,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #dajf  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,febru>y #bg1 #bjad   
,mr4 ,b>r 7= himself & ,mr4 ,b]a (      
,cali=nia7 introduc$ ! foll[+ bill2 :i* 
0 ref]r$ to ! ,committee on ,en]gy &    
,comm]ce1 & 9 addition to ! ,committee  
on ! ,judici>y1 = a p]iod to be         
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to provide = !     
developm5t & dissem9ation ( cl9ical     
practice guidel9es & ! e/abli%m5t ( a "r
 ( removal to ,f$]al c\rts = def5dants 9
 m$ical malpractice actions involv+ a   
,f$]al payor1 & = o!r purposes4  #a4    
,%ort title ,?is ,act may be cit$ z !   
,sav+ ,lives1 ,sav+ ,co/s ,act4  #b4    
,purposes  ,! purposes ( ?is ,act are3  
7#a7 ,to (f] physicians :o docum5t      
adh]5ce to c]ta9 evid5ce-bas$           
cl9ical-practice guidel9es1 &1 :5       
applicable1 appropriate use crit]ia1 a  
safe h>bor f m$ical-malpractice         

litigation4  7#b7 ,to r$uce ! practice (
 def5sive m$ic9e & result+ heal? c>e    
co/s4  7#c7 ,to increase adh]5ce to     
evid5ce-bas$ cl9ical practice guidel9es 
to r$uce cl9ical v>iation 9 heal? c>e   
practice4  7#d7 ,to improve quality (   
c>e & pati5t safety4  7#e7 ,to p]mit    
organizations ) relevant exp]tise to    
p>ticipate 9 ! selection ( cl9ical      
practice guidel9es4  7#f7 ,to p]mit     
pr(essionals ) relevant exp]tise to     
p>ticipate & b5efit f liability re=m4   
#c4 ,requirem5ts = selection ( cl9ical  
practice guidel9es  7a7 ,selection ,n   
lat] ?an #f mon?s aft] ! date ( enactm5t
 ( ?is ,act1 eligible pr(essional       
organizations t h e/abli%$1 publi%$1    
ma9ta9$ & updat$ on a regul> basis1     
cl9ical practice guidel9es1 includ+ :5  
applicable1 appropriate use crit]ia1 t  
incorporate be/ practices1 %all submit  
to ! ,secret>y ^? guidel9es4 ,n lat] ?an
 #f mon?s aft] t submission date1 !     
,secret>y %all select & designate "o or 
m ( ^? eligible pr(essional             

organizations to provide & ma9ta9 su*   
cl9ical practice guidel9es on behalf ( !
 ,secret>y4 ,to ?is end1 n m ?an #f     
mon?s aft] designat+ ea* su* eligible   
pr(essional organization1 ! ,secret>y   
%all ent] into an agreem5t ) ea* su*    
eligible pr(essional organization =     
ma9t5ance & updat+ ( su* cl9ical        
practice guidel9es4  7b7 ,ma9t5ance     
7#a7 ,p]iodic review ,n lat] ?an #e ye>s
 aft] publication ( guidel9es1 & e five 
ye>s !reaft]1 ! ,secret>y %all review ! 
cl9ical practice guidel9es & %all1 z    
necess>y1 ent] into agreem5ts ) eligible
 pr(essional organizations4  7#b7       
,update by eligible pr(essional         
organization ,an eligible pr(essional   
organization t collaborat$ 9 !          
e/abli%m5t ( a cl9ical practice guidel9e
 may submit am5dm5ts to t cl9ical       
practice guidel9e at any "t to !        
,secret>y1 :o %all review ! am5dm5ts4   
7#c7 ,notification requir$ = c]ta9      
updates ,9 ! case ( an am5dm5t "u       
p>agraph 7#b7 t adds1 mat]ially *anges1 

