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entities upon request data and information relied
upon by the foundation in making the referral.
(B) 
NOTIFICATION.—A 
finding 
under
clause (i) shall be forwarded—
(i) if the finding pertains to a health
plan, to the appropriate alliance(s), accred-
itation organization(s), State officials re-
sponsible for plan certification under sec-
tion 301, the consumer health care advo-
cate authorized under section 203, and the
public;
(ii) if the finding pertains to a pro-
vider, to the appropriate State health facil-
ity or State professional licensure board(s),
the consumer health care advocate author-
ized under section 203, and health plan(s)
with which the provider is associated.
(iii) IMMINENT RISK.—If a foundation
identifies a provider who posses an immi-
nent risk to the health of patients receiving
or likely to receive health care from the
provider, the foundation shall immediately
notify the appropriate authorities listed
under clause (ii).
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(e) LIMITATION
ON LIABILITY.—No organization
having a grant from the Secretary under this section, and
no person who is employed by, or who has a fiduciary rela-
tionship with any such organization, or who furnishes pro-
fessional services to such organization, shall be held by
reason of the performance of any duty or activity author-
ized pursuant to this part to have violated any criminal
law, or to be civilly liable under any law of the United
States or of any State (or political subdivision thereof)
provided that the performance of such duty or activity was
not conducted in bad faith.
SEC. 203 CONSUMER HEALTH CARE ADVOCATE.
(a) IN GENERAL.—The Secretary shall, no later than
two years after the date of enactment of this Act, make
grants to an entity in each State which shall serve as the
consumer health care advocate for the population of the
State.
(b) SELECTION OF GRANTEES.—
(1) COMPETITION.—Grants shall be awarded
under subsection (a) on a competitive basis to appli-
cants meeting the criteria in paragraph (2).
(2) CRITERIA.—In awarding grants under sub-
section (a)—
(A) preference shall be given to private or-
ganizations which are exempt from taxation
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under section 501(c)(3) or (4) of the Internal
Revenue Act of 1986;
(B) preference shall be given to organiza-
tions with a governing body which includes rep-
resentation of ethnic and low-income popu-
lations of the State;
(C) preference shall be given to an organi-
zation which has previously received, and satis-
factorily performed under the terms of a grant
from the Secretary for the purpose of providing
health insurance counseling for enrollees under
title XVIII of the Social Security Act; and
(D) an applicant for a grant under sub-
section (a) shall be ineligible if the applicant is,
or is affiliated with (through ownership, man-
agement, or common control), a health plan,
provider, State office responsible for health fa-
cilities or health professional licensing or certifi-
cation, health alliance, or association of such
entities.
(c) GRANT PROVISIONS.—Each grant with an organi-
zation under this section shall provide that—
(1) the organization shall perform the duties set
forth in subsection (d);
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(2) the Secretary shall have access to docu-
ments and personnel necessary to evaluate the effec-
tiveness of the organization in fulfilling the provi-
sions of the grant;
(3) the grant shall be for an initial term of four
years and shall be renewable thereafter based upon
favorable performance without reopening the com-
petitive selection process;
(4) if the Secretary intends not to renew a
grant to an organization under this section, the or-
ganization shall be notified of the decision at least
one hundred and eighty days prior to the expiration
of the grant, and be afforded an opportunity to
present information for the purpose of appeal;
(5) the Secretary may terminate a grant to an
organization under this section if it determines that
the organization does not meet the requirements of
this section, and provides an opportunity for the or-
ganization to appeal its determination;
(6) an organization which has received a grant
under this section may terminate the grant upon one
hundred and eighty days notice to the Secretary;
(d) DUTIES.—An organization which has received a
grant under this section shall have the following duties—
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(1) investigate and resolve complaints made by
or on behalf of individuals;
(2) provide information, referral and assistance
to individuals on the availability of health insurance
coverage and health care items and services;
(3) identify, investigate and promote solutions
to problems arising from public or private practices
and policies which adversely affect individuals’ ac-
cess to quality health care, including—
(A) marketing of health plans, and
(B) accessibility of services, subsidies or
other resources;
(4) monitor, analyze, and comment on the de-
velopment and implementation of Federal, State, or
local laws affecting access to quality health care;
(5) facilitate public comment on Federal, State,
or local laws affecting access to quality health care;
(6) compile and report to the Secretary and na-
tional consumer representative support center data
regarding complaints received and actions taken, in
a form defined by the Secretary;
(7) protect the identity of any complainant, un-
less released from this responsibility by the com-
plainant;
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(8) coordinate activities and advocacy with
other organizations, including legal assistance pro-
viders, State and local long-term care ombudsman
programs, and protection and advocacy programs es-
tablished for persons with disabilities under—
(A) part A of the Developmental Disabil-
ities Assistance and Bill of Rights Act (42
U.S.C. 6001 et seq.),
(B) the Protection and Advocacy for Men-
tally Ill Individuals Act of 1986 (42 U.S.C.
