I
105TH CONGRESS
2D SESSION
H. R. 3239
To amend the Social Security Act to require health maintenance organizations
under the Medicare Program to disclose to enrollees and potential enroll-
ees certain information on the credentials of physicians providing services
by or through the organization, the financial status of the organization,
and the compensation paid to officers and executives of the organization.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 12, 1998
Mr. SHAW introduced the following bill; which was referred to the Committee
on Ways and Means, and in addition to the Committee on Commerce,
for a period to be subsequently determined by the Speaker, in each case
for consideration of such provisions as fall within the jurisdiction of the
committee concerned
A BILL
To amend the Social Security Act to require health mainte-
nance organizations under the Medicare Program to dis-
close to enrollees and potential enrollees certain informa-
tion on the credentials of physicians providing services
by or through the organization, the financial status of
the organization, and the compensation paid to officers
and executives of the organization.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Medicare Managed
Health Care Sunshine Act of 1998’’.
SEC. 2. PROVIDING MEDICARE MANAGED CARE ENROLL-
EES 
WITH 
CERTAIN 
INFORMATION 
ON
HEALTH PLANS.
(a) INFORMATION ON PHYSICIAN CREDENTIALING.—
Section 1852(c)(2) of the Social Security Act (42 U.S.C.
1395w–22(c)(2)) is amended by adding at the end the fol-
lowing new subparagraph:
‘‘(E) Descriptive information regarding the
credentials of each physician who is authorized
by the organization to provide services by or
through the organization to enrollees under this
part, including the medical education and train-
ing received by the physician, the physician’s
history of medical practice (whether domestic or
foreign), and the positions held by the physician
at the time of the request.’’.
(b) CERTAIN
FINANCIAL
INFORMATION.—Section
1857(d)(4)(A) 
of 
such 
Act 
(42 
U.S.C. 
1395w–
27(d)(4)(A)) is amended by adding at the end the follow-
ing new clauses:
‘‘(iv) An audited financial statement
of the organization for the most recently
concluded fiscal year that complies with
generally accepted accounting principles.
‘‘(v) A statement identifying the sala-
ries, bonuses, and other remuneration paid
to the 5 highest-paid officers or executives
of the organization, as well as the other
benefits provided to such officers or execu-
tives.’’.
(c) AVAILABILITY OF INFORMATION.—
(1) DISCLOSURE OF AVAILABILITY OF INFOR-
MATION.—Section 1851(d)(3) of such Act (42
U.S.C. 1395w–21(d)(3)) is amended by adding at
the end the following new subparagraph:
‘‘(F) AVAILABILITY OF CERTAIN INFORMA-
TION.—A statement as to the availability, upon
request, 
of 
information 
on 
physician
credentialing under section 1852(c)(2)(E) and
on the financial status of a Medicare+Choice
organization under section 1857(d)(4)(C).’’.
(2) CONFORMING AMENDMENT TO APPLY FI-
NANCIAL
DISCLOSURE
TO
PROSPECTIVE
ENROLL-
EES.—Section 1857(d)(4)(C) of such Act (42 U.S.C.
1395w–27(d)(4)(C)) is amended by inserting ‘‘and
prospective enrollees’’ after ‘‘its enrollees’’.
(d) APPLICATION OF REQUIREMENTS UNDER SEC-
TION 1876 CONTRACTS.—Section 1876(k)(4) of such Act
(42 U.S.C. 1395mm(k)(4)) is amended by adding at the
end the following new subparagraph:
‘‘(E) Disclosure of certain information under
sections 
1851(d)(3)(F), 
1852(c)(2)(E), 
and
1857(d)(4)(C).’’.
(e) EFFECTIVE DATE.—The amendments made by
this section apply with respect to contract years beginning
on or after the date that is 6 months after the date of
the enactment of this Act.
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