149 
‘‘(b) DELEGATIONS.—Any department, agency, or in-
strumentality of a State to which authority is delegated 
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.’’. 
TITLE III—APPLICATION OF PA-
TIENT PROTECTION STAND-
ARDS TO FEDERAL HEALTH 
INSURANCE PROGRAMS 
SEC. 301. APPLICATION OF PATIENT PROTECTION STAND-
ARDS TO FEDERAL HEALTH INSURANCE PRO-
GRAMS. 
(a) SENSE OF CONGRESS.—It is the sense of Con-
gress that enrollees in Federal health insurance programs 
should have the same rights and privileges as those af-
forded under title I and under the amendments made by 
title IV to participants and beneficiaries under group 
health plans. 
(b) CONFORMING FEDERAL HEALTH INSURANCE 
PROGRAMS.—It is the sense of Congress that the Presi-
dent should require, by executive order, the Federal offi-
cial with authority over each Federal health insurance pro-
gram, to the extent feasible, to take such steps as are nec-
150 
essary to implement the rights and privileges described in 
subsection (a) with respect to such program. 
(c) GAO REPORT
ON
ADDITIONAL
STEPS
RE-
QUIRED.—Not later than 1 year after the date of the en-
actment of this Act, the Comptroller General of the United 
States shall submit to Congress a report on statutory 
changes that are required to implement such rights and 
privileges in a manner that is consistent with the missions 
of the Federal health insurance programs and that avoids 
unnecessary duplication or disruption of such programs. 
(d) FEDERAL HEALTH INSURANCE PROGRAM.—In 
this section, the term ‘‘Federal health insurance program’’ 
means a Federal program that provides creditable cov-
erage (as defined in section 2701(c)(1) of the Public 
Health Service Act) and includes a health program of the 
Department of Veterans Affairs.
151 
TITLE IV—AMENDMENTS TO THE 
EMPLOYEE RETIREMENT IN-
COME SECURITY ACT OF 1974 
SEC. 401. APPLICATION OF PATIENT PROTECTION STAND-
ARDS TO GROUP HEALTH PLANS AND GROUP 
HEALTH INSURANCE COVERAGE UNDER THE 
EMPLOYEE RETIREMENT INCOME SECURITY 
ACT OF 1974. 
Subpart B of part 7 of subtitle B of title I of the 
Employee Retirement Income Security Act of 1974 is 
amended by adding at the end the following new section: 
‘‘SEC. 714. PATIENT PROTECTION STANDARDS. 
‘‘(a) IN GENERAL.—Subject to subsection (b), a 
group health plan (and a health insurance issuer offering 
group health insurance coverage in connection with such 
a plan) shall comply with the requirements of title I of 
the Patient Protection Act of 2005 (as in effect as of the 
date of the enactment of such Act), and such requirements 
shall be deemed to be incorporated into this subsection. 
‘‘(b) PLAN SATISFACTION OF CERTAIN REQUIRE-
MENTS.— 
‘‘(1) SATISFACTION
OF
CERTAIN
REQUIRE-
MENTS
THROUGH
INSURANCE.—For purposes of 
subsection (a), insofar as a group health plan pro-
vides benefits in the form of health insurance cov-
152 
erage through a health insurance issuer, the plan 
shall be treated as meeting the following require-
ments of title I of the Patient Protection Act of 
2005 with respect to such benefits and not be con-
sidered as failing to meet such requirements because 
of a failure of the issuer to meet such requirements 
so long as the plan sponsor or its representatives did 
not cause such failure by the issuer: 
‘‘(A) Section 111 (relating to consumer 
choice option). 
‘‘(B) Section 112 (relating to choice of 
health care professional). 
‘‘(C) Section 113 (relating to access to 
emergency care). 
‘‘(D) Section 114 (relating to timely access 
to specialists). 
‘‘(E) Section 115 (relating to patient ac-
cess to obstetrical and gynecological care). 
‘‘(F) Section 116 (relating to access to pe-
diatric care). 
‘‘(G) Section 117 (relating to continuity of 
care), but only insofar as a replacement issuer 
assumes the obligation for continuity of care. 
‘‘(H) Section 118 (relating to access to 
needed prescription drugs).
153 
‘‘(I) Section 119 (relating to coverage for 
individuals participating in approved clinical 
trials). 