or removes a guidel9e f a set (         
guidel9es1 su* update %all n apply "u   
?is subsection unless notification ( su*
 update is made available to applicable 
eligible pr(essionals4  #d4 ,developm5t 
7a7 ,guidel9e /&>ds ,to ! ext5t         
possible1 ! developm5t ( cl9ical        
practice guidel9es %\ld be guid$ by !   
,in/itute ( ,m$ic9e's ,/&>ds = ,develop+
 ,tru/wor?y ,guidel9es & %\ld--  7#a7 be
 develop$ ?r\gh a transp>5t process t   
m9imizes conflicts ( int]e/2  7#b7 be   
develop$ by a kn[l$geable1              
multidiscipl9>y panel ( exp]ts &        
repres5tatives f key affect$ gr\ps2     
7#c7 take into consid]ation important   
pati5t subgr\ps & pati5t pref]5ces z    
appropriate2  7#d7 be bas$ on a         
sy/ematic review ( ! exi/+ evid5ce2     
7#e7 provide a cle> explanation ( !     
relation%ip betwe5 c>e options & heal?  
outcomes2  7#f7 provide rat+s ( bo? !   
quality ( evid5ce & /r5g? (             
recomm5dation2  7#g7 be reconsid]$ &    
revis$ :5 new evid5ce em]ges2 &  7#h7   

cle>ly id5tify any exceptions to !      
application ( ! cl9ical practice        
guidel9e4  7b7 ,requir$ disclosures f   
eligible pr(essional organizations ,any 
p]son :o is affiliat$ ) an eligible     
pr(essional organization & :o directly  
p>ticipat$ 9 ! creation ( a cl9ical     
practice guidel9e %all disclose any     
conflicts ( int]e/ p]ta9+ to !          
developm5t ( ! cl9ical practice         
guidel9e1 includ+ any conflict ( int]e/ 
p]ta9+ to any in/rum5t1 m$ic9e1 drug1 or
 any o!r sub/ance1 device1 or means     
includ$ 9 ! cl9ical practice guidel9e4  
,disclosures by eligible pr(essional    
organizations %all be made promptly1 ^u 
submission ( ! guidel9es1 & dur+ e      
review ( ! guidel9es1 to ! ,secret>y4   
,disclosures %all additionally include !
 foll[+3  7#a7 ,sci5tific me?odology &  
evid5ce t supports cl9ical practice     
guidel9es4  7#b7 ,outside collaborators4
  7#c7 ,endorsem5ts4  #e4 ,int]net      
publication ( guidel9es  ,! ,secret>y ( 
,heal? & ,human ,s]vices %all publi% all

 cl9ical practice guidel9es on !        
,int]net ?r\gh ! ,national ,guidel9e    
,cle>+h\se or o!r appropriate sites or  
s\rces1 includ+ all data & me?odology   
us$ 9 ! developm5t & selection ( !      
guidel9es 9 compliance ) data disclosure
 /&>ds 9 ! ,heal? ,insurance            
,portability & ,acc\ntability ,act (    
#aiif4  #f4 ,/ate flexibility &         
protection ( ,/ates' rights  7a7        
,limitation ,?is ,act %all n preempt or 
sup]s$e any ,/ate or ,f$]al law t       
imposes great] proc$ural or sub/antive  
protections = heal? c>e provid]s & heal?
 c>e organizations f liability1 loss1 or
 damages ?an ^? provid$ by ?is title or 
create a cause ( action4  7b7 ,/ate     
,flexibility ,no provision ( ?is ,act   
%all be con/ru$ to preempt any def5se   
available to a p>ty 9 a heal? c>e       
liability action "u any o!r provision ( 
,/ate or ,f$]al law4  #g4 ,"r ( removal 
,section #adda ( title #bh1 ,unit$      
,/ates ,code1 is am5d$ by add+ at ! end 
! foll[+3  7g7 ,c]ta9 actions aga9/     

m$ical pr(essionals  7#a7 ,any heal? c>e
 liability action br\ght 9 a ,/ate c\rt 
aga9/ an applicable eligible pr(essional
 or heal? c>e provid] may be remov$ by  
any def5dant or ! def5dants to ! di/rict
 c\rt ( ! ,unit$ ,/ates = ! di/rict &   
division embrac+ ! place :]e su* action 
is p5d+4  7#b7 ,= purposes ( ?is        
subsection ! t]ms applicable eligible   
pr(essional1 heal? c>e provid]1 heal?   
c>e liability action1 & heal? c>e       
liability claim h ! mean+ giv5 su* t]m 9
 section #aj ( ! ,sav+ ,lives1 ,sav+    
,co/s ,act ( #bjad4  4  #h4 ,m&atory    
review by indep5d5t m$ical review panel 
7a7 ,9 g5]al ,if1 9 any heal? c>e       
liability action aga9/ an applicable    
eligible pr(essional1 ! applicable      
eligible pr(essional alleges1 9 any     
response to ! claimant's fil+1 t !      
applicable eligible pr(essional adh]$ to
 an applicable cl9ical practice guidel9e
 9 ! provision ( heal? c>e goods or     
s]vices to ! claimant1 !n ! c\rt %all   
susp5d fur!r proce$+s on ! heal? c>e    

