illnesses upon which the
action or claim was based.
‘‘(B) A statement by the physician or practi-
tioner regarding the action or claim, if the physician
or practitioner elects to make such a statement.
‘‘(C) If the payment was made without the con-
sent of the physician or practitioner, a statement
specifying such fact and the reasons underlying the
decision to make the payment without such consent.
‘‘(5) Such other information as the Secretary
determines is required for appropriate interpretation
of information reported under this section.
‘‘(c) CERTAIN REPORTING CRITERIA; NOTICE
TO
PRACTITIONERS.—
‘‘(1) REPORTING
CRITERIA.—In establishing
criteria under section 424(a) for reports under this
section, the Secretary shall establish criteria regard-
ing statements under subsection (b)(4). Such criteria
shall include—
(2) by inserting after paragraph (4) the follow-
ing paragraph:
‘‘(5) The term ‘health services organization’
means an entity that, directly or through contracts,
provides health services. Such term includes hos-
pitals; health maintenance organizations and other
health plans; and health care entities (as defined in
paragraph (4)).’’.
(c) CONFORMING AMENDMENTS.—
(1) IN
GENERAL.—The Health Care Quality
Improvement Act of 1986 (42 U.S.C. 11101 et seq.)
is amended—
(A) in section 411(a)(1), in the matter pre-
ceding subparagraph (A), by striking ‘‘431(9)’’
and inserting ‘‘431(10)’’;
(B) in section 421(d) (as redesignated by
subsection (a)(2) of this section), by inserting
‘‘person or’’ before ‘‘entity’’;
(C) in section 422(a)(2)(A), by inserting
before the comma at the end the following: ‘‘,
and (to the extent authorized under title II of
the Social Security Act) the social security ac-
count number assigned to the physician’’; and
(D) in section 423(a)(3)(A), by inserting
before the comma at the end the following: ‘‘,
and (to the extent authorized under title II of
the Social Security Act) the social security ac-
count number assigned to the physician or
practitioner’’.
(2) APPLICABILITY OF REQUIREMENTS TO FED-
ERAL ENTITIES.—
(A) Section 432 of the Health Care Qual-
ity Improvement Act of 1986 (42 U.S.C.
11152) is amended—
(i) by striking subsection (b); and
(ii) by redesignating subsection (c) as
subsection (b).
(B) Section 423 of the Health Care Qual-
ity Improvement Act of 1986 (42 U.S.C.
11133) is amended by adding at the end the
following subsection:
‘‘(e) APPLICABILITY TO FEDERAL FACILITIES AND
PHYSICIANS.—
‘‘(1) IN GENERAL.—Subsection (a) applies to
Federal health facilities (including hospitals) and ac-
tions by such facilities regarding the competence or
professional conduct of Federal physicians to the
same extent and in the same manner as such sub-
section applies to health care entities and profes-
sional review actions.
‘‘(2) RELEVANT BOARD OF MEDICAL EXAMIN-
ERS.—For purposes of paragraph (1), the Board of
Medical Examiners to which a Federal health facility
is to report is the Board of Medical Examiners of
the State within which the facility is located.’’.
(C) Section 425 of the Health Care Qual-
ity Improvement Act of 1986 (42 U.S.C.
11135) is amended by adding at the end the
following subsection:
‘‘(d) APPLICABILITY
TO FEDERAL HOSPITALS.—
This section applies to Federal hospitals to the same ex-
tent and in the same manner as such subsection applies
to other hospitals.’’.
SEC. 4. REPORTING OF SANCTIONS TAKEN BY BOARDS OF
MEDICAL EXAMINERS.
Section 422(a)(1)(A) of the Health Care Quality Im-
provement Act of 1986 (42 U.S.C. 11132(a)(1)(A)) is
amended by striking ‘‘which revokes or suspends’’ and in-
serting ‘‘which denies, revokes, or suspends’’.
SEC. 5. DUTY TO OBTAIN INFORMATION.
Part B of the Health Care Quality Improvement Act
of 1986 (42 U.S.C. 11131 et seq.) is amended by inserting
after section 425 the following section:
‘‘SEC. 425A. DUTY OF BOARDS OF MEDICAL EXAMINERS TO
OBTAIN INFORMATION.