‘‘(J) Section 120 (relating to required cov-
erage 
for 
minimum 
hospital 
stay 
for 
mastectomies and lymph node dissections for 
the treatment of breast cancer and coverage for 
secondary consultations). 
‘‘(K) Section 134 (relating to payment of 
claims). 
‘‘(2) INFORMATION.—With respect to informa-
tion required to be provided or made available under 
section 121 of the Patient Protection Act of 2005, 
in the case of a group health plan that provides ben-
efits in the form of health insurance coverage 
through a health insurance issuer, the Secretary 
shall determine the circumstances under which the 
plan is not required to provide or make available the 
information (and is not liable for the issuer’s failure 
to provide or make available the information), if the 
issuer is obligated to provide and make available (or 
provides and makes available) such information. 
‘‘(3) INTERNAL APPEALS.—With respect to the 
internal appeals process required to be established 
under section 103 of such Act, in the case of a
154 
group health plan that provides benefits in the form 
of health insurance coverage through a health insur-
ance issuer, the Secretary shall determine the cir-
cumstances under which the plan is not required to 
provide for such process and system (and is not lia-
ble for the issuer’s failure to provide for such proc-
ess and system), if the issuer is obligated to provide 
for (and provides for) such process and system. 
‘‘(4) EXTERNAL APPEALS.—Pursuant to rules 
of the Secretary, insofar as a group health plan en-
ters into a contract with a qualified external appeal 
entity for the conduct of external appeal activities in 
accordance with section 104 of such Act, the plan 
shall be treated as meeting the requirement of such 
section and is not liable for the entity’s failure to 
meet any requirements under such section. 
‘‘(5) APPLICATION TO PROHIBITIONS.—Pursu-
ant to rules of the Secretary, if a health insurance 
issuer offers health insurance coverage in connection 
with a group health plan and takes an action in vio-
lation of any of the following sections of the Patient 
Protection Act of 2005, the group health plan shall 
not be liable for such violation unless the plan 
caused such violation:
155 
‘‘(A) Section 131 (relating to prohibition of 
interference with certain medical communica-
tions). 
‘‘(B) Section 132 (relating to prohibition 
of discrimination against providers based on li-
censure). 
‘‘(C) Section 133 (relating to prohibition 
against improper incentive arrangements). 
‘‘(D) Section 135 (relating to protection 
for patient advocacy). 
‘‘(6) CONSTRUCTION.—Nothing in this sub-
section shall be construed to affect or modify the re-
sponsibilities of the fiduciaries of a group health 
plan under part 4 of subtitle B. 
‘‘(7) TREATMENT OF SUBSTANTIALLY COMPLI-
ANT STATE LAWS.—For purposes of applying this 
subsection in connection with health insurance cov-
erage, any reference in this subsection to a require-
ment in a section or other provision in the Patient 
Protection Act of 2005 with respect to a health in-
surance issuer is deemed to include a reference to a 
requirement under a State law that substantially 
complies (as determined under section 152(c) of 
such Act) with the requirement in such section or 
other provisions.
156 
‘‘(8) APPLICATION TO CERTAIN PROHIBITIONS 
AGAINST RETALIATION.—With respect to compliance 
with the requirements of section 135(b)(1) of the 
Patient Protection Act of 2005, for purposes of this 
subtitle the term ‘group health plan’ is deemed to in-
clude a reference to an institutional health care pro-
vider. 
‘‘(c) ENFORCEMENT OF CERTAIN REQUIREMENTS.— 
‘‘(1) COMPLAINTS.—Any protected health care 
professional who believes that the professional has 
been retaliated or discriminated against in violation 
of section 135(b)(1) of the Patient Protection Act of 
2005 may file with the Secretary a complaint within 
180 days of the date of the alleged retaliation or dis-
crimination. 
‘‘(2) INVESTIGATION.—The Secretary shall in-
vestigate such complaints and shall determine if a 
violation of such section has occurred and, if so, 
shall issue an order to ensure that the protected 
health care professional does not suffer any loss of 
position, pay, or benefits in relation to the plan, 
issuer, or provider involved, as a result of the viola-
tion found by the Secretary. 
