‘‘(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
include—
‘‘(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.’’.
‘‘SEC. 2787. REQUIREMENTS FOR PRESCRIPTION DRUG
COVERAGE.
‘‘(a) REQUIREMENT FOR COVERAGE OF MEDICALLY
NECESSARY AND APPROPRIATE DRUGS.—In a case in
which a managed care plan provides coverage for prescrip-
tion drugs, such plan may not limit coverage if a treating
health professional determines that such coverage is medi-
cally necessary and appropriate.
‘‘(b) REQUIREMENT FOR SUBSTITUTING DRUGS.—
‘‘(1) IN
GENERAL.—A determination as to
whether or not a drug prescribed to treat a medical
condition may be substituted with a different drug
may only be made by a treating physician. A man-
aged care plan may not provide a standard for sub-
stituting prescription drugs.
‘‘(2) GENERIC
DRUGS.—A generic drug may
not be substituted for a name brand drug unless it
has the same chemical composition as the name
brand drug.
‘‘(c) LIMITATION ON ACCESS.—A managed care plan
that provides prescription drug coverage may not limit ac-
cess to drugs covered solely on the basis of costs associated
with providing coverage of such drugs.
‘‘SEC. 2788. NOTICE; DEFINITIONS.
‘‘(a) NOTICE.—A managed care plan under this part
shall comply with the notice requirement under section
711(d) of the Employee Retirement Income Security Act
of 1974 with respect to the requirements of this part as
if such section applied to such plan and such plan were
a group health plan.
‘‘(b) DEFINITIONS.—For purposes of this part:
‘‘(1) ENROLLEE.—The term ‘enrollee’ means,
with respect to health insurance coverage offered by
a managed care plan, an individual enrolled with the
plan to receive such coverage.
‘‘(2) 
HEALTH
PROFESSIONAL.—The 
term
‘health professional’ means a physician or other
health care practitioner licensed, accredited, or cer-
tified to perform specified health services consistent
with law.
‘‘(3) MANAGED CARE PLAN.—The term ‘man-
aged care plan’ means a health plan that provides or
arranges for the provision of health care items and
services to participants, beneficiaries, or enrollees
primarily through participating physicians and pro-
viders.
‘‘(4) NETWORK.—The term ‘network’ means,
with respect to a managed care plan, the partici-
pating health professionals and providers through
which the plan provides health care items and serv-
ices to enrollees.
‘‘(5) NETWORK COVERAGE.—The term ‘network
coverage’ means health insurance coverage offered
by a managed care plan that provides or arranges
for the provision of health care items and services to
enrollees through participating health professionals
and providers.
‘‘(6) PARTICIPATING.—The term ‘participating’
means, with respect to a health professional or pro-
vider, a health professional or provider that provides
health care items and services to enrollees under
network coverage under an agreement with the man-
aged care plan offering the coverage.
‘‘(7) PRIOR AUTHORIZATION.—The term ‘prior
authorization’ means the process of obtaining prior
approval from a managed care plan as to the neces-
sity or appropriateness of receiving medical or clin-
ical services for treatment of a medical or clinical
condition.
‘‘(8) 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.
‘‘(9) SERVICE AREA.—The term ‘service area’
means, with respect to a managed care plan, the ge-
ographic area served by the plan with respect to the
coverage.
SEC. 3. PATIENT PROTECTION STANDARDS UNDER THE EM-
PLOYEE 
RETIREMENT 
INCOME 
SECURITY
ACT OF 1974.
(a) IN GENERAL.—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 part C of
title XXVII of the Public Health Service Act.
‘‘(b) REFERENCES
IN APPLICATION.—In applying
subsection (a) under this part, any reference in such part
C—
‘‘(1) to a managed care plan and health insur-
ance coverage offered by such a plan is deemed to
include a reference to a group health plan and cov-
erage under such plan, respectively;
‘‘(2) to the Secretary is deemed a reference to
the Secretary of Labor;
‘‘(3) to an applicable State authority is deemed
a reference to the Secretary of Labor; and
‘‘(4) to an enrollee with respect to health insur-
ance coverage is deemed to include a reference to a
participant or beneficiary with respect to a group
health plan.
‘‘(c) ENSURING COORDINATION.—The Secretary of
Health and Human Services and the Secretary of Labor
shall ensure, through the execution of an interagency
memorandum of understanding between such Secretaries,
that—
plementation of such a State law, that provides protections
for individuals that are equivalent to or stricter than the
protections provided under such provisions.’’.
(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 734 of such Act (29 U.S.C. 1187) is
amended by inserting ‘‘and section 714(d)’’ after ‘‘of
1996’’.
(d) EFFECTIVE DATE.—(1) Subject to paragraph
(2), the amendments made by this section shall apply with
respect to group health plans for plan years beginning on
or after 90 days after the date of the enactment of this
Act, and also shall apply to portions of plan years occur-
ring on and after January 1, 2000.
(2) In the case of a group health plan maintained
pursuant to 1 or more collective bargaining agreements
between employee representatives and 1 or more employ-
ers ratified before the date of enactment of this Act, the
amendments made by this section shall not apply to plan
years beginning before the later of—
(A) the date on which the last collective bar-
gaining agreements relating to the plan terminates
(determined without regard to any extension thereof
agreed to after the date of enactment of this Act);
or
(B) the general effective date.
For purposes of subparagraph (A), any plan amendment
made pursuant to a collective bargaining agreement relat-
ing to the plan which amends the plan solely to conform
to any requirement added by subsection (a) shall not be
treated as a termination of such collective bargaining
agreement.
SEC. 4. NONPREEMPTION OF STATE LAW RESPECTING LI-
ABILITY OF GROUP HEALTH PLANS.
(a) IN GENERAL.—Section 514(b) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C.
1144(b)) is amended by redesignating paragraph (9) as
paragraph (10) and inserting the following new para-
graph:
‘‘(9) Subsection (a) of this section shall not be con-
strued to preclude any State cause of action to recover
damages for personal injury or wrongful death against any
person that provides insurance or administrative services
to or for an employee welfare benefit plan maintained to
provide health care benefits.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply to causes of action arising on
or after the date of the enactment of this Act.
SEC. 5. EFFECTIVE DATE.
The amendments made by this Act shall take effect
90 days after the date of the enactment of this Act.
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