‘‘(1) trained medical interpreters, whose pri-
mary responsibility is to interpret, are present in all
health care settings; and
‘‘(2) an adequate number of health profes-
sionals receive training in cultural competency and
communication skills development as it relates to
medical interviews.
‘‘SEC. 2781. PROHIBITION ON FINANCIAL INCENTIVES TO
LIMIT CARE.
‘‘A managed care plan may not offer any financial
incentives, directly or indirectly, to health professionals as
an inducement to reduce or limit medically necessary serv-
ices provided to an enrollee.
‘‘SEC. 2782. PROHIBITION ON GAG CLAUSES.
‘‘(a) IN GENERAL.—The provisions of any contract
or agreement, or the operation of any contract or agree-
ment, between a managed care plan and a health profes-
sional shall not prohibit or restrict the health professional
from engaging in medical communication with his or her
patient.
‘‘(b) NULLIFICATION.—Any contract provision or
agreement described in subsection (a) shall be null and
void.
‘‘(c) MEDICAL
COMMUNICATION
DEFINED.—For
purposes of this section, the term ‘medical communication’
means a communication made by a health professional
with a patient of the health professional (or the guardian
or legal representative of the patient) with respect to—
‘‘(1) the patient’s health status, medical care,
or legal treatment options;
‘‘(2) any utilization review requirements that
may affect treatment options for the patient; or
‘‘(3) any financial incentives that may affect
the treatment of the patient.
‘‘SEC. 2783. RIGHT TO APPEAL DENIAL OF CARE.
‘‘(a) ESTABLISHMENT OF SYSTEM.—Not later than
90 days after the date of the enactment of this Act, the
Secretary, through the Health Care Financing Adminis-
tration, shall establish and implement guidelines for griev-
ance and appeals procedures regarding any aspect of a
managed care plan’s services, including complaints regard-
ing quality of care, choice and accessibility of providers,
network adequacy, and compliance with the requirements
of this part.
‘‘(b) NO REPRISAL FOR EXERCISE OF RIGHTS.—A
managed care plan shall not take any action with respect
to an enrollee or a health care provider that is intended
to penalize the enrollee, a designee of the enrollee, or the
health care provider for discussing or exercising any rights
provided under this part (including the filing of a com-
plaint or appeal pursuant to this section).
‘‘SEC. 2784. EXTERNAL REVIEW.
‘‘An external review process shall be available to en-
rollees after all internal appeal options have been exer-
cised. The requirements for an external review process are
as follows:
‘‘(1) The process is established under State law
and provides for review of decisions made pursuant
to section 2783 by an independent review organiza-
tion certified by the State.
‘‘(2) If the process provides that decisions in
such process are not binding on managed care plans,
the process must provide for public methods of dis-
closing frequency of noncompliance with such deci-
sions and for sanctioning plans that consistently
refuse to take appropriate actions in response to
such decisions.
‘‘(3) Results of all such reviews under the proc-
ess are disclosed to the public, along with at least
annual disclosure of information on managed care
plan compliance.
‘‘(4) All decisions under the process shall be in
writing and shall be accompanied by an explanation
of the basis for the decision.
‘‘(5) Direct costs of the process shall be borne
by the managed care plan, and not by the enrollee.
‘‘(6) The managed care plan shall provide for
publication at least annually of information on the
number of appeals and decisions considered under
the process.
‘‘SEC. 2785. NONDISCRIMINATION RIGHT.
‘‘A managed care plan may not discriminate (directly
or through contractual arrangements) against enrollees or
providers on the basis of race, national origin, gender, lan-
guage, socioeconomic status, age, disability, health status,
or anticipated need for health services.
‘‘SEC. 2786. PROTECTION OF PATIENT CONFIDENTIALITY.
‘‘A managed care plan shall establish policies and
procedures to ensure that all applicable laws that protect
the confidentiality of an individual’s medical information
are followed.
‘‘SEC. 
2787. 
ESTABLISHMENT 
OF 
MANAGED 
CARE
CONSUMER ADVISORY COMMISSION.
‘‘(a) ESTABLISHMENT.—The Secretary shall estab-
lish and appoint a 5 member Managed Care Consumer
Advisory Commission.
‘‘(b) PURPOSE.—The purpose of the Commission is
to assist consumers in the following areas:
‘‘(1) Accessing appropriate and high-quality
health care services.
‘‘(2) Understanding and exercising their rights
and responsibilities as managed care plan enrollees.
‘‘(3) Making an informed and appropriate
choice of a managed care plan.
‘‘(c) MEMBERSHIP.—Members of the Commission
shall—
‘‘(1) be selected from nonpartisan labor, reli-
gious, human service, or consumer organizations;
and
‘‘(2) demonstrate a commitment to representing
consumers in an equitable manner.
‘‘(d) DUTIES.—
‘‘(1) ANALYZE AND COLLECT INFORMATION.—
The Commission shall collect and analyze informa-
tion for the purpose of identifying—
‘‘(A) recurring barriers to access to health
care for persons enrolled in managed care
plans;
‘‘(B) patterns of national, regional, or local
access problems with special focus on under-
served and vulnerable populations and persons
with chronic illness and disabilities;
‘‘(C) quality of care problems; and
‘‘(D) the extent to which managed care
plans comply with Federal laws, regulations,
and rules governing their responsibilities and
performance.
‘‘(2) PROMOTE SOLUTIONS.—The Commission
shall investigate, identify, and promote solutions re-
garding managed care practices, policies, laws, or
regulations that adversely affect, or fail to promote,
informed access of individuals and populations to
high-quality health care.
‘‘(3) REPORT.—Not later than January 1 of
each year, the Secretary, through the Commission,
shall submit a report to Congress which shall in-
clude—
‘‘(A) a description of the efforts of the
Commission; and
‘‘(B) findings and recommendations based
on problems identified to improve consumer and
enrollee rights and protections so as to facilitate
access to high-quality health care and improve
health outcomes.’’.