Summary: H.R.4315 — 104th Congress (1995-1996)All Information (Except Text)

There is one summary for H.R.4315. Bill summaries are authored by CRS.

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Introduced in House (09/28/1996)


Title I: Health Plan Requirements

Title II: Office of Consumer Advocacy for Health

Title III: Independent Consumer Advisory Committees

Title IV: Coordination Among Office, Committees, and


Patient and Health Care Provider Protection Act of 1996 - Title I: Health Plan Requirements - Prohibits a health plan that is part of any contract or agreement with a health care provider from providing any restriction on or interference with any medical communication (other than a knowing misrepresentation): (1) between the provider and a current, former, or prospective patient (or the guardian or legal representative of a patient); (2) between the provider and or any employee or representative of the plan; or (3) between the provider and any employee or representative of any State or Federal licensing or oversight authority. Authorizes States to establish or enforce requirements related to such prohibition, but only if they are more protective of a medical communication than that provided by such prohibition.

(Sec. 102) Prohibits the operation of an improper health care provider incentive plan.

(Sec. 103) Requires health plans to: (1) establish criteria for the denial of plan services, as well as criteria to assure the quality of plan care; (2) provide for an initial physical exam of enrollees before denying plan services; and (3) establish standards and procedures to protect certain private information from public disclosure.

(Sec. 106) Requires a health plan to pay the State an annual fee of one percent of the total amount of the annual premiums paid by State residents enrolled in the plan.

(Sec. 107) Provides for the enforcement of this title through the imposition of civil monetary penalties.

(Sec. 108) Prohibits the taking of adverse actions against health care providers for certain actions, including those taken for the purpose of notifying a health plan of potentially dangerous conditions.

Title II: Office of Consumer Advocacy for Health - Directs the Secretary of Health and Human Services to establish for each State an independent Office for such State to assist consumers in dealing with problems that arise with respect to health plans and health care providers operating in the State, including assistance to individuals with grievances against a plan as well as assistance for individuals who seek to report dangerous conditions in health care services.

(Sec. 201) Requires the Secretary, through a competitive grant award process, to designate a non-profit organization to serve as the Office for a State, which shall be headed by a Consumer Advocate for Health for the State selected from among individuals with expertise and experience in the fields of health care and consumer advocacy. Requires the State Office to establish a local office in each community rating area established by the Secretary. Gives the Secretary oversight over such offices.

(Sec. 208) Funds such Offices out of certain fees collected under this Act that are imposed on health plans.

Title III: Independent Consumer Advisory Committees - Requires each health plan to establish and maintain an independent Consumer Advisory Committee to develop and coordinate programs for outreach to the community and ensure that enrollee grievances are addressed.

(Sec. 305) Requires each Committee to report annually to the Office for the State in which the health plan offers services, providing recommendations for improvements in health care delivery under the plan.

(Sec. 306) Provides for funding of Committees.

Title IV: Coordination Among Office, Committees, and Secretary - Requires an Office to establish and maintain a system of referrals among the Office, other consumer advocacy organizations, legal assistance providers serving low-income persons, and protection and advocacy systems for individuals with disabilities.

(Sec. 402) Requires an Office to provide technical assistance to such Committees and distribute and account for funding for them.

(Sec. 403) Requires annual submissions from each Committee to each Office, and from each Office to the Secretary, of compilations of enrollee quality care data, for analysis and use in developing Federal guidelines for evaluating the performance of health plans operating in community rating areas.