Family Health Insurance Protection Act

TABLE OF CONTENTS:

Title I: Health Insurance Market Reform

Subtitle A: Insurance Market Standards

Subtitle B: Establishment and Application of Standards

Subtitle C: Health Care Cost and Access Advisory

Commission

Subtitle D: Definitions

Title II: Improving Access to Health Care Coverage

Subtitle A: Coverage Under Qualified Health Plans and

Premium Assistance

Subtitle B: Self-Employed Health Insurance Deduction

Title III: Improving Access in Rural Areas

Subtitle A: Offfice of Rural Health Policy

Subtitle B: Development of Telemedicine in Rural

Underserved Areas

Subtitle C: Rural Health Plan Demonstration Projects

Subtitle D: Antitrust Safe Harbors for Rural Health

Providers

Title IV: Quality and Consumer Protection

Subtitle A: Administrative Simplification

Subtitle B: Privacy of Health Information

Subtitle C: Enhanced Penalties for Health Care Fraud

Subtitle D: Health Care Malpractice Reform

Title V: Budget Neutrality

Family Health Insurance Protection Act - Title I: Health Insurance Market Reform - Subtitle A: Insurance Market Standards - Prohibits a health plan, with specified exceptions, from denying, limiting, or conditioning its coverage (or benefits), or varying its premium, for an individual based on the health status, medical condition, claims experience, receipt of health care, medical history, anticipated need for health care services, disability, or lack of evidence of insurability.

(Sec. 1002) Requires each health plan that offers coverage in the small group market or large employer market to guarantee enrollment in and renewal of (at the option of the individual or employer) such plan to each individual purchaser and employer.

(Sec. 1003) Requires a health plan offering coverage in the small group market to comply with certain rating (premium rates) standards to be developed by the National Association of Insurance Commissioners (NAIC).

(Sec. 1004) Requires the Secretary of Health and Human Services to establish minimum guidelines for the issuance by each State of delivery system quality standards. Sets forth such guidelines, including: (1) establishing health plan quality assurance; (2) providing consumer protection for health plan enrollees; and (3) ensuring reasonable access for vulnerable populations in underserved areas.

(Sec. 1005) Requires a sponsor of a health plan to offer a benchmark benefits package which covers specified health care items and services and provides for a cost-sharing schedule. Authorizes a sponsor to offer any other health benefits package.

(Sec. 1006) Requires each health plan offering coverage in the small group market in a State to participate in a risk adjustment program.

Subtitle B: Establishment and Application of Standards - Prohibits any requirement or standard imposed on a health plan under this Act from preempting any State consumer protection laws unless such laws conflict with such requirement or standard.

(Sec. 1012) Declares that nothing in this Act shall be construed as prohibiting States from enacting health care reform measures that exceed the measures established under this Act, including reforms that expand access to health care services, control health care costs, and enhance quality of care.

(Sec. 1013) Requires the Secretary to make grants to States that submit applications that meet certain requirements for the establishment and operation of small group health insurance purchasing arrangements. Requires the Secretary in awarding such grants to consider the potential impact of the State's proposal on the cost of health insurance for the small group market and on the number of uninsured, and the need for regional variation in the award of such grants. Authorizes the use of grant funds to finance administrative costs associated with developing such arrangements. Authorizes appropriations.

(Sec. 1014) Directs States to require that each health plan issued, sold, offered for sale, or operated in such State meets the insurance reform standards established under this title pursuant to an enforcement plan filed by it with, and approved by, the Secretary.

Subtitle C: Health Care Cost and Access Advisory Commission - Establishes the Health Care Cost and Advisory Commission to monitor and respond to trends in national health care spending and health insurance coverage. Requires the Commission to report annually to the Congress and the President on the status of health care spending and health insurance coverage in the nation.

Sec. 1023) Authorizes appropriations.

Subtitle D: Definitions - Sets forth definitions.

Title II: Improving Access to Health Care Coverage - Subtitle A: Coverage Under Qualified Health Plans and Premium Assistance - Part 1: Access to Qualified Health Plans - Requires States, in order to qualify for certain Federal payments, to establish a program under which a State: (1) makes available at least one qualifed health plan to each premium subsidy eligible individual residing there; and (2) furnishes premium assistance to such individual.

(Sec. 2002) Requires the Secretary to issue regulations specifying requirements for State programs with respect to determining eligibility for premium assistance, including measures to prevent individuals from knowingly making material misrepresentations of information or providing false information in applications for assistance under the program. Requires a premium subsidy eligible individual who receives premium assistance to use such assistance only for payments toward the premium under a qualified State health plan.

