To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to assure patient access to primary pediatric care through pediatricians under group health plans and group health insurance coverage.

June 27, 2001

Ms. GRANGER introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and 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

To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to assure patient access to primary pediatric care through pediatricians under group health plans and group health insurance coverage.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Primary Care for Children Act of 2001'.

SEC. 2. PATIENT ACCESS TO PEDIATRIC CARE THROUGH PEDIATRICIANS.

(a) AMENDMENT TO PUBLIC HEALTH SERVICE ACT- Subpart 2 of part A of title XXVII of the Public Health Service Act is amended by adding at the end the following new section:

`SEC. 2707. PATIENT ACCESS TO PEDIATRIC CARE THROUGH PEDIATRICIANS.

`(a) PATIENT ACCESS TO PEDIATRIC CARE- In any case in which a group health plan (or a health insurance issuer offering health insurance coverage in connection with the plan) provides benefits consisting of primary pediatric care provided by a participating primary care physician who specializes in pediatrics (or consisting of payment for such care) and the plan requires or provides for designation by a participant or beneficiary of a participating primary care physician with respect to such care, the plan (or issuer) shall provide that such a participating physician who specializes in pediatrics may be designated, if available, by a parent or guardian of any beneficiary under the plan who is under 18 years of age, as the primary care physician with respect to any such benefits.

`(b) CONSTRUCTION- Nothing in subsection (a) shall waive any requirements of coverage relating to medical necessity or appropriateness with respect to coverage of pediatric care.'.

(b) ERISA AMENDMENTS-

(1) IN GENERAL- Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 is amended by adding at the end the following new section:

`SEC. 714. PATIENT ACCESS TO PEDIATRIC CARE.

`(a) PATIENT ACCESS TO PEDIATRIC CARE- In any case in which a group health plan (or a health insurance issuer offering health insurance coverage in connection with the plan) provides benefits consisting of primary pediatric care provided by a participating primary care physician who specializes in pediatrics (or consisting of payment for such care) and the plan requires or provides for designation by a participant or beneficiary of a participating primary care physician with respect to such care, the plan (or issuer) shall provide that such a participating physician who specializes in pediatrics may be designated, if available, by a parent or guardian of any beneficiary under the plan who is under 18 years of age, as the primary care physician with respect to any such benefits.

`(b) CONSTRUCTION- Nothing in subsection (a) shall waive any requirements of coverage relating to medical necessity or appropriateness with respect to coverage of pediatric care.'.

(2) CLERICAL AMENDMENT- The table of contents in section 1 of such Act is amended by inserting after the item relating to section 713 the following new item:

`Sec. 714. Patient access to pediatric care.'.

(c) INTERNAL REVENUE CODE AMENDMENTS- Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended--

(1) in the table of sections, by inserting after the item relating to section 9812 the following new item:

`Sec. 9813. Patient access to pediatric care.'; and

(2) by inserting after section 9812 the following:

`SEC. 9813. PATIENT ACCESS TO PEDIATRIC CARE.

`(a) PATIENT ACCESS TO PEDIATRIC CARE- In any case in which a group health plan provides benefits consisting of primary pediatric care provided by a participating primary care physician who specializes in pediatrics (or consisting of payment for such care) and the plan requires or provides for designation by a participant or beneficiary of a participating primary care physician with respect to such care, the plan shall provide that such a participating physician who specializes in pediatrics may be designated, if available, by a parent or guardian of any beneficiary under the plan is who under 18 years of age, as the primary care physician with respect to any such benefits.

`(b) CONSTRUCTION- Nothing in subsection (a) shall waive any requirements of coverage relating to medical necessity or appropriateness with respect to coverage of pediatric care.'

(d) EFFECTIVE DATE AND RELATED RULES-

(1) IN GENERAL- The amendments made by this section apply with respect to plan years beginning on or after January 1, 2003, except that the Secretaries of Health and Human Services, of Labor, and of the Treasury may issue regulations before such date under such amendments. Such Secretaries shall first issue all regulations necessary to carry out such amendments before the effective date thereof.

(2) LIMITATION ON ENFORCEMENT ACTIONS- No enforcement action shall be taken, pursuant to the amendments made by this section, against a group health plan or health insurance issuer with respect to a violation of a requirement imposed by such amendments before the date of issuance of regulations issued in connection with such requirement, if the plan or issuer has sought to comply in good faith with such requirement.

(3) SPECIAL RULE FOR COLLECTIVE BARGAINING AGREEMENTS- In the case of a group health plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers ratified before the date of the enactment of this Act, the amendments made by this section shall not apply with respect to plan years beginning before the later of--

(1) the date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to after the date of the enactment of this Act); or

(2) January 1, 2003.

For purposes of this paragraph, any plan amendments made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by this section shall not be treated as a termination of such collective bargaining agreement.

END