162
HR 2563 PCS
(3) Section 502(b)(3) of such Act (29 U.S.C.
1132(b)(3)) is amended by inserting ‘‘(other than section
135(b) of the Bipartisan Patient Protection Act, as
enforcible under section 714(c))’’ after ‘‘part 7’’.
SEC. 402. AVAILABILITY OF CIVIL REMEDIES.
(a) IN GENERAL.—Section 502 of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 1132)
is amended by adding at the end the following:
‘‘(n) CAUSE OF ACTION RELATING TO CLAIMS FOR
HEALTH BENEFITS.—
‘‘(1) CAUSE OF ACTION.—
‘‘(A) IN GENERAL.—With respect to an ac-
tion commenced by a participant or beneficiary
(or the estate of the participant or beneficiary)
in connection with a claim for benefits under a
group health plan, if—
‘‘(i) a designated decisionmaker de-
scribed in paragraph (2) fails to exercise
ordinary care—
‘‘(I) in making a determination
denying the claim for benefits under
section 503A (relating to an initial
claim for benefits),
‘‘(II) in making a determination
denying the claim for benefits under
163
HR 2563 PCS
section 503B (relating to an internal
appeal), or
‘‘(III) in failing to authorize cov-
erage in compliance with the written
determination of an independent med-
ical 
reviewer 
under 
section
503C(d)(3)(F) that reverses a deter-
mination denying the claim for bene-
fits, and
‘‘(ii) the delay in receiving, or failure
to receive, benefits attributable to the fail-
ure described in clause (i) is the proximate
cause of personal injury to, or death of,
the participant or beneficiary,
such designated decisionmaker shall be liable to
the participant or beneficiary (or the estate) for
economic and noneconomic damages in connec-
tion with such failure and such injury or death
(subject to paragraph (4)).
‘‘(B) REBUTTABLE PRESUMPTION.—In the
case of a cause of action under subparagraph
(A)(i)(I) or (A)(i)(II), if an independent med-
ical 
reviewer 
under 
section 
503C(d) 
or
503C(e)(4)(B) upholds the determination deny-
ing the claim for benefits involved, there shall
164
HR 2563 PCS
be a presumption (rebuttable by clear and con-
vincing evidence) that the designated decision-
maker exercised ordinary care in making such
determination.
‘‘(2) DESIGNATED DECISIONMAKER.—
‘‘(A) APPOINTMENT.—
‘‘(i) IN GENERAL.—The plan sponsor
or named fiduciary of a group health plan
shall, in accordance with this paragraph
with respect to a participant or beneficiary,
designate a person that meets the require-
ments of subparagraph (B) to serve as a
designated decisionmaker with respect to
the cause of action described in paragraph
(1), except that—
‘‘(I) with respect to health insur-
ance coverage offered in connection
with a group health plan, the health
insurance issuer shall be the des-
ignated decisionmaker unless the plan
sponsor and the issuer specifically
agree in writing (on a form to be pre-
scribed by the Secretary) to substitute
another person as the designated deci-
sionmaker; or
165
HR 2563 PCS
‘‘(II) with respect to the designa-
tion of a person other than a plan
sponsor or health insurance issuer,
such person shall satisfy the require-
ments of subparagraph (D).
‘‘(ii) PLAN
DOCUMENTS.—The des-
ignated decisionmaker shall be specifically
designated as such in the written instru-
ments of the plan (under section 402(a))
and be identified as required under section
121(b)(20) of the Bipartisan Patient Pro-
tection Act.
‘‘(B) REQUIREMENTS.—For purposes of
this paragraph, a designated decisionmaker
meets the requirements of this subparagraph
with respect to any participant or beneficiary
if—
‘‘(i) such designation is in such form
as may be specified in regulations pre-
scribed by the Secretary,
‘‘(ii) the designated decisionmaker—
‘‘(I) meets the requirements of
subparagraph (C),
‘‘(II) assumes unconditionally all
liability arising under this subsection
166
HR 2563 PCS
in connection with actions and failures
to act described in subparagraph (A)
(whether undertaken by the des-
ignated decisionmaker or the em-
ployer, plan, plan sponsor, or em-
ployee or agent thereof) during the
period in which the designation under
this paragraph is in effect relating to
such participant or beneficiary, and
‘‘(III) 
where 
subparagraph
(C)(ii) applies, assumes uncondition-
ally the exclusive authority under the
group health plan to make determina-
tions on claims for benefits (irrespec-
tive of whether they constitute medi-
cally reviewable determinations) under
the plan with respect to such partici-
pant or beneficiary, and
‘‘(iii) the designated decisionmaker
and the participants and beneficiaries for
whom the decisionmaker has assumed li-
ability are identified in the written instru-
ment required under section 402(a) and as
required under section 121(b)(15) of the
Bipartisan Patient Protection Act.
