article: SECTION 1. SHORT TITLE. This Act may be cited as the ``Hippocratic Oath and Patient Protection Act of 1996''. SEC. 2. DUTIES OF A HEALTH CARRIER. Under a contract or agreement with a health care provider or enrollee, a health carrier-- (1) shall not-- (A) prevent or limit a health care provider's protected communication to a patient or the public as described in section 3; (B) operate an improper incentive plan as described in section 4; or (C) include indemnification clauses as described in section 5; and (2) shall disclose (in plain English understandable by a layperson) to a health care provider and to an enrollee-- (A) a list of all services and benefits offered under the health plan, including any service or benefit maximum, limitation, or exclusion; (B) the procedures used in authorizing, approving, limiting, or denying services or benefits under the health plan; and (C) any health care provider incentive plan as described in section 4(b) that exists under the contract or agreement. SEC. 3. PROTECTED COMMUNICATION. (a) In General.--Except as limited in subsection (b), for purposes of section 2(1)(A) a protected communication is a communication of information relevant to the care or course of treatment of a patient. (b) Limitations.--Such a protected communication does not include-- (1) a trade secret; or (2) a knowing misrepresentation by a health care provider. SEC. 4. IMPROPER HEALTH CARE PROVIDER INCENTIVE PLAN. (a) In General.--For purposes of section 2(1)(B), a health care provider incentive plan is improper, unless such plan meets the requirements of section 1876(i)(8)(A) of the Social Security Act (42 U.S.C. 1395mm(i)(8)(A)) for physician incentive plans in contracts with eligible organizations under section 1876 of such Act. (b) Incentive Plan Defined.--The term ``health care provider incentive plan'' means any compensation or other financial arrangement between a health carrier and a health care provider that may directly or indirectly have the effect of limiting services provided with respect to an enrollee. SEC. 5. PROHIBITED INDEMNIFICATION CLAUSES. For purposes of section 2(1)(C), a prohibited indemnification clause is any provision to indemnify a health carrier against liability from a civil action brought by, or on behalf of, an enrollee or a health care provider for any damage caused to the enrollee or the health care provider by the health carrier. SEC. 6. ENFORCEMENT. (a) In General.--The Secretary of Health and Human Services may impose upon a health carrier who violates a provision of this Act a civil money penalty of-- (1) up to $25,000 for each violation, or (2) up to $100,000 for each violation if the Secretary determines that the health carrier has engaged, within the 5 years immediately preceding such violation, in a pattern of such violations. (b) Procedures.--Subsections (c) through (l) of section 1128A of the Social Security Act (42 U.S.C. 1320a-7a) apply to a civil penalty under this paragraph in the same manner as they apply to a civil penalty under section 1128A(a) of such Act. SEC. 7. PRIVATE CAUSE OF ACTION. Whoever is aggrieved by a violation of this Act may in a civil action obtain appropriate relief. SEC. 8. REPORT TO CONGRESS. (a) In General.--Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit a report to Congress that evaluates-- (1) the impact of this Act on health carriers, health care providers, and enrollees; and (2) the enforcement of this Act by the Secretary. (b) Recommendations.--The Secretary shall include in the report required under subsection (a) recommendations for such changes as may be needed to ensure compliance by health carriers with this Act. SEC. 9. DEFINITIONS. As used in this Act-- (1) the term ``health plan'' means any public or private entity or program that provides for payments for health care, including-- (A) a group health plan (as defined in section 607 of the Employee Retirement Income Security Act of 1974) or a multiple employer welfare arrangement (as defined in section 3(40) of such Act) that provides health benefits; (B) any other health insurance arrangement, including any arrangement consisting of a hospital or medical expense incurred policy or certificate, hospital or medical service plan contract, or health maintenance organization subscriber contract; (C) workers' compensation or similar insurance to the extent that it relates to workers' compensation medical benefits (as defined by the Federal Trade Commission); and (D) automobile medical insurance to the extent that it relates to medical benefits (as defined by the Federal Trade Commission); (2) the term ``health care provider'' means a person who contracts with a health carrier to provide health care services to enrollees; (3) the term ``health carrier'' means a person who contracts or offers to contract on a risk-assuming basis-- (A) to provide, deliver, or arrange for health care services; or (B) to pay for or reimburse any of the cost of health care services; and (4) the term ``enrollee'' means a person enrolled under a health plan. SEC. 10. EFFECTIVE DATES. (a) Subsections 2(1) (A) and (C) shall take effect on the date of the enactment of this Act, and apply to contracts or agreements entered into or renewed before, on, or after the date of the enactment of this Act. (b) Subsections 2(1)(B) and 2(2) shall take effect 90 days after the date of the enactment of this Act, and apply to contracts or agreements entered into or renewed before, on, or after the date of the enactment of this Act.
summary: Hippocratic Oath and Patient Protection Act of 1996 - Prohibits health carriers, in contracts with providers or enrollees, from: (1) preventing or limiting provider communications to a patient or the public; (2) operating an incentive plan that does not meet requirements of specified provisions of title XVIII (Medicare) of the Social Security Act; or (3) including a provision to indemnify a carrier against liability from an action brought by or for an enrollee or provider for damage caused to the enrollee or provider by the carrier. Requires carriers to disclose in plain English: (1) a list of all services and benefits offered; (2) procedures used by the plan; and (3) any existing incentive plan. Mandates a civil monetary penalty and authorizes a private cause of action for violations.