108th CONGRESS
2d Session
S. 2083
To amend the Public Health Service Act and the Employee Retirement
Income Security Act of 1974 to protect consumers in managed care plans and
other health coverage.
IN THE SENATE OF THE UNITED STATES
February 12, 2004
Mrs. BOXER introduced the following bill; which was read twice and referred
to the Committee on Health, Education, Labor, and Pensions
A BILL
To amend the Public Health Service Act and the Employee Retirement
Income Security Act of 1974 to protect consumers in managed care plans and
other health coverage.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE- This Act may be cited as the `Bipartisan Patient Protection
Act of 2004'.
(b) TABLE OF CONTENTS- The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I--IMPROVING MANAGED CARE
Subtitle A--Utilization Review; Claims; and Internal and External Appeals
Sec. 101. Utilization review activities.
Sec. 102. Procedures for initial claims for benefits and prior authorization
determinations.
Sec. 103. Internal appeals of claims denials.
Sec. 104. Independent external appeals procedures.
Sec. 105. Health Care Consumer Assistance Fund.
Subtitle B--Access to Care
Sec. 111. Consumer choice option.
Sec. 112. Choice of health care professional.
Sec. 113. Access to emergency care.
Sec. 114. Timely access to specialists.
Sec. 115. Patient access to obstetrical and gynecological care.
Sec. 116. Access to pediatric care.
Sec. 117. Continuity of care.
Sec. 118. Access to needed prescription drugs.
Sec. 119. Coverage for individuals participating in approved clinical trials.
Sec. 120. Required coverage for minimum hospital stay for mastectomies and
lymph node dissections for the treatment of breast cancer and coverage for
secondary consultations.
Subtitle C--Access to Information
Sec. 121. Patient access to information.
Sec. 122. Genetic information.
Subtitle D--Protecting the Doctor-Patient Relationship
Sec. 131. Prohibition of interference with certain medical communications.
Sec. 132. Prohibition of discrimination against providers based on licensure.
Sec. 133. Prohibition against improper incentive arrangements.
Sec. 134. Payment of claims.
Sec. 135. Protection for patient advocacy.
Subtitle E--Definitions
Sec. 152. Preemption; State flexibility; construction.
Sec. 154. Coverage of limited scope plans.
Sec. 156. Incorporation into plan or coverage documents.
TITLE II--APPLICATION OF QUALITY CARE STANDARDS TO GROUP HEALTH PLANS AND
HEALTH INSURANCE COVERAGE UNDER THE PUBLIC HEALTH SERVICE ACT
Sec. 201. Application to group health plans and group health insurance coverage.
Sec. 202. Application to individual health insurance coverage.
Sec. 203. Cooperation between Federal and State authorities.
Sec. 204. Elimination of option of non-Federal governmental plans to be
excepted from requirements concerning genetic information.
TITLE III--APPLICATION OF PATIENT PROTECTION STANDARDS TO FEDERAL HEALTH
CARE PROGRAMS
Sec. 301. Application of patient protection standards to Federal health
care programs.
TITLE IV--AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974
Sec. 401. Application of patient protection standards to group health plans
and group health insurance coverage under the Employee Retirement Income
Security Act of 1974.
Sec. 402. Availability of civil remedies.
Sec. 403. Limitation on certain class action litigation.
Sec. 404. Limitations on actions.
Sec. 405. Cooperation between Federal and State authorities.
Sec. 406. Sense of the senate concerning the importance of certain unpaid
services.
TITLE V--EFFECTIVE DATES; COORDINATION IN IMPLEMENTATION
Sec. 501. Effective dates.
Sec. 502. Coordination in implementation.
TITLE VI--MISCELLANEOUS PROVISIONS
Sec. 601. No impact on Social Security Trust Fund.
Sec. 602. Customs user fees.
Sec. 603. Fiscal year 2005 medicare payments.
Sec. 604. Sense of Senate with respect to participation in clinical trials
and access to specialty care.
Sec. 605. Sense of the Senate regarding fair review process.
This piece of legislation is quite lengthy. For the remainder
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