I
106TH CONGRESS
1ST SESSION
H. R. 989
To amend the Public Health Service Act, Employee Retirement Income Secu-
rity Act of 1974, and titles XVIII and XIX of the Social Security
Act to require that group and individual health insurance coverage and
group health plans and managed care plans under the Medicare and
Medicaid Programs provide coverage for hospital lengths of stay as
determined by the attending health care provider in consultation with
the patient.
IN THE HOUSE OF REPRESENTATIVES
MARCH 4, 1999
Mr. COBURN (for himself and Mr. STRICKLAND) introduced the following bill;
which was referred to the Committee on Commerce, and in addition to
the Committees on Education and the Workforce, and Ways and Means,
for a period to be subsequently determined by the Speaker, in each case
for consideration of such provisions as fall within the jurisdiction of the
committee concerned
A BILL
To amend the Public Health Service Act, Employee Retire-
ment Income Security Act of 1974, and titles XVIII
and XIX of the Social Security Act to require that
group and individual health insurance coverage and
group health plans and managed care plans under the
Medicare and Medicaid Programs provide coverage for
hospital lengths of stay as determined by the attending
health care provider in consultation with the patient.
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 ‘‘Hospital Length of
Stay Act of 1999’’.
SEC. 2. COVERAGE OF HOSPITAL LENGTH OF STAY.
(a) GROUP HEALTH PLANS.—
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—
(A) IN GENERAL.—Subpart 2 of part A of
title XXVII of the Public Health Service Act
(42 U.S.C. 300gg–4 et seq.) is amended by
adding at the end the following new section:
‘‘SEC. 2707. STANDARDS RELATING TO COVERAGE OF HOS-
PITAL LENGTHS OF STAY.
‘‘(a) REQUIREMENT.—A group health plan and a
health insurance issuer offering group health insurance
coverage in connection with a group health plan (including
a self-insured issuer) that provides coverage for inpatient
hospital services—
‘‘(1) shall provide coverage for the length of an
inpatient hospital stay as determined by the attend-
ing physician (or other attending health care pro-
vider to the extent permitted under State law) in
consultation with the patient to be medically appro-
priate; and
‘‘(2) may not require that a provider obtain au-
thorization from the plan or the issuer for prescrib-
ing any length of stay required under paragraph (1).
‘‘(b) PROHIBITIONS.—A group health plan and a
health insurance issuer offering group health insurance
coverage in connection with a group health plan (including
a self-insured issuer) may not—
‘‘(1) deny to an individual eligibility, or contin-
ued eligibility, to enroll or to renew coverage under
the terms of the plan, solely for the purpose of
avoiding the requirements of this section;
‘‘(2) provide monetary payments or rebates to
an individual to encourage the individual to accept
less than the minimum protections available under
this section;
‘‘(3) penalize or otherwise reduce or limit the
reimbursement of an attending provider because
such provider provided care to an individual partici-
pant or beneficiary in accordance with this section;
‘‘(4) provide incentives (monetary or otherwise)
to an attending provider to induce such provider to
provide care to an individual participant or bene-
ficiary in a manner inconsistent with this section; or