BIPARTISAN CHANGES MADE DURING FLOOR DEBATE TO McCAIN/EDWARDS BIPARTISAN PATIENT PROTECTION ACT (S.1052)

LIABILITY:
Warner (R-VA) Amendment -- This amendment caps attorneys= fees at one-third of a damage award, after expenses.

Snowe (R-ME)/Dewine (R-OH) Amendment -- This amendment further strengthens the bill’s language protecting employers from liability. It allows an employer to shift responsibility to a designated decision maker (DDM) and thus free itself from liability when not involved in medical decision making. A health insurance issuer is deemed to be the DDM unless the employer or plan sponsor affirmatively enters into a contract to prevent the service of the DDM.

Self-insured, self-administered plans are exempt from any liability unless they directly make a medical decision that harms or kills an employee. These plans are exempt from any liability for administrative or contractual decisions.

Bond (R-MO) Amendment -- The language added by this amendment limits the application of the liability provisions of the Act if the Institute of Medicine (IOM) finds that the application of such provisions has increased the number of uninsured individuals by more than 1 million. Studies to be done 24 months after passage of the Act and annually for four years thereafter.

Dewine (R-OH) Amendment -- This amendment further restricts the ability to file class actions. A group of claimants for a class action is limited to the participants or beneficiaries of a group health plan established by only one plan sponsor.

INTERNAL/EXTERNAL APPEALS:
Gramm (R-TX)/McCain (R-AZ) Amendment -- This amendment clarifies that nothing in the bill permits independent medical reviewers to require that plans or issuers cover specifically excluded items or services.

Thompson (R-TN) Amendment -- This amendment requires exhaustion of appeal remedies before cause of action can be brought. A participant or beneficiary may seek relief exclusively in Federal court prior to the exhaustion of administrative remedies if it is demonstrated to the court that the exhaustion of such remedies would cause irreparable harm to the health of the participant or beneficiary. If the appeals process is not completed within the statutory time limits plus 10 days, then an action may be brought.

McCain (R-AZ) Amendment -- This amendment is a Sense of the Senate that the independent external appeals process provides that any patient denied care by an HMO or other health insurance company be entitled to a fair, speedy, impartial appeal by a review organization that has not been selected by the health plan. It further stipulates that patient protection legislation should not preempt existing state laws in States where there already are strong laws in place regarding the selection of independent review organizations.

SCOPE:
Nickles (R-OK) Amendment -- This amendment applies the patient protection standards in the bill to Federal health benefits programs.

Santorum (R-PA) Amendment -- This amendment defines fetuses born alive as persons under Federal law and makes them eligible for protection under the patients= rights bill.

PROTECTION OF STATE LAWS:
Breaux (D-LA) Amendment -- This amendment clarifies that State patient protection laws shall apply rather than Federal laws so long as, pursuant to a review by the Secretary of Health and Human Services, those State laws are certified by the Secretary as being in "substantial compliance" with the federal rules. The Secretary shall give deference to States in determining whether substantial compliance has been met. This amendment replaced language in the underlying bill which had called for "substantial equivalence" between State and Federal laws.

OTHER:
Ensign (R-NV) Amendment -- This amendment stipulates that health insurance plans cannot discriminate against patients based on genetic information.

Gramm (R-TX) Amendment -- This amendment states that any explicit exclusion of benefits in the plain language or coverage documents of a health plan shall be considered to govern the scope of the benefits that may be required by the external review body: Provided, that the terms and conditions of the plan or coverage relating to such an exclusion or limit are in compliance with the requirements of law.

Hutchison (R-TX) Amendment -- This amendment requires information on how to disenroll from the health plan be included in the information provided to patients.

McCain (R-AZ) Amendment -- This Sense of the Senate amendment addresses clinical trials and access to specialty care. It states that individuals battling life-threatening diseases should have the opportunity to participate in a federally approved or funded clinical trial recommended by their physician. Further, patients should be able to appeal to an independent review body when an HMO decides that an in-network physician without the necessary expertise can provide care for a seriously ill patient and that this right should be available to all Americans in need of high quality specialty care.

Reid (D-NV) / Kennedy (D-MA) / Gregg (R-NH) Amendment -- This is the managers= technical amendment that instructs the Secretary of Health and Human Services to establish a "Health Care Consumer Assistance Fund" to be used to award grants to eligible States. These grants would allow States to carry out consumer assistance activities designed to provide information, assistance, and referrals to consumers of health insurance products.