10801 et seq.), and
(C) the Americans with Disabilities Act;
(9) perform such other duties the Secretary
may specify.
(e) AUTHORITY OF CONSUMER HEALTH CARE ADVO-
CATE.—The consumer health care advocate in each State
shall be vested with the following powers and authorities:
(1) The advocate may establish local programs
with the same powers and authorities, subject to the
same restrictions regarding eligibility and conflict of
interest.
(2) Representatives of the consumer health care
advocate shall have access to health care facilities
for the purpose of communicating with individuals
receiving care on the premises.
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(3) Representatives of the consumer health care
advocate shall have access to the medical and social
records of an individual if the individual, or the legal
representative of the individual, has granted permis-
sion to do so.
(4) The consumer health care advocate shall
have access to, and upon request copies of, all licens-
ing and certification reports and data pertaining to
health care providers and developed by a State.
(f) LIMITED LIABILITY.—No consumer health care
advocate or its local programs or representatives shall be
liable under State or Federal law for the good faith per-
formance of official duties.
(g) FUNDING.—The Secretary shall provide funding
for the entities described under this section through the
following mechanisms:
(1) BASE FUNDING.—The Secretary shall pro-
vide grants to the consumer health care advocate in
each State and the Center described under sub-
section (g) from the proceeds of the assessment
under section 201, up to a total of $50,000,000; and
(2) VOLUNTARY
CONTRIBUTIONS.—The Sec-
retary shall assist States in ensuring that consumer
health care advocate entities are permitted to seek
voluntary contributions through a prominent solicita-
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tion in the enrollment materials distributed by or on
behalf of each health plan.
SEC. 204 NATIONAL CONSUMER REPRESENTATIVE SUP-
PORT CENTER
The Secretary shall, no later than six months after
the date of enactment of this Act, make one or more
grants of a total amount not exceeding $5,000,000 per
annum to establish national consumer representative sup-
port center(s) to assist consumer representatives serving
on State medical boards, quality improvement foundation
governing boards, and consumer health care advocates in
performing their duties. Entities eligible for a grant under
this section shall be nonprofit organizations with dem-
onstrated expertise in training and representing diverse
consumers of health care insurance, and health care items
and services.
SEC. 205. NATIONAL MEASURES OF QUALITY PERFORM-
ANCE.
(a) IN GENERAL.—The Secretary shall develop a set
of national measures of quality performance, which shall
be used to assess the provision if health care services and
access to such services.
(b) SUBJECT OF MEASURES.—National measures of
quality performance shall be selected in a manner that
provides information on the following subjects:
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(1) Access to health care services by consumers;
(2) Appropriateness of health care services pro-
vided to consumers;
(3) Outcomes of health care services and proce-
dures;
(4) Health promotion;
(5) Prevention of diseases, disorders, and other
health conditions;
(6) Consumer satisfaction with care, including
satisfaction of consumers who disenroll from health
plans and those who utilize services from providers
not included in their plan network.
(c) SELECTION OF MEASURES.—
(1) CONSULTATION.—In developing and select-
ing the national measures of quality performance,
the Secretary shall consult with appropriate inter-
ested parties, including—
(A) States;
(B) health plans;
(C) employers and individuals purchasing
health care through regional and corporate alli-
ances;
(D) health care providers;
(E) health care consumers;
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(F) the quality improvement foundations
established under section 202;
(G) the consumer health care advocate es-
tablished under section 203;
(H) nationally recognized accreditation or-
ganizations.