‘‘(d) CONFORMING REGULATIONS.—The Secretary 
shall issue regulations to coordinate the requirements on
157 
group health plans and health insurance issuers under this 
section with the requirements imposed under the other 
provisions of this title. In order to reduce duplication and 
clarify the rights of participants and beneficiaries with re-
spect to information that is required to be provided, such 
regulations shall coordinate the information disclosure re-
quirements under section 121 of the Patient Protection 
Act of 2005 with the reporting and disclosure require-
ments imposed under part 1, so long as such coordination 
does not result in any reduction in the information that 
would otherwise be provided to participants and bene-
ficiaries.’’. 
(b) SATISFACTION OF ERISA CLAIMS PROCEDURE 
REQUIREMENT.—Section 503 of such Act (29 U.S.C. 
1133) is amended by inserting ‘‘(a)’’ after ‘‘Sec. 503.’’ and 
by adding at the end the following new subsection: 
‘‘(b) In the case of a group health plan (as defined 
in section 733), compliance with the requirements of sub-
title A of title I of the Patient Protection Act of 2005, 
and compliance with regulations promulgated by the Sec-
retary, in the case of a claims denial, shall be deemed com-
pliance with subsection (a) with respect to such claims de-
nial.’’.
158 
(c) CONFORMING AMENDMENTS.—(1) Section 732(a) 
of such Act (29 U.S.C. 1185(a)) is amended by striking 
‘‘section 711’’ and inserting ‘‘sections 711 and 714’’. 
(2) The table of contents in section 1 of such Act 
is amended by inserting after the item relating to section 
713 the following new item: 
‘‘714. Patient protection standards.’’. 
(3) Section 502(b)(3) of such Act (29 U.S.C. 
1132(b)(3)) is amended by inserting ‘‘(other than section 
135(b))’’ after ‘‘part 7’’. 
SEC. 402. COOPERATION BETWEEN FEDERAL AND STATE 
AUTHORITIES. 
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 adding 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 delega-
tion to the State of some or all of the Secretary’s authority 
under this title to enforce the requirements applicable 
under title I of the Patient Protection Act of 2005 with 
respect to health insurance coverage offered by a health 
insurance issuer.
159 
‘‘(b) DELEGATIONS.—Any department, agency, or in-
strumentality of a State to which authority is delegated 
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.’’. 
SEC. 403. SENSE OF THE CONGRESS CONCERNING THE IM-
PORTANCE OF CERTAIN UNPAID SERVICES. 
It is the sense of the Congress 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. 
TITLE V—AMENDMENTS TO THE 
INTERNAL 
REVENUE 
CODE 
OF 1986 
SEC. 501. APPLICATION TO GROUP HEALTH PLANS UNDER 
THE INTERNAL REVENUE CODE OF 1986. 
Subchapter B of chapter 100 of the Internal Revenue 
Code of 1986 is amended— 
(1) in the table of sections, by inserting after 
the item relating to section 9812 the following new 
item: 
‘‘9813. Standard relating to patients’ bill of rights.’’;
160 
and 
(2) by inserting after section 9812 the fol-
lowing: 
‘‘SEC. 9813. STANDARD RELATING TO PATIENTS’ BILL OF 
RIGHTS. 
‘‘A group health plan shall comply with the require-
ments of title I of the Patient Protection Act of 2005 (as 
in effect as of the date of the enactment of such Act), 
and such requirements shall be deemed to be incorporated 
into this section.’’. 
SEC. 502. CONFORMING ENFORCEMENT FOR WOMEN’S 
HEALTH AND CANCER RIGHTS. 
Subchapter B of chapter 100 of the Internal Revenue 
Code of 1986, as amended by section 501, is further 
amended— 
(1) in the table of sections, by inserting after 
the item relating to section 9813 the following new 
item: 
‘‘9814. Standard relating to women’s health and cancer rights.’’; 
and 
(2) by inserting after section 9813 the fol-
lowing: 
‘‘SEC. 9814. STANDARD RELATING TO WOMEN’S HEALTH 
AND CANCER RIGHTS. 
‘‘The provisions of section 713 of the Employee Re-
tirement Income Security Act of 1974 (as in effect as of
161 
the date of the enactment of this section) shall apply to 
group health plans as if included in this subchapter.’’. 
TITLE 
VI—EFFECTIVE 
DATES; 
COORDINATION 
IN 
IMPLE-
MENTATION 
SEC. 601. EFFECTIVE DATES. 
