text: 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.
target: 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.
feat_title: Patient Right to Know Act