,i #aaf? ,,congress #b;d ,session ,h4 ,r4 #ehaf ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,febru>y #g1 #bjbj,ms4 ,moore 7= h]self & ,mr4 ,s*weik]t7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committees on ,ways & ,means1 & ,education & ,labor1 = 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 am5d title ,,xxvii ( ! ,public ,heal? ,s]vice ,act1 ! ,int]nal ,rev5ue ,code ( #aihf1 ! ,employee ,retirem5t ,income ,security ,act ( #aigd1 & title ,,xi ( ! ,social ,security ,act to require gr\p heal? plans & heal? insurance issu]s to provide = c]ta9 cov]age 9 ! case ( a *ange 9 a provid]'s network /atus1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,cont9u+ ,c>e = ,pati5ts ,act ( #bjbj4 #b4 ,requir+ gr\p heal? plans & heal? insurance issu]s to provide = c]ta9 cov]age 9 ! case ( a *ange 9 a provid]'s network /atus 7a7 ,gr\p heal? plan & heal? insurance issu] requirem5ts 7#a7 ,public ,heal? ,s]vice ,act 7,a7 ,9 g5]al ,subp>t ,,ii ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #bgcj4 ,cont9uity ( c>e 7a7 ,ensur+ cont9uity ( c>e ) respect to t]m9ations ( c]ta9 contractual relation%ips result+ 9 *anges 9 provid] network /atus 7#a7 ,9 g5]al ,9 ! case ( an individual ) b5efits "u a gr\p heal? plan or gr\p or individual heal? insurance cov]age (f]$ by a heal? insurance issu] & ) respect to a heal? c>e provid] or facility t has a contractual relation%ip ) su* plan or su* issu] 7z applicable7 = furni%+ items & s]vices "u su* plan or su* cov]age1 if1 :ile su* individual is a cont9u+ c>e pati5t 7z def9$ 9 subsection 7b77 ) respect to su* provid] or facility-- 7,a7 su* contractual relation%ip is t]m9at$ 7z def9$ 9 subsection 7b772 7,b7 b5efits provid$ "u su* plan or su* heal? insurance cov]age ) respect to su* provid] or facility are t]m9at$ because ( a *ange 9 ! t]ms ( ! p>ticipation ( su* provid] or facility 9 su* plan or cov]age2 or 7,c7 a contract betwe5 su* gr\p heal? plan & a heal? insurance issu] (f]+ heal? insurance cov]age 9 connection ) su* plan is t]m9at$1 result+ 9 a loss ( b5efits provid$ "u su* plan ) respect to su* provid] or facility1 ! plan or issu]1 respectively1 %all meet ! requirem5ts ( p>agraph 7#b7 ) respect to su* individual4 7#b7 ,requirem5ts ,! requirem5ts ( ?is p>agraph are t ! plan or issu]-- 7,a7 notify ea* individual enroll$ "u su* plan or cov]age :o is a cont9u+ c>e pati5t ) respect to a provid] or facility at ! "t ( a t]m9ation describ$ 9 p>agraph 7#a7 affect+ su* provid] or facility on a timely basis ( su* t]m9ation & su* individual's "r to elect cont9u$ transitional c>e f su* provid] or facility "u ?is section2 7,b7 provide su* individual ) an opportunity to notify ! plan or issu] ( ! individual's ne$ = transitional c>e2 & 7,c7 p]mit ! pati5t to elect to cont9ue to h b5efits provid$ "u su* plan or su* cov]age1 "u ! same t]ms & conditions z w\ld h appli$ & ) respect to su* items & s]vices z w\ld h be5 cov]$ "u su* plan or cov]age _h su* t]m9ation n occurr$1 ) respect to ! c\rse ( treatm5t furni%$ by su* provid] or facility relat+ to su* individual's /atus z a cont9u+ c>e pati5t dur+ ! p]iod beg9n+ on ! date on :i* ! notice "u subp>agraph 7,a7 is provid$ & end+ on ! e>li] (-- 7i7 ! #ij-;day p]iod beg9n+ on su* date2 or 7ii7 ! date on :i* su* individual is no long] a cont9u+ c>e pati5t ) respect to su* provid] or facility4 7b7 ,def9itions ,9 ?is section3 7#a7 ,cont9u+ c>e pati5t ,= purposes ( ?is section1 ! t]m cont9u+ c>e pati5t means an individual :o1 ) respect to a provid] or facility-- 7,a7 is und]go+ a c\rse ( treatm5t = a s]i\s & complex condition f ! provid] or facility2 7,b7 is und]go+ a c\rse ( in/itutional or inpati5t c>e f ! provid] or facility2 7,c7 is s*$ul$ to und]go nonelective surg]y f ! provid] or facility1 includ+ receipt ( po/op]ative c>e f su* provid] or facility ) respect to su* a surg]y2 7,d7 is pregnant & und]go+ a c\rse ( treatm5t = ! pregnancy f ! provid] or facility2 or 7,e7 is or 0 det]m9$ to be t]m9ally ill 7z det]m9$ "u section #ahfa7;dd77#c77;,a7 ( ! ,social ,security ,act7 & is receiv+ treatm5t = su* illness f su* provid] or facility4 7#b7 ,s]i\s & complex condition ,! t]m s]i\s & complex condition means1 ) respect to a p>ticipant1 b5efici>y1 or enrollee "u a gr\p heal? plan or heal? insurance cov]age-- 7,a7 9 ! case ( an acute illness1 a condition t is s]i\s en\gh to require specializ$ m$ical treatm5t to avoid ! reasonable possibility ( dea? or p]man5t h>m2 or 7,b7 9 ! case ( a *ronic illness or condition1 a condition t-- 7i7 is life-?reat5+1 deg5]ative1 pot5tially disabl+1 or cong5ital2 & 7ii7 requires specializ$ m$ical c>e ov] a prolong$ p]iod ( "t4 7#c7 ,t]m9at$ ,! t]m t]m9at$ includes1 ) respect to a contract1 ! expiration or nonr5ewal ( ! contract1 b does n include a t]m9ation ( ! contract = failure to meet applicable quality /&>ds or = fraud4 4 7,b7 ,effective date ,! am5dm5ts made by ?is p>agraph %all apply ) respect to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbb4 7#b7 ,int]nal ,rev5ue ,code ( #aihf 7,a7 ,9 g5]al ,sub*apt] ,b ( *apt] #ajj ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new section3 #ihaf4 ,cont9uity ( c>e 7a7 ,ensur+ cont9uity ( c>e ) respect to t]m9ations ( c]ta9 contractual relation%ips result+ 9 *anges 9 provid] network /atus 7#a7 ,9 g5]al ,9 ! case ( an individual ) b5efits "u a gr\p heal? plan & ) respect to a heal? c>e provid] or heal? c>e facility t has a contractual relation%ip ) su* plan = furni%+ items & s]vices "u su* plan1 if1 :ile su* individual is a cont9u+ c>e pati5t 7z def9$ 9 subsection 7b77 ) respect to su* provid] or facility-- 7,a7 su* contractual relation%ip is t]m9at$ 7z def9$ 9 p>agraph 7b772 7,b7 b5efits provid$ "u su* plan ) respect to su* provid] or facility are t]m9at$ because ( a *ange 9 ! t]ms ( ! p>ticipation ( ! provid] or facility 9 su* plan2 or 7,c7 a contract betwe5 su* gr\p heal? plan & a heal? insurance issu] (f]+ heal? insurance cov]age 9 connection ) su* plan is t]m9at$1 result+ 9 a loss ( b5efits provid$ "u su* plan ) respect to su* provid] or facility1 ! plan %all meet ! requirem5ts ( p>agraph 7#b7 ) respect to su* individual4 7#b7 ,requirem5ts ,! requirem5ts ( ?is p>agraph are t ! plan-- 7,a7 notify ea* individual enroll$ "u su* plan :o is a cont9u+ c>e pati5t ) respect to a provid] or facility at ! "t ( a t]m9ation describ$ 9 p>agraph 7#a7 affect+ su* provid] or facility on a timely basis ( su* t]m9ation & su* individual's "r to elect cont9u$ transitional c>e f su* provid] or facility "u ?is section2 7,b7 provide su* individual ) an opportunity to notify ! plan ( ! individual's ne$ = transitional c>e2 & 7,c7 p]mit ! pati5t to elect to cont9ue to h b5efits provid$ "u su* plan1 "u ! same t]ms & conditions z w\ld h appli$ & ) respect to su* items & s]vices z w\ld h be5 cov]$ "u su* plan _h su* t]m9ation n occurr$1 ) respect to ! c\rse ( treatm5t furni%$ by su* provid] or facility relat+ to su* individual's /atus z a cont9u+ c>e pati5t dur+ ! p]iod beg9n+ on ! date on :i* ! notice "u subp>agraph 7,a7 is provid$ & end+ on ! e>li] (-- 7i7 ! #ij-;day p]iod beg9n+ on su* date2 or 7ii7 ! date on :i* su* individual is no long] a cont9u+ c>e pati5t ) respect to su* provid] or facility4 7b7 ,def9itions ,9 ?is section3 7#a7 ,cont9u+ c>e pati5t ,= purposes ( ?is section1 ! t]m cont9u+ c>e pati5t means an individual :o1 ) respect to a provid] or facility-- 7,a7 is und]go+ a c\rse ( treatm5t = a s]i\s & complex condition f ! provid] or facility2 7,b7 is und]go+ a c\rse ( in/itutional or inpati5t c>e f ! provid] or facility2 7,c7 is s*$ul$ to und]go nonelective surg]y f ! provid] or facility1 includ+ receipt ( po/op]ative c>e f su* provid] or facility ) respect to su* a surg]y2 7,d7 is pregnant & und]go+ a c\rse ( treatm5t = ! pregnancy f ! provid] or facility2 or 7,e7 is or 0 det]m9$ to be t]m9ally ill 7z det]m9$ "u section #ahfa7;dd77#c77;,a7 ( ! ,social ,security ,act7 & is receiv+ treatm5t = su* illness f su* provid] or facility4 7#b7 ,s]i\s & complex condition ,! t]m s]i\s & complex condition means1 ) respect to a p>ticipant or b5efici>y "u a gr\p heal? plan-- 7,a7 9 ! case ( an acute illness1 a condition t is s]i\s en\gh to require specializ$ m$ical treatm5t to avoid ! reasonable possibility ( dea? or p]man5t h>m2 or 7,b7 9 ! case ( a *ronic illness or condition1 a condition t-- 7i7 is life-?reat5+1 deg5]ative1 pot5tially disabl+1 or cong5ital2 & 7ii7 requires specializ$ m$ical c>e ov] a prolong$ p]iod ( "t4 7#c7 ,t]m9at$ ,! t]m t]m9at$ includes1 ) respect to a contract1 ! expiration or nonr5ewal ( ! contract1 b does n include a t]m9ation ( ! contract = failure to meet applicable quality /&>ds or = fraud4 4 7,b7 ,con=m+ am5dm5t ,section #ihae7;a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7i7 9 p>agraph 7#a71 by /rik+ 7z am5d$ by ! ,pati5t ,protection & ,af=dable ,c>e ,act7 & ins]t+ 7o!r ?an ! provisions ( section #bgcj ( su* ,act72 & 7ii7 9 p>agraph 7#b71 by ins]t+ 7o!r ?an ! provisions ( section #bgcj ( su* ,act7 aft] ! fir/ occurr5ce ( su* "p ,a4 7,c7 ,cl]ical am5dm5t ,! table ( sections = su* sub*apt] is am5d$ by add+ at ! end ! foll[+ new items3 ,sec4 #ihae4 ,additional m>ket re=ms4 ,sec4 #ihaf4 ,cont9uity ( c>e4 4 7,d7 ,effective date ,! am5dm5ts made by ?is p>agraph %all apply ) respect to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbb4 7#c7 ,employee ,retirem5t ,income ,security ,act ( #aigd 7,a7 ,9 g5]al ,subp>t ,b ( "p #g ( subtitle ,b ( title ,i ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aahe et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #gaf4 ,cont9uity ( c>e 7a7 ,ensur+ cont9uity ( c>e ) respect to t]m9ations ( c]ta9 contractual relation%ips result+ 9 *anges 9 provid] network /atus 7#a7 ,9 g5]al ,9 ! case ( an individual ) b5efits "u a gr\p heal? plan or heal? insurance cov]age (f]$ by a heal? insurance issu] 9 connection ) su* gr\p heal? plan & ) respect to a heal? c>e provid] or heal? c>e facility t has a contractual relation%ip ) su* plan or su* issu] 7z applicable7 = furni%+ items & s]vices "u su* plan or su* cov]age1 if1 :ile su* individual is a cont9u+ c>e pati5t 7z def9$ 9 subsection 7b77 ) respect to su* provid] or facility-- 7,a7 su* contractual relation%ip is t]m9at$ 7z def9$ 9 subsection 7b772 7,b7 b5efits provid$ "u su* plan or su* heal? insurance cov]age ) respect to su* provid] are t]m9at$ because ( a *ange 9 ! t]ms ( ! p>ticipation ( su* provid] or facility 9 su* plan or cov]age2 or 7,c7 a contract betwe5 su* gr\p heal? plan & a heal? insurance issu] (f]+ heal? insurance cov]age 9 connection ) su* plan is t]m9at$1 result+ 9 a loss ( b5efits provid$ "u su* plan ) respect to su* provid] or facility1 ! plan or issu]1 respectively1 %all meet ! requirem5ts ( p>agraph 7#b7 ) respect to su* individual4 7#b7 ,requirem5ts ,! requirem5ts ( ?is p>agraph are t ! plan or issu]-- 7,a7 notify ea* individual enroll$ "u su* plan or cov]age :o is a cont9u+ c>e pati5t ) respect to a provid] or facility at ! "t ( a t]m9ation describ$ 9 p>agraph 7#a7 affect+ su* provid] or facility on a timely basis ( su* t]m9ation & su* individual's "r to elect cont9u$ transitional c>e f su* provid] or facility "u ?is section2 7,b7 provide su* individual ) an opportunity to notify ! plan or issu] ( ! individual's ne$ = transitional c>e2 & 7,c7 p]mit ! pati5t to elect to cont9ue to h b5efits provid$ "u su* plan or su* cov]age1 "u ! same t]ms & conditions z w\ld h appli$ & ) respect to su* items & s]vices z w\ld h be5 cov]$ "u su* plan or cov]age _h su* t]m9ation n occurr$1 ) respect to ! c\rse ( treatm5t furni%$ by su* provid] or facility relat+ to su* individual's /atus z a cont9u+ c>e pati5t dur+ ! p]iod beg9n+ on ! date on :i* ! notice "u subp>agraph 7,a7 is provid$ & end+ on ! e>li] (-- 7i7 ! #ij-;day p]iod beg9n+ on su* date2 or 7ii7 ! date on :i* su* individual is no long] a cont9u+ c>e pati5t ) respect to su* provid] or facility4 7b7 ,def9itions ,9 ?is section3 7#a7 ,cont9u+ c>e pati5t ,= purposes ( ?is section1 ! t]m cont9u+ c>e pati5t means an individual :o1 ) respect to a provid] or facility-- 7,a7 is und]go+ a c\rse ( treatm5t = a s]i\s & complex condition f ! provid] or facility2 7,b7 is und]go+ a c\rse ( in/itutional or inpati5t c>e f ! provid] or facility2 7,c7 is s*$ul$ to und]go nonelective surg]y f ! provid] or facility1 includ+ receipt ( po/op]ative c>e f su* provid] or facility ) respect to su* a surg]y2 7,d7 is pregnant & und]go+ a c\rse ( treatm5t = ! pregnancy f ! provid] or facility2 or 7,e7 is or 0 det]m9$ to be t]m9ally ill 7z det]m9$ "u section #ahfa7;dd77#c77;,a7 ( ! ,social ,security ,act7 & is receiv+ treatm5t = su* illness f su* provid] or facility4 7#b7 ,s]i\s & complex condition ,! t]m s]i\s & complex condition means1 ) respect to a p>ticipant1 b5efici>y1 or enrollee "u a gr\p heal? plan or