article: SECTION 1. SHORT TITLE; FINDINGS. (a) Short Title.--This Act may be cited as the ``Patient Right to Know Act''. (b) Findings.--Congress finds the following: (1) Patients need access to all relevant information to make appropriate decisions about their health care. (2) Open medical communications between health care providers and their patients is a key to prevention and early diagnosis and treatment, as well as to informed consent and quality, cost-effective care. (3) Open medical communications are in the best interests of patients. (4) Open medical communications must meet applicable legal and ethical standards of care. (5) It is critical that health care providers continue to exercise their best medical, ethical, and moral judgment in advising patients without interference from health plans. (6) The offering and operation of health plans affect commerce among the States. (c) Purpose.--It is the purpose of this Act to establish a Federal standard that protects medical communications between health care providers and patients. SEC. 2. PROHIBITION OF INTERFERENCE WITH CERTAIN MEDICAL COMMUNICATIONS. (a) Prohibition.-- (1) General rule.--The provisions of any contract or agreement, or the operation of any contract or agreement, between an entity operating a health plan (including any partnership, association, or other organization that enters into or administers such a contract or agreement) and a health care provider (or group of health care providers) shall not prohibit or restrict the provider from engaging in medical communications with his or her patient. (2) Nullification.--Any contract provision or agreement described in paragraph (1) shall be null and void. (3) Prohibition on provisions.--Effective on the date described in section 5, a contract or agreement described in paragraph (1) shall not include a provision that violates paragraph (1). (b) Rules of Construction.--Nothing in this Act shall be construed-- (1) to prohibit the enforcement, as part of a contract or agreement to which a health care provider is a party, of any mutually agreed upon terms and conditions, including terms and conditions requiring a health care provider to participate in, and cooperate with, all programs, policies, and procedures developed or operated by a health plan to assure, review, or improve the quality and effective utilization of health care services (if such utilization is according to guidelines or protocols that are based on clinical or scientific evidence and the professional judgment of the provider) but only if the guidelines or protocols under such utilization do not prohibit or restrict medical communications between providers and their patients; or (2) to permit a health care provider to misrepresent the scope of benefits covered under a health plan or to otherwise require the plan to reimburse providers for benefits not covered under the plan (c) Enforcement.-- (1) State authority.--Except as otherwise provided in this subsection, each State shall enforce the provisions of this Act with respect to health insurance issuers that issue, sell, renew, or offer health plans in the State. (2) Enforcement by secretary.-- (A) In general.--Effective on January 1, 1998, if the Secretary, after consultation with the chief executive officer of a State and the insurance commissioner or chief insurance regulatory official of the State, determines that the State has failed to substantially enforce the requirements of this Act with respect to health insurance issuers in the State, the Secretary shall enforce the requirements of this Act with respect to such State. (B) Enforcement through imposition of civil money penalty.-- (i) In general.--With respect to a State in which the Secretary is enforcing the requirements of this Act, an entity operating a health plan in that State that violates subsection (a) shall be subject to a civil money penalty of up to $25,000 for each such violation. (ii) Procedures.--For purposes of imposing a civil money penalty under clause (i), the provisions of subparagraphs (C) through (G) of section 2722(b)(2) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 300gg-22(b)(2)) shall apply except that the provisions of clause (i) of subparagraph (C) of such section shall not apply. (3) Self-insured plans.--Effective on January 1, 1998, the Secretary of Labor shall enforce the requirements of this section in the case of a health plan not subject to State regulation by reason of section 514(b) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1144(b)). (4) Rule of construction.--Nothing in this Act shall be construed to affect or modify the provisions of section 514 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1144). (d) No Preemption of More Protective Laws.--A State may establish or enforce requirements with respect to the protection of medical communications, but only if such requirements are equal to or more protective of such communications than the requirements established under this section. SEC. 3. DEFINITIONS. In this Act: (1) Health care provider.--The term ``health care provider'' means anyone licensed or certified under State law to provide health care services who is operating within the scope of such license. (2) Health insurance issuer.--The term ``health insurance issuer'' has the meaning given such term in section 2791(b)(2) of the Public Health Service Act (as added by the Health Insurance Portability and Accountability Act of 1996). (3) Health plan.--The term ``health plan'' means a group health plan (as defined in section 2791(a) of the Public Health Service Act (as added by the Health Insurance Portability and Accountability Act of 1996)) and any individual health insurance (as defined in section 2791(b)(5)) operated by a health insurance issuer and includes any other health care coverage provided through a private or public entity. In the case of a health plan that is an employee welfare benefit plan (as defined in section 3(1) of the Employee Retirement Income Security Act of 1974), any third party administrator or other person with responsibility for contracts with health care providers under the plan shall be considered, for purposes of enforcement under this section, to be a health insurance issuer operating such health plan. (4) Medical communication.-- (A) In general.--The term ``medical communication'' means any communication made by a health care provider with a patient of the health care provider (or the guardian or legal representative of such patient) with respect to-- (i) the patient's health status, medical care, or legal treatment options; (ii) any utilization review requirements that may affect treatment options for the patient; or (iii) any financial incentives that may affect the treatment of the patient. (B) Misrepresentation.--The term ``medical communication'' does not include a communication by a health care provider with a patient of the health care provider (or the guardian or legal representative of such patient) if the communication involves a knowing or willful misrepresentation by such provider. (5) Secretary.--The term ``Secretary'' means the Secretary of Health and Human Services. SEC. 4. EFFECTIVE DATE. This Act shall take effect on the date of enactment of this Act, except that section 2(a)(3) shall take effect 180 days after such date of enactment.
summary: Patient Right to Know Act - Prohibits any contract or agreement, or the operation of any contract or agreement, between an entity operating a health plan (including any partnership, association, or other organization that enters into or administers such a contract or agreement) and a health care provider (or group of health care providers) from prohibiting or restricting the provider from engaging in medical communications with his or her patient. Requires that each State shall enforce this Act with respect to health insurance issuers that sell, renew, or offer health plans in the State. Provides for enforcement of this Act by the Secretary of Health and Human Services if the Secretary, after consultation with the chief executive officer of a State and the insurance commissioner or chief insurance regulatory official of the State, determines that the State has failed to substantially enforce the requirements. Mandates a civil money penalty. Allows State requirements equal to or more protective of medical communications than the requirements of this Act. Defines "medical communication" as being a communication between a provider and a patient (or the patient's guardian or legal representative) regarding the patient's health status, medical care, or legal treatment options.