Union Calendar No. 204
104TH CONGRESS
1ST SESSION
H. R. 1747
[Report No. 104–398]
A BILL
To amend the Public Health Service Act to perma-
nently extend and clarify malpractice coverage
for health centers, and for other purposes.
DECEMBER 12, 1995
Reported with amendments, committed to the Committee
of the Whole House on the State of the Union, and or-
dered to be printed
IB
Union Calendar No. 204
104TH CONGRESS
1ST SESSION
H. R. 1747
[Report No. 104–398]
To amend the Public Health Service Act to permanently extend and clarify
malpractice coverage for health centers, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JUNE 6, 1995
Mrs. JOHNSON of Connecticut (for herself, Mr. WYDEN, and Mr. FRANK of
Massachusetts) introduced the following bill; which was referred to the
Committee on Commerce
DECEMBER 12, 1995
Additional sponsors: Mr. GOSS, Mr. SANDERS, Mr. BARRETT of Wisconsin,
Mr. CALLAHAN, Mr. EHLERS, Mr. WILLIAMS, Mr. STUPAK, Mr. MAS-
CARA, Mr. HASTERT, Mr. KOLBE, Mr. GUTIERREZ, Mr. TAUZIN, Mrs.
COLLINS of Illinois, Mr. WAXMAN, Mr. SERRANO, Mr. ENGEL, Mr. WICK-
ER, Mr. MOORHEAD, Mr. GREENWOOD, Ms. PELOSI, Ms. MOLINARI, Mr.
DINGELL, Mr. TEJEDA, Mr. PAYNE of Virginia, Mr. BONIOR, Mr. DEL-
LUMS, Mr. BLUTE, Mr. STENHOLM, Mrs. KELLY, Mr. KILDEE, Mr. PAS-
TOR, and Mr. KENNEDY of Rhode Island
DECEMBER 12, 1995
Reported with amendments, committed to the Committee of the Whole House
on the State of the Union, and ordered to be printed
[Strike out all after the enacting clause and insert the part printed in italic]
[For text of introduced bill, see copy of bill as introduced on June 6, 1995]
A BILL
To amend the Public Health Service Act to permanently
extend and clarify malpractice coverage for health cen-
ters, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; REFERENCES.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Federally Supported Health Centers Assistance Act of
1995’’.
(b) REFERENCES.—Except as otherwise expressly pro-
vided, whenever in this Act an amendment or repeal is ex-
pressed in terms of an amendment to, or repeal of, a section
or other provision, the reference shall be considered to be
made to a section or other provision of the Public Health
Service Act.
SEC. 2. EXTENSION OF PROGRAM.
(a) IN
GENERAL.—Section 224(g)(3) (42 U.S.C.
233(g)(3)) is amended in the last sentence by striking ‘‘Jan-
uary 1, 1996’’ and inserting ‘‘January 1, 1999’’.
(b) CONFORMING AMENDMENTS.—Section 224(k) (42
U.S.C. 233(k)) is amended—
(1) in paragraph (1)(A), by striking ‘‘each of the
fiscal years 1993, 1994, and 1995’’ and inserting
‘‘each of the fiscal years 1996 through 1998’’; and
(2) in paragraph (2), by striking ‘‘each of the
fiscal years 1993, 1994, and 1995’’ and inserting
‘‘each of the fiscal years 1996 through 1998’’.
SEC. 3. CLARIFICATION OF COVERAGE.
Section 224(g)(1) (42 U.S.C. 233(g)(1)) is amended—
(1) in the first sentence, by striking ‘‘officer, em-
ployee, or contractor’’ and inserting ‘‘officer, govern-
ing board member, or employee of such an entity, and
any contractor’’; and
(2) in the second sentence, by inserting after ‘‘of-
ficer,’’ the following ‘‘governing board member,’’.
SEC. 4. COVERAGE FOR SERVICES FURNISHED TO INDIVID-
UALS OTHER THAN CENTER PATIENTS.
Section 224(g)(1) (42 U.S.C. 233(g)) is amended—
(1) by redesignating paragraph (1) as para-
graph (1)(A); and
(2) by adding at the end thereof the following:
‘‘(B) The deeming of any entity or officer, governing
board member, employee, or contractor of the entity to be
an employee of the Public Health Service under subpara-
graph (A) shall apply with respect to services provided—
‘‘(i) to all patients of the entity, and
‘‘(ii) subject to subparagraph (C), to individuals
who are not patients of the entity.