(a) GROUP HEALTH COVERAGE.— 
(1) IN
GENERAL.—Subject to paragraph (2) 
and subsection (d), the amendments made by sec-
tions 201(a), 401, 501, and 502 (and title I insofar 
as it relates to such sections) shall apply with re-
spect to group health plans, and health insurance 
coverage offered in connection with group health 
plans, for plan years beginning on or after October 
1, 2005 (in this section referred to as the ‘‘general 
effective date’’). 
(2) TREATMENT OF COLLECTIVE BARGAINING 
AGREEMENTS.—In the case of a group health plan 
maintained pursuant to one or more collective bar-
gaining agreements between employee representa-
tives and one or more employers ratified before the 
date of the enactment of this Act, the amendments 
made by sections 201(a), 401, 501, and 502 (and 
title I insofar as it relates to such sections) shall not 
apply to plan years beginning before the later of—
162 
(A) the date on which the last collective 
bargaining agreements relating to the plan ter-
minates (excluding any extension thereof agreed 
to after the date of the enactment of this Act); 
or 
(B) the general effective date; 
but shall apply not later than 1 year after the gen-
eral effective date. For purposes of subparagraph 
(A), any plan amendment made pursuant to a collec-
tive bargaining agreement relating to the plan which 
amends the plan solely to conform to any require-
ment added by this Act shall not be treated as a ter-
mination of such collective bargaining agreement. 
(b) INDIVIDUAL HEALTH INSURANCE COVERAGE.— 
Subject to subsection (d), the amendments made by sec-
tion 202 shall apply with respect to individual health in-
surance coverage offered, sold, issued, renewed, in effect, 
or operated in the individual market on or after the gen-
eral effective date. 
(c) TREATMENT OF RELIGIOUS NONMEDICAL PRO-
VIDERS.— 
(1) IN GENERAL.—Nothing in this Act (or the 
amendments made thereby) shall be construed to— 
(A) restrict or limit the right of group 
health plans, and of health insurance issuers of-
163 
fering health insurance coverage, to include as 
providers religious nonmedical providers; 
(B) require such plans or issuers to— 
(i) utilize medically based eligibility 
standards or criteria in deciding provider 
status of religious nonmedical providers; 
(ii) use medical professionals or cri-
teria to decide patient access to religious 
nonmedical providers; 
(iii) utilize medical professionals or 
criteria in making decisions in internal or 
external appeals regarding coverage for 
care by religious nonmedical providers; or 
(iv) compel a participant or bene-
ficiary to undergo a medical examination 
or test as a condition of receiving health 
insurance coverage for treatment by a reli-
gious nonmedical provider; or 
(C) require such plans or issuers to ex-
clude religious nonmedical providers because 
they do not provide medical or other required 
data, if such data is inconsistent with the reli-
gious nonmedical treatment or nursing care 
provided by the provider.
164 
(2) RELIGIOUS NONMEDICAL PROVIDER.—For 
purposes of this subsection, the term ‘‘religious non-
medical provider’’ means a provider who provides no 
medical care but who provides only religious non-
medical treatment or religious nonmedical nursing 
care. 
(d) TRANSITION FOR NOTICE REQUIREMENT.—The 
disclosure of information required under section 121 of 
this Act shall first be provided pursuant to— 
(1) subsection (a) with respect to a group 
health plan that is maintained as of the general ef-
fective date, not later than 30 days before the begin-
ning of the first plan year to which title I applies 
in connection with the plan under such subsection; 
or 
(2) subsection (b) with respect to an individual 
health insurance coverage that is in effect as of the 
general effective date, not later than 30 days before 
the first date as of which title I applies to the cov-
erage under such subsection. 
SEC. 602. COORDINATION IN IMPLEMENTATION. 
The Secretary of Labor and the Secretary of Health 
and Human Services shall ensure, through the execution 
of an interagency memorandum of understanding among 
such Secretaries, that—
165 
(1) regulations, rulings, and interpretations 
issued by such Secretaries relating to the same mat-
ter over which such Secretaries have responsibility 
under the provisions of this Act (and the amend-
ments made thereby) are administered so as to have 
the same effect at all times; and 
(2) coordination of policies relating to enforcing 
the same requirements through such Secretaries in 
order to have a coordinated enforcement strategy 
that avoids duplication of enforcement efforts and 
assigns priorities in enforcement. 
