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106th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 106-709
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PROVIDING FOR THE CONSIDERATION OF H.R. 1304, THE QUALITY HEALTH-CARE
COALITION ACT OF 2000
_______
June 28, 2000.--Referred to the House Calendar and ordered to be
printed
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Mr. Goss, from the Committee on Rules, submitted the following
R E P O R T
[To accompany H. Res. 542]
The Committee on Rules, having had under consideration
House Resolution 542, by a non-record vote, report the same to
the House with the recommendation that the resolution be
adopted.
summary of provisions of the resolution
The resolution provides for the consideration of H.R. 1304,
the Quality Health-Care Coalition Act of 2000, under a
structured rule. The rule provides one hour of general debate
divided equally between the chairman and ranking minority
member of the Committee on the Judiciary.
The rule waives all points of order against consideration
of the bill. The rule makes in order the committee amendment in
the nature of a substitute now printed in the bill as an
original bill for the purpose of amendment, which shall be
considered as read. The rule also waives all points of order
against the amendment in the nature of a substitute.
The rule makes in order only those amendments printed in
this report. The amendments made in order may be offered only
in the order printed in this report, may be offered only by a
Member designated in this report, shall be considered as read,
shall be debatable for the time specified in this report
equally divided and controlled by the proponent and an
opponent, shall not be subject to amendment, and shall not be
subject to a demand for a division of the question in the House
or in the Committee of the Whole. All points of order are
waived against the amendments printed in this report.
The Chairman of the Committee of the Whole may postpone
votes during consideration of the bill, and reduce voting time
to five minutes on a postponed question if the vote follows a
fifteen minute vote. Finally, the rule provides one motion to
recommit with or without instructions.
summary of amendments made in order under the rule
1. Ballenger: Provides that the exemption included in the
bill not apply to: (1) negotiations between health
professionals and health plans relating to fees, payments,
reimbursements, or other compensation arrangements; or (2)
negotiations with a health plan that would allow health
professionals to balance bill patients of a health plan. The
exemption would also not apply to a health professional if they
had not submitted and received approval from the Sec. of HHS on
a plan to reduce medical errors. Health professionals availing
themselves of the exemption would also be required to notify
patients and prospective patients of their participation in
exempt negotiations. The exemption would not apply to health
professional who engaged in boycotts of health plans. (20
minutes)
2. Stearns: Exempts groups of health care professionals
engaged in negotiations with health plans from federal
antitrust laws if the FTC or the Department of Justice has
certified that such negotiations would promote competition and
enhance the quality of patient care. Groups representing fewer
than 20% of the health care professionals in a specialty in a
market area would get an antitrust exemption without having to
obtain approval from the FTC or DOJ. Finally, the amendment
clarifies that the bill does not create any legal right for
such groups of health care professionals to engage in boycotts,
coercive behavior or engage in a collective cessation of
service to patients. (10 minutes)
3. Cox: Provides that a physician may not be forced to join
a union as a condition of employment by a health plan. (10
minutes)
4. Terry: Prevents doctors, or any health care professional
covered in the bill, from using the bill language to negotiate
fees. (10 minutes)
5. Coburn: Exempts discussions regarding requiring abortion
coverage from collective bargaining negotiations. (20 minutes)
6. Davis (IL): Sense of Congress that medical decisions
regarding treatment should be made by the physician or health
care professional and the patient. (10 minutes)
text of amendments made in order under the rule
1. An Amendment To Be Offered by Representative Ballenger of North
Carolina, or a Designee, Debatable for 20 Minutes
Page 3, line 9, strike ``Any'' and insert ``Except as
provided in paragraph (3) of subsection (c), any''.
Page 4, after line 20 insert the following:
(3) Application.--The exemption provided in
subsection (a) shall not apply to the following:
(A) Any negotiations with a health plan
regarding or relating to fees, payments, or
reimbursement, including the methodology of
such fees, payments, or reimbursement between
health care professionals and health plans.
(B) Any negotiations with a health plan to
permit health care professionals to balance
bill patients.
(C) Any health care professional who has not
submitted to and received approval from the
Secretary of Health and Human Services for a
plan that specifies policies and procedures to
identify and reduce the incidence of medical
errors.
(D) Any health care professional who has not
disclosed to patients and prospective patients
information regarding the professional's
participation in such negotiations.
(E) Any acts by health care professionals to
engage in boycotts.
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2. An Amendment To Be Offered by Representative Stearns of Florida, or
a Designee, Debatable for 10 Minutes
Page 3, line 17, insert before the period the following: ``,
but only if such health care professionals have received prior
approval for such negotiations from the Federal Trade
Commission or the Assistant Attorney General pursuant to
subsection (i).''.
