text: 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.
target: 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.
feat_title: Hippocratic Oath and Patient Protection Act of 1996