H.R. 2563, the "Bipartisan Patient Protection Act"
(Ganske-Dingell-Norwood-Berry)

Changes made to the Senate-passed bill

1.  Section 111 (the point-of-service provision) has been changed to include physician pathology services. Similar language is in the Fletcher and Frist bills, and the provision was in the Manager’s Amendment on the Senate debate, but it was stricken by Senate Republicans.

2.  Removed Section 122 on genetic non-discrimination. The consensus is that the provision should move on its own track.

3.  In Section 134 (prompt payment of claims), language has been added to clarify that the prompt pay provision is a floor and that states may go further as allowed under ERISA. Questions had been raised about the original language being interpreted as not allowing a state to go further.

4.  In Section 152(c)(3)(C) (the scope provision), a change was made to the Breaux-Jeffords Amendment to clarify that the Secretary shall defer to the state’s interpretation of a state patient protection law. It clarifies a concern that the Secretary could have been required to defer to the state’s interpretation of the federal law, thus making application of a federal patient protection law impossible.

5.  A new Section 157 has been added to clarify that a patient cannot be required to submit to arbitration in lieu of the rights under this bill. Patients can agree to arbitration to settle disputes after a dispute has occurred, but patients should not be required to give up their rights as a function of accepting insurance. A recent federal court ruling had brought into question that principle.

6.  Section 301 of the Senate-passed bill (the Nickles Amendment) attempted to apply the bill to all federal health programs. However, the intent and meaning of the language was very difficult to understand and in many cases was duplicative since most federal programs have these protections. It has been replaced with new language that states a Sense of Congress that, where they don’t already, the provisions should apply to all federal health insurance programs and commissions a GAO study to determine what steps would be necessary to apply the bill to all federal health insurance programs.

7.  Minor technical changes were made, including: corrects outdated reference for physician incentive plans; clarifies wording of language including National Cancer Institute grant awardees in clinical trial provision; conforms language which prohibits suit over payment disputes for care already provided in section 402.

8.  At Section 502(n)(20) of the liability provision (Section 402), language has been added to clarify that board members and trustees of health plans are not personally liable. The original language protected board members and trustees working within the scope of their employment, but many board members and trustees of health plans volunteer. Language has been added to protect those who volunteer as well.

9.  In Section 601, the effective dates have been synchronized to October 1, 2002. A concern had been raised that the effect of having the liability provision come into force before the review provisions was unworkable.

10.  Title IV of the Ganske-Dingell bill (applying the bill to the Internal Revenue Code and the access provisions) has been added to the bill.

11. After extensive negotiations with representatives of physician specialty societies, language has been added to clarify that this legislation does not create new liability for treating physicians, treating health professionals or treating hospitals.

12. Added clarifying language to make explicitly clear this bill does not apply to excepted benefits plans like long term care insurance or disability insurance.