2000
<PRE>[DOCID: f:h1747enr.txt]
        H.R.1747

                       One Hundred Fourth Congress

                                 of the

                        United States of America


                          AT THE FIRST SESSION

         Begun and held at the City of Washington on Wednesday,
  the fourth day of January, one thousand nine hundred and ninety-five


                                 An Act


 
To amend the Public Health Service Act to permanently extend and clarify 
    malpractice coverage for health centers, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; REFERENCES.

    (a) Short Title.--This Act may be cited as the ``Federally 
Supported Health Centers Assistance Act of 1995''.
    (b) References.--Except as otherwise expressly provided, whenever 
in this Act an amendment or repeal is expressed in terms of an 
amendment to, or repeal of, a section or other provision, the reference 
shall be considered to be made to a section or other provision of the 
Public Health Service Act.

SEC. 2. PERMANENT EXTENSION OF PROGRAM.

    (a) In General.--Section 224(g)(3) (42 U.S.C. 233(g)(3)) is amended 
by striking the last sentence.
    (b) Conforming Amendments.--Section 224(k) (42 U.S.C. 233(k)) is 
amended--
        (1) in paragraph (1)(A)--
            (A) by striking ``For each of the fiscal years 1993, 1994, 
        and 1995'' and inserting ``For each fiscal year''; and
            (B) by striking ``(except'' and all that follows through 
        ``thereafter)''; and
        (2) in paragraph (2), by striking ``for each of the fiscal 
    years 1993, 1994, and 1995'' and inserting ``for each fiscal 
    year''.

SEC. 3. CLARIFICATION OF COVERAGE.

    Section 224 (42 U.S.C. 233) is amended--
        (1) in subsection (g)(1), by striking ``an entity described in 
    paragraph (4)'' in the first sentence and all that follows through 
    ``contractor'' in the second sentence and inserting the following: 
    ``an entity described in paragraph (4), and any officer, governing 
    board member, or employee of such an entity, and any contractor of 
    such an entity who is a physician or other licensed or certified 
    health care practitioner (subject to paragraph (5)), shall be 
    deemed to be an employee of the Public Health Service for a 
    calendar year that begins during a fiscal year for which a transfer 
    was made under subsection (k)(3) (subject to paragraph (3)). The 
    remedy against the United States for an entity described in 
    paragraph (4) and any officer, governing board member, employee, or 
    contractor''; and
        (2) in subsection (k)(3), by inserting ``governing board 
    member,'' after ``officer,''.

SEC. 4. COVERAGE FOR SERVICES FURNISHED TO INDIVIDUALS OTHER THAN 
              CENTER PATIENTS.

    Section 224(g)(1) (42 U.S.C. 233(g)) is amended--
        (1) by redesignating paragraph (1) as paragraph (1)(A); and
        (2) by adding at the end thereof the following:
    ``(B) The deeming of any entity or officer, governing board member, 
employee, or contractor of the entity to be an employee of the Public 
Health Service for purposes of this section shall apply with respect to 
services provided--
        ``(i) to all patients of the entity, and
        ``(ii) subject to subparagraph (C), to individuals who are not 
    patients of the entity.
    ``(C) Subparagraph (B)(ii) applies to services provided to 
individuals who are not patients of an entity if the Secretary 
determines, after reviewing an application submitted under subparagraph 
(D), that the provision of the services to such individuals--
        ``(i) benefits patients of the entity and general populations 
    that could be served by the entity through community-wide 
    intervention efforts within the communities served by such entity;
        ``(ii) facilitates the provision of services to patients of the 
    entity; or
        ``(iii) are otherwise required under an employment contract (or 
    similar arrangement) between the entity and an officer, governing 
    board member, employee, or contractor of the entity.''.

SEC. 5. APPLICATION PROCESS.