167
HR 2563 PCS
Any liability assumed by a designated decision-
maker pursuant to this paragraph shall be in
addition to any liability that it may otherwise
have under applicable law.
‘‘(C) QUALIFICATIONS
FOR
DESIGNATED
DECISIONMAKERS.—
‘‘(i) IN GENERAL.—Subject to clause
(ii), an entity is qualified under this sub-
paragraph to serve as a designated deci-
sionmaker with respect to a group health
plan if the entity has the ability to assume
the liability described in subparagraph (A)
with respect to participants and bene-
ficiaries under such plan, including re-
quirements relating to the financial obliga-
tion for timely satisfying the assumed li-
ability, and maintains with the plan spon-
sor certification of such ability. Such cer-
tification shall be provided to the plan
sponsor or named fiduciary upon designa-
tion under this paragraph and not less fre-
quently than annually thereafter, or if such
designation constitutes a multiyear ar-
rangement, in conjunction with the renewal
of the arrangement.
168
HR 2563 PCS
‘‘(ii) SPECIAL QUALIFICATION IN THE
CASE
OF
CERTAIN
REVIEWABLE
DECI-
SIONS.—In the case of a group health plan
that provides benefits consisting of medical
care to a participant or beneficiary only
through health insurance coverage offered
by a health insurance issuer, such issuer is
the only entity that may be qualified under
this subparagraph to serve as a designated
decisionmaker with respect to such partici-
pant or beneficiary, and shall serve as the
designated decisionmaker unless the em-
ployer or other plan sponsor acts affirma-
tively to prevent such service.
‘‘(D) REQUIREMENTS
RELATING
TO
FI-
NANCIAL OBLIGATIONS.—For purposes of sub-
paragraphs (A)(i)(II) and (C)(i), the require-
ments relating to the financial obligation of an
entity for liability shall include—
‘‘(i) coverage of such entity under an
insurance policy or other arrangement, se-
cured and maintained by such entity, to ef-
fectively insure such entity against losses
arising from professional liability claims,
including those arising from its service as
169
HR 2563 PCS
a designated decisionmaker under this sub-
section; or
‘‘(ii) evidence of minimum capital and
surplus levels that are maintained by such
entity to cover any losses as a result of li-
ability arising from its service as a des-
ignated decisionmaker under this sub-
section.
The appropriate amounts of liability insurance
and minimum capital and surplus levels for
purposes of clauses (i) and (ii) shall be deter-
mined by an actuary using sound actuarial
principles and accounting practices pursuant to
established guidelines of the American Academy
of Actuaries and in accordance with such regu-
lations as the Secretary may prescribe and shall
be maintained throughout the term for which
the designation is in effect. The provisions of
this subparagraph shall not apply in the case of
a designated decisionmaker that is a group
health plan, plan sponsor, or health insurance
issuer and that is regulated under Federal law
or a State financial solvency law.
‘‘(E) LIMITATION
ON
APPOINTMENT
OF
TREATING
PHYSICIANS.—A treating physician
170
HR 2563 PCS
who directly delivered the care or treatment or
provided services which is the subject of a cause
of action by a participant or beneficiary under
paragraph (1) may not be appointed (or deemed
to be appointed) as a designated decisionmaker
under this paragraph with respect to such par-
ticipant or beneficiary.
‘‘(F) FAILURE TO APPOINT.—With respect
to any cause of action under paragraph (1) re-
lating to a denial of a claim for benefits where
a designated decisionmaker has not been ap-
pointed in accordance with this paragraph, the
plan sponsor or named fiduciary responsible for
determinations under section 503 shall be
deemed to be the designated decisionmaker.
‘‘(G) EFFECT OF APPOINTMENT.—The ap-
pointment of a designated decisionmaker in ac-
cordance with this paragraph shall not affect
the liability of the appointing plan sponsor or
named fiduciary for the failure of the plan
sponsor or named fiduciary to comply with any
other requirement of this title.
