article: SECTION 1. SHORT TITLE. This Act may be cited as the ``Federal Employees Health Benefits Access Act''. SEC. 2. PROVISIONS TO MAKE FEHBP AVAILABLE TO THE GENERAL PUBLIC. (a) In General.--Chapter 89 of title 5, United States Code, is amended by adding at the end the following: ``Sec. 8915. Provisions to require that benefits be extended to the general public ``(a) A contract may not be made or a plan approved unless the carrier agrees to offer to the general public, throughout each term for which the contract or approval remains effective, the same benefits (subject to the same maximums, limitations, exclusions, and other similar terms or conditions) as would be offered under such contract or plan to employees and annuitants and their family members. ``(b)(1) Premiums for coverage under this section shall be established in conformance with such requirements as the Office of Personnel Management shall by regulation prescribe, including provisions to ensure conformance with generally accepted standards and practices associated with community rating. ``(2) In no event shall the enactment of this section result in-- ``(A) any increase in the level of individual or Government contributions required under section 8906 or any other provision of this chapter, including copayments or deductibles; ``(B) any decrease in the types of benefits offered under this chapter; or ``(C) any other change that would adversely affect the coverage afforded under this chapter to employees and annuitants and their family members. ``(c) Benefits under this section shall, with respect to an individual who is entitled to benefits under part A of title XVIII of the Social Security Act, be offered (for use in coordination with those Social Security benefits) to the same extent and in the same manner as if coverage were under the preceding provisions of this chapter, rather than under this section. ``(d)(1) A carrier may file an application with the Office setting forth reasons why it, or a plan provided by such carrier, should be excluded from the requirements of this section. ``(2) In reviewing any such application, the Office may consider such factors as-- ``(A) any bona fide enrollment restrictions which would make the application of this section inappropriate, including those common to plans which are limited to individuals having a past or current employment relationship with a particular agency or other authority of the Government; ``(B) whether compliance with this section would jeopardize the financial solvency of the plan or carrier, or otherwise compromise its ability to offer health benefits under the preceding provisions of this chapter; and ``(C) the anticipated duration of the requested exclusion, and what efforts the plan or carrier proposes to take in order to be able to comply with this section. ``(e) Except as the Office may by regulation prescribe, any reference to this chapter (or any requirement of this chapter), made in any provision of law, shall not be considered to include this section (or any requirement of this section).''. (b) Conforming Amendment.--The table of sections for chapter 89 of title 5, United States Code, is amended by adding at the end the following: ``8915. Provisions to require that benefits be extended to the general public.''. SEC. 3. STANDARDIZED CLAIMS PROCESSING. Section 8902 of title 5, United States Code, is amended by adding at the end the following: ``(o) A claim for payment or reimbursement under this chapter (whether electronic or otherwise) shall be submitted on such a standard form or in such a standard manner as may be required by the Office in relation to health benefit plans. Each contract under this chapter shall include appropriate provisions to carry out the preceding sentence.''. SEC. 4. ADVANCE DIRECTIVES. Section 8907 of title 5, United States Code, is amended by adding at the end the following: ``(c) The Office shall-- ``(1) prepare information relating to the use of advance directives regarding the type or intensity of care which an individual desires in the event that such individual becomes unable to communicate by reason of incapacity due to illness or injury; and ``(2) require, as a condition for approval of any contract under section 8902, that appropriate provisions be included so that such information may be made available to enrollees of the plan involved.''. SEC. 5. DEMONSTRATION PROJECT TO EXAMINE THE FEASIBILITY OF OFFERING FEHBP ENROLLEES THE OPTION OF USING ARBITRATION INSTEAD OF LITIGATION TO RESOLVE MEDICAL MALPRACTICE CLAIMS. (a) In General.--The Office of Personnel Management shall conduct a demonstration project to assess the feasibility and desirability of offering the use of arbitration, instead of litigation, to resolve medical malpractice claims arising out of covered health care services. (b) Definition.--For the purpose of this section, the term ``covered health care services'' means any care, treatment, or other service for which the individual who receives such service has coverage under chapter 89 of title 5, United States Code. (c) Project Requirements.-- (1) In general.--The demonstration project shall be conducted as a demonstration project under section 4703 of title 5, United States Code. (2) Plan design.--In developing a plan for such project under section 4703 of title 5, United States Code, the Office shall include (in addition to any information otherwise required)-- (A) suggestions for incentives that may be offered in order to obtain the voluntary participation of enrollees, such as reductions in premiums, copayments, or deductibles; (B) the criteria for identifying the types of health benefit plans which are appropriate for inclusion, and the procedures and conditions in accordance with which any such plan may participate; (C) the general framework for arbitration, including (to the extent the Office considers appropriate) methods for the selection of arbitrators, length of hearings, and limitations on damages; and (D) the effect of an award resulting from the arbitration process, and the extent to which review of such an award may be obtained. (d) Evaluation.--The evaluation required under section 4703(h) of title 5, United States Code, with respect to the demonstration project shall include data and analysis relating to matters such as-- (1) the number of claims brought for arbitration; (2) how those claims were disposed of (whether by settlement, hearing, or otherwise), and the percentage of the total number of claims represented by each; (3) the average dollar amount of those awards or settlements; (4) the various costs involved in connection with those claims; and (5) the advantages and disadvantages of arbitration, relative to other methods of dispute resolution, and the extent to which arbitration should continue to be used under chapter 89 of such title. SEC. 6. APPLICABILITY. The amendments made by this Act shall apply with respect to contract terms beginning after the end of the 6-month period beginning on the date of the enactment of this Act.
summary: Federal Employees Health Benefits Access Act - Prohibits a Government health services contract from being made or a plan approved unless the carrier agrees to offer to the general public the same benefits as would be offered under such contract or plan to Federal employees and annuitants and their family members. Requires premiums for coverage to be established in conformance with such requirements as the Office of Personnel Management (OPM) shall prescribe. Specifies that in no event shall this Act's enactment result in any: (1) increase in the level of individual or Government contributions required, including copayments or deductibles; (2) decrease in the types of benefits offered; or (3) other change that would adversely affect the coverage afforded to employees and annuitants and their family members. Permits a carrier to file an application with OPM setting forth reasons why it, or a plan provided by such carrier, should be excluded from the requirements of this Act. Allows OPM, in reviewing any such application, to consider such factors as: (1) any bona fide enrollment restrictions which would make the application of this Act inappropriate; (2) whether compliance would jeopardize the financial solvency of the plan or carrier or otherwise compromise its ability to offer health benefits; and (3) the anticipated duration of the requested exclusion and what efforts the plan or carrier proposes to take in order to be able to comply with this Act. Requires a claim for payment or reimbursement to be submitted on a standard form or in a standard manner as may be required by OPM in relation to health benefit plans. Directs OPM to: (1) prepare information relating to the use of advance directives regarding the type or intensity of care which an individual desires in the event that such individual becomes unable to communicate by reason of incapacity due to illness or injury; and (2) require, as a condition for contract approval, that appropriate provisions be included so that such information may be made available to enrollees of the plan involved. Requires OPM to conduct a demonstration project to assess the feasibility and desirability of offering the use of arbitration, instead of litigation, to resolve medical malpractice claims arising out of covered health care services. Sets forth provisions regarding project requirements and evaluation.