Patient Protection bill

TABLE OF CONTENTS:

Title I: Patients' Bill of Rights

Subtitle A: Right to Advice and Care

Subtitle B: Right to Information about Plans and

Providers

Subtitle C: Right to Hold Health Plans Accountable

Title II: Individual Rights with Respect to Personal Medical

Information

Subtitle A: Access to Medical Records

Subtitle B: Establishment of Safeguards

Subtitle C: Enforcement; Definitions

Title III: Genetic Information and Services

Title IV: Healthcare Quality Research

Title V: Women's Health Research and Prevention

Subtitle A: Provisions Relating to Women's Health

Research at the National Institutes of Health

Subtitle B: Provisions Relating to Women's Health at

the Centers for Disease Control and Prevention

Subtitle C: Women's Health and Cancer Rights

Title VI: Enhanced Access to Health Insurance Coverage

Patients' Bill of Rights Act - Title I: Patients' Bill of Rights - Subtitle A: Right to Advice and Care - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to require a group health plan covering emergency medical care to provide coverage, without requiring preauthorization, for appropriate emergency medical screening examinations to the extent that a prudent layperson, possessing an average knowledge of health and medicine, would determine such examinations to be necessary to determine whether emergency medical care is necessary.

(Sec. 101) Requires a plan to cover additional emergency medical services following such an examination to the extent that a prudent emergency medical professional would determine such services to be necessary to avoid specified serious consequences.

Requires a plan (other than a small employer's plan) providing benefit coverage only through a defined set of participating health care professionals to offer the option of point-of-service coverage (of the same benefits provided by a nonparticipating health care professional), unless the plan offers multiple issuer or coverage options.

Requires any plan offering gynecological, obstetric, or pediatric care not to require prior authorization from a participant's primary care provider if such provider is not a gynecologist, obstetrician, or pediatrician.

Requires a plan to permit a participant or beneficiary undergoing a course of treatment to continue such treatment for a period of time even though the contract between the plan and a health care provider is terminated, or the schedule of benefits or coverage is terminated by a change in the terms of the provider's participation in the plan. Specifies a 90-day continuation of coverage generally, and other transitional periods for institutionalization (until discharge), pregnancy (through post-partum care), and terminal illness (remainder of life).

Declares that a plan shall not prohibit a health care professional from advising a patient about the patient's health status, medical care, or treatment for the patient's condition or disease, regardless of whether coverage for such care or treatment is provided under the contract, if the professional is acting within the lawful scope of the practice.

Applies the requirements of this subtitle to group health plans, but not to a health insurance issuer licensed by a State and subject to State insurance regulation while engaged in the business of insurance in such State.

Subtitle B: Right to Information about Plans and Providers - Requires plans and group health insurance issuers to disclose specified plan information to enrollees and (upon request) potential enrollees.

(Sec. 112) Directs the Secretary of Health and Human Services (HHS) to contract with the Institute of Medicine for a study and report to the appropriate congressional committees on: (1) health care professionals information currently available to patients, consumers, States, and professional societies, nationally and on a State-by-State basis; (2) the legal and other barriers to the sharing of information about health care professionals; and (3) recommendations for disclosure of such information on health care professionals, including their competencies and professional qualifications, to better facilitate patient choice, quality improvement, and market competition.

Subtitle C: Right to Hold Health Plans Accountable - Revises requirements for plan provision of a procedure for appealing denied claims.

(Sec. 121) Requires a plan or health insurance issuer conducting utilization review to have: (1) specified procedures in place for coverage determinations, including expedited determinations; (2) written procedures for addressing grievances between a plan and enrollees; (3) an internal procedure for coverage determination appeals; and (4) an external review procedure for enrollee appeals, involving specified entities and independent medical experts, whose determination shall be binding.

Prescribes external review standards.

Directs the General Accounting Office to study and report to the appropriate congressional committees on a statistically appropriate sample of completed external reviews.

Title II: Individual Rights with Respect to Personal Medical Information - Personal Medical Information Access Act - Subtitle A: Access to Medical Records - Amends ERISA to require any health care provider, health plan, employer, health or life insurer, school, or university, except in specified circumstances, to: (1) permit an individual who is the subject of protected health information (or the individual's designee) to inspect and copy protected health information concerning the individual; (2) amend such information upon the individual's request; and (3) make reasonable efforts to inform any person to whom the unamended portion of the information was previously disclosed of any nontechnical amendment that has been made.

(Sec. 212) Prescribes procedures for: (1) an entity's denial of a request to amend such information; and (2) an individual's filing of a statement of disagreement with such denial, which shall accompany any subsequent disclosure of the disputed portion of the information.