(2) CRITERIA.—The following criteria shall be
used in developing and selecting national measures
of quality performance:
(A) SIGNIFICANCE.—When a measure re-
lates to a specific disease, disorder, or other
health condition, the disease, disorder, or condi-
tion shall be of significance in terms of preva-
lence, morbidity, mortality, or the costs associ-
ated with the prevention, diagnosis, treatment,
or clinical management of the disease, disorder,
or condition.
(B) RANGE
OF
SERVICES.—The set of
measures, taken as a whole, shall be representa-
tive of the range of items and services provided
to consumers of health care by health care pro-
viders and suppliers.
(C) RELIABILITY
AND
VALIDITY.—The
measures shall be reliable and valid.
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(D) UNDUE BURDEN.—The data needed to
calculate the measures shall be obtained with-
out undue burden on the entity or individual
providing the data.
(E) LINKAGE
TO
HEALTH
OUTCOME.—
When a measure is a rate of a process of care,
the process shall, to the extent practicable, be
linked to a health outcome based upon the best
available scientific evidence.
(F) CONTROL AND RISK ADJUSTMENT.—
When a measure of a provider or plan is an
outcome of the provision of care, the outcome
shall be within the control of the provider or
plan and shall be one with respect to which an
adequate risk adjustment can be made.
(G) PUBLIC HEALTH.—The measures shall
incorporate standards identified by the Sec-
retary of Health and Human Services for meet-
ing public health objectives.
(d) UPDATING.—The Secretary shall review and up-
date the set of national measures of quality performance
annually to reflect changing goals for quality improve-
ment. The Secretary shall establish and maintain a prior-
ity list of performance measures that within a five-year
period it intends to consider for inclusion within the set
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through the updating process. The Secretary may select
different performance measures for inclusion within the
set from year to year.
(e) CONSUMER SURVEYS.—
(1) IN GENERAL.—The Secretary shall conduct
periodic surveys of health care consumers to gather
information concerning access to care, use of health
services, health outcomes, and patient satisfaction.
The surveys shall monitor consumer reaction to the
implementation of this Act and be designed to assess
the impact of this Act on the general population of
the United States and potentially vulnerable popu-
lations.
(2) SURVEY ADMINISTRATION.—The Secretary
shall develop and approve a standard design for the
surveys, which shall be administered by the Adminis-
trator for Health Care Policy and Research on a
plan-by-plan and State-by-State basis. A State may
add survey questions on quality measures of local in-
terest to surveys conducted in the State.
(3) SAMPLING
STRATEGIES.—The Secretary
shall develop sampling strategies that ensure survey
samples adequately measure populations considered
by the Secretary to be at risk of receiving inad-
equate health care or who may be difficult to reach
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through consumer sampling methods, including indi-
viduals who—
(A) fail to enroll in a health plan;
(B) resign from a plan;
(C) are members of a vulnerable popu-
lation, as defined by the Secretary; or
(D) have received health care items or
services from providers or suppliers which were
not members of the network maintained by the
plan in which the individual was enrolled.
(f) EFFECTIVE DATE.—The requirements of this sec-
tion taken effect upon the date of enactment of this Act,
with the first publication for comment of draft perform-
ance measures defined under subsection (a), and the sur-
veys described under subsection (e), to take place no later
than two years after the date of enactment of this Act.
The Secretary shall publish, for use by the public in evalu-
ating health plans and providers, the first set of perform-
ance measures no later than three years after the date
of enactment of this Act.
SEC. 206 PAYMENT FOR PHARMACIST COUNSELING.
(a) RELATIVE VALUE SCALE FOR EVALUATION AND
MANAGEMENT SERVICES
BY PHARMACISTS.—The Sec-
retary shall develop and publish, no later than three years
from the date of enactment of this Act, a relative value
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scale that defines and establishes a numerical relationship
among various evaluation and management services per-
formed by pharmacists, taking into account—
(1) differences in skill levels and training re-
quired to perform the services;
(2) differences in level of risk associated with
use of individual drugs or groups of drugs; and
(3) differences in the level of risk associated
with drug use by certain individuals.