heal? insurance cov]age (f]$ 9 connection ) su* plan-- 7,a7 9 ! case ( an acute illness1 a condition t is s]i\s en\gh to require specializ$ m$ical treatm5t to avoid ! reasonable possibility ( dea? or p]man5t h>m2 or 7,b7 9 ! case ( a *ronic illness or condition1 a condition t-- 7i7 is life-?reat5+1 deg5]ative1 pot5tially disabl+1 or cong5ital2 & 7ii7 requires specializ$ m$ical c>e ov] a prolong$ p]iod ( "t4 7#c7 ,t]m9at$ ,! t]m t]m9at$ includes1 ) respect to a contract1 ! expiration or nonr5ewal ( ! contract1 b does n include a t]m9ation ( ! contract = failure to meet applicable quality /&>ds or = fraud4 4 7,b7 ,con=m+ am5dm5t ,section #gae7;a7 ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aahe;d7a77 is am5d$-- 7i7 9 p>agraph 7#a71 by /rik+ 7z am5d$ by ! ,pati5t ,protection & ,af=dable ,c>e ,act7 & ins]t+ 7o!r ?an ! provisions ( section #bgcj ( su* ,act72 & 7ii7 9 p>agraph 7#b71 by ins]t+ 7o!r ?an ! provisions ( section #bgcj ( su* ,act7 aft] ! fir/ occurr5ce ( su* "p ,a4 7,c7 ,cl]ical am5dm5t ,! table ( cont5ts 9 section #a ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd is am5d$ by ins]t+ aft] ! item relat+ to section #gad ! foll[+ new items3 ,sec4 #gae4 ,additional m>ket re=ms4 ,sec4 #gaf4 ,cont9uity ( c>e4 4 7,d7 ,effective date ,! am5dm5ts made by ?is p>agraph %all apply ) respect to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbb4 7b7 ,heal? c>e provid]s ,"p ,a ( title ,,xi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq471 z am5d$ by subsection 7a71 is fur!r am5d$ by add+ at ! end ! foll[+ new sections3 #aaej;,c4 ,cont9uity ( c>e 7a7 ,9 g5]al ,a heal? c>e provid] or heal? c>e facility %all1 9 ! case ( an individual furni%$ items & s]vices by su* provid] or facility = :i* cov]age is provid$ "u a gr\p heal? plan or gr\p or individual heal? insurance cov]age pursuant to section #bgcj ( su* ,act1 section #ihaf ( ! ,int]nal ,rev5ue ,code ( #aihf1 or section #gaf ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd-- 7#a7 accept paym5t f su* plan or su* issu] 7z applicable7 7& co/-%>+ f su* individual1 if applicable1 9 accordance ) subsection 7a77#b77;,c7 ( su* section #bgcj1 #ihag1 or #gag7 = su* items & s]vices z paym5t 9 full = su* items & s]vices2 & 7#b7 cont9ue to adh]e to all policies1 proc$ures1 & quality /&>ds impos$ by su* plan or issu] ) respect to su* individual & su* items & s]vices 9 ! same mann] z if su* t]m9ation _h n occurr$4 7b7 ,p5alty 7#a7 ,9 g5]al ,ea* heal? c>e provid] or heal? c>e facility t violates a provision ( subsection 7a7 %all be subject to a civil monet>y p5alty 9 an am\nt n to exce$ #aj1jjj = ea* su* violation4 7#b7 ,application ( provisions ,! provisions ( section #aabh;,a 7o!r ?an subsection 7a71 subsection 7b71 ! fir/ s5t5ce ( subsection 7c77#a71 & subsection 7o77 %all apply ) respect to a civil monet>y p5alty impos$ "u ?is subsection 9 ! same mann] z su* provisions apply ) respect to a p5alty or proce$+ "u subsection 7a7 ( su* section4 7c7 ,def9itions ,9 ?is section1 ! t]ms heal? insurance issu]1 gr\p heal? plan1 gr\p heal? insurance cov]age1 & individual heal? insurance cov]age h ! mean+ giv5 su* t]ms1 respectively1 9 section #bgia ( ! ,public ,heal? ,s]vice ,act4 4