SEC. 603. SEVERABILITY. 
If any provision of this Act, an amendment made by 
this Act, or the application of such provision or amend-
ment to any person or circumstance is held to be unconsti-
tutional, the remainder of this Act, the amendments made 
by this Act, and the application of the provisions of such 
to any person or circumstance shall not be affected there-
by. 
TITLE VII—MISCELLANEOUS 
PROVISIONS 
SEC. 701. NO IMPACT ON SOCIAL SECURITY TRUST FUND. 
(a) IN GENERAL.—Nothing in this Act (or an amend-
ment made by this Act) shall be construed to alter or
166 
amend the Social Security Act (or any regulation promul-
gated under that Act). 
(b) TRANSFERS.— 
(1) ESTIMATE OF SECRETARY.—The Secretary 
of the Treasury shall annually estimate the impact 
that the enactment of this Act has on the income 
and balances of the trust funds established under 
section 201 of the Social Security Act (42 U.S.C. 
401). 
(2) TRANSFER
OF
FUNDS.—If, under para-
graph (1), the Secretary of the Treasury estimates 
that the enactment of this Act has a negative impact 
on the income and balances of the trust funds estab-
lished under section 201 of the Social Security Act 
(42 U.S.C. 401), the Secretary shall transfer, not 
less frequently than quarterly, from the general reve-
nues of the Federal Government an amount suffi-
cient so as to ensure that the income and balances 
of such trust funds are not reduced as a result of 
the enactment of such Act. 
SEC. 702. SENSE OF CONGRESS WITH RESPECT TO PARTICI-
PATION IN CLINICAL TRIALS AND ACCESS TO 
SPECIALTY CARE. 
(a) FINDINGS.—The Congress finds the following:
167 
(1) Breast cancer is the most common form of 
cancer among women, excluding skin cancers. 
(2) During 2005, 211,240 new cases of female 
breast cancer are projected to be diagnosed, and an 
estimated 40,410 women are projected to die from 
the disease. 
(3) During 2005, 1,690 male breast cancer 
cases are projected to be diagnosed, and 460 men 
are projected to die from the disease. 
(4) Breast cancer is the second leading cause of 
cancer death among all women and a leading cause 
of cancer death among women between ages 40 and 
55. 
(5) During 2004, 9,200 children were projected 
to be diagnosed with cancer. 
(6) During 2004, 1,510 children were projected 
to die from cancer. 
(7) There are approximately 400,000 people di-
agnosed with multiple sclerosis in the United States 
and approximately 250 new cases are diagnosed 
each week. 
(8) Parkinson’s disease is a chronic and pro-
gressive disorder of the central nervous system, af-
fecting as many as 1,500,000 people in the United 
States.
168 
(9) During 2005, 232,090 men are projected to 
be diagnosed with prostate cancer. 
(10) During 2005, 30,350 men are projected to 
die from prostate cancer. It is the second leading 
cause of cancer death in men. 
(11) Information obtained from clinical trials is 
essential to improve the way diseases are prevented, 
screened for, diagnosed, and treated. While there are 
already measures in place, clinical trials are not 
without risk. Future efforts should be taken in addi-
tion to those already undertaken to protect the 
health and safety of adults and children who enroll 
in clinical trials. Some of these include the use of in-
stitutional review boards, informed consent, and 
data safety monitoring boards. 
(12) While employers and health plans should 
be responsible for covering the routine costs associ-
ated with Federally approved or funded clinical 
trials, such employers and health plans should not 
be held legally responsible for the design, implemen-
tation, or outcome of such clinical trials, consistent 
with any applicable State or Federal liability stat-
utes. 
(13) By passing legislation or instituting special 
agreements, 21 states now require that insurance
169 
companies cover the routine costs of medical care for 
patients who enroll on a clinical trial. There is little 
information available regarding the effect these laws 
and agreements have had on clinical trial participa-
tion. 
(14) When evaluating clinical trial participa-
tion, it is vital to review the issues of quantity and 
quality. Identifying as many patients as possible who 
meet the eligibility criteria to participate in a clinical 
trial, and providing all of those eligible patients with 
the opportunity to decide whether or not to enroll, 
are together one important aspect. Having quality 
clinical trials available which utilize sound scientific 
and ethical guidelines to answer imminent questions 
related to particular diseases is also quite important. 
