236
TITLE 
XIII—AMENDMENTS 
TO
THE EMPLOYEE RETIREMENT
INCOME SECURITY ACT OF
1974
SEC. 1301. 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 XI of
the Bipartisan Consensus Managed Care Improvement
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 subsection.
‘‘(b) PLAN SATISFACTION OF CERTAIN REQUIRE-
MENTS.—
‘‘(1) SATISFACTION
OF
CERTAIN
REQUIRE-
MENTS
THROUGH
INSURANCE.—For purposes of
237
subsection (a), insofar as a group health plan pro-
vides benefits in the form of health insurance cov-
erage through a health insurance issuer, the plan
shall be treated as meeting the following require-
ments of title XI of the Bipartisan Consensus Man-
aged Care Improvement Act of 1999 with respect to
such benefits and not be considered 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 1112 (relating to choice of
providers).
‘‘(B) Section 1113 (relating to access to
emergency care).
‘‘(C) Section 1114 (relating to access to
specialty care).
‘‘(D) Section 1115 (relating to access to
obstetrical and gynecological care).
‘‘(E) Section 1116 (relating to access to
pediatric care).
‘‘(F) Section 1117(a)(1) (relating to con-
tinuity in case of termination of provider con-
tract) and section 117(a)(2) (relating to con-
tinuity in case of termination of issuer con-
238
tract), but only insofar as a replacement issuer
assumes the obligation for continuity of care.
‘‘(G) Section 1118 (relating to access to
needed prescription drugs).
‘‘(H) Section 1119 (relating to coverage
for individuals participating in approved clinical
trials.)
‘‘(I) Section 1134 (relating to payment of
claims).
‘‘(2) INFORMATION.—With respect to informa-
tion required to be provided or made available under
section 1121, in the case of a group health plan that
provides benefits in the form of health insurance
coverage through a health insurance issuer, the Sec-
retary 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 in-
formation), if the issuer is obligated to provide and
make available (or provides and makes available)
such information.
‘‘(3) GRIEVANCE
AND
INTERNAL
APPEALS.—
With respect to the internal appeals process and the
grievance system required to be established under
sections 1102 and 1104, in the case of a group
239
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 1103, 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, the group
health plan shall not be liable for such violation un-
less the plan caused such violation:
240
‘‘(A) Section 1131 (relating to prohibition
of interference with certain medical communica-
tions).
‘‘(B) Section 1132 (relating to prohibition
of discrimination against providers based on li-
censure).
‘‘(C) Section 1133 (relating to prohibition
against improper incentive arrangements).
‘‘(D) Section 1135 (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) APPLICATION TO CERTAIN PROHIBITIONS
AGAINST RETALIATION.—With respect to compliance
with the requirements of section 1135(b)(1) of the
Bipartisan Consensus Managed Care Improvement
Act of 1999, for purposes of this subtitle the term
‘group health plan’ is deemed to include a reference
to an institutional health care provider.
‘‘(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
241
of section 1135(b)(1) of the Bipartisan Consensus
Managed Care Improvement Act of 1999 may file
with the Secretary a complaint within 180 days of
the date of the alleged retaliation or discrimination.
‘‘(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
may issue regulations to coordinate the requirements on
group health plans under this section with the require-
ments imposed under the other provisions of this title.’’.
(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 XI of the Bipartisan Consensus Managed
Care Improvement Act of 1999 in the case of a claims
242
denial shall be deemed compliance with subsection (a) with
respect to such claims denial.’’.
(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:
‘‘Sec. 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. 1302. 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)
(as amended by section 301(b)) is amended further by
adding at the end the following subsections:
‘‘(f) PREEMPTION NOT TO APPLY TO CERTAIN AC-
TIONS ARISING OUT OF PROVISION OF HEALTH BENE-
FITS.—
‘‘(1) NON-PREEMPTION OF CERTAIN CAUSES OF
ACTION.—
‘‘(A) IN GENERAL.—Except as provided in
this subsection, nothing in this title shall be
244
Bipartisan Consensus Managed Care
Improvement Act of 1999);
‘‘(II) an external appeal with re-
spect to such decision was completed
under such section 1103;
‘‘(III) in the case such external
appeal was initiated by the plan or
issuer filing the request for the exter-
nal appeal, the request was filed on a
timely basis before the date the action
was brought or, if later, within 30
days after the date the externally ap-
pealable decision was made; and
‘‘(IV) the plan or issuer complied
with the determination of the external
appeal entity upon receipt of the de-
termination of the external appeal en-
tity.
The provisions of this clause supersede any
State law or common law to the contrary.
‘‘(ii) EXCEPTION.—Clause (i) shall
not apply with respect to damages in the
case of a cause of action for wrongful
death if the applicable State law provides
(or has been construed to provide) for
245
damages in such a cause of action which
are only punitive or exemplary in nature.
‘‘(C) PERSONAL
INJURY
DEFINED.—For
purposes of this subsection, the term ‘personal
injury’ means a physical injury and includes an
injury arising out of the treatment (or failure
to treat) a mental illness or disease.