(b) REPORT TO CONGRESS.—No later than three
years after the date of enactment of this subsection, the
Secretary shall provide to Congress a report on the rel-
ative value scale developed under paragraph (1), together
with recommendations regarding adoption of such scale by
Federal health insurance programs and by health plans
certified under section 301.
TITLE III—STATE HEALTH QUALITY
MANAGEMENT PROGRAMS
SEC. 301 CERTIFICATION OF HEALTH PLANS.
(a) IN GENERAL.—(1) To be certified by a State, a
plan must be determined to be in substantial compliance
with the standards described in this section.
(2) OVERSIGHT.—The Secretary may conduct onsite
inspections and inspect documents generated by or in the
possession of a plan, accreditation organization, or State,
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to verify the compliance of a plan with the requirements
of this section.
(b) ACCREDITATION.—A State may accept, in lieu of
making its own determination of compliance with these
standards, the determination of compliance by an accredi-
tation organization designated by the Secretary as utiliz-
ing a process consistent with subsection (c).
(c) PROCESS.—A State or accreditation organization
making a determination under subsection (a)—
(1) shall verify compliance with each of the
standards under this section.
(2) shall make available to the public its find-
ings related to a plan’s compliance with each of the
standards under this section.
(3) may charge plans fees sufficient to cover the
cost of assuring compliance with the standards
under this section.
(d) QUALITY STANDARDS.—
(1) QUALITY IMPROVEMENT.—
(A) IN GENERAL.—Each health plan shall
establish a quality improvement program to sys-
tematically measure, assess and improve en-
rollee health status, patient outcomes, processes
of care, and enrollee satisfaction associated with
health care provided under the plan.
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(B) FUNCTIONS.—Each quality improve-
ment program shall perform the following func-
tions—
(i) measure performance of the plan
and its member providers, using at least
the quality measures developed under sec-
tion 5003, and communicate findings of
such monitoring to such providers and plan
administrative personnel;
(ii) furnish the information required
under subtitle B of this title and provide
such other reports and information on the
quality of care delivered by providers as
may be required under this Act;
(iii) demonstrate measureable im-
provement in medical outcomes (including
morbidity, mortality, functional impair-
ment, and quality of life), as measured by
the plan and as assessed by plan enrollees
and patients;
(iv) establish procedures for—
(I) educational intervention when
services characterized by underuse,
overuse, or poor technical quality are
provided, and
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(II) referral to State licensure
board or other appropriate regulatory
authorities if the interventions de-
scribed in subclause (I) are unsuccess-
ful; and
(v) cooperate with the health quality
improvement foundation established under
section 5008, including providing access to
appropriate medical records and quality
performance data upon the request of such
foundation, and undertaking investigation
of quality problems and opportunities for
quality improvement identified by the foun-
dation.
(2) COMMUNITY HEALTH IMPROVEMENT.—
(A) IN GENERAL.—Each health plan shall
establish a community health improvement pro-
gram that meets the requirements of subpara-
graph (C) for the benefit of—
(i) plan enrollees; and
(ii) uninsured individuals residing in
the geographic area served by the plan, or,
with respect to self-insured plans, the geo-
graphic area served by insured plans in
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which the plan’s principle place of business
is located.
(B) 
REQUIREMENTS.—A 
community
health improvement program shall consist of:
(i) identification of baseline health
status problems in the population ad-
dressed by the program;
(ii) development of measures to ad-
dress such problems in consultation with
local public health officials, community or-
ganizations, and other health plans operat-
ing in the service area of the plan;
(iii) implementation of measures de-
veloped under clause (ii);
(iv) evaluation of the effectiveness of
such measures in improvement of health
status in the population; and
(v) an annual report of the results of
the evaluation.
(3) UTILIZATION MANAGEMENT.—
(A) IN
GENERAL.—The utilization man-
agement activities of a plan are subject to the
requirements of this paragraph to the extent
such activities involve case by case review of
care proposed for or provided to individual pa-
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tients. A plan may satisfy the requirements of
subparagraphs (C) through (G) by conducting
its utilization management efforts through its
quality improvement program.