‘‘(a) IN GENERAL.—Effective 2 years after the date
of the enactment of the Health Care Quality Improvement
Act Amendments of 1994, it is the duty of each Board
of Medical Examiners to request from the Secretary (or
the agency designated under section 424(b)) information
reported under this part concerning a physician—
‘‘(1) at the time the physician submits the ini-
tial application for a physician’s license in the State
involved, and
‘‘(2) at each time the physician submits an ap-
plication to continue in effect the license, subject to
subsection (d).
A Board of Medical Examiners may request information
reported under this part concerning a physician at other
times.
‘‘(b) FAILURE TO OBTAIN INFORMATION.—With re-
spect to an action for mandamus or other cause of action
against a Board of Medical Examiners, a Board which
does not request information respecting a physician as re-
quired under subsection (a) is presumed to have knowl-
edge of any information reported under this part to the
Secretary with respect to the physician.
‘‘(c) RELIANCE ON INFORMATION PROVIDED.—With
respect to a cause of action against a Board of Medical
Examiners, each Board of Medical Examiners may rely
upon information provided to the Board under this title,
unless the Board has knowledge that the information pro-
vided was false.
‘‘(d) STATE OPTION REGARDING CONTINUATION OF
LICENSES.—
‘‘(1) ESTABLISHMENT OF ELECTRONIC SYSTEM
FOR
TRANSMISSION
OF
DATA.—After consultation
with the States, the Secretary shall establish a sys-
tem for electronically transmitting information under
this part to States that elect to install equipment
necessary for participation in the system. The sys-
tem shall possess the capability to receive trans-
missions of data from such States.
‘‘(2) STATE OPTION REGARDING ELECTRONIC
SYSTEM.—With respect to compliance with sub-
section (a)(2) (relating to applications to continue in
effect physicians’ licenses), if a State is participating
in the system under paragraph (1) and provides the
Board of Medical Examiners of the State with ac-
cess to the system, the Board may elect, in lieu of
complying with subsection (a)(2), to comply with
paragraph (3) of this subsection.
‘‘(3) DESCRIPTION OF OPTION.—For purposes
of paragraph (2), a Board of Medical Examiners is
complying with this paragraph if—
‘‘(A) through the system under paragraph
(1), the Board annually transmits to the Sec-
retary (or the agency designated under section
424(b)) data identifying all individuals who
hold a valid physician’s license issued by the
Board, without regard to whether the licenses
are expiring, and
‘‘(B) after receiving from the Secretary (or
such agency) a list of physicians under para-
graph (4)(B), the Board complies with para-
graph (5).
‘‘(4) IDENTIFICATION BY SECRETARY OF REL-
EVANT
PHYSICIANS.—After receiving data under
paragraph (3)(A) from a Board of Medical Examin-
ers, the Secretary (or the agency designated under
section 424(b)) shall—
‘‘(A) from among the physicians identified
through the data, determine which of such phy-
sicians has been the subject of information re-
ported under this part, and the State in which
the incidents involved occurred, and
‘‘(B) provide to the Board, through the
system under paragraph (1), a list of the physi-
cians who have been such subjects, which list
specifies for each physician the States in which
the incidents involved occurred.
‘‘(5) REQUEST BY STATE OF INFORMATION ON
RELEVANT PHYSICIANS.—For purposes of paragraph
(3)(B), a Board of Medical Examiners of a State is
complying with this paragraph if, after receiving the
list of physicians under paragraph (4)(B), the Board
promptly—
(A) identifies which of the physicians has
had, for purposes of paragraph (4), an incident
in another State, and
(B) requests from the Secretary (or the
agency) information reported under this part
concerning each of the physicians so identi-
fied.’’.
SEC. 6. ADDITIONAL PROVISIONS REGARDING ACCESS TO
INFORMATION; 
MISCELLANEOUS 
PROVI-
SIONS.
(a) ACCESS TO INFORMATION.—Section 427(a) of the
Health Care Quality Improvement Act of 1986 (42 U.S.C.
11137(a)) is amended to read as follows:
‘‘(a) ACCESS REGARDING LICENSING, EMPLOYMENT,
AND CLINICAL PRIVILEGES.—The Secretary (or the agen-
cy designated under section 424(b)) shall, upon request,
provide information reported under this part concerning
a physician or other licensed health care practitioner to—
‘‘(1) State licensing boards, and
‘‘(2) hospitals and other health services organi-
zations—
‘‘(A) that have entered (or may be enter-
ing) into an employment or affiliation relation-
ship with the physician or practitioner, or
‘‘(B) to which the physician or practitioner
has applied for clinical privileges or appoint-
ment to the medical staff.’’.