(Sec. 2011) Sets forth a formula for: (1) the amount of premium assistance for a month that a premium subsidy eligible individual shall receive; and (2) the maximum subsidy amount for a State.

(Sec. 2012) Sets forth eligibility requirements for children and temporarily unemployed individuals to receive premium assistance.

Part 2: Aggregate Federal Payments - Sets forth a formula for determining the amount of Federal payments to States for the payment of premium assistance under a qualified State health plan.

Part 3: Definitions and Determinations of Income - Sets forth definitions.

Subtitle B: Self-Employed Health Insurance Deduction - Amends the Internal Revenue Code to increase the deduction for health insurance costs of self-employed individuals from 25 percent through 1996 to 50 percent in 1997 to 75 percent in 1998 and to 100 percent in 1999 and thereafter.

Title III: Improving Access in Rural Areas - Subtitle A: Office of Rural Health Policy - Amends the Social Security Act (SSA) to mandate that the Office of Rural Health Policy of the Department of Health and Human Services (HHS) be headed by an Assistant Secretary for Rural Health, who shall report directly to the Secretary. Adds as one of the duties of the Assistant Secretary that he or she advise the Secretary on reforms to the health care system and their implications for rural areas. Transfers the functions, powers, duties, and authority of the Office of Rural Health Policy to the Office of the Assistant Secretary for Rural Health.

Subtitle B: Development of Telemedicine in Rural Underserved Areas - Directs the Secretary to award grants to eligible entities to expand access to health care services for individuals in rural areas through the use of telemedicine.

(Sec. 3102) Directs the White House Information Infrastructure Task Force to report to the Congress an evaluation of the cost effectiveness of telemedicine, including recommendations for a coordinated Federal strategy to increase access to health care through telemedicine.

(Sec. 3103) Directs the Secretary to issue regulations regarding reimbursement for telemedicine services provided under title XVIII (Medicare) of the SSA.

(Sec. 3104) Authorizes appropriations.

Subtitle C: Rural Health Plan Demonstration Projects - Directs the Secretary to establish not more than three demonstration projects for the designation of rural health plan areas.

Subtitle D: Antitrust Safe Harbors for Rural Health Providers - Directs the Attorney General to establish, and publish in the Federal Register, policy guidelines to assist rural health care providers in complying with safe harbor requirements with respect to the provision of health care services in rural areas.

Title IV: Quality and Consumer Protection - Subtitle A: Administrative Simplification - Part 1: Purpose and Definitions - Establishes a national framework for health information whose goal, through standardization of data elements, code sets, and electronic transactions, and by assuring a secure environment for the transmission and exchange of health information, is to reduce the burden of administrative complexity, paper work, and cost on the health care system, including Medicare under title XVIII and Medicaid under title XIX the SSA.

Part 2: Standards for Data Elements and Information Transactions - Directs the Secretary to adopt standards for health information transactions and data elements.

(Sec. 4012) Directs the Secretary to promulgate regulations specifying procedures for the electronic transmission and authentication of signatures on medical records and prescriptions.

Part 3: Requirements with Respect to Certain Transactions and Information - Sets forth specified requirements with respect to certain transactions conducted by a health plan or health care provider.

Part 4: Accessing Health Information - Requires the Secretary to adopt technical standards for persons to locate and access health information that is available through the health information network.

Part 5: Penalties - Sets forth penalties for violations committed under this subtitle.

Part 6: Miscellaneous Provisions - Mandates that any provision, requirement, or standard under this subtitle supercede any contrary provision of State law (except State provisions governing the reporting of disease or injury, child abuse, birth, or death, public serveillance, or public health investigation or intervention).

(Sec. 4052) Authorizes appropriations.

Subtitle B: Privacy of Health Information - Part 1: Defintions - Set forth definitions.

Part 2: Authorized Disclosures - Subpart A: General Provisions - Sets forth requirements for the disclosure of protected health information by a health information trustee, or by a health care provider and person receiving such information, including a health information protection organization.

Subpart B: Specific Disclosures Relating to Patient - Authorizes a health care provider, health plan, employer, or person who receives protected health information to disclose it to a health care provider for the purpose of providing health care (including emergency situations) to, or providing for the payment of such care for, an individual.

Subpart C: Disclosure for Oversight, Public Health, and Research Purposes - Authorizes a health information trustee to disclose protected health information to a health oversight agency or to a health researcher.

(Sec. 4117) Authorizes a health care provider, health plan, public health authority, employer, or person who receives protected health information to disclose it to a public health authority or other person authorized by law for use in: (1) disease or injury reporting; (2) public health surveillance; or (3) public health investigation or intervention.

