Health Care Access and Security Act of 1991

Health Care Access and Security Act of 1991 - Title I: Improvements in Health Insurance Affordability for Small Employers - Amends the Internal Revenue code to raise from 25 to 100 percent the deduction allowed to self-employed individuals for health insurance premiums and makes the deduction permanent.

Directs the Secretary of Health and Human Services (the Secretary) to make grants to States for the establishment and operation of small employer health insurance purchasing programs. Permits grant funds to be used to finance administrative costs associated with developing and operating a group purchasing program for small employers. Authorizes appropriations.

Title II: Improvements in Health Insurance for Small Employers - Amends the Social Security Act to add a new title, Title XXI: Standards for Small Employer Health Insurance and Certification of Managed Care Plans. Directs the Secretary to request the National Association of Insurance Commissioners to develop model standards and regulations concerning requirements for health insurance plans for small employers. Requires such plans to provide for: (1) guaranteed eligibility; (2) guaranteed availability; and (3) guaranteed renewability. Prohibits: (1) an insurer from refusing to renew or terminate a plan, except for nonpayment of premiums, fraud, or failure to maintain minimum participation rates; and (2) for certain services, discrimination based on health status. Sets limits controlling the variation of premium charges permitted among all small employers insured by an insurer. Requires the full disclosure of an insurer's rating practices.

Requires a health insurance plan for small employers to offer: (1) both a standard benefit package and basic benefit package; and (2) a managed care option, if the insurer also offers such an option to other employers. Provides, under both the standard and basic package, for coverage of: (1) inpatient and outpatient hospital care; (2) inpatient and outpatient physician services; (3) diagnostic tests; and (4) preventive services. Provides, in addition, under the standard plan: (1) for the coverage of certain mental health care; (2) that, except as specified, there will be no limits on the amount, scope, or duration of benefits, and (3) for specified limits on deductibles, copayment, coinsurance, and out-of-pocket expenses. Provides under the basic plan that: (1) premiums, deductibles, copayments, or other cost-sharing may be imposed; and (2) there shall be an out-of-pocket limit.

Amends the Internal Revenue Code to impose an excise tax of 25 percent of gross premiums on the issuer of any health insurance plan to a small employer if the plan does not meet the requirements of title XXI.

Sets forth study and reporting requirements.

Title III: Improvements in Portability of Private Health Insurance - Imposes an excise tax of $100 per day, with respect to a covered individual, on a group health plan for its failure to provide coverage for a preexisting condition, subject to stated exceptions.

Title IV: Health Care Cost Containment - Establishes a Health Care Cost Commission which shall report annually to the President and the Congress on national health care costs. Authorizes appropriations.

Requires the Secretary of Health and Human Services, under title XXI of the Social Security Act, to establish a process for the certification of managed care plans and of utilization review programs. Sets forth requirements for certification.

Amends the Public Health Service Act to direct the Administrator of the Agency for Health Care Policy and Research to develop outcomes research and practice parameters for mental health services, including at least the diagnosis and treatment of childhood attention deficit syndrome disorders and manic depression. Amends Part A (General Provisions) of title XI of the Social Security Act to authorize appropriations for research outcomes of health care services and procedures.

Requires all Medicare carriers and intermediaries to accept electronic submission of claims in a specified uniform format.

Title V: Malpractice Reform - Directs the Secretary of Health and Human Services to make grants to States for the implementation and evaluation of alternative dispute resolution systems (ADR). Sets forth eligibility requirements for States seeking such grants. Directs the Secretary to award not less than ten such grants each fiscal year, with exceptions.

Requires the Secretary to: (1) designate each State receiving such a grant as a model ADR State (making such State eligible for a two-year extension); and (2) disseminate information on the ADR systems implemented by such States to other States, health care professionals and providers, and other interested parties.

Directs the Secretary to: (1) develop and promulgate standards and regulations necessary to carry out the grant program, including qualification standards that States must meet to receive grants and regulations establishing State data gathering requirements; (2) take into account, in developing qualification standards, specified factors such as the effectiveness of such systems in supporting access to health care, encouraging improvements in the quality of care, resolving claims promptly, and providing predictable outcomes; (3) provide States with technical assistance; and (4) report to the Congress, within four years of the first grant, describing and evaluating the ADR systems implemented.

