(8) 
NONPARTICIPATING.—The 
term 
‘‘non-
participating’’ means, with respect to a health care
provider that provides health care items and services
to a participant, beneficiary, or enrollee under group
health plan or health insurance coverage, a health
care provider that is not a participating health care
provider with respect to such items and services.
(9) PARTICIPATING.—The term ‘‘participating’’
means, with respect to a health care provider that
provides health care items and services to a partici-
pant, beneficiary, or enrollee under group health
plan or health insurance coverage offered by a
health insurance issuer, a health care provider that
furnishes such items and services under a contract
or other arrangement with the plan or issuer.
(10) PRIOR AUTHORIZATION.—The term ‘‘prior
authorization’’ means the process of obtaining prior
approval from a health insurance issuer for the
treatment of a medical or clinical condition.
(11) PROVIDER.—The term ‘‘provider’’ means a
health organization, health facility, or health agency
that is licensed, accredited, or certified to provide
health care items and services under applicable State
law.
(12) SERVICE AREA.—The term ‘‘service area’’
means, with respect to a health insurance issuer
with respect to health insurance coverage, the geo-
graphic area served by the issuer with respect to the
coverage.
(13) UTILIZATION REVIEW.—The term ‘‘utiliza-
tion review’’ means prospective, concurrent, or retro-
spective review of health care items and services,
and includes prior authorization requirements for
coverage of such items and services.
(d) ABORTION
AND EUTHANASIA SERVICES DE-
FINED.—For purposes of this sections 104 and 116:
(1) ABORTION SERVICES.—The term ‘‘abortion
services’’ means the performance of an abortion, the
providing of drugs to induce an abortion, and serv-
ices related directly to the performance of an abor-
tion (such as the performance of ultrasound and
similar preparatory procedures and preparation of
post-abortion pathology reports), but does not in-
clude the treatment of injuries or illnesses caused by
an abortion.
(2) EUTHANASIA SERVICES.—The term ‘‘eutha-
nasia services’’ means anything for which the use of
funds appropriated by the Congress is prohibited
under the Assisted Suicide Funding Restriction Act
of 1997 (Public Law 105–12; 42 U.S.C. 14401 et
seq.), subject to sections 3(b) of such Act (42 U.S.C.
14402(b)).
(e) APPLICATION
TO PARTNERSHIPS.—The provi-
sions of paragraphs (1), (2), and (3) of section 732(d)
of the Employee Retirement Income Security Act of 1974
shall apply with respect to partnerships.
SEC. 152. PREEMPTION; STATE FLEXIBILITY; CONSTRUC-
TION.
(a) CONTINUED APPLICABILITY
OF STATE LAW
WITH RESPECT TO HEALTH INSURANCE ISSUERS.—
(1) IN GENERAL.—Subject to paragraph (2),
this title shall not be construed to supersede any
provision of State law which establishes, implements,
or continues in effect any standard or requirement
solely relating to health insurance issuers (in connec-
tion with group health insurance coverage or other-
wise) except to the extent that such standard or re-
quirement prevents the application of a requirement
of this title.
(2) CONTINUED
PREEMPTION
WITH
RESPECT
TO GROUP HEALTH PLANS.—Nothing in this title
shall be construed to affect or modify the provisions
of section 514 of the Employee Retirement Income
Security Act of 1974 with respect to group health
plans.
(b) RULES OF CONSTRUCTION.—Nothing in this title
shall be construed as requiring a group health plan or
health insurance coverage to provide specific benefits
under the terms of such plan or coverage.
(c) DEFINITIONS.—For purposes of this section:
(1) STATE
LAW.—The term ‘‘State law’’ in-
cludes all laws, decisions, rules, regulations, or other
State action having the effect of law, of any State.
A law of the United States applicable only to the
District of Columbia shall be treated as a State law
rather than a law of the United States.
(2) STATE.—The term ‘‘State’’ includes a
State, the Northern Mariana Islands, any political
subdivisions of a State or such Islands, or any agen-
cy or instrumentality of either.
SEC. 153. REGULATIONS.
The Secretaries of Health and Human Services,
Labor, and the Treasury shall issue such regulations as
may be necessary or appropriate to carry out this title.
Such regulations shall be issued consistent with section
104 of Health Insurance Portability and Accountability
Act of 1996. Such Secretaries may promulgate any in-
terim final rules as the Secretaries determine are appro-
priate to carry out this title.
TITLE 
II—APPLICATION 
OF
QUALITY CARE STANDARDS
TO GROUP HEALTH PLANS
AND 
HEALTH 
INSURANCE
COVERAGE 
UNDER 
PUBLIC
HEALTH SERVICE ACT
SEC. 201. APPLICATION TO GROUP HEALTH PLANS AND
GROUP HEALTH INSURANCE COVERAGE.
(a) IN GENERAL.—Subpart 2 of part A of title
XXVII of the Public Health Service Act is amended by
adding at the end the following new section:
‘‘SEC. 2706. PATIENT PROTECTION STANDARDS.
‘‘(a) IN GENERAL.—Each group health plan shall
comply with patient protection requirements under title I
of the Access to Quality Care Act of 1999, and each health
insurance issuer shall comply with patient protection re-
quirements under such title with respect to group health
insurance coverage it offers, and such requirements shall
be deemed to be incorporated into this subsection.
