article: SECTION 1. SHORT TITLE. This Act may be cited as the ``Prostate Testing Full Information Act''. SEC. 2. REQUIREMENT RELATING TO CERTAIN PHYSICIANS. (a) Requirement.--If a covered physician, during a physical examination, examines the prostate gland of a patient, the physician shall provide information to the patient concerning the availability of appropriate diagnostic procedures, including the prostate antigen test, if any of the following conditions are present: (1) The patient is over 50 years of age. (2) The patient manifests clinical symptomatology. (3) The patient is at an increased risk of prostate cancer. (4) The provision of the information to the patient is medically necessary, in the opinion of the physician. (b) Enforcement.--The Secretary of Health and Human Services shall promulgate regulations that-- (1) require the reporting of covered physicians that violate subsection (a) to the Secretary; and (2) provide for the application of sanctions to enforce the provisions of subsection (a). (c) Definition.--In this section, the term ``covered physician'' means a physician as defined in section 1861(r) of the Social Security Act (42 U.S.C. 1395x(r)) who has received any Federal payment or assistance under any program under-- (1) the Public Health Service Act (42 U.S.C. 201 et seq.); or (2) the Social Security Act (42 U.S.C. 301 et seq.). SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974. (a) In General.--Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (as added by section 603(a) of the Newborns' and Mothers' Health Protection Act of 1996 and amended by section 702(a) of the Mental Health Parity Act of 1996) is amended by adding at the end the following: ``SEC. 713. REQUIREMENT RELATING TO PROSTATE SPECIFIC ANTIGEN TEST. ``(a) Requirement.--If a physician, during a physical examination, examines the prostate gland of a patient, the physician shall provide information to the patient concerning the availability of appropriate diagnostic procedures, including the prostate antigen test, if any of the following conditions are present: ``(1) The patient is over 50 years of age. ``(2) The patient manifests clinical symptomatology. ``(3) The patient is at an increased risk of prostate cancer, as determined pursuant to regulations promulgated by the Secretary of Health and Human Services. ``(4) The provision of the information to the patient is medically necessary, in the opinion of the physician. ``(b) Prohibition on Limitation.--The provision of information in accordance with subsection (a) may not be prohibited under the terms of-- ``(1) any written contract or written agreement between the physician and any group health plan, any health insurance issuer providing health insurance coverage in connection with a group health plan, or any related party with respect to a group health plan; or ``(2) any written statement from the plan, issuer, or related party to the physician. ``(c) Rule of Construction.--Nothing in this section shall be construed as requiring a group health plan or a health insurance issuer providing health insurance coverage in connection with a group health plan to provide coverage for prostate specific antigen tests. ``(d) Definition.--In this section, the term `physician' has the meaning given such term in section 1861(r) of the Social Security Act (42 U.S.C. 1395x(r)).''. (b) Clerical Amendment.--The table of contents in section 1 of such Act, as amended by section 603 of the Newborns' and Mothers' Health Protection Act of 1996 and section 702 of the Mental Health Parity Act of 1996, is amended by inserting after the item relating to section 712 the following new item: ``Sec. 713. Requirement relating to prostate specific antigen test.''. (c) Effective Date.--The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 1998. SEC. 4. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT RELATING TO THE GROUP MARKET. (a) In General.--Subpart 2 of part A of title XXVII of the Public Health Service Act (as added by section 604(a) of the Newborns' and Mothers' Health Protection Act of 1996 and amended by section 703(a) of the Mental Health Parity Act of 1996) is amended by adding at the end the following new section: ``SEC. 2706. REQUIREMENT RELATING TO PROSTATE SPECIFIC ANTIGEN TEST. ``(a) Requirement.--If a physician, during a physical examination, examines the prostate gland of a patient, the physician shall provide information to the patient concerning the availability of appropriate diagnostic procedures, including the prostate antigen test, if any of the following conditions are present: ``(1) The patient is over 50 years of age. ``(2) The patient manifests clinical symptomatology. ``(3) The patient is at an increased risk of prostate cancer, as determined pursuant to regulations promulgated by the Secretary of Health and Human Services. ``(4) The provision of the information to the patient is medically necessary, in the opinion of the physician. ``(b) Prohibition on Limitation.