(B) Disclosure of utilization management
criteria upon the request of practitioners or en-
rollees.
(C) Inclusion of utilization management
criteria to identify underutilization as well as
overutilization.
(D) Systematic updating of utilization re-
view criteria to reflect current scientific and
medical findings.
(E) Supervision of utilization determina-
tions by qualified medical professionals.
(F) Consistency in the application of utili-
zation review criteria.
(G) Personnel responsible for utilization
management shall—
(i) monitor the outcome of utilization
management decisions which are appealed
by an enrollee or provider, and
(ii) revise utilization management cri-
teria and procedures to eliminate future
reversed decisions to the extent practicable,
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except where such reversals were not the
result of deficiencies in such criteria or
procedures.
(4) PHYSICIAN INCENTIVE PLANS.—
(A) IN GENERAL.—A health plan may es-
tablish and operate a physician incentive plan
(as defined in subparagraph (B)) if—
(i) the requirements specified in
clauses 
(i) 
through 
(iii) 
of 
section
1876(i)(8)(A) of the Social Security Act
are met (in the same manner as they apply
to eligible organizations under section
1876 of such Act); and
(ii) the plan prominently discloses to
the public, in its enrollment information,
the nature of the incentives provided to
providers under the plan.
(B) DEFINITION.—For purposes of this
paragraph, the term ‘‘physician incentive plan’’
means any compensation or other financial ar-
rangement between a health plan and a physi-
cian or physician group that may directly or in-
directly have the effect of reducing or limiting
services provided with respect to individuals en-
rolled under the plan.
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(5) ENROLLEE
RIGHTS
AND
RESPONSIBIL-
ITIES.—
(A) IN GENERAL.—A plan shall provide to
all enrollees written information, translated for
the benefit of any population representing 5
percent or more of the plan’s enrollees whose
primary language is other than English, de-
scribing—
(i) enrollee rights and responsibilities,
including the grievance and appeals rights
defined in subpart C of this title, the
rights 
defined 
in 
subparagraphs 
(B)
through (H), and
(ii) any limitations of coverage, exclu-
sions, and out-of-pocket costs (including
any copayment, coinsurance, deductible)
and any limit(s) on out-of-pocket costs.
(B) WAIVER OF RIGHTS.—No health plan
or provider may require an individual or en-
rollee to waive the rights set forth in this para-
graph as a condition of enrollment in a plan,
admission to a health care facility, or provision
of treatment.
(C) RIGHT
TO
REFUSE
TREATMENT.—
Each enrollee shall have the right—
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(i) to refuse any health care item or
service;
(ii) to refuse to receive any health
care item or service from a specified pro-
vider;
(iii) to leave the premises of any pro-
vider, except as otherwise provided under
law;
(iv) to refuse participation in experi-
mental research, and to have either a re-
fusal or consent documented in the medical
record, except the (HHS) Secretary may
define in regulations circumstances under
which obtaining consent directly from a pa-
tient is not possible; and
(v) to receive an explanation of any
available alternative item, service, or pro-
vider, and any likely medical consequences
of the exercise of the rights described in
clauses (i)–(iv).
(D) RIGHT TO PARTICIPATE IN PLANNING
TREATMENT.—Enrollees shall have the right to
participate in the planning of their health care,
including the opportunity to discuss treatment
alternatives with providers and to be rep-
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resented in such discussions by a family mem-
ber or other chosen representative.
(E) RIGHT
TO
CHOOSE
PRIMARY
CARE
PHYSICIAN.—Each plan shall permit enrollees
to choose a primary care physician from among
providers who are members of the plan, and
permit enrollees to change physicians upon re-
quest.
(F) RIGHT TO PRIVACY.—Enrollees shall
have the right—
(i) to privacy in regard to their health
care during discussion or consultation
among providers regarding their care,
physical examination, and treatment; and
(ii) while admitted to a health facility,
to associate and communicate privately
with persons of their choice, including
being afforded opportunities to commu-
nicate privately with a representative of
the consumer ombudsman or protection
and advocacy organization, upon the re-
quest of such representative.