Specifies that, with respect to any health care liability action brought in a Federal or State court and any medical malpractice claim or medical product liability claim subject to an ADR system: (1) no person may be required to pay more than $100,000 in a single payment in damages (whether for economic or non-economic losses) for expenses to be incurred in the future, but shall be permitted to make periodic payments (as determined by the court); (2) the total amount of damages that may be awarded to an individual and the family members of such individual for non-economic losses may not exceed $250,000; (3) the total amount of damages received by an individual shall be reduced by any other payment that has been or will be made to the individual to compensate such individual for the injury that was the subject of the action or claim; (4) a claimant's attorney's fees may not exceed 25 percent of the first $150,000 of any award or settlement, or 15 percent of any additional amounts, paid to the claimant; (5) the total amount of punitive damages that may be assessed may not exceed twice the total amount of the damages awarded to compensate the claimant for losses resulting from the injury; and (6) the liability of each defendant for non-economic losses shall be several only and not joint, and each defendant shall be liable only for the amount of non-economic losses allocated to the defendant in direct proportion to the defendant's percentage of responsibility.

Establishes a two year statute of limitations for medical malpractice and product liability claims, beginning on the earlier of the date on which the injury that is the subject of the action was discovered or should reasonably have been discovered.

Specifies that, in the case of a medical malpractice or product liability claim relating to services provided during labor or the delivery of a baby, if the claimant was not previously treated for the pregnancy by the defendant health care professional or provider a court may not find that the defendant committed malpractice and assess damages against the defendant unless the malpractice is proven by clear and convincing evidence.

Bars a defendant from being found to have committed malpractice unless the defendant's conduct at the time of providing the health care services that are the subject of the action was not reasonable, except where the claimant asserts that the defendant is liable under a strict liability theory.

Bars the award of punitive damages with respect to any medical product liability claim alleged against a medical product producer if the drug or device that is the subject of the claim: (1) was subject to approval or premarket approval under the Federal Food, Drug, and Cosmetic Act by the Food and Drug Administration (FDA) with respect to the safety or performance of the drug or device, or the adequacy of the packaging or labeling; (2) was approved by FDA; or (3) is generally recognized as safe and effective pursuant to conditions established by FDA and applicable regulations. Makes an exception in the case of withheld information, misrepresentation, or illegal payment to an FDA official for purposes of securing approval of the drug or device.

Provides for a separate proceeding to determine punitive damages. Sets forth provisions with respect to: (1) the admissibility of evidence; and (2) criteria for determining the amount of punitive damages.

Provides that the U.S. district courts shall not have jurisdiction over health care liability actions based on Federal questions or based on specified provisions concerning commerce and antitrust regulations.

Specifies that these provisions preempt State law only to the extent that State law: (1) permits the recovery by a claimant or the assessment against a defendant of a greater amount of damages; (2) permits the awarding of a greater amount of attorneys' fees; (3) establishes a longer period during which medical malpractice or product liability claims may be initiated; or (4) establishes a less strict standard of proof for determining whether a defendant has committed malpractice than these provisions.

Amends the Public Health Service Act to direct the Secretary to encourage the establishment of a nationwide risk retention group (RRG) for community and migrant health centers receiving assistance under such Act that meets specified requirements.

Defines a RRG for purposes of these provisions as an entity defined in the Liability Risk Retention Act of 1986 that: (1) provides professional liability insurance and other types of profitable insurance approved for issuance by the Secretary to community and migrant health centers; (2) provides insurance that applies to all claims filed against a community or migrant health center after the entity initiates insurance coverage and to claims arising from acts that occurred prior to the initiation of coverage if the claims are not covered by other insurance; and (3) meets such other requirements as the Secretary may establish.

Title VI: Incentives for Private Long-Term Care Coverage - Amends the Internal Revenue Code to provide for: (1) long-term care insurance contracts to be treated as accident or health insurance contracts; (2) amounts received under such contracts with respect to qualified long-term care services to be treated as amounts received for personal injuries or sickness; and (3) employer plans providing such services to be treated as an accident or health plan.

Includes amounts paid for qualified long-term care services as medical expenses for individual itemized deductions. Excludes benefits received under such contracts from gross income. Provides for the treatment of prefunded post-retirement long-term care benefits plans in the same manner as prefunded post-retirement medical and life insurance benefit plans.

Permits qualified long-term care insurance contracts to be offered in cafeteria plans (plans which offer two or more benefits).

Allows the tax-free exchange of life insurance contracts for long-term care insurance contracts.

Provides for the treatment of amounts paid to a terminally ill individual or one who is chronically ill and confined to a qualified facility as death benefits. Allows insurance companies to issue such accelerated death benefit riders on life insurance contracts.

Declares that gross income does include excessive long-term care benefits.