I
104TH CONGRESS
1ST SESSION
H. R. 2249
To amend the Social Security Act to require health maintenance organizations
under the medicare program to disclose to enrollees and potential enroll-
ees certain information on the credentials of physicians providing services
by or through the organization, the financial status of the organization,
and the compensation paid to officers and executives of the organization.
IN THE HOUSE OF REPRESENTATIVES
AUGUST 4, 1995
Mr. SHAW introduced the following bill; which was referred to the Committee
on Ways and Means, and in addition to the Committee on Commerce,
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 Social Security Act to require health mainte-
nance organizations under the medicare program to dis-
close to enrollees and potential enrollees certain informa-
tion on the credentials of physicians providing services
by or through the organization, the financial status of
the organization, and the compensation paid to officers
and executives of the organization.
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 ‘‘Medicare Managed
Health Care Sunshine Act of 1995’’.
SEC. 2. PROVIDING HMO ENROLLEES WITH CERTAIN IN-
FORMATION ON PLANS.
Section 1876(c) of the Social Security Act (42 U.S.C.
1395mm(c)) is amended by adding at the end the follow-
ing:
‘‘(9)(A) Upon the request of a member enrolled with
the organization under this section, or an individual con-
sidering enrollment with the organization under this sec-
tion, the organization shall provide the enrollee or individ-
ual with the following:
‘‘(i) Descriptive information regarding the cre-
dentials of each physician who is authorized by the
organization to provide services by or through the
organization to enrollees under this section, includ-
ing the medical education and training received by
the physician, the physician’s history of medical
practice (whether domestic or foreign), and the posi-
tions held by the physician at the time of the re-
quest.
‘‘(ii) An audited financial statement of the or-
ganization for the most recently concluded fiscal
year that complies with generally accepted account-
ing principles and includes a balance sheet, income
statement, and statement of changes in financial po-
sition.
‘‘(iii) A statement identifying the salaries, bo-
nuses, and other remuneration paid to the 5 highest-
paid officers or executives of the organization, as
well as the other benefits provided to such officers
or executives.
‘‘(B) The organization shall include in any brochure,
application form, or other promotional or informational
material that is distributed by the organization to (or for
the use of) individuals eligible to enroll with the organiza-
tion under this section a statement that the information
described in subparagraph (A) is available from the orga-
nization upon request.’’.
SEC. 3. EFFECTIVE DATE.
The amendment made by this Act shall apply with
respect to contract years beginning on or after the date
that is 6 months after the date of the enactment of this
Act.
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