‘‘(H) TREATMENT
OF
CERTAIN
TRUST
FUNDS.—For purposes of this subsection, the
terms ‘employer’ and ‘plan sponsor’, in connec-
171
HR 2563 PCS
tion with the assumption by a designated deci-
sionmaker of the liability of employer or other
plan sponsor pursuant to this paragraph, shall
be construed to include a trust fund maintained
pursuant to section 302 of the Labor Manage-
ment Relations Act, 1947 (29 U.S.C. 186) or
the Railway Labor Act (45 U.S.C. 151 et seq.).
‘‘(3) REQUIREMENT OF EXHAUSTION OF INDE-
PENDENT MEDICAL REVIEW.—
‘‘(A) IN
GENERAL.—Paragraph (1) shall
apply only if—
‘‘(i) a final determination denying a
claim for benefits under section 503B has
been referred for independent medical re-
view under section 503C(d) and a written
determination by an independent medical
reviewer has been issued with respect to
such review, or
‘‘(ii) the qualified external review enti-
ty 
has 
determined 
under 
section
503C(c)(3) that a referral to an inde-
pendent medical reviewer is not required.
‘‘(B) INJUNCTIVE
RELIEF
FOR
IRREP-
ARABLE
HARM.—A participant or beneficiary
may seek relief under subsection (a)(1)(B) prior
172
HR 2563 PCS
to the exhaustion of administrative remedies
under section 503B or 503C (as required under
subparagraph (A)) if it is demonstrated to the
court, by a preponderance of the evidence, that
the exhaustion of such remedies would cause ir-
reparable harm to the health of the participant
or beneficiary. Any determinations that already
have been made under section 503A, 503B, or
503C in such case, or that are made in such
case while an action under this subparagraph is
pending, shall be given due consideration by the
court in any action under subsection (a)(1)(B)
in such case. Notwithstanding the awarding of
such relief under subsection (a)(1)(B) pursuant
to this subparagraph, no relief shall be available
under paragraph (1), with respect to a partici-
pant or beneficiary, unless the requirements of
subparagraph (A) are met.
‘‘(C) RECEIPT OF BENEFITS DURING AP-
PEALS PROCESS.—Receipt by the participant or
beneficiary of the benefits involved in the claim
for benefits during the pendency of any admin-
istrative processes referred to in subparagraph
(A) or of any action commenced under this
subsection—
173
HR 2563 PCS
‘‘(i) shall not preclude continuation of
all such administrative processes to their
conclusion if so moved by any party, and
‘‘(ii) shall not preclude any liability
under subsection (a)(1)(C) and this sub-
section in connection with such claim.
The court in any action commenced under this
subsection shall take into account any receipt of
benefits during such administrative processes or
such action in determining the amount of the
damages awarded.
‘‘(4) LIMITATIONS
ON
RECOVERY
OF
DAM-
AGES.—
‘‘(A) MAXIMUM AWARD OF NONECONOMIC
DAMAGES.—The aggregate amount of liability
for noneconomic loss in an action under para-
graph (1) may not exceed $1,500,000.
‘‘(B) LIMITATION ON AWARD OF PUNITIVE
DAMAGES.—In the case of any action com-
menced pursuant to paragraph (1), the court
may not award any punitive, exemplary, or
similar damages against a defendant, except
that the court may award punitive, exemplary,
or similar damages (in addition to damages de-
174
HR 2563 PCS
scribed in subparagraph (A)), in an aggregate
amount not to exceed $1,500,000, if—
‘‘(i) the denial of a claim for benefits
involved in the case was reversed by a writ-
ten determination by an independent med-
ical reviewer under section 503C(d)(3)(F);
and
‘‘(ii) there has been a failure to au-
thorize coverage in compliance with such
written determination.
‘‘(C) PERMITTING APPLICATION OF LOWER
STATE
DAMAGE
LIMITS.—A State may limit
damages for noneconomic loss or punitive, ex-
emplary, or similar damages in an action under
paragraph (1) to amounts less than the
amounts permitted under this paragraph.
‘‘(5) ADMISSIBILITY.—In an action described in
subclause (I) or (II) of paragraph (1)(A) relating to
a denial of a claim for benefits, any determination
by an independent medical reviewer under section
503C(d) or 503C(e)(4)(B) relating to such denial is
admissible.
‘‘(6) WAIVER OF INTERNAL REVIEW.—In the
case of any cause of action under paragraph (1), the
waiver or nonwaiver of internal review under section
175
HR 2563 PCS
503B(a)(4) by the group health plan, or health in-
surance issuer that offers health insurance coverage
in connection with a group health plan, shall not be
used in determining liability.
