Tuesday, November 3, 2009

The Final House Bill--Title II--Subtitles D, E & F

Here is a summary of the remainder of Title II of the House health reform bill that I did not cover in my previous post.


Subtitle D—Additional Consumer Protections

Sec. 231. Requiring fair marketing practices by health insurers. The Commissioner shall establish uniform marketing standards all Qualified Health Benefits Providers (QHBP0 (in Exchange) must meet.

Sec. 232. Requiring fair grievance and appeals mechanisms. QHBP’s must provide timely grievance and appeals procedures including internal and external reviews.

Sec. 233. Requiring information transparency and plan disclosure. Requires QHBP’s and employer-based health plans to provide accurate and timely disclosure of plan documents, terms, conditions, claims payment polices, periodic financial disclosure, data on enrollment, claim denials, etc. Disclosures must be in plain language. Private information must be protected.

Sec. 234. Application to qualified health benefits plans not offered through the
Health Insurance Exchange. Application of this sub-titled to health insurance providers not participating in the exchange is up to Commissioner.

Sec. 235. Timely payment of claims. QHBP’s must comply with Medicare standards for timeliness of payment of claims.

Sec. 236. Standardized rules for coordination and subrogation of benefits. Commissioner to set rules for coordination of benefits involving individuals with multiple insurance plans.

Sec. 237. Application of administrative simplification. QHBP’s must comply with administrative simplification procedures of Medicare.

Sec. 238. State prohibitions on discrimination against health care providers. This act does not supersede state laws dealing with discriminatory practices when it comes to health insurance.

Sec. 239. Protection of physician prescriber information. Orders Sec of Health and Human Services to conduct a study and make recommendations to Congress on the use of physician prescriber information in sales and marketing practices of pharmaceutical manufacturers.

Sec. 240. Dissemination of advance care planning information. QHBP’s shall for the dissemination of information related to end-of-life planning to enrollees as an option. The information presented to the enrollee shall not presume the withdrawal of treatment and shall include options to maintain all or most medical interventions. No one can be required to complete an advanced directive or any other end-of-life planning document. No one may be required to consent to a restriction in the amount or scope of treatment. Nothing in this section shall be construed to promote suicide, assisted suicide, euthanasia, or mercy killing. This section does not preempt state law.

Subtitle E—Governance [In general this subtitle sets up office of Health Choices Commissioner to administer the health insurance exchanges and establishing qualified plan standards.

Sec. 241. Health Choices Administration; Health Choices Commissioner. Establishes Health Choices Administration in Executive Branch headed by Health Choices Commissioner

Sec. 242. Duties and authority of Commissioner. Spells out the duties of the Commissioner to operate the Health Insurance Exchange, conduct compliance examinations and audits, etc.

Sec. 243. Consultation and coordination. Commissioner is to coordinate his activities with State Attorneys General, National Association of Insurance Commissioners, appropriate State agencies, FTC, other Federal agencies and Indian tribes.

Sec. 244. Health Insurance Ombudsman. Creates ombudsman to receive complaints and assist individuals seeking information about the Health Insurance Exchange.

Subtitle F—Relation to Other Requirements; Miscellaneous
Sec. 251. Relation to other requirements. Does not supersede other state or Federal requirements for insurance providers not operating through the Exchange or offering employer-based plans.

Sec. 252. Prohibiting discrimination in health care. All health care and related services covered by the Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.

Sec. 253. Whistleblower protection. Whistleblowers cannot be discriminated against.

Sec. 254. Construction regarding collective bargaining. Doesn’t supersede collective bargaining agreements.

Sec. 255. Severability. If any provision of the Act is found unconstitutional, the remainder of the Act is not affected.

Sec. 256. Treatment of Hawaii Prepaid Health Care Act. Doesn’t supersede Hawaii Prepaid Health Care Act.

Sec. 257. Actions by State attorneys general. State attorneys general may bring civil actions in the name of the state on behave of natural persons residing in the state.
Sec. 258. Application of State and Federal laws regarding abortion. This Act does not supersede or change any existing state or Federal law regarding abortion nor rights and obligations of employees and employers under title VII of the Civil Rights Act of 1964.

Sec. 259. Nondiscrimination on abortion and respect for rights of conscience. Outlaws discrimination by any Federal, State or local agency that receives Federal financial assistance under the Act against any individual or agency for NOT providing, paying for or covering abortion including individual physicians, health care professionals, hospitals, health insurance plan and so on.

Sec. 260. Authority of Federal Trade Commission. FTC will prepare reports and studies to share information about the business of health insurance.

Sec. 261. Construction regarding standard of care. The development, recognition or implementation of any guideline or other standard under a provision of this subsection shall not be construed as establishing a standard of care or duty of care by health care providers to their patients in any medical malpractice action or claim.

Sec. 262. Restoring application of antitrust laws to health sector insurers. Ends health insurance industry’s exemption from antitrust laws.

Sec. 263. Study and report on methods to increase EHR use by small health care providers. The Secretary is to study potential methods for encouraging the increased use of electronic medical records through such means as providing higher rates of reimbursement to providers who use electronic records, promoting development of low-cost electronic record software, training and education on use of electronic health records, and providing assistance to providers in implementation of electronic health records. By December 31, 2013, the Secretary is to make recommendations to Congress on legislation and administrative actions needed to increase the use of medical records.

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