(b) FEES.—Section 427(b)(4) of the Health Care
Quality 
Improvement 
Act 
of 
1986 
(42 
U.S.C.
11137(b)(4)) is amended to read as follows:
‘‘(4) FEES.—In disclosing information under
subsection (a) or section 426, the Secretary may im-
pose fees in amounts reasonably related to the costs
of carrying out the duties of the Secretary regarding
the information reported under this part (including
the functions specified in section 424(b) with respect
to the information), except that a fee may not be im-
posed 
for 
providing 
a 
list 
under 
section
425A(d)(4)(B) to any Board of Medical Examiners.
Such fees are available to the Secretary (or, in the
Secretary’s discretion, to the agency designated
under section 424(b)) to cover such costs. Such fees
remain available until expended.’’.
(c) ADDITIONAL DISCLOSURES OF INFORMATION.—
Section 427 of the Health Care Quality Improvement Act
of 1986 (42 U.S.C. 11137) is amended by adding at the
end the following subsection:
‘‘(e) AVAILABILITY OF INFORMATION TO PUBLIC.—
‘‘(1) IN
GENERAL.—Not later than 30 days
after the effective date for this subsection under sec-
tion 9 of the Health Care Quality Improvement Act
Amendments of 1994, and semiannually thereafter,
the Secretary shall publish and make available to the
public the following information reported under this
part:
‘‘(A) Information reported under section
421, excepting the following:
‘‘(i) Information concerning a physi-
cian or other licensed health care practi-
tioner with respect to whom the number of
discrete incidents on which information is
required to be submitted under such sec-
tion is 1.
‘‘(ii) The social security account num-
ber of the physician or practitioner.
‘‘(iii) Information disclosing the iden-
tity of any patient involved in such an inci-
dent.
‘‘(iv) With respect to information that
the 
Secretary 
requires 
under 
section
421(b)(5)—
‘‘(I) the home address of the phy-
sician or practitioner, and
‘‘(II) the number assigned to the
physician or practitioner by the Drug
Enforcement Administration.
‘‘(v) Information not required to be
reported under such section.
‘‘(B) Information reported under section
422(a).
‘‘(C) Information reported under section
423(b).
‘‘(2) DISSEMINATION; FEES.—The Secretary
shall disseminate each publication under paragraph
(1) to public libraries without charge. In providing
the publication to other entities, the Secretary may
impose a fee reasonably related to the costs of the
Secretary in carrying out this subsection. Such fees
are available to the Secretary (or, in the Secretary’s
discretion, to the agency designated under section
424(b)) to cover such costs. Such fees remain avail-
able until expended.’’
(d) CONFORMING AMENDMENTS.—Section 427 of the
Health Care Quality Improvement Act of 1986 (42 U.S.C.
11137) is amended—
(1) in subsection (b)(1), in the first sentence,
by striking ‘‘Information reported’’ and inserting the
following: ‘‘Except for information disclosed under
subsection (e), information reported’’; and
(2) in the heading for the section, by striking
‘‘MISCELLANEOUS
PROVISIONS’’ and inserting
the following: ‘‘ADDITIONAL
PROVISIONS
RE-
GARDING
ACCESS
TO
INFORMATION; 
MIS-
CELLANEOUS PROVISIONS’’.
SEC. 7. OTHER MATTERS.
The Health Care Quality Improvement Act of 1986
(42 U.S.C. 11101 et seq.) is amended—
(1) by redesignating part C as part D; and
(2) by inserting after part B the following part:
‘‘PART C—OTHER MATTERS REGARDING
IMPROVEMENT OF HEALTH CARE QUALITY
‘‘SEC. 428. PROHIBITION AGAINST SETTLEMENT WITHOUT
CONSENT OF PRACTITIONER.
‘‘(a) PROHIBITION.—With respect to a physician or
other licensed health care practitioner whose acts or omis-
sions are the basis of a medical malpractice action or
claim, an entity may not make a payment described in
section 421(a)(1) without the written consent of the physi-
cian or practitioner, subject to subsection (b).
