To amend title I of the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code of 1986 to improve and clarify accountability for violations with respect to managed care group health plans.
Managed Care Plan Accountability Act of 1997 - Amends the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code (IRC) with respect to accountability for violations of requirements for managed care group health plans, especially failure to provide health benefits due to improper cost-driven delivery policy decisions.
Imposes joint and several liability for actual (including compensatory and consequential) damages, and, in the court's discretion, for punitive damages, on a group health plan, or a plan health insurance issuer, for failure to provide a benefit in accordance with plan terms, insofar as such failure occurs pursuant to a clinically or medically inappropriate decision or determination resulting from application of any cost containment technique, related utilization review, or any other medical care delivery policy decision which restricts the ability of medical care providers to use their full discretion for treatment of patients. Provides for an action for damages in either a State or Federal court.
Requires managed care group health plans to provide for full indemnification of medical care providers bound by plan restrictions for any liability incurred for such a failure if it is the direct result of a plan restriction on medical communications.
Amends the IRC to establish an excise tax for such cost-driven violations of plan terms.
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E1036)
Referred to House Education and the Workforce
Referred to the Committee on Education and the Workforce, and in addition to the Committee on Ways and Means, 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.
Referred to House Ways and Means
Referred to the Subcommittee on Employer-Employee Relations.
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