    (a) Application Requirement.--Section 224(g)(1) (42 U.S.C. 
233(g)(1)) (as amended by section 4) is further amended--
        (1) in subparagraph (A), by inserting after ``For purposes of 
    this section'' the following: ``and subject to the approval by the 
    Secretary of an application under subparagraph (D)''; and
        (2) by adding at the end thereof the following:
    ``(D) The Secretary may not under subparagraph (A) deem an entity 
or an officer, governing board member, employee, or contractor of the 
entity to be an employee of the Public Health Service for purposes of 
this section, and may not apply such deeming to services described in 
subparagraph (B)(ii), unless the entity has submitted an application 
for such deeming to the Secretary in such form and such manner as the 
Secretary shall prescribe. The application shall contain detailed 
information, along with supporting documentation, to verify that the 
entity, and the officer, governing board member, employee, or 
contractor of the entity, as the case may be, meets the requirements of 
subparagraphs (B) and (C) of this paragraph and that the entity meets 
the requirements of paragraphs (1) through (4) of subsection (h).
    ``(E) The Secretary shall make a determination of whether an entity 
or an officer, governing board member, employee, or contractor of the 
entity is deemed to be an employee of the Public Health Service for 
purposes of this section within 30 days after the receipt of an 
application under subparagraph (D). The determination of the Secretary 
that an entity or an officer, governing board member, employee, or 
contractor of the entity is deemed to be an employee of the Public 
Health Service for purposes of this section shall apply for the period 
specified by the Secretary under subparagraph (A).
    ``(F) Once the Secretary makes a determination that an entity or an 
officer, governing board member, employee, or contractor of an entity 
is deemed to be an employee of the Public Health Service for purposes 
of this section, the determination shall be final and binding upon the 
Secretary and the Attorney General and other parties to any civil 
action or proceeding. Except as provided in subsection (i), the 
Secretary and the Attorney General may not determine that the provision 
of services which are the subject of such a determination are not 
covered under this section.
    ``(G) In the case of an entity described in paragraph (4) that has 
not submitted an application under subparagraph (D):
        ``(i) The Secretary may not consider the entity in making 
    estimates under subsection (k)(1).
        ``(ii) This section does not affect any authority of the entity 
    to purchase medical malpractice liability insurance coverage with 
    Federal funds provided to the entity under section 329, 330, 340, 
    or 340A.
    ``(H) In the case of an entity described in paragraph (4) for which 
an application under subparagraph (D) is in effect, the entity may, 
through notifying the Secretary in writing, elect to terminate the 
applicability of this subsection to the entity. With respect to such 
election by the entity:
        ``(i) The election is effective upon the expiration of the 30-
    day period beginning on the date on which the entity submits such 
    notification.
        ``(ii) Upon taking effect, the election terminates the 
    applicability of this subsection to the entity and each officer, 
    governing board member, employee, and contractor of the entity.
        ``(iii) Upon the effective date for the election, clauses (i) 
    and (ii) of subparagraph (G) apply to the entity to the same extent 
    and in the same manner as such clauses apply to an entity that has 
    not submitted an application under subparagraph (D).
        ``(iv) If after making the election the entity submits an 
    application under subparagr
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aph (D), the election does not preclude 
    the Secretary from approving the application (and thereby restoring 
    the applicability of this subsection to the entity and each 
    officer, governing board member, employee, and contractor of the 
    entity, subject to the provisions of this subsection and the 
    subsequent provisions of this section.''.
    (b) Approval Process.--Section 224(h) (42 U.S.C. 233(h)) is 
amended--
        (1) in the matter preceding paragraph (1), by striking 
    ``Notwithstanding'' and all that follows through ``entity--'' and 
    inserting the following: ``The Secretary may not approve an 
    application under subsection (g)(1)(D) unless the Secretary 
    determines that the entity--''; and
        (2) by striking ``has fully cooperated'' in paragraph (4) and 
    inserting ``will fully cooperate''.
    (c) Delayed Applicability for Current Participants.--If, on the day 
before the date of the enactment of this Act, an entity was deemed to 
be an employee of the Public Health Service for purposes of section 
224(g) of the Public Health Service Act, the condition under paragraph 
(1)(D) of such section (as added by subsection (a) of this section) 
that an application be approved with respect to the entity does not 
apply until the expiration of the 180-day period beginning on such 
date.