(G) RIGHT
TO
MEDICAL
RECORDS.—En-
rollees shall have a right to review and, for a
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nominal charge, copy, their own medical records
during business hours.
(H) RIGHT
TO
CONFIDENTIALITY
OF
RECORDS.—Enrollees shall be assured confiden-
tial treatment of their medical records, and
shall be afforded the opportunity to approve or
refuse their release to any individual other than
providers involved in their care, except the Sec-
retary, entities authorized under section 5008
of this Act, or others granted access to such
records by law.
(6) PRACTITIONER CREDENTIALING AND COM-
PETENCY.—Each health plan shall—
(A) establish an ongoing credentialing and
recredentialing process for all physicians and
other licensed practitioners which are members
of the plan;
(B) require practitioners applying for
membership to complete an application and
statement attesting to their professional stand-
ing and the accuracy of all information pro-
vided;
(C) assure the demonstrated competence of
member practitioners to perform the duties
under the plan’s membership agreement, and
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establish policies and procedures for educational
intervention or reduction, suspension, or termi-
nation of privileges of practitioners failing to
demonstrate competence.
(7) INFORMATION MANAGEMENT.—Each health
plan shall—
(A) protect the confidentiality and security
of information identifying any individual en-
rollee;
(B) standardize throughout the health plan
and its member providers, to the extent prac-
ticable and consistent with the requirements of
section 205, data sets, codes, definitions, classi-
fications, and terminology.
(8) DISCLOSURES RELATED TO MARKETING IN-
FORMATION.—
(A) Each health plan which sponsors or
distributes any comparative information per-
taining to plans marketed in an area shall
prominently disclose in such information—
(i) the identity of the plan (or related
organization) sponsoring or distributing
the comparative information, and whether
the performance of the plan (or organiza-
tion) is included in the comparative infor-
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mation being sponsored or distributed by
such plan; and
(ii) if clinical outcomes or other clini-
cal performance data are included in such
information, whether such data were ad-
justed to reflect the health status and se-
verity of illness of enrollees or patients in-
cluded in such comparisons, and the meth-
od by which any severity adjustment was
accomplished.
(B) Enrollment materials provided to po-
tential enrollees by each health plan shall make
a prominent disclosure of the features, avail-
ability, cost sharing and the additional premium
cost (if any) associated with purchase of the
self-referral option described in paragraph (11).
(9) COUNSELING
REQUIREMENTS
FOR
PHAR-
MACIES.—Each health plan shall ensure that no
pharmacy may receive payment from the plan for
dispensing a covered outpatient drug unless the
pharmacy agrees that a pharmacist employed by the
pharmacy will ask individuals enrolled in the plan
who receive a covered outpatient drug from the
pharmacy questions regarding—
(A) the appropriate use of the drug,
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(B) major potential interactions between
the drug and other drugs used by the individ-
ual, and
(C) other questions necessary to determine,
in the professional judgment of the phar-
macist—
(i) whether the individual understands
and is likely to comply with instructions
for the safe and effective use of such
drugs, and
(ii) if any counseling or other action
by the pharmacist is needed.
(10) 
VOLUNTARY
CONTRIBUTIONS.—Each
health plan shall, upon the request of the consumer
health care advocate described under section 203—
(A) publish in a prominent location in its
enrollment document a solicitation for voluntary
contributions for the consumer health care ad-
vocate designated by the Secretary to serve the
State; and
(B) collect such contributions, through the
same mechanism as periodic premium payments
of the enrollee are collected, and forward them
to the consumer health care advocate no less
frequently than monthly.
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but which will not pose an unreasonable barrier
to exercise of the point of service option.
(C) SELF-REFERRAL.—With respect to an
enrollee who has purchased the point of service
option, no plan may require a referral from a
network provider as a precondition of coverage
of out-of-network items and services.
(D) MEDICAL
NECESSITY.—A plan may
deny payment for items or services received
from an out-of-network provider or supplier if
such items or services were not medically nec-
essary.
SEC. 302. STANDARDS FOR STATE MEDICAL BOARDS.