‘‘(b) EXCEPTIONS.—Subsection (a) shall not apply
with respect to a payment by an entity regarding an action
or claim, subject to subsection (c)—
‘‘(1) if the payment is made in satisfaction of
a judgment in a court of competent jurisdiction,
‘‘(2) if, with respect to the action or claim, the
physician or other licensed health care practitioner
involved enters a process of alternative dispute reso-
lution, and the process has been concluded or any of
the individuals involved has terminated participation
in the process,
‘‘(3)(A) the entity delivers directly, or makes a
reasonable effort to deliver through the mail, a writ-
ten notice to the physician or practitioner involved
providing the information specified in subsection (c),
and
such right expires in 30 days, with a specification of
the date on which the right expires, and
‘‘(5) the 30-day period begins on the date on
which the notice is delivered directly to the physician
or practitioner, or on the seventh day after the date
on which the notice is posted, as the case may be.
‘‘(d) CIVIL
MONEY
PENALTY.—Any entity that
makes a payment in violation of subsection (a) shall be
subject to a civil money penalty of not more than $10,000
for each such payment involved. Such penalty shall be im-
posed and collected in the same manner as civil money
penalties under subsection (a) of section 1128A of the So-
cial Security Act are imposed and collected under that sec-
tion.
‘‘SEC. 429. EMPLOYMENT TERMINATION OF PHYSICIAN.
‘‘(a) REQUIREMENT
OF ADEQUATE NOTICE
AND
HEARING.—
‘‘(1) IN GENERAL.—A health services organiza-
tion may not terminate the employment of a physi-
cian, and may not terminate a contract with a physi-
cian for the provision of health services, unless ade-
quate notice and hearing procedures have been af-
forded the physician involved.
‘‘(2) APPLICABILITY.—Section 412(a)(3) ap-
plies in lieu of paragraph (1) in the case of an em-
ployment termination that is a professional review
action. (With respect to the preceding sentence,
paragraph (1) does apply to an employment termi-
nation that is an action described in subparagraph
(A) of section 431(10) or in the other subpara-
graphs of such section.)
‘‘(b) SAFE HARBOR.—
‘‘(1) IN GENERAL.—A health services organiza-
tion is deemed to have met the adequate notice and
hearing requirement of subsection (a) with respect
to the employment of, or a contract of, a physician
if the conditions described in paragraphs (2)
through (4) are met (or are waived voluntarily by
the physician).
‘‘(2) NOTICE
OF
PROPOSED
ACTION.—Condi-
tions under paragraph (1) are that the physician in-
volved has been given notice stating—
‘‘(A)(i) that the health services organiza-
tion proposes to take action to terminate the
employment or contract,
‘‘(ii) reasons for the proposed action,
‘‘(B)(i) that the physician has the right to
request a hearing on the proposed action,
‘‘(ii) any time limit (of not less than 30
days) within which to request such a hearing,
and
‘‘(C) a summary of the rights in the hear-
ing under paragraph (4).
‘‘(3) NOTICE OF HEARING.—Conditions under
paragraph (1) are that, if a hearing is requested on
a timely basis under paragraph (2)(B), the physician
involved must be given notice stating—
‘‘(A) the place, time, and date, of the hear-
ing, which date shall not be less than 30 days
after the date of the notice, and
‘‘(B) a list of the witnesses (if any) ex-
pected to testify at the hearing on behalf of the
health services organization.
‘‘(4) CONDUCT
OF
HEARING
AND
NOTICE.—
Conditions under paragraph (1) are that, if a hear-
ing is requested on a timely basis under paragraph
(2)(B)—
‘‘(A) subject to subparagraph (B), the
hearing shall be held (as determined by the
health services organization)—
‘‘(i) before an arbitrator mutually ac-
ceptable to the physician involved and the
health services organization,
‘‘(ii) before a hearing officer who is
appointed by the organization and who is
not in direct economic competition with the
physician, or
‘‘(iii) before a panel of individuals who
are appointed by the organization and are
not in direct economic competition with the
physician,
‘‘(B) the right to the hearing may be for-
feited if the physician fails, without good cause,
to appear,
‘‘(C) in the hearing the physician has the
right—
‘‘(i) to representation by an attorney
or other person of the physician’s choice,
‘‘(ii) to have a record made of the
proceedings, copies of which may be ob-
tained by the physician upon payment of
any reasonable charges associated with the
preparation thereof,
‘‘(iii) to call, examine, and cross-ex-
amine witnesses,
‘‘(iv) to present evidence determined
to be relevant by the hearing officer, re-