liability action prior to discov]y      
proce$+s1 until ! completion ( a review 
( ! action by an indep5d5t m$ical review
 panel4  7b7 ,indep5d5t m$ical review   
panel  7#a7 ,composition ,an indep5d5t  
m$ical review panel "u ?is section %all 
be compos$ ( #c memb]s :o are exp]ts 9 !
 relevant field ( cl9ical practice4     
7#b7 ,requirem5ts = memb] eligibility   
,to be eligible to s]ve on an indep5d5t 
m$ical review panel1 a memb] %all--     
7,a7 be an exp]i5c$ physician c]tifi$ by
 a bo>d recogniz$ by ! ,am]ican ,bo>d ( 
,m$ical ,specialties2  7,b7 n e>li] ?an 
#b ye>s prior to ! date ( selection to !
 bo>d1 h be5 9 active m$ical practice or
 devot$ a sub/antial portion ( 8 or h]  
"t to tea*+ at an accr$it$ m$ical s*ool1
 or h be5 engag$ 9 univ]sity-bas$ rese>*
 9 relation to ! m$ical c>e & type (    
treatm5t at issue2 &  7,c7 be approv$ by
 8 or h] specialty society4  ,:5        
possible1 memb]s %\ld be f ! region :]e 
! case 9 "q orig9ates to acc\nt =       
geographical practice v>iation4  7#c7   

,no civil liability = memb]s ,no civil  
action %all be br\ght 9 any c\rt aga9/  
any memb] = any act done1 failure to    
act1 or /atem5t or op9ion made1 )9 !    
scope ( 8 or h] duties z a memb] ( !    
indep5d5t m$ical review panel4  7#d7    
,consid]ations 9 mak+ det]m9ations ,!   
memb]s ( ! indep5d5t m$ical review panel
 %all ackn[l$ge ! ability ( physicians  
to dep>t f ! recomm5dations 9 cl9ical   
practice guidel9es1 :5 appropriate1 9 ! 
c>e ( individual pati5ts4  7#e7         
,selection ( memb]s ,ea* memb] ( ! panel
 %all be jo9tly select$ by ! p>ties4 ,a 
memb] ^: selection "o p>ty does n concur
 9 may n s]ve on ! panel1 except t1 if1 
n lat] ?an #cj days aft] a response to !
 heal? c>e liability action is fil$1 #c 
memb]s h n be5 select$ by ! p>ties1 !   
c\rt %all appo9t any rema9+ memb]s4     
7#f7 ,comp5sation ( memb]s ,! co/s (    
comp5sation to ! memb]s ( ! panel %all  
be split betwe5 ! p>ties equally1 unless
 o!rwise agre$ to by ! p>ties4  7c7     
,t]ms ( review ,a review by an indep5d5t

 m$ical review panel "u ?is section %all
 comply ) ! foll[+3  7#a7 ,/&>d (       
conduct ,! m&atory indep5d5t m$ical     
review panel t is *>g$ ) !              
responsibility ( mak+ a prelim9>y f9d+ z
 to liability ( ! def5dant applicable   
eligible pr(essional %all deem !        
prescrib$ cl9ical practice guidel9es z !
 /&>d ( conduct1 c>e1 & skill expect$ ( 
memb]s ( ! m$ical pr(ession engag$ 9 !  
def5dant's field ( practice "u ! same or
 simil> circum/ances4  7#b7 ,record =   
review ,! review panel %all make a      
prelim9>y f9d+ bas$ solely ^u !         
pre-discov]y evid5ce submitt$ to x      
pursuant to ,rule #bf ( ! ,f$]al ,rules 
( ,civil ,proc$ure & ! applicable       
prescrib$ cl9ical practice guidel9es4   
7#c7 ,limitation ,! review panel %all n 
make a f9d+ ( neglig5ce f ! m]e fact t a
 treatm5t or proc$ure 0 unsuccessful1   
fail$ to br+ ! be/ result or t ! pati5t 
di$4  7#d7 ,use at trial ( "w product ( 
review panel ,no prelim9>y f9d+ by !    
review panel t ! def5dant applicable    