‘‘(2) EXCEPTION FOR GROUP HEALTH PLANS,
EMPLOYERS, AND OTHER PLAN SPONSORS.—
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), paragraph (1) does not authorize—
‘‘(i) any cause of action against a
group health plan or an employer or other
plan sponsor maintaining the plan (or
against an employee of such a plan, em-
ployer, or sponsor acting within the scope
of employment), or
‘‘(ii) a right of recovery, indemnity, or
contribution by a person against a group
health plan or an employer or other plan
sponsor (or such an employee) 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
246
in paragraph (1) against group health plan or
an employer or other plan sponsor (or against
an employee of such a plan, employer, or spon-
sor acting within the scope of employment) if—
‘‘(i) such action is based on the exer-
cise by the plan, employer, or sponsor (or
employee) 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 the plan, em-
ployer, or sponsor (or employee) of such
authority resulted 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 to provide extra-con-
tractual benefits; or
‘‘(iii) any decision not to consider the
provision of a benefit while internal or ex-
ternal review is being conducted.
247
‘‘(3) FUTILITY OF EXHAUSTION.—An individual
bringing an action under this subsection is required
to exhaust administrative processes under sections
1102 and 1103 of the Bipartisan Consensus Man-
aged Care Improvement Act of 1999, unless the in-
jury to or death of such individual has occurred be-
fore the completion of such processes.
‘‘(4) CONSTRUCTION.—Nothing in this sub-
section shall be construed as—
‘‘(A) permitting a cause of action under
State law for the failure to provide an item or
service which is specifically excluded under the
group health plan involved;
‘‘(B) as preempting a State law which re-
quires an affidavit or certificate of merit in a
civil action; or
‘‘(C) permitting a cause of action or rem-
edy under State law in connection with the pro-
vision or arrangement of excepted benefits (as
defined in section 733(c)), other than those de-
scribed in section 733(c)(2)(A).
‘‘(g) RULES
OF
CONSTRUCTION
RELATING
TO
HEALTH CARE.—Nothing in this title shall be construed
as—
248
‘‘(1) permitting the application of State laws
that are otherwise superseded by this title and that
mandate the provision of specific benefits by a group
health plan (as defined in section 733(a)) or a mul-
tiple employer welfare arrangement (as defined in
section 3(40)), or
‘‘(2) affecting any State law which regulates the
practice of medicine or provision of medical care, or
affecting any action based upon such a State law.’’.
(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. 1303. LIMITATIONS ON ACTIONS.
Section 502 of the Employee Retirement Income Se-
curity Act of 1974 (29 U.S.C. 1132) (as amended by sec-
tion 304(b)) is amended further by adding at the end the
following new subsection:
‘‘(o)(1) Except as provided in this subsection, no ac-
tion may be brought under subsection (a)(1)(B), (a)(2),
or (a)(3) by a participant or beneficiary seeking relief
based on the application of any provision in section 1101,
subtitle B, or subtitle D of title XI of the Bipartisan Con-
sensus Managed Care Improvement Act of 1999 (as incor-
porated under section 714).
249
‘‘(2) An action may be brought under subsection
(a)(1)(B), (a)(2), or (a)(3) by a participant or beneficiary
seeking relief based on the application of section 1101,
1113, 1114, 1115, 1116, 1117, 1119, or 1118(3) of the
Bipartisan Consensus Managed Care Improvement Act of
1999 (as incorporated under section 714) to the individual
circumstances of that participant or beneficiary, except
that—
‘‘(A) such an action may not be brought or
maintained as a class action; and
‘‘(B) in such an action, relief may only provide
for the provision of (or payment of) benefits, items,
or services denied to the individual participant or
beneficiary involved (and for attorney’s fees and the
costs of the action, at the discretion of the court)
and shall not provide for any other relief to the par-
ticipant or beneficiary or for any relief to any other
person.
‘‘(3) Nothing in this subsection shall be construed as
affecting any action brought by the Secretary.’’.
250
TITLE 
XIV—APPLICATION 
TO
GROUP 
HEALTH 
PLANS
UNDER THE INTERNAL REV-
ENUE CODE OF 1986
SEC. 1401. AMENDMENTS TO 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:
‘‘Sec. 9813. Standard relating to patient freedom of choice.’’;
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 XI of the Bipartisan Consensus Managed
Care Improvement 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.’’.
251
TITLE 
XV—EFFECTIVE 
DATES;
COORDINATION 
IN 
IMPLE-
MENTATION
SEC. 1501. EFFECTIVE DATES.
(a) GROUP HEALTH COVERAGE.—
(1) IN GENERAL.—Subject to paragraph (2),
the amendments made by sections 1201(a), 1301,
1303, and 1401 (and title XI insofar as it relates to
such sections) shall apply with respect to group
health plans, and health insurance coverage offered
in connection with group health plans, for plan years
beginning on or after January 1, 2001 (in this sec-
tion referred to as the ‘‘general effective date’’) and
also shall apply to portions of plan years occurring
on and after such 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 1201(a), 1301, 1303, and 1401
(and title XI insofar as it relates to such sections)
shall not apply to plan years beginning before the
later of—
252
(A) the date on which the last collective
bargaining agreements relating to the plan ter-
minates (determined without regard to any ex-
tension thereof agreed to after the date of the
enactment of this Act); or
(B) the general effective date.