‘‘(C) Subparagraph (B)(ii) applies to services provided
to individuals who are not patients of an entity if the Sec-
retary determines, after reviewing an application submitted
under subparagraph (D), that the provision of the services
to such individuals—
‘‘(i) benefits patients of the entity and general
populations that could be served by the entity through
community-wide intervention efforts within the com-
munities served by such entity;
‘‘(ii) facilitates the provision of services to pa-
tients of the entity; or
‘‘(iii) are otherwise required under an employ-
ment contract (or similar arrangement) between the
entity and an officer, governing board member, em-
ployee, or contractor of the entity.’’.
SEC. 5. APPLICATION PROCESS.
(a) APPLICATION REQUIREMENT.—Section 224(g)(1)
(42 U.S.C. 233(g)(1)) (as amended by section 4) is further
amended—
(1) in subparagraph (A), by inserting ‘‘and sub-
ject to the approval by the Secretary of an applica-
tion under subparagraph (D)’’ after ‘‘For purposes of
this section’’; and
(2) by adding at the end thereof the following:
‘‘(D) The Secretary may not deem an entity or an offi-
cer, governing board member, employee, or contractor of the
entity to be an employee of the Public Health Service under
subparagraph (A), and may not apply such deeming to
services described in subparagraph (B)(ii), unless the entity
has submitted an application for such deeming to the Sec-
retary in such form and such manner as the Secretary shall
prescribe. The application shall contain detailed informa-
tion, along with supporting documentation, to verify that
the entity, and the officer, governing board member, em-
ployee, or contractor of the entity, as the case may be, meets
the requirements of subparagraphs (B) and (C) of this
paragraph and that the entity meets the requirements of
paragraphs (1) through (4) of subsection (h).
‘‘(E) The Secretary shall make a determination of
whether an entity or an officer, governing board member,
employee, or contractor of the entity is deemed to be an
employee of the Public Health Service for purposes of this
section within 30 days after the receipt of an application
under subparagraph (D). The determination of the Sec-
retary that an entity or an officer, governing board mem-
ber, employee, or contractor of the entity is deemed to be
an employee of the Public Health Service for purposes of
this section shall apply for the period specified by the Sec-
retary under subparagraph (A).
‘‘(F) Once the Secretary makes a determination that
an entity or an officer, governing board member, employee,
or contractor of an entity is deemed to be an employee of
the Public Health Service for purposes of this section, the
determination shall be final and binding upon the Sec-
retary and the Attorney General and other parties to any
civil action or proceeding. Except as provided in subsection
(i), the Secretary and the Attorney General may not deter-
mine that the provision of services which are the subject
of such a determination are not covered under this section.’’.
(b) APPROVAL PROCESS.—Section 224(h) (42 U.S.C.
233(h)) is amended—
(1) in the matter preceding paragraph (1), by
striking ‘‘Notwithstanding’’ and all that follows
through ‘‘entity—’’ and inserting the following: ‘‘The
Secretary may not approve an application under sub-
section (g)(1)(D) unless the Secretary determines that
the entity—’’; and
(2) by striking ‘‘has fully cooperated’’ in para-
graph (4) and inserting ‘‘will fully cooperate’’.
SEC. 6. TIMELY RESPONSE TO FILING OF ACTION OR PRO-
CEEDING.
Section 224 (42 U.S.C. 233) is amended by adding
at the end thereof the following subsection:
‘‘(l)(1) If a civil action or proceeding is filed in a State
court against any entity described in subsection (g)(4) or
any officer, governing board member, employee, or any con-
tractor of such an entity for damages described in sub-
section (a), the Attorney General, within 15 days after
being notified of such filing, shall make an appearance in
such court and advise such court as to whether the Secretary
has determined under subsections (g) and (h), that such en-
tity, officer, governing board member, employee, or contrac-
tor of the entity is deemed to be an employee of the Public
Health Service for purposes of this section with respect to
the actions or omissions that are the subject of such civil
action or proceeding. Such advice shall be deemed to satisfy
the provisions of subsection (c) that the Attorney General
certify that an entity, officer, governing board member, em-
ployee, or contractor of the entity was acting within the
scope of their employment or responsibility.