‘‘(7) LIMITATIONS
ON
ACTIONS.—Paragraph
(1) shall not apply in connection with any action
that is commenced more than 5 years after the date
on which the failure described in such paragraph oc-
curred or, if earlier, not later than 2 years after the
first date the participant or beneficiary became
aware of the personal injury or death referred to in
such paragraph.
‘‘(8) 
EXCLUSION
OF
DIRECTED
RECORD-
KEEPERS.—
‘‘(A) IN
GENERAL.—Paragraph (1) shall
not apply with respect to a directed record
keeper in connection with a group health plan.
‘‘(B) 
DIRECTED
RECORDKEEPER.—For
purposes of this paragraph, the term ‘directed
record keeper’ means, in connection with a
group health plan, a person engaged in directed
recordkeeping activities pursuant to the specific
instructions of the plan, the employer, or an-
other plan sponsor, including the distribution of
enrollment information and distribution of dis-
176
HR 2563 PCS
closure materials under this Act or title I of the
Bipartisan Patient Protection Act and whose
duties do not include making determinations on
claims for benefits.
‘‘(C) 
LIMITATION.—Subparagraph 
(A)
does not apply in connection with any directed
recordkeeper to the extent that the directed rec-
ordkeeper fails to follow the specific instruction
of the plan or the employer or other plan spon-
sor.
‘‘(9) PROTECTION
OF
THE
REGULATION
OF
QUALITY OF MEDICAL CARE UNDER STATE LAW.—
Nothing in this subsection shall be construed to pre-
clude any action under State law against a person
or entity for liability or vicarious liability with re-
spect to the delivery of medical care. A cause of ac-
tion that is based on or otherwise relates to a group
health plan’s determination on a claim for benefits
shall not be deemed to be the delivery of medical
care under any State law for purposes of this para-
graph. Any such cause of action shall be maintained
exclusively under this section. Nothing in this para-
graph shall be construed to alter, amend, modify, in-
validate, impair, or supersede section 514.
177
HR 2563 PCS
‘‘(10) COORDINATION
WITH
FIDUCIARY
RE-
QUIREMENTS.—A fiduciary shall not be treated as
failing to meet any requirement of part 4 solely by
reason of any action taken by a fiduciary which con-
sists of full compliance with the reversal under sec-
tion 503C (relating to independent external appeals
procedures for group health plans) of a denial of
claim for benefits (within the meaning of section
503C(i)(2)).
‘‘(11) CONSTRUCTION.—Nothing in this sub-
section shall be construed as authorizing a cause of
action under paragraph (1) for the failure of a
group health plan or health insurance issuer to pro-
vide an item or service that is specifically excluded
under the plan or coverage.
‘‘(12) LIMITATION ON CLASS ACTION LITIGA-
TION.—A claim or cause of action under this sub-
section may not be maintained as a class action, as
a derivative action, or as an action on behalf of any
group of 2 or more claimants.
‘‘(13) PURCHASE OF INSURANCE TO COVER LI-
ABILITY.—Nothing in section 410 shall be construed
to preclude the purchase by a group health plan of
insurance to cover any liability or losses arising
178
HR 2563 PCS
under a cause of action under subsection (a)(1)(C)
and this subsection.
‘‘(14) RETROSPECTIVE
CLAIMS
FOR
BENE-
FITS.—A cause of action shall not arise under para-
graph (1) where the claim for benefits relates to an
item or service that has already been provided to the
participant or beneficiary under the plan or coverage
and the claim relates solely to the subsequent denial
of payment for the provision of such item or service.
‘‘(15) EXEMPTION FROM PERSONAL LIABILITY
FOR INDIVIDUAL MEMBERS OF BOARDS OF DIREC-
TORS, JOINT BOARDS OF TRUSTEES, ETC.—Any indi-
vidual who is—
‘‘(A) a member of a board of directors of
an employer or plan sponsor; or
‘‘(B) a member of an association, com-
mittee, employee organization, joint board of
trustees, or other similar group of representa-
tives of the entities that are the plan sponsor
of plan maintained by two or more employers
and one or more employee organizations;
shall not be personally liable under this subsection
for conduct that is within the scope of employment
or of plan-related duties of the individuals unless the
179
HR 2563 PCS
individual acts in a fraudulent manner for personal
enrichment.
‘‘(16) DEFINITIONS
AND
RELATED
RULES.—
For purposes of this subsection:
‘‘(A) CLAIM
FOR
BENEFITS.—The term
‘claim for benefits’ shall have the meaning given
such term in section 503A(e).
‘‘(B) GROUP
HEALTH
PLAN.—The term
‘group health plan’ shall have the meaning
given such term in section 733(a).