--The provision of information in accordance with subsection (a) may not be prohibited under the terms of-- ``(1) any written contract or written agreement between the physician and any group health plan, any health insurance issuer providing health insurance coverage in connection with a group health plan, or any related party with respect to a group health plan; or ``(2) any written statement from the plan, issuer, or related party to the physician. ``(c) Rule of Construction.--Nothing in this section shall be construed as requiring a group health plan or a health insurance issuer providing health insurance coverage in connection with a group health plan to provide coverage for prostate specific antigen tests. ``(d) Definition.--In this section, the term `physician' has the meaning given such term in section 1861(r) of the Social Security Act (42 U.S.C. 1395x(r)).''. (b) Effective Date.--The amendments made by this section shall apply with respect to group health plans for plan years beginning on or after January 1, 1998. SEC. 5. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT RELATING TO THE INDIVIDUAL MARKET. (a) In General.--Subpart 3 of part B of title XXVII of the Public Health Service Act (as added by section 605(a) of the Newborn's and Mother's Health Protection Act of 1996) is amended by adding at the end the following new section: ``SEC. 2752. REQUIREMENT RELATING TO PROSTATE SPECIFIC ANTIGEN TEST. ``The provisions of section 2706 shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as they apply to health insurance coverage offered by a health insurance issuer in connection with a group health plan in the small or large group market.''. (b) Effective Date.--The amendment made by this section shall apply with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market on or after January 1, 1998. SEC. 6. RESEARCH AND EDUCATION REGARDING PROSTATE CANCER; CERTAIN PROGRAMS OF THE PUBLIC HEALTH SERVICE. (a) National Institutes of Health.--Section 417B(c) of the Public Health Service Act (42 U.S.C. 286a-8(c)) is amended in the first sentence by striking ``$72,000,000'' and all that follows and inserting the following: ``$90,250,000 for fiscal year 1998, $108,500,000 for fiscal year 1999, $126,500,000 for fiscal year 2000, and $145,000,000 for fiscal year 2001.''. (b) Agency for Health Care Policy and Research.--Section 902 of the Public Health Service Act (42 U.S.C. 299a) is amended by adding at the end the following: ``(f) Activities Regarding Prostate Cancer.--The Administrator shall, with respect to prostate cancer-- ``(1) conduct and support research on the outcomes, effectiveness, and appropriateness of health services and procedures; and ``(2) in carrying out section 912(a), provide for the development, periodic review, and updating of clinically relevant guidelines, standards of quality, performance measures, and medical review criteria.''.
summary: Prostate Testing Full Information Act - Requires any physician who has received any Federal payment or assistance under any program under the Public Health Service Act or the Social Security Act, if the physician examines a patient's prostate gland, to provide information on appropriate diagnostic procedures, including the prostate antigen test, if: (1) the patient is over 50, manifests clinical symptoms, or is at increased risk of prostate cancer; or (2) the provision of the information is, in the opinion of the physician, medically necessary. Amends the Employee Retirement Income Security Act of 1974 and the Public Health Service Act to impose the same requirement as above and to declare that such information may not be prohibited under the terms of: (1) any agreement between the physician and any group health plan, insurance issuer providing group health coverage, or related party; or (2) any written statement from the plan, issuer, or related party. Amends the Public Health Service Act to declare that such information may not be prohibited under those terms by an issuer in the individual market. Authorizes appropriations to carry out provisions relating to National Cancer Institute prostate cancer research. Requires the Agency for Health Care Policy and Research, with regard to prostate cancer, to: (1) conduct and support research on the outcomes, effectiveness, and appropriateness of health services and procedures; and (2) in carrying out provisions relating to the Forum for Quality and Effectiveness in Health Care, provide for the development, review, and updating of clinically relevant guidelines, quality standards, performance measures, and medical review criteria.