eligible pr(essional brea*$ ! /&>d ( c>e
 z set =? "u ! prescrib$ cl9ical        
practice guidel9es %all con/itute       
neglig5ce p] se or conclusive evid5ce ( 
liability4 ,h[ev]1 said f9d+s1 op9ions &
 conclusions ( ! review panel %all be   
admissible z evid5ce 9 any & all        
subsequ5t proce$+s be=e ! c\rt1 includ+ 
= purposes ( motions = summ>y judgm5t & 
at trial4  7d7 ,results ( review  7#a7  
,9 g5]al ,n lat] ?an #fj days aft] all  
memb]s ( ! panel h be5 select$1 ! panel 
%all complete a review ( ! record ( !   
liability action & %all make a f9d+ "u  
?is subsection4  7#b7 ,f9d+ describ$ ,a 
f9d+ "u ?is subsection %all include !   
foll[+3  7,a7 ,a det]m9ation ( :e!r or n
 !re are any applicable cl9ical practice
 guidel9es to ! heal? c>e liability     
action t sub/antively p]ta9s to ! injury
 suff]$ by ! claimant4  7,b7 ,if !      
applicable eligible pr(essional has     
alleg$ adh]5ce to any su* guidel9e4     
7,c7 ,if ! applicable eligible          
pr(essional did adh]e to any su*        

guidel9e4  7,d7 ,:e!r !re is a          
reasonable probability t--  7i7 !       
applicable eligible pr(essional violat$ 
! applicable /&>d ( c>e2  7ii7 t        
violation proximately caus$ ! claimant's
 alleg$ injury2 &  7iii7 ! claimant     
suff]$ damages z a result ( ! injury4   
7#c7 ,use at trial ,! f9d+ "u ?is       
subsection may be receiv$ into evid5ce  
by ! c\rt4 ,if ! panel made any f9d+ "u 
p>agraph 7#b77;,d7 t !re 0 no reasonable
 probability1 ! c\rt may issue a summ>y 
judgm5t 9 favor ( ! applicable eligible 
pr(essional unless ! claimant is able to
 %[ o!rwise by cle> & conv9c+ evid5ce4  
,if ! panel made a f9d+ "u subp>agraphs 
7,a7 ?r\gh 7,c7 t !re 0 an applicable   
cl9ical practice guidel9e t ! def5dant  
adh]$ to1 ! c\rt %all issue summ>y      
judgm5t 9 favor ( ! applicable eligible 
pr(essional unless ! claimant is able to
 %[ o!rwise by cle> & conv9c+ evid5ce4  
,any prelim9>y f9d+ t ! def5dant        
applicable eligible pr(essional did n   
brea* ! /&>d ( c>e z set =? "u !        

prescrib$ m$ical practice guidel9es or t
 ! def5dant applicable eligible         
pr(essional's failure to con=m to !     
requir$ /&>d 0 nei!r ! cause 9 fact nor 
! proximate cause ( ! pla9tiff's injury 
or t ! pla9tiff did n incur any damages 
z a result %all be giv5 def]5ce by !    
c\rt & %all entitle ! def5dant          
applicable eligible pr(essional to      
summ>y judgm5t unless ! pla9tiff is able
 to %[ by cle> & conv9c+ evid5ce t !    
indep5d5t m$ical review panel 0 9 error 
& t !re is a g5u9e issue z to a mat]ial 
fact 9 ! case4  #i4 ,recov]y ( ,co/s ,if
 ! def5dant applicable eligible         
pr(essional prevails subsequ5t to a     
prelim9>y f9d+ 9 8 or h] favor by !     
indep5d5t m$ical review panel1 !        
def5dant may recov] co/s & attorneys'   
fees f ! pla9tiff4  #aj4 ,def9itions ,9 
?is ,act3  7#a7 applicable eligible     
pr(essional ,! t]m applicable eligible  
pr(essional means physicians practic+ )9
 cl9ical practice guidel9es submitt$ by 
an eligible pr(essional organization &  