‘‘(2) If the Attorney General fails to appear in State
court within the time period prescribed under paragraph
(1), upon petition of any entity or officer, governing board
member, employee, or contractor of the entity named, the
civil action or proceeding shall be removed to the appro-
priate United States district court. The civil action or pro-
ceeding shall be stayed in such court until such court con-
ducts a hearing, and makes a determination, as to the ap-
propriate forum or procedure for the assertion of the claim
for damages described in subsection (a) and issues an order
consistent with such determination.’’.
SEC. 7. APPLICATION OF COVERAGE TO MANAGED CARE
PLANS.
Section 224 (42 U.S.C. 223) (as amended by section
6) is amended by adding at the end thereof the following
subsection:
‘‘(m)(1) An entity or officer, governing board member,
employee, or contractor of an entity described in subsection
(g)(1) shall, for purposes of this section, be deemed to be
an employee of the Public Health Service with respect to
services provided to individuals who are enrollees of a man-
aged care plan if the entity contracts with such managed
care plan for the provision of services.
‘‘(2) Each managed care plan which enters into a con-
tract with an entity described in subsection (g)(4) shall
deem the entity and any officer, governing board member,
employee, or contractor of the entity as meeting whatever
malpractice coverage requirements such plan may require
of contracting providers for a calendar year if such entity
or officer, governing board member, employee, or contractor
of the entity has been deemed to be an employee of the Pub-
lic Health Service for purposes of this section for such cal-
endar year. Any plan which is found by the Secretary on
the record, after notice and an opportunity for a full and
fair hearing, to have violated this subsection shall upon
such finding cease, for a period to be determined by the
Secretary, to receive and to be eligible to receive any Fed-
eral funds under titles XVIII or XIX of the Social Security
Act.
‘‘(3) For purposes of this subsection, the term ‘man-
aged care plan’ shall mean health maintenance organiza-
tions and similar entities that contract at-risk with payors
for the provision of health services or plan enrollees and
which contract with providers (such as entities described
in subsection (g)(4)) for the delivery of such services to plan
enrollees.’’.
SEC. 8. COVERAGE FOR PART-TIME PROVIDERS UNDER
CONTRACTS.
Section 224(g)(5)(B) (42 U.S.C. 223(g)(5)(B)) is
amended to read as follows:
‘‘(B) in the case of an individual who normally
performs an average of less than 321⁄2 hours of serv-
ices per week for the entity for the period of the con-
tract, the individual is a licensed or certified provider
of services in the fields of family practice, general in-
ternal medicine, general pediatrics, or obstetrics and
gynecology.’’.
SEC. 9. DUE PROCESS FOR LOSS OF COVERAGE.
Section 224(i)(1) (42 U.S.C. 233(i)(1)) is amended by
striking ‘‘may determine, after notice and opportunity for
a hearing’’ and inserting ‘‘may on the record determine,
after notice and opportunity for a full and fair hearing’’.
SEC. 10. AMOUNT OF RESERVE FUND.
Section 224(k)(2) (42 U.S.C. 223(k)(2)) is amended by
striking ‘‘$30,000,000’’ and inserting ‘‘$10,000,000’’.
SEC. 11. REPORT ON RISK EXPOSURE OF COVERED ENTI-
TIES.
Section 224 (as amended by section 7) is amended by
adding at the end thereof the following subsection:
‘‘(n)(1) Not later than April 1, 1997, the Secretary,
in consultation with the Attorney General, shall submit to
the Congress a report on the medical malpractice liability
claims experience of entities that have been deemed to be
employees for purposes of this section, and the risk exposure
associated with such entities.
‘‘(2) The report under paragraph (1) shall include an
analysis by the Secretary comparing—
‘‘(A) the Secretary’s estimate of the aggregate
amounts that such entities (together with the officers,
governing board members, employees, and contractors
of such entities who have been deemed to be employees
for purposes of this section) would have directly or in-
directly paid to obtain medical malpractice liability
insurance coverage if this section were not in effect;
with
‘‘(B) the aggregate amounts by which the grants
received by such entities under this Act were reduced
pursuant to subsection (k)(2).
‘‘(3) In preparing the report under paragraph (1), the
Secretary shall consult with public and private entities
with expertise on the matters with which the report is
concerned.’’.
Amend the title so as to read: ‘‘A bill to amend the
Public Health Service Act to extend and clarify
malpractice coverage for health centers, and for other
purposes.’’.