Subpart D: Disclosure for Judicial, Administrative, and Law Enforcement Purposes - Authorizes a health care provider, health plan, health oversight agency, employer, or person who receives protected health information to disclose it, (subject to a court's rules of procedure): (1) in connection with litigation where an individual's physical or mental condition is at issue; (2) in response to a court- ordered physical or mental examination; or (3) pursuant to a law requiring the reporting of specific medical information to law enforcement authorities.

(Sec. 4122) Authorizes such entities or persons to disclose such information to law enforcement agencies.

Subpart E: Disclosure Pursuant to Government Subpoena or Warrant - Authorizes a health care provider, health plan, health oversight agency, employer, or person who receives protected health information to disclose it pursuant to an administrative or judicial subpoena or warrant.

Subpart F: Disclosure Pursuant to Party Subpoena - Authorizes a health care provider, health plan, employer, or person who receives protected health information to disclose it pursuant to a party subpoena.

Part 3: Procedures for Ensuring Security of Protected Health Information - Subpart A: Establishment of Safeguards - Directs a health information trustee to establish administrative, technical, and physical safeguards to ensure the confidentiality of protected health information created or received by such trustee.

Subpart B: Review of Protected Health Information By Subjects of the Information - Requires a health care provider or health plan to allow an individual who is the subject of protected health information to inspect any such information, with specified exceptions, that the provider or plan maintains.

(Sec. 4142) Requires a health care provider or health plan, upon the written request of the subject individual, to correct or amend his or her protected health information.

(Sec. 4143) Requires a health care provider or health plan to provide written notice of its information practices, including notice of individual rights with respect to protected health information.

Part 4: Sanctions - Subpart A: Civil Sanctions - Sets forth civil penalties for violations of this subtitle.

(Sec. 4152) Authorizes an individual who is aggrieved by the negligent conduct of a health information trustee to bring a civil action in court.

Subpart B: Criminal Sanctions - Subjects to civil and criminal penalties any person who, in violation of this subtitle, knowingly: (1) obtains protected health information relating to an individual; or (2) discloses such information to another person.

Part 5: Administrative Provisions - Sets forth provisions regarding: (1) preemption of State law with respect to the disclosure of protected health information; and (2) the rights of incompetents with respect to such information.

Subtitle C: Enhanced Penalties for Health Care Fraud - Directs the Secretary to establish a program to: (1) coordinate Federal, State, and local law enforcement programs to control fraud and abuse with respect to the delivery of and payment for health care in the United States; (2) conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for such health care; (3) facilitate the enforcement of specified sections of the SSA and other applicable statutes with respect to health care fraud and abuse; and (4) provide for the modification and establishment of safe harbors, and to issue interpretative rulings and special fraud alerts.

(Sec. 4201) Establishes a Health Care Fraud and Abuse Control Account which shall comprise all criminal and administrative fines imposed in cases involving a Federal health care offense.

(Sec. 4202) Amends SSA title XI to provide for the application of sanctions under the Medicare and Medicaid Fraud and abuse programs for all fraud and abuse against any health plan. Subjects any person (including any organization, agency, or other entity, but excluding a beneficiary) who violates a provision of this section to a civil monetary penalty.

(Sec. 4203) Directs the Secretary to establish a national health care fraud and abuse data collection program for the reporting of final adverse actions (not including settlements in which no findings of liability have been made) against health care providers, suppliers, or practitioners.

(Sec. 4204) Amends Federal criminal law to subject to civil and criminal penalties any person who knowingly executes, or attempts to execute, a scheme to: (1) defraud any health plan or other person, in connection with the delivery of or payment for health care benefits or services; or (2) obtain, by false pretenses, any money or property owned by, or under the control of, any health plan, or person in connection with the delivery of or payment for such health care or services.

Subtitle D: Health Care Malpractice Reform - Declares that these provisions apply to any health care liability action (except damages for vaccine-related injury or death) brought in any Federal or State court.

(Sec. 4302) Requires each State to adopt an alternative dispute resolution method for the resolution of health care malpractice claims and consumer grievances.

(Sec. 4303) Limits attorney contingency fees and award amounts for noneconomic damages.

(Sec. 4304) Authorizes a party to a medical malpractice liability action to petition the court to instruct the trier of fact to award any future damages on an appropriate periodic basis.

(Sec. 4305) Requires 50 percent of any punitive damages awarded in a medical liability action to be paid to the State in which such action is brought to carry out: (1) licensing or cretifying health care professionals and providers; (2) implementing health care quality assurance and improvement programs; (3) reducing malpractice-related costs for providers volunteering to provide services in medically underserved sreas; and (4) providing resources for additional investigation and disciplinary activites.

Title V: Budget Neutrality - Prohibits any provision of this Act from taking effect until legislation is enacted which provides for its Federal budget neutrality.