(Sec. 213) Requires any health care provider, health plan, employer, health or life insurer, school, or university to post notice of the entity's confidentiality practices, including specified information. Requires the Secretary to develop and disseminate model notices of confidentiality practices.

Subtitle B: Establishment of Safeguards - Requires any health care provider, health plan, employer, health or life insurer, school, or university to establish and maintain appropriate administrative, technical, and physical safeguards to protect the confidentiality, security, accuracy, and integrity of protected health information the entity creates, receives, obtains, maintains, uses, transmits, or disposes of.

Subtitle C: Enforcement; Definitions - Prescribes civil money penalties for substantial and material failure to comply with this Act.

(Sec. 232) Sets forth definitions.

Title III: Genetic Information and Services - Genetic Information Nondiscrimination in Health Insurance Act of 1998 - Amends ERISA, the Public Health Service Act (PHSA), and the Internal Revenue Code to prohibit a health care plan or health insurance issuer from restricting enrollment or adjusting premium or contribution amounts for a group on the basis of predictive genetic information concerning an individual in the group or a family member of the individual (including information about a request for or receipt of genetic services).

(Sec. 302) Prohibits a plan or issuer from requesting or requiring predictive genetic information concerning an individual or a family member of the individual (including information about a request for or receipt of genetic services). Permits a plan or issuer to request, but not require, such information for diagnosis, treatment, or payment purposes only.

Title IV: Healthcare Quality Research - Healthcare Quality Research Act of 1998 - Amends PHSA to establish within the Public Health Service (PHS) an Agency for Healthcare Quality Research to replace the current Agency for Health Care Policy and Research.

(Sec. 402) Directs the Agency to identify and disseminate methods or systems used to assess healthcare research results, particularly to rate the strength of the scientific evidence behind healthcare practice and technology recommendations in the research.

Requires the Agency to employ research strategies and mechanisms that will link research directly with clinical practice in geographically diverse locations throughout the United States, including: (1) Healthcare Improvement Research Centers that combine demonstrated multidisciplinary expertise in outcomes or quality improvement research with linkages to relevant sites of care; (2) Practice-based Research Networks, including plan, facility, or delivery system sites of care (especially primary care), that can evaluate and promote quality improvement; and (3) other innovative mechanisms or strategies.

Directs the Agency to: (1) award grants to enable eligible entities at geographically diverse locations throughout the United States to carry out research training programs dedicated to health services research training at the doctoral, post-doctoral, and junior faculty levels; and (2) provide specified scientific and technical support for private and public efforts to improve healthcare quality, including accrediting organizations.

Directs the Secretary, acting through the Agency Director, to establish a demonstration program of grants for one or more centers to conduct: (1) state-of-the-art clinical research on drugs, biological products, and devices; (2) research on the comparative effectiveness, cost-effectiveness, and safety of drugs, biological products, and devices; and (3) other appropriate activities (excluding the review of new drugs).

Requires the Agency Director to: (1) collect certain data on the cost and quality of healthcare; (2) support research on and initiatives to advance the use of information systems for the study of healthcare quality; and (3) provide ongoing administrative, research, and technical support for the Preventive Services Task Force, which shall review scientific evidence on the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services regarding their usefulness in daily clinical practice.

Establishes within the Agency a Center for Primary Care Delivery Research to serve as the principal funding source for HHS primary care delivery research and demonstrations with respect to the first contact when illness or health concerns arise, the diagnosis, treatment or referral to specialty care, preventive care, and the relationship between the clinician and the patient in the context of the family and community.

Requires the Agency Director by specified activities to promote innovation in evidence-based clinical practice and healthcare technologies.

Requires the Secretary, acting through the Director, to coordinate all research, evaluations, and demonstrations related to health services research and quality measurement and improvement activities undertaken and supported by the Federal Government.

Requires the Secretary to contract with the Institute of Medicine to: (1) describe and evaluate current quality improvement research and monitoring processes; and (2) recommend options to improve the efficiency and effectiveness of such processes, and optimize public- private sector accreditation bodies.

Directs the Secretary, acting through the Director, to establish a nonprofit, nongovernmental Foundation for Healthcare Research, which shall: (1) support the Agency and foster public-private partnerships to support Agency programs and activities; (2) advance collaboration with healthcare researchers from universities, industry, and nonprofit organizations; and (4) develop linkages with users of healthcare and quality research. Requires the Secretary, acting through the Agency Director, to make grants each fiscal year to support the Foundation.

Establishes an Advisory Council for Healthcare Quality Research to replace the current Advisory Council for Health Care Policy, Research, and Evaluation.