‘‘(b) NOTICE.—A group health plan shall comply with
the notice requirement under section 711(d) of the Em-
ployee Retirement Income Security Act of 1974 with re-
spect to the requirements referred to in subsection (a) and
a health insurance issuer shall comply with such notice
requirement as if such section applied to such issuer and
such issuer were a group health plan.’’.
(b) 
CONFORMING
AMENDMENT.—Section
2721(b)(1)(A) of such Act (42 U.S.C. 300gg–21(b)(1)(A))
is amended by inserting ‘‘(other than section 2706)’’ after
‘‘requirements of such subparts’’.
SEC. 202. APPLICATION TO INDIVIDUAL HEALTH INSUR-
ANCE COVERAGE.
Part B of title XXVII of the Public Health Service
Act is amended by inserting after section 2751 the follow-
ing new section:
‘‘SEC. 2752. PATIENT PROTECTION STANDARDS.
‘‘(a) IN GENERAL.—Each health insurance issuer
shall comply with patient protection requirements under
title I of the Access to Quality Care Act of 1999 with re-
spect to individual health insurance coverage it offers, and
such requirements shall be deemed to be incorporated into
this subsection.
‘‘(b) NOTICE.—A health insurance issuer under this
part shall comply with the notice requirement under sec-
tion 711(d) of the Employee Retirement Income Security
Act of 1974 with respect to the requirements of such title
as if such section applied to such issuer and such issuer
were a group health plan.’’.
TITLE 
III—AMENDMENTS 
TO
THE EMPLOYEE RETIREMENT
INCOME SECURITY ACT OF
1974
SEC. 301. 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. 713. PATIENT PROTECTION STANDARDS.
‘‘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 Access to Quality Care Act of 1999 (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. 302. ERISA PREEMPTION NOT TO APPLY TO CERTAIN
ACTIONS INVOLVING HEALTH INSURANCE
POLICYHOLDERS.
(a) IN GENERAL.—Section 514 of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 1144)
is amended by adding at the end the following subsection:
‘‘(e) PREEMPTION NOT TO APPLY TO CERTAIN AC-
TIONS ARISING OUT OF PROVISION OF HEALTH BENE-
FITS.—
‘‘(1) IN GENERAL.—Except as provided in this
subsection, nothing in this title shall be construed to
invalidate, impair, or supersede any cause of action
under State law to recover damages resulting from
personal injury or for wrongful death against any
person—
‘‘(A) in connection with the provision of in-
surance, administrative services, or medical
services by such person to or for a group health
plan (as defined in section 733), or
‘‘(B) that arises out of the arrangement by
such person for the provision of such insurance,
administrative services, or medical services by
other persons.
‘‘(2) EXCEPTION FOR EMPLOYERS AND OTHER
PLAN SPONSORS.—
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), paragraph (1) does not authorize—
‘‘(i) any cause of action against an
employer or other plan sponsor maintain-
ing the group health plan, or
‘‘(ii) a right of recovery or indemnity
by a person against an employer or other
plan sponsor for damages assessed against
the person pursuant to a cause of action
under paragraph (1).
‘‘(B) SPECIAL RULE.—Subparagraph (A)
shall not preclude any cause of action described
in paragraph (1) against an employer or other
plan sponsor if—
‘‘(i) such action is based on the em-
ployer’s or other plan sponsor’s exercise of
discretionary authority to make a decision
on a claim for benefits covered under the
plan or health insurance coverage in the
case at issue; and
‘‘(ii) the exercise by such employer or
other plan sponsor of such authority re-
sulted in personal injury or wrongful
death.
‘‘(C) EXCEPTION.—The exercise of discre-
tionary authority described in subparagraph
(B)(i) shall not be construed to include—
‘‘(i) the decision to include or exclude
from the plan any specific benefit;
‘‘(ii) any decision affirming the deci-
sion of a treating health care professional;
or
‘‘(iii) any decision to provide benefits
beyond those specified in the plan at the
request of a treating health care profes-
sional.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply to acts and omissions occurring
on or after the date of the enactment of this Act from
which a cause of action arises.
SEC. 303. DIRECT ACCESS TO COURTS.
Section 502 of the Employee Retirement Income Se-
curity Act is amended—
(1) in subsection (a)(8) by striking ‘‘or’’ at the
end;
(2) in subsection (a)(9) by striking the period
at the end and inserting ‘‘; or’’;
(3) by adding at the end of subsection (a) the
following new paragraph:
‘‘(10) by a participant or beneficiary for appro-
priate relief under subsection (b)(4).’’; and
(4) by adding at the end of subsection (b) the
following new paragraph:
‘‘(4) In any case in which exhaustion of admin-
istrative remedies otherwise necessary for an action
for relief has not been obtained and it is dem-
onstrated to the court by means of certification by
an appropriate physician that such exhaustion is not
reasonably attainable under the facts and cir-
cumstances without undue risk of irreparable harm
to the health of the participant or beneficiary, a civil
action may be brought by a participant or bene-
ficiary to obtain appropriate equitable relief. Any de-
terminations made while an action under this para-
graph is pending shall be given due consideration by
the court in any such action.’’.
TITLE 
IV—EFFECTIVE 
DATES;
COORDINATION 
IN 
IMPLE-
MENTATION
SEC. 401. EFFECTIVE DATES.
(a) GROUP HEALTH COVERAGE.—
(1) IN GENERAL.—Subject to paragraph (2),
the amendments made by sections 201(a) and 301
(and title I insofar as it relates to such sections)