SEC. 6. TIMELY RESPONSE TO FILING OF ACTION OR PROCEEDING.

    Section 224 (42 U.S.C. 233) is amended by adding at the end thereof 
the following subsection:
    ``(l)(1) If a civil action or proceeding is filed in a State court 
against any entity described in subsection (g)(4) or any officer, 
governing board member, employee, or any contractor of such an entity 
for damages described in subsection (a), the Attorney General, within 
15 days after being notified of such filing, shall make an appearance 
in such court and advise such court as to whether the Secretary has 
determined under subsections (g) and (h), that such entity, officer, 
governing board member, employee, or contractor of the entity is deemed 
to be an employee of the Public Health Service for purposes of this 
section with respect to the actions or omissions that are the subject 
of such civil action or proceeding. Such advice shall be deemed to 
satisfy the provisions of subsection (c) that the Attorney General 
certify that an entity, officer, governing board member, employee, or 
contractor of the entity was acting within the scope of their 
employment or responsibility.
    ``(2) If the Attorney General fails to appear in State court within 
the time period prescribed under paragraph (1), upon petition of any 
entity or officer, governing board member, employee, or contractor of 
the entity named, the civil action or proceeding shall be removed to 
the appropriate United States district court. The civil action or 
proceeding shall be stayed in such court until such court conducts a 
hearing, and makes a determination, as to the appropriate forum or 
procedure for the assertion of the claim for damages described in 
subsection (a) and issues an order consistent with such 
determination.''.

SEC. 7. APPLICATION OF COVERAGE TO MANAGED CARE PLANS.

    Section 224 (42 U.S.C. 223) (as amended by section 6) is amended by 
adding at the end thereof the following subsection:
    ``(m)(1) An entity or officer, governing board member, employee, or 
contractor of an entity described in subsection (g)(1) shall, for 
purposes of this section, be deemed to be an employee of the Public 
Health Service with respect to services provided to individuals who are 
enrollees of a managed care plan if the entity contracts with such 
managed care plan for the provision of services.
    ``(2) Each managed care plan which enters into a contract with an 
entity described in subsection (g)(4) shall deem the entity and any 
officer, governing board member, employee, or contractor of the entity 
as meeting whatever malpractice coverage requirements such plan may 
require of contracting providers for a calendar year if such entity or 
officer, governing board member, employee, or contractor of the entity 
has been deemed to be an employee of the Public Health Service for 
purposes of this section for such calendar year. Any plan which is 
found by the Secretary on the record, after notice and an opportunity 
for a full and fair hearing, to have violated this subsection shall 
upon such finding cease, for a period to be determined by the 
Secretary, to receive and to be eligible to receive any Federal funds 
under titles XVIII or XIX of the Social Security Act.
    ``(3) For purposes of this subsection, the term `managed care plan' 
shall mean health maintenance organizations and similar entities that 
contract at-risk with payors for the provision of health services or 
plan enrollees and which contract with providers (such as entities 
described in subsection (g)(4)) for the delivery of such services to 
plan enrollees.''.

SEC. 8. COVERAGE FOR PART-TIME PROVIDERS UNDER CONTRACTS.

    Section 224(g)(5)(B) (42 U.S.C. 223(g)(5)(B)) is amended to read as 
follows:
        ``(B) in the case of an individual who normally performs an 
    average of less than 32\1/2\ hours of services per week for the 
    entity for the period of the contract, the individual is a licensed 
    or certified provider of services in the fields of family practice, 
    general internal medicine, general pediatrics, or obstetrics and 
    gynecology.''.