Requires the Agency Director to establish technical and scientific peer review groups to review each application for a grant, cooperative agreement, or contract under this title.

Repeals the mandates for: (1) a demonstration program regarding centers for education and research on therapeutics; and (2) the Office of the Forum for Quality and Effectiveness in Health Care.

Authorizes appropriations.

(Sec. 404) Requires the Secretary, within 30 days after enactment of any Act providing for a qualifying health care benefit, to evaluate scientifically and report to the appropriate congressional committees on: (1) the safety, efficacy, cost, benefits and value of such benefit; (2) alternative approaches in improving care compared with such benefit; and (3) the benefit's overall impact on health care as measured through research.

Title V: Women's Health Research and Prevention - Women's Health Research and Prevention Amendments of 1998 - Subtitle A: Provisions Relating to Women's Health Research at the National Institutes of Health - Amends PHSA to extend the authorization of appropriations for research on the drug diethylstilbestrol (commonly known as DES). Directs the Secretary, acting through PHS agency heads, to carry out a national program to educate health professionals and the public about DES.

(Sec. 512) Extends the authorization of appropriations for research on: (1) osteoporosis, Paget's disease, and related bone disorders; (2) breast and ovarian cancers; and (3) aging processes relating to women.

(Sec. 514) Requires the Director of the National Heart, Lung, and Blood Institute to expand, intensify, and coordinate research and related activities with respect to heart attack, stroke, and other cardiovascular diseases in women.

(Sec. 516) Requires the Director of the National Institutes of Health (currently, the Director of the Office of Research on Women's Health) to appoint members of the Advisory Committee on Research on Women's Health.

Subtitle B: Provisions Relating to Women's Health at the Centers for Disease Control and Prevention - Amends PHSA to extend the authorization of appropriations for: (1) the National Center for Health Statistics; (2) the National Program of Cancer Registries; (3) the National Breast and Cervical Cancer Early Detection Program; (4) Centers for Research and Demonstration of Health Promotion; and (5) community programs on domestic violence.

(Sec. 523) Authorizes a State receiving a Federal grant to make grants to or contract with for-profit private entities to carry out programs of preventive health measures for breast and cervical cancers.

Subtitle C: Women's Health and Cancer Rights - Women's Health and Cancer Rights Act of 1998 - Amends ERISA, PHSA, and the Internal Revenue Code to require certain group health plans and health insurance issuers to ensure specified minimum coverage regarding: (1) breast cancer mastectomies, lumpectomies, and lymph node dissections; (2) post-mastectomy breast reconstruction on both breasts; and (3) the costs of prostheses and complications of mastectomy, including lymphedemas. Prohibits: (1) denial of eligibility to a patient, and other related practices, solely to avoid the requirements of this subtitle; (2) incentives or rebates to encourage individuals to accept less than the minimum coverage; and (2) certain penalties or incentives to providers to evade application of this subtitle.

(Sec. 535) Amends PHSA to apply the same requirements to health insurance issuers in the individual market.

(Sec. 537) Directs the Agency for Health Care Policy and Research to study and report to the appropriate congressional committees on the scientific issues relating to prevention and treatment of breast cancer.

Title VI: Enhanced Access to Health Insurance Coverage - Amends the Internal Revenue Code to: (1) allow the annual carryover of up to $500 of unused benefits from cafeteria plans, flexible spending arrangements, and health flexible spending accounts; (2) allow a full deduction from gross income of the health insurance costs of self-employed individuals; and (3) repeal the limitation of the availability of medical savings accounts (MSAs) to employees of small employers and the self-employed.

(Sec. 603) Reduces from $1,500 to $1,000 (self-only coverage) and from $3,000 to $2,000 (family coverage) the minimum annual deductible of a high deductible health plan.

Revises the formula for the monthly limitation on the allowable deduction for MSAs to increase the contribution limit to 100 percent of the annual deductible under a high deductible health plan.

Waives the additional tax on MSA distributions not used for qualified medical expenses to the extent any payment or distribution does not reduce the fair market value of the MSA assets to an amount less than the annual deductible for the account holder's high deductible health plan.

(Sec. 604) Authorizes the Office of Personnel Management to contract for or approve catastrophic FEHBP plans, whose covered expenses exceed $500.

Amends Federal civil service law, with respect to Government contributions under the Federal Employees Health Benefits Program (FEHBP), to require an additional Government contribution, according to a certain formula, to an individual's MSA with respect to a catastrophic plan.

Increases the Government's biweekly contribution to an employee's or annuitant's FEHBP catastrophic plan from 75 percent to 100 percent of the subscription charge.