Page 6, after line 21, insert the following new subsection
(and redesignate the succeeding subsection accordingly):
(i) Prior Approval.--
(1) In general.--Health care professionals who seek
to engage in negotiations with a health plan as
provided in subsection (a) must obtain approval from
the Commission or the Assistant Attorney General prior
to commencing such negotiations. The Commission or the
Assistant Attorney General shall grant such approval if
the Commission or Assistant Attorney General has
determined that recognition under subsection (a) of the
group of health care professionals for the purpose of
engaging in collective negotiations with the health
plan will promote competition and enhance the quality
of patient care. The approval that is granted under
this subsection may be limited in time or scope to
ensure that these criteria are met. The Commission and
the Assistant Attorney General shall make a
determination regarding a request for approval under
this paragraph within 30 days after the date it is
received, if the request contains the information
specified in regulations issued under paragraph (2).
Failure by the Commission or Assistant Attorney General
to make such determination within such 30-day period
will be deemed to be an approval of the request by the
Commission or the Assistant Attorney General.
(2) Regulations.--The Commission, in consultation
with the Assistant Attorney General, shall publish
regulations implementing this subsection within six
months of the effective date of this Act. Such
regulations shall include the following:
(A) A description of the information that
must be submitted by health care professionals
who seek to obtain approval to engage in
collective negotiations.
(B) Provisions for the opportunity for the
public to submit comments to the Commission or
the Assistant Attorney General for
consideration in reviewing any request for
approval by health care professionals to engage
in collective negotiations under this section.
(C) Provision for a filing fee in an amount
reasonable and necessary to cover the costs of
the Commission and the Assistant Attorney
General to implement this subsection. On an
annual basis, this fee shall be updated to
reflect any increases or decreases determined
to be necessary to cover such costs.
(3) Coordination.--The Commission and the Assistant
Attorney General shall coordinate so that an
application is reviewed under this subsection by either
the Commission or the Assistant Attorney General, but
not both.
(4) Exemption for small groups.--
(A) In general.--Notwithstanding any other
provision of this subsection (other than
subparagraph (B)), no prior approval is
required under this subsection in the case of a
group of health care professionals who are
acting collectively with respect to a
negotiation if such group constitutes less than
20 percent of the health care professionals in
a specialty (or subspecialty) in the market
area involved, as determined under regulations
of the Commission.
(B) Oversight.--The Commission shall
establish a process under which, if it receives
a bona fide request that alleges that the
negotiations of a group described in
subparagraph (A) has not promoted competition
or has not enhanced the quality of patient
care, the Commission will review the request
and may take such action as the Commission
determines to be appropriate. Such action may
include ordering that the results of the
negotiations be vitiated and that the exemption
under subparagraph (A) not apply to such group
for such period as the Commission may specify.
Page 8, after line 8, insert the following:
(4) Commission.--The term ``Commission'' means the
Federal Trade Commission.
(5) Assistant attorney general.--The term ``Assistant
Attorney General'' means the Assistant Attorney General
in charge of the Antitrust Division of the Department
of Justice.
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3. An Amendment To Be Offered by Representative Cox of California, or a
Designee, Debatable for 10 Minutes
Page 4, after line 20, insert the following new paragraph:
(3) Physicians' right to choose whether to join a
labor organization.--Nothing in this Act shall impair
the right of any health care professional to refrain
from self-organizing, from forming, joining or
assisting a labor organization (including an
organization of other health care professionals), from
bargaining collectively, or from engaging in concerted
activities, and no agreement with a health care plan
may require membership by a health care professional
(who under existing law prior to the enactment of this
Act would not have been treated as an employee) in a
labor organization, including any organization of other
health care professionals, as a condition of
employment.
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4. An Amendment To Be Offered by Representative Terry of Nebraska, or a
Designee, Debatable for 10 Minutes
Page 4, after line 20, insert the following:
(3) No negotiation over fees.--The exemption provided
in subsection (a) shall not apply to negotiations over
fees.
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5. An Amendment To Be Offered by Representative Coburn of Oklahoma, or
a Designee, Debatable for 20 Minutes
Page 6, after line 10, insert the following new subsection
(and redesignate the succeeding subsections accordingly):
(h) Exemption of Abortion and Abortion Services.--Nothing in
this section shall apply to negotiations specifically relating
to requiring a health plan to cover abortion or abortion
services.
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6. An Amendment To Be Offered by Representative Davis of Illinois, or a
Designee, Debatable for 10 Minutes
Add at the end the following new subsection:
(j) Sense of Congress.--It is the sense of Congress that
decisions regarding medical care and treatment should be made
by the physician or health care professional in consultation
with the patient.