SEC. 9. DUE PROCESS FOR LOSS OF COVERAGE.

    Section 224(i)(1) (42 U.S.C. 233(i)(1)) is amended by striking 
``may determine, after notice and opportunity for a hearing'' and 
inserting ``may on the record determine, after notice and opportunity 
for a full and fair hearing''.

SEC. 10. AMOUNT OF RESERVE FUND.

    Section 224(k)(2) (42 U.S.C. 223(k)(2)) is amended by striking 
``$30,000,000'' and inserting ``$10,000,000''.

SEC. 11. REPORT ON RISK EXPOSURE OF COVERED ENTITIES.

    Section 224 (as amended by section 7) is amended by adding at the 
end thereof the following subsection:
    ``(n)(1) Not later than one year after the date of the enactment of 
the Federally Supported Health Centers Assistance Act of 1995, the 
Comptroller General of the United States shall submit to the Congress a 
report on the following:
        ``(A) The medical malpractice liability claims experience of 
    entities that have been deemed to be employees for purposes of this 
    section.
        ``(B) The risk exposure of such entities.
        ``(C) The value of private sector risk-management services, and 
    the value of risk-management services and procedures required as a 
    condition of receiving a grant under section 329, 330, 340, or 
    340A.
        ``(D) A comparison of the costs and the benefits to taxpayers 
    of maintaining medical malpractice liability coverage for such 
    entities pursuant to this section, taking into account--
            ``(i) a comparison of the costs of premiums paid by such 
        entities for private medical malpractice liability insurance 
        with the cost of coverage pursuant to this section; and
            ``(ii) an analysis of whether the cost of premiums for 
        private medical malpractice liability insurance coverage is 
        consistent with the liability claims experience of such 
        entities.
    ``(2) The report under paragraph (1) shall include the following:
        ``(A) A comparison of--
            ``(i) an estimate of the aggregate amounts that such 
        entities (together with the officers, governing board members, 
        employees, and contractors of such entities who have been 
        deemed to be employees for purposes of this section) would have 
        directly or indirectly paid in premiums to obtain medical 
        malpractice liability insurance coverage if this section were 
        not in effect; with
            ``(ii) the aggregate amounts by which the grants received 
        by such entities under this Act were reduced pursuant to 
        subsection (k)(2).
        ``(B) A comparison of--
            ``(i) an estimate of the amount of privately offer
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ed such 
        insurance that such entities (together with the officers, 
        governing board members, employees, and contractors of such 
        entities who have been deemed to be employees for purposes of 
        this section) purchased during the three-year period beginning 
        on January 1, 1993; with
            ``(ii) an estimate of the amount of such insurance that 
        such entities (together with the officers, governing board 
        members, employees, and contractors of such entities who have 
        been deemed to be employees for purposes of this section) will 
        purchase after the date of the enactment of the Federally 
        Supported Health Centers Assistance Act of 1995.
        ``(C) An estimate of the medical malpractice liability loss 
    history of such entities for the 10-year period preceding October 
    1, 1996, including but not limited to the following:
            ``(i) Claims that have been paid and that are estimated to 
        be paid, and legal expenses to handle such claims that have 
        been paid and that are estimated to be paid, by the Federal 
        Government pursuant to deeming entities as employees for 
        purposes of this section.
            ``(ii) Claims that have been paid and that are estimated to 
        be paid, and legal expenses to handle such claims that have 
        been paid and that are estimated to be paid, by private medical 
        malpractice liability insurance.
      ``(D) An analysis of whether the cost of premiums for private 
    medical malpractice liability insurance coverage is consistent with 
    the liability claims experience of entities that have been deemed 
    as employees for purposes of this section.
    ``(3) In preparing the report under paragraph (1), the Comptroller 
General of the United States shall consult with public and private 
entities with expertise on the matters with which the report is 
concerned.''.

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.

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