H.R.1415 - Patient Access to Responsible Care Act of 1997105th Congress (1997-1998)
Summary: H.R.1415 — 105th Congress (1997-1998)
Introduced in House (04/23/1997)
Patient Access to Responsible Care Act of 1997 - Amends the Public Health Service Act to require a health insurance issuer to: (1) assure that covered items and services are available and accessible to each enrollee; (2) assure the availability and accessibility of emergency services and urgent care 24 hours a day, 7 days a week; (3) not require prior authorization for emergency services; and (4) cover emergency and urgent (and related ancillary) services.
Requires an issuer offering network coverage to show that enrollees have access to specialized treatment. Regulates network incentive plans.
Requires an issuer to: (1) permit each network enrollee to select a personal health professional from participating professionals; (2) cover nonparticipating providers, regulating premiums and cost sharing; (3) avoid undue enrollee burden from care coordination and cost control processes; (4) ensure direct specialist access; (5) provide for continuity of care for those with special needs or a chronic condition; and (6) provide for continued coverage in certain circumstances.
Prohibits issuer discrimination on the basis of specified factors against individuals or providers.
Prohibits any issuer-professional agreement from restricting the professional from engaging in medical communications with the professional's patient.
Sets forth requirements regarding utilization review, an appeals process, and the process by which health professionals and providers become participants.
Requires issuers to: (1) disclose certain information to enrollees and prospective enrollees; (2) comply with Federal and State confidentiality laws; (3) meet State solvency-related requirements; and (4) establish a quality improvement program.
Requires issuers to comply with this Act regarding group and individual coverage. Declares that the requirements of this Act do not preempt any State law providing equivalent or stricter protections for individuals.
Amends the Employee Retirement Income Security Act of 1974 to require a group health plan and an issuer offering coverage under such a plan to comply with the requirements of this Act. Declares that this Act does not preempt any State: (1) law providing equivalent or stricter protections for individuals; or (2) cause of action for personal injury or wrongful death damages that provides insurance or administrative services to or for an employee welfare benefit plan maintained to provide health benefits.