‘‘(C) HEALTH
INSURANCE
COVERAGE.—
The term ‘health insurance coverage’ has the
meaning given such term in section 733(b)(1).
‘‘(D) HEALTH
INSURANCE
ISSUER.—The
term ‘health insurance issuer’ has the meaning
given such term in section 733(b)(2).
‘‘(E) ORDINARY
CARE.—The term ‘ordi-
nary care’ means, with respect to a determina-
tion on a claim for benefits, that degree of care,
skill, and diligence that a reasonable and pru-
dent individual would exercise in making a fair
determination on a claim for benefits of like
kind to the claims involved.
‘‘(F) PERSONAL INJURY.—The term ‘per-
sonal injury’ means a physical injury and in-
180
HR 2563 PCS
cludes an injury arising out of the treatment
(or failure to treat) a mental illness or disease.
‘‘(G) TREATMENT
OF
EXCEPTED
BENE-
FITS.—The provisions of this subsection (and
subsection (a)(1)(C)) shall not apply to ex-
cepted benefits (as defined in section 733(c)),
other 
than 
benefits 
described 
in 
section
733(c)(2)(A), in the same manner as the provi-
sions of part 7 do not apply to such benefits
under subsections (b) and (c) of section 732.
(2) 
CONFORMING
AMENDMENT.—Section
502(a)(1) of such Act (29 U.S.C. 1132(a)(1)) is
amended—
(A) by striking ‘‘or’’ at the end of subpara-
graph (A);
(B) in subparagraph (B), by striking
‘‘plan;’’ and inserting ‘‘plan, or’’; and
(C) by adding at the end the following new
subparagraph:
‘‘(C) for the relief provided for in sub-
section (n) of this section.’’.
(b) AVAILABILITY OF ACTIONS IN STATE COURT.—
(1) JURISDICTION OF STATE COURTS.—Section
502(e)(1) of such Act (29 U.S.C. 1132(e)) is
amended—
181
HR 2563 PCS
(A) in the first sentence, by striking ‘‘sub-
section (a)(1)(B)’’ and inserting ‘‘paragraphs
(1)(B), (1)(C), and (7) of subsection (a)’’;
(B) in the second sentence, by striking
‘‘paragraphs (1)(B) and (7)’’ and inserting
‘‘paragraphs (1)(B), (1)(C), and (7)’’; and
(C) by adding at the end the following new
sentence: ‘‘State courts of competent jurisdic-
tion in the State in which the plaintiff resides
and district courts of the United States shall
have concurrent jurisdiction over actions under
subsections (a)(1)(C) and (n).’’.
(2) LIMITATION ON REMOVABILITY OF CERTAIN
ACTIONS IN STATE COURT.—Section 1445 of title
28, United States Code, is amended by adding at
the end the following new subsection:
‘‘(e)(1) A civil action brought in any State court
under subsections (a)(1)(C) and (n) of section 502 of the
Employee Retirement Income Security Act of 1974
against any party (other than the employer, plan, plan
sponsor, or other entity treated under section 502(n) of
such Act as such) arising from a medically reviewable de-
termination may not be removed to any district court of
the United States.
182
HR 2563 PCS
‘‘(2) For purposes of paragraph (1), the term ‘medi-
cally reviewable decision’ means a denial of a claim for
benefits under the plan which is described in section
503C(d)(2) of the Employee Retirement Income Security
Act of 1974.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to acts and omissions, from which
a cause of action arises, occurring on or after the applica-
ble effective date under section 601.
SEC. 403. LIMITATION ON CERTAIN CLASS ACTION LITIGA-
TION.
(a) IN GENERAL.—Section 502 of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 1132),
as amended by section 402, is further amended by adding
at the end the following:
‘‘(o) LIMITATION ON CLASS ACTION LITIGATION.—
Any claim or cause of action that is maintained under this
section (other than under subsection (n)) or under section
1962 or 1964(c) of title 18, United States Code, in con-
nection with a group health plan, or health insurance cov-
erage issued in connection with a group health plan, as
a class action, derivative action, or as an action on behalf
of any group of 2 or more claimants, may be maintained
only if the class, the derivative claimant, or the group of
claimants is limited to the participants or beneficiaries of
183
HR 2563 PCS
a group health plan established by only 1 plan sponsor.