includes employees & ag5ts ( a          
physician4  7#b7 appropriate use crit]ia
 ,! t]m appropriate use crit]ia means   
e/abli%$ evid5ce-bas$ guidel9es develop$
 or endors$ by an eligible pr(essional  
organization t specify :5 ! heal?       
b5efits ( a proc$ure or s]vice exce$ !  
expect$ heal? risks by a significantly  
wide m>g94  7#c7 cl9ical practice       
guidel9e ,! t]m cl9ical practice        
guidel9e means sy/ematically develop$   
/atem5ts bas$ on ! review ( cl9ical     
evid5ce = assi/+ a heal? c>e provid] to 
det]m9e ! appropriate heal? c>e 9       
specific cl9ical circum/ances4  7#d7    
eligible pr(essional organization ,! t]m
 eligible pr(essional organization means
 a national or ,/ate m$ical society or  
m$ical specialty society4  7#e7 ,f$]al  
payor ,! t]m ,f$]al payor includes      
reimbursem5ts made "u ! ,m$ic>e program 
"u title ,,xviii ( ! ,social ,security  
,act or ! ,m$icaid program "u title     
,,xix ( ! ,social ,security ,act1       
premium tax cr$its "u section #cf;,b ( !

 ,int]nal ,rev5ue ,code ( #aihf or      
co/-%>+ r$uctions "u section #adjb ( !  
,pati5t ,protection & ,af=dable ,c>e    
,act1 or m$ical scre5+s1 treatm5ts1 or  
transf] s]vices provid$ pursuant to     
section #ahfg ( ! ,social ,security ,act
 is n made by ! individual or any       
non-,f$]al ?ird p>ty on behalf ( !      
individual4  7#f7 ,heal? c>e goods or   
s]vices ,! t]m heal? c>e goods or       
s]vices means any goods or s]vices      
provid$ by a heal? c>e organization1    
provid]1 or by any individual work+ "u !
 sup]vision ( a heal? c>e provid]1 t    
relates to ! diagnosis1 prev5tion1 or   
treatm5t ( any human disease or         
impairm5t1 or ! assessm5t or c>e ( !    
heal? ( human be+s4  7#g7 ,heal? c>e    
liability action ,! t]m heal? c>e       
liability action means a civil action   
aga9/ a heal? c>e provid] or a heal? c>e
 organization1 reg>dless ( ! !ory (     
liability on :i* ! claim is bas$1 or !  
numb] ( pla9tiffs1 def5dants1 or o!r    
p>ties1 or ! numb] ( causes ( action1 9 

:i* ! claimant alleges a heal? c>e      
liability claim4  7#h7 ,heal? c>e       
liability claim ,! t]m heal? c>e        
liability claim means a claim by any    
p]son aga9/ a heal? c>e provid] or a    
heal? c>e organization :i* is bas$ ^u ! 
provision (1 use (1 or paym5t = 7or !   
failure to provide1 use1 or pay =7 heal?
 c>e goods s]vices = :i* at lea/ p>tial 
paym5t 0 made by a ,f$]al payor or :i* 0
 m&at$ by ,f$]al law1 reg>dless ( ! !ory
 ( liability on :i* ! claim is bas$4    
7#i7 ,heal? c>e organization ,! t]m     
heal? c>e organization means any p]son  
or entity :i* is obligat$ to provide or 
pay = heal? b5efits "u any heal? plan1  
includ+ any p]son or entity act+ "u a   
contract or arrangem5t ) a heal? c>e    
organization to provide or adm9i/] any  
heal? b5efit4  7#aj7 ,heal? c>e provid] 
,! t]m heal? c>e provid] means any p]son
 or entity requir$ by ,/ate or ,f$]al   
laws or regulations to be lic5s$1       
regi/]$1 or c]tifi$ to provide heal? c>e
 s]vices1 & be+ ei!r s lic5s$1 regi/]$1 

or c]tifi$1 or exempt$ f su* requirem5t 
by o!r /atute or regulation4  7#aa7     
p]=mance p]iod ,! t]m p]=mance p]iod    
means ! p]iod ( "t dur+ :i* ! f9al rule 
e/abli%+ a cl9ical practice guidel9e is 
9 effect4  7#ab7 ,secret>y ,! t]m       
,secret>y means ! ,secret>y ( ,heal? &  
,human ,s]vices4