For purposes of subparagraph (A), any plan amend-
ment made pursuant to a collective bargaining
agreement relating to the plan which amends the
plan solely to conform to any requirement added by
this division shall not be treated as a termination of
such collective bargaining agreement.
(b) INDIVIDUAL HEALTH INSURANCE COVERAGE.—
The amendments made by section 1202 shall apply with
respect to individual health insurance coverage offered,
sold, issued, renewed, in effect, or operated in the indi-
vidual market on or after the general effective date.
SEC. 1502. COORDINATION IN IMPLEMENTATION.
The Secretary of Labor, the Secretary of Health and
Human Services, and the Secretary of the Treasury shall
ensure, through the execution of an interagency memo-
randum of understanding among such Secretaries, that—
(1) regulations, rulings, and interpretations
issued by such Secretaries relating to the same mat-
ter over which such Secretaries have responsibility
253
under the provisions of this division (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.
TITLE XVI—HEALTH CARE
PAPERWORK SIMPLIFICATION
SEC. 1601. HEALTH CARE PAPERWORK SIMPLIFICATION.
(a) ESTABLISHMENT OF PANEL.—
(1) ESTABLISHMENT.—There is established a
panel to be known as the Health Care Panel to De-
vise a Uniform Explanation of Benefits (in this sec-
tion referred to as the ‘‘Panel’’).
(2) DUTIES OF PANEL.—
(A) IN GENERAL.—The Panel shall devise
a single form for use by third-party health care
payers for the remittance of claims to providers.
(B) DEFINITION.—For purposes of this
section, the term ‘‘third-party health care
payer’’ means any entity that contractually
pays health care bills for an individual.
(3) MEMBERSHIP.—
254
(A) SIZE
AND
COMPOSITION.—The Sec-
retary of Health and Human Services shall de-
termine the number of members and the com-
position of the Panel. Such Panel shall include
equal numbers of representatives of private in-
surance organizations, consumer groups, State
insurance commissioners, State medical soci-
eties, State hospital associations, and State
medical specialty societies.
(B) TERMS OF APPOINTMENT.—The mem-
bers of the Panel shall serve for the life of the
Panel.
(C) VACANCIES.—A vacancy in the Panel
shall not affect the power of the remaining
members to execute the duties of the Panel, but
any such vacancy shall be filled in the same
manner in which the original appointment was
made.
(4) PROCEDURES.—
(A) MEETINGS.—The Panel shall meet at
the call of a majority of its members.
(B) FIRST
MEETING.—The Panel shall
convene not later than 60 days after the date
of the enactment of the Bipartisan Consensus
Managed Care Improvement Act of 1999.
255
(C) QUORUM.—A quorum shall consist of
a majority of the members of the Panel.
(D) HEARINGS.—For the purpose of car-
rying out its duties, the Panel may hold such
hearings and undertake such other activities as
the Panel determines to be necessary to carry
out its duties.
(5) ADMINISTRATION.—
(A) COMPENSATION.—Except as provided
in subparagraph (B), members of the Panel
shall receive no additional pay, allowances, or
benefits by reason of their service on the Panel.
(B) TRAVEL EXPENSES AND PER DIEM.—
Each member of the Panel who is not an officer
or employee of the Federal Government shall
receive travel expenses and per diem in lieu of
subsistence in accordance with sections 5702
and 5703 of title 5, United States Code.
(C) CONTRACT
AUTHORITY.—The Panel
may contract with and compensate Government
and private agencies or persons for items and
services, without regard to section 3709 of the
Revised Statutes (41 U.S.C. 5).
(D) USE OF MAILS.—The Panel may use
the United States mails in the same manner
256
and under the same conditions as Federal agen-
cies and shall, for purposes of the frank, be
considered a commission of Congress as de-
scribed in section 3215 of title 39, United
States Code.
(E) 
ADMINISTRATIVE
SUPPORT
SERV-
ICES.—Upon the request of the Panel, the Sec-
retary of Health and Human Services shall pro-
vide to the Panel on a reimbursable basis such
administrative support services as the Panel
may request.
(6) SUBMISSION OF FORM.—Not later than 2
years after the first meeting, the Panel shall submit
a form to the Secretary of Health and Human Serv-
ices for use by third-party health care payers.
(7) TERMINATION.—The Panel shall terminate
on the day after submitting the form under para-
graph (6).
(b) REQUIREMENT FOR USE OF FORM BY THIRD-
PARTY CARE PAYERS.—A third-party health care payer
shall be required to use the form devised under subsection
257
(a) for plan years beginning on or after 5 years following
the date of the enactment of this Act.
Passed the House of Representatives October 7,
1999.
Attest:
Clerk.