No action maintained by such class, such derivative claim-
ant, or such group of claimants may be joined in the same
proceeding with any action maintained by another class,
derivative claimant, or group of claimants or consolidated
for any purpose with any other proceeding. In this para-
graph, the terms ‘group health plan’ and ‘health insurance
coverage’ have the meanings given such terms in section
733.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply with respect to actions com-
menced on or after August 2, 2001. Notwithstanding the
preceding sentence, with respect to class actions, the
amendment made by subsection (a) shall apply with re-
spect to civil actions which are pending on such date in
which a class action has not been certified as of such date.
SEC. 404. LIMITATIONS ON ACTIONS.
Section 502 of the Employee Retirement Income Se-
curity Act of 1974 (29 U.S.C. 1132) (as amended by sec-
tions 402 and 403) is amended further by adding at the
end the following new subsection:
‘‘(p) LIMITATIONS ON ACTIONS RELATING TO GROUP
HEALTH PLANS.—
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), no action may be brought under sub-
184
HR 2563 PCS
section (a)(1)(B), (a)(2), or (a)(3) by a participant
or beneficiary seeking relief based on the application
of any provision in section 101, subtitle B, or sub-
title D of title I of the Bipartisan Patient Protection
Act (as incorporated under section 714).
‘‘(2) CERTAIN ACTIONS ALLOWABLE.—An ac-
tion may be brought under subsection (a)(1)(B),
(a)(2), or (a)(3) by a participant or beneficiary seek-
ing relief based on the application of section 101,
113, 114, 115, 116, 117, 118(a)(3), 119, or 120 of
the Bipartisan Patient Protection Act (as incor-
porated under section 714) to the individual cir-
cumstances of that participant or beneficiary, except
that—
‘‘(A) such an action may not be brought or
maintained as a class action; and
‘‘(B) in such an action, relief may only
provide for the provision of (or payment of)
benefits, items, or services denied to the indi-
vidual participant or beneficiary involved (and
for attorney’s fees and the costs of the action,
at the discretion of the court) and shall not pro-
vide for any other relief to the participant or
beneficiary or for any relief to any other person.
185
HR 2563 PCS
‘‘(3) OTHER PROVISIONS UNAFFECTED.—Noth-
ing in this subsection shall be construed as affecting
subsections (a)(1)(C) and (n).
‘‘(4) ENFORCEMENT
BY
SECRETARY
UNAF-
FECTED.—Nothing in this subsection shall be con-
strued as affecting any action brought by the Sec-
retary.’’.
SEC. 405. COOPERATION BETWEEN FEDERAL AND STATE
AUTHORITIES.
(a) IN GENERAL.—Subpart C of part 7 of subtitle
B of title I of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1191 et seq.) is amended by add-
ing at the end the following new section:
‘‘SEC. 735. COOPERATION BETWEEN FEDERAL AND STATE
AUTHORITIES.
‘‘(a) AGREEMENT WITH STATES.—A State may enter
into an agreement with the Secretary for the delegation
to the State of some or all of the Secretary’s authority
under this title to enforce the requirements applicable
under sections 503A, 503B, 503C, and 714 with respect
to health insurance coverage offered by a health insurance
issuer and with respect to a group health plan that is a
non-Federal governmental plan.
‘‘(b) DELEGATIONS.—Any department, agency, or in-
strumentality of a State to which authority is delegated
186
HR 2563 PCS
pursuant to an agreement entered into under this section
may, if authorized under State law and to the extent con-
sistent with such agreement, exercise the powers of the
Secretary under this title which relate to such authority.’’.
(b) CLERICAL AMENDMENTS.—The table of contents
in section 1 of such Act is amended—
(1) by inserting after the item relating to sec-
tion 503 the following new items:
‘‘Sec. 503A. Procedures for initial claims for benefits and prior authorization
determinations.
‘‘Sec. 503B. Internal appeals of claims denials.
‘‘Sec. 503C. Independent external appeals procedures.’’;
(2) by inserting after the item relating to sec-
tion 713 the following new item:
‘‘Sec. 714. Patient protection standards.’’; and
(3) by inserting after the item relating to sec-
tion 734 the following new item:
‘‘Sec. 735. Cooperation between Federal and State authorities.’’.
SEC. 406. SENSE OF THE SENATE CONCERNING THE IMPOR-
TANCE OF CERTAIN UNPAID SERVICES.
It is the sense of the Senate that the court should
consider the loss of a nonwage earning spouse or parent
as an economic loss for the purposes of this section. Fur-
thermore, the court should define the compensation for the
loss not as minimum services, but, rather, in terms that
fully compensate for the true and whole replacement cost
to the family.