Quality Health Care Coalition Act of 2014 - Exempts health care professionals, including individuals and entities, from federal and state antitrust laws in connection with negotiations with a health plan regarding contract terms under which the professionals provide health care items or services for which plan benefits are provided.
Declares that this Act: (1) applies only to health care professionals excluded from the National Labor Relations Act; and (2) does not apply to such negotiations relating to Medicare or Medicaid programs, the Children's Health Insurance Program (CHIP, formerly known as SCHIP), medical and dental care for members of the uniformed services, veterans' medical care, the federal employees health benefits program, or the Indian Health Care Improvement Act.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4077 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 4077
To ensure and foster continued patient safety and quality of care by
clarifying the application of the antitrust laws to negotiations
between groups of health care professionals and health plans and health
care insurance issuers.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 25, 2014
Mr. Conyers (for himself and Mr. Benishek) introduced the following
bill; which was referred to the Committee on the Judiciary
_______________________________________________________________________
A BILL
To ensure and foster continued patient safety and quality of care by
clarifying the application of the antitrust laws to negotiations
between groups of health care professionals and health plans and health
care insurance issuers.
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 ``Quality Health Care Coalition Act of
2014''.
SEC. 2. APPLICATION OF THE FEDERAL ANTITRUST LAWS TO HEALTH CARE
PROFESSIONALS NEGOTIATING WITH HEALTH PLANS.
(a) In General.--Any health care professionals who are engaged in
negotiations with a health plan regarding the terms of any contract
under which the professionals provide health care items or services for
which benefits are provided under such plan shall, in connection with
such negotiations, be exempt from the Federal antitrust laws.
(b) Limitation.--
(1) No new right for collective cessation of service.--The
exemption provided in subsection (a) shall not confer any new
right to participate in any collective cessation of service to
patients not already permitted by existing law.
(2) No change in national labor relations act.--This
section applies only to health care professionals excluded from
the National Labor Relations Act. Nothing in this section shall
be construed as changing or amending any provision of the
National Labor Relations Act, or as affecting the status of any
group of persons under that Act.
(c) No Application to Federal Programs.--Nothing in this section
shall apply to negotiations between health care professionals and
health plans pertaining to benefits provided under any of the
following:
(1) The Medicare Program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
(2) The Medicaid program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(3) The SCHIP program under title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.).
(4) Chapter 55 of title 10, United States Code (relating to
medical and dental care for members of the uniformed services).
(5) Chapter 17 of title 38, United States Code (relating to
Veterans' medical care).
(6) Chapter 89 of title 5, United States Code (relating to
the Federal employees' health benefits program).
(7) The Indian Health Care Improvement Act (25 U.S.C. 1601
et seq.).
SEC. 3. DEFINITIONS.
In this Act, the following definitions shall apply:
(1) Antitrust laws.--The term ``antitrust laws''--
(A) has the meaning given it in subsection (a) of
the first section of the Clayton Act (15 U.S.C. 12(a)),
except that such term includes section 5 of the Federal
Trade Commission Act (15 U.S.C. 45) to the extent such
section applies to unfair methods of competition; and
(B) includes any State law similar to the laws
referred to in subparagraph (A).
(2) Group health plan.--The term ``group health plan''
means an employee welfare benefit plan to the extent that the
plan provides medical care (including items and services paid
for as medical care) to employees or their dependents (as
defined under the terms of the plan) directly or through
insurance, reimbursement, or otherwise.
(3) Group health plan, health insurance issuer.--The terms
``group health plan'' and ``health insurance issuer'' include a
third-party administrator or other person acting for or on
behalf of such plan or issuer.
(4) Health care services.--The term ``health care
services'' means any services for which payment may be made
under a health plan, including services related to the delivery
or administration of such services.
(5) Health care professional.--The term ``health care
professional'' means any individual or entity that provides
health care items or services, treatment, assistance with
activities of daily living, or medications to patients and who,
to the extent required by State or Federal law, possesses
specialized training that confers expertise in the provision of
such items or services, treatment, assistance, or medications.
(6) Health insurance coverage.--The term ``health insurance
coverage'' means benefits consisting of medical care (provided
directly, through insurance or reimbursement, or otherwise and
including items and services paid for as medical care) under
any hospital or medical service policy or certificate, hospital
or medical service plan contract, or health maintenance
organization contract offered by a health insurance issuer.
(7) Health insurance issuer.--The term ``health insurance
issuer'' means an insurance company, insurance service, or
insurance organization (including a health maintenance
organization) that is licensed to engage in the business of
insurance in a State and that is subject to State law
regulating insurance. Such term does not include a group health
plan.
(8) Health maintenance organization.--The term ``health
maintenance organization'' means--
(A) a federally qualified health maintenance
organization (as defined in section 1301(a) of the
Public Health Service Act (42 U.S.C. 300e(a)));
(B) an organization recognized under State law as a
health maintenance organization; or
(C) a similar organization regulated under State
law for solvency in the same manner and to the same
extent as such a health maintenance organization.
(9) Health plan.--The term ``health plan'' means a group
health plan or a health insurance issuer that is offering
health insurance coverage.
(10) Medical care.--The term ``medical care'' means amounts
paid for--
(A) the diagnosis, cure, mitigation, treatment, or
prevention of disease, or amounts paid for the purpose
of affecting any structure or function of the body; and
(B) transportation primarily for and essential to
receiving items and services referred to in
subparagraph (A).
(11) Person.--The term ``person'' includes a State or unit
of local government.
(12) State.--The term ``State'' includes the several
States, the District of Columbia, Puerto Rico, the Virgin
Islands of the United States, Guam, American Samoa, and the
Commonwealth of the Northern Mariana Islands.
SEC. 4. EFFECTIVE DATE.
This Act shall take effect on the date of the enactment of this Act
and shall not apply with respect to conduct occurring before such date.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on the Judiciary.
Referred to the Subcommittee on Regulatory Reform, Commercial And Antitrust Law.
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