Patient Right to Pediatric Care Act of 1999

Patient Right to Pediatric Care Act of 1999 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to require a group health plan or issuer, if it provides benefits for routine pediatric specialist care benefits, to allow designation of a participating pediatric specialist as the primary care provider for any beneficiary under 18 years of age.

[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2044 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 2044

To amend title I of the Employee Retirement Income Security Act of 1974 
  to provide to participants and beneficiaries of group health plans 
                       access to pediatric care.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 8, 1999

 Mr. Sherwood introduced the following bill; which was referred to the 
                Committee on Education and the Workforce

_______________________________________________________________________

                                 A BILL


 
To amend title I of the Employee Retirement Income Security Act of 1974 
  to provide to participants and beneficiaries of group health plans 
                       access to pediatric care.

    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 ``Patient Right to Pediatric Care Act 
of 1999''.

SEC. 2. PATIENT ACCESS TO PEDIATRIC CARE.

    (a) 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) In General.--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 routine 
pediatric care provided by a participating 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 provider, the plan (or issuer) shall 
provide that such a participating physician 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 provider 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.
    ``(c) Treatment of Multiple Coverage Options.--In the case of a 
plan providing benefits under two or more coverage options, the 
requirements of this section shall apply separately with respect to 
each coverage option.''.
    (b) Conforming Amendment.--The table of contents in section 1 of 
such Act is amended by adding at the end of the items relating to 
subpart B of part 7 of subtitle B of title I of such Act the following 
new item:

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

SEC. 3. EFFECTIVE DATE AND RELATED RULES.

    (a) In General.--The amendments made by this Act shall apply with 
respect to plan years beginning on or after January 1 of the second 
calendar year following the date of the enactment of this Act, except 
that the Secretary of Labor may issue regulations before such date 
under such amendments. The Secretary shall first issue regulations 
necessary to carry out the amendments made by this Act before the 
effective date thereof.
    (b) Limitation on Enforcement Actions.--No enforcement action shall 
be taken, pursuant to the amendments made by this Act, 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.
    (c) 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 Act 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, 2002.
For purposes of this subsection, any plan amendment made pursuant to a 
collective bargaining agreement relating to the plan which amends the 
plan solely to conform to any requirement added by this Act shall not 
be treated as a termination of such collective bargaining agreement.
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