(a) REQUIREMENTS FOR STATE BOARD OF MEDICAL
EXAMINERS.—
(1) PUBLIC
ACCOUNTABILITY.—Each State
Board of Medical Examiners shall make available to
the public upon request:
(A) a description of any final actions (in-
cluding those described in paragraph (4)(E))
taken by the Board with respect to a physician;
(B) an annual performance report indicat-
ing the number and type of investigations un-
dertaken and actions taken by the Board dur-
ing the preceding year.
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(2) COMPOSITION OF BOARD OF MEDICAL EX-
AMINERS
AND
COMMITTEES.—Each State Board
shall be structured so as to include:
(A) public members in sufficient numbers
that no fewer than fifty percent of board mem-
bers are public members;
(B) in the membership of each committee
or subdivision of the board, at least one public
member.
(3) FUNDING.—
(A) Each State medical licensure board
shall be adequately funded to fulfill the require-
ments of this section.
(B) All revenue generated by medical licen-
sure fees shall be used to fund the activities of
the State medical board, to the extent necessary
to fulfill the requirement of subparagraph (A).
(4) INVESTIGATIONS.—A State medical licen-
sure board shall—
(A) investigate any credible evidence which
alleges that a physician—
(i) is incompetent to perform the du-
ties reflected in the physician’s license;
(ii) engages in unprofessional conduct
that jeopardized patients;
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(iii) is mentally or physically unable to
safely and effectively perform the duties
reflected in the physician’s license;
(B) employ or arrange for the availability
of personnel with the appropriate medical train-
ing necessary to investigate and document find-
ings related to allegations described in subpara-
graph (A);
(C) investigate allegations submitted to the
board by a health quality improvement founda-
tion established under section 202.
(D) possess the following investigative
powers:
(i) the power to subpoena documents
and individuals possessing information rel-
evant to investigations;
(ii) the power to require professional
competency examinations upon reasonable
suspicion of incompetence;
(iii) the power to obtain the involun-
tary temporary summary suspension of a
licensee from practice, based upon a rea-
sonable belief that the licensee poses an
imminent threat to patient health, followed
as soon as practicable by a formal hearing;
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(E) possess the following authorities relat-
ed to disciplinary action:
(i) revocation or suspension of a li-
cense;
(ii) restriction or limitation of the ex-
tent, scope, or type of practice, including
the authority to order such limited practice
to be conducted under the supervision of
another licensee;
(iii) imposition of civil penalties;
(iv) issuance of a warning or rep-
rimand;
(v) probation with or without condi-
tions, such as submission to treatment,
continuing education, or reexamination;
(vi) the authority to condition a rein-
statement of a license or removal of license
limitations upon the licensee obtaining
minimum results on one or more forms of
competency examination, and
(vii) assessment of the reasonable
costs of investigation, hearings or reviews,
and supervision of practice.
(b) ELIGIBILITY FOR GRANTS.—
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(1) IN GENERAL.—The Secretary may make a
grant to a State Board of Medical Examiners for
any purpose related to its duties under this section,
or for demonstration projects, if such Board dem-
onstrates it is eligible under paragraph (2).
(2) ELIGIBILITY.—A State Board of Medical
Examiners is eligible for a grant under paragraph
(1) if the Secretary determines that the Board is in
substantial compliance with this section and the cur-
rent model standards established by the Federation
of State Medical Boards.
(3) CONSTRUCTION.—If any of the model
standards referred to in paragraph (2) are inconsist-
ent with the provisions of this section, the Sec-
retary’s determination of eligibility shall be based
upon on compliance with the requirements of this
section.
(c) DEFINITIONS.—
(1) For purposes of this section, a ‘‘Board of
Medical Examiners’’ shall have the meaning given in
section 431(14) of the Health Care Quality Improve-
ment Act of 1986.
(2) For purposes of this section, a ‘‘public
member’’ means an individual who resides in the
State and is a person of integrity and good reputa-
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tion who has lived in the State for at least five years
immediately preceding appointment to the Board,
and has never been authorized to practice a healing
art, and has never had a substantial personal, busi-
ness, professional, or pecuniary connection with a
healing art or with a medical education or health
care facility, except as a patient or a potential
patient.
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