(b) SENSE OF THE CONGRESS.—It is the sense of 
the Congress that— 
(1) men and women battling life-threatening, 
deadly diseases, including advanced breast or ovar-
ian cancer, should have the opportunity to partici-
pate in a Federally approved or funded clinical trial 
recommended by their physician; 
(2) an individual should have the opportunity to 
participate in a Federally approved or funded clin-
ical trial recommended by their physician if—
170 
(A) that individual— 
(i) has a life-threatening or serious ill-
ness for which no standard treatment is ef-
fective; or 
(ii) is eligible to participate in a Fed-
erally approved or funded clinical trial ac-
cording to the trial protocol with respect to 
treatment of the illness; 
(B) that individual’s participation in the 
trial offers meaningful potential for significant 
clinical benefit for the individual; and 
(C) either— 
(i) the referring physician is a partici-
pating health care professional and has 
concluded that the individual’s participa-
tion in the trial would be appropriate, 
based upon the individual meeting the con-
ditions described in subparagraph (A); or 
(ii) the participant, beneficiary, or en-
rollee provides medical and scientific infor-
mation establishing that the individual’s 
participation in the trial would be appro-
priate, based upon the individual meeting 
the conditions described in subparagraph 
(A);
171 
(3) a child with a life-threatening illness, in-
cluding cancer, should be allowed to participate in a 
Federally approved or funded clinical trial if that 
participation meets the requirements of paragraph 
(2); 
(4) a child with a rare cancer should be allowed 
to go to a cancer center capable of providing high 
quality care for that disease; and 
(5) a health maintenance organization’s deci-
sion that an in-network physician without the nec-
essary expertise can provide care for a seriously ill 
patient, including a woman battling cancer, should 
be appealable to an independent, impartial body, and 
that this same right should be available to all Ameri-
cans in need of access to high quality specialty care. 
SEC. 703. SENSE OF THE CONGRESS REGARDING FAIR RE-
VIEW PROCESS. 
(a) FINDINGS.—The Congress finds the following: 
(1) A fair, timely, impartial independent exter-
nal appeals process is essential to any meaningful 
program of patient protection. 
(2) The independence and objectivity of the re-
view organization and review process must be en-
sured.
172 
(3) It is incompatible with a fair and inde-
pendent appeals process to allow a health mainte-
nance organization to select the review organization 
that is entrusted with providing a neutral and unbi-
ased medical review. 
(4) The American Arbitration Association and 
arbitration standards adopted under chapter 44 of 
title 28, United States Code (28 U.S.C. 651 et seq.) 
both prohibit, as inherently unfair, the right of one 
party to a dispute to choose the judge in that dis-
pute. 
(b) SENSE OF THE CONGRESS.—It is the sense of 
the Congress that— 
(1) every patient who is denied care by a health 
maintenance organization or other health insurance 
company should be entitled to a fair, speedy, impar-
tial appeal to a review organization that has not 
been selected by the health plan; 
(2) the States should be empowered to maintain 
and develop the appropriate process for selection of 
the independent external review entity; 
(3) a child battling a rare cancer whose health 
maintenance organization has denied a covered 
treatment recommended by its physician should be 
entitled to a fair and impartial external appeal to a
173 
review organization that has not been chosen by the 
organization or plan that has denied the care; and 
(4) patient protection legislation should not pre-
empt existing State laws in States where there al-
ready are strong laws in place regarding the selec-
tion of independent review organizations. 
SEC. 704. ANNUAL REVIEW. 
(a) IN GENERAL.—Not later than 24 months after 
the general effective date referred to in section 601(a)(1), 
and annually thereafter for each of the succeeding 4 cal-
endar years (or until a repeal is effective under subsection 
(b)), the Secretary of Health and Human Services shall 
request that the Institute of Medicine of the National 
Academy of Sciences prepare and submit to the appro-
priate committees of Congress a report concerning the im-
pact of this Act, and the amendments made by this Act, 
on the number of individuals in the United States with 
health insurance coverage. 
(b) FUNDING.—From funds appropriated to the De-
partment of Health and Human Services for fiscal years 
2006 and 2007, the Secretary of Health and Human Serv-
ices shall provide for such funding as the Secretary deter-
mines necessary for the conduct of the study of the Na-
tional Academy of Sciences under this section. 
Æ