PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the Subcommittee on Employer-Employee Relations.
Congressional Research Service
Version 00 · Introduced in House · Jun 9, 1999
Health Care Quality and Access Act of 1999 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to revise provisions relating to group health plans.Title I: Patient Right to Unrestricted Medical Advice - Prohibits a group health plan, or a health insurance issuer offering group coverage, from imposing on a health professional any restriction on advice provided to a participant or beneficiary.Title II: Patient Right to Emergency Medical Care - Requires a group health plan or issuer, if it provides benefits for emergencies, to provide benefits (without preauthorization and without regard to network limitations) for emergency medical screening examinations if a prudent layperson would determine them necessary.Title III: Patient Right to Obstetric and Gynecological Care - Requires a group health plan or issuer, if it provides benefits for routine gynecological or obstetric specialist care benefits, to: (1) provide those benefits from a participating specialist without authorization or referral by a primary care provider; and (2) treat the ordering of other routine care by such participating specialist as an authorization by a primary care provider.Title IV: Patient Right to Pediatric Care - Requires a group health plan or issuer, if it provides benefits for routine pediatric specialist care benefits, to allow designation of a participating pediatric specialist as the primary care provider for any beneficiary under 18 years of age.Title V: Patient Access to Information - Requires plan administrators to include specified information in summary plan descriptions, and to provide certain other information upon request of the participant or beneficiary. Requires advance notice of exclusion from a drug formulary of a drug or biological that is used in the treatment of a chronic illness or disease.Title VI: Group Health Plan Review Standards - Requires group health plans to provide written notice of adverse coverage decisions to participants or beneficiaries and care providers.(Sec. 601) Requires group health plans to meet specified time limits for: (1) making decisions on requests for benefit payments, advance determination of coverage, and medical necessity determinations; and (2) making coverage decisions relating to accelerated need medical care, and for completing internal reviews of initial denials of such coverage.Requires internal reviews by medical professionals of initial coverage decisions involving: (1) medical appropriateness or necessity; (2) investigational items; or (3) experimental treatment or technology.Allows participants or beneficiaries, under certain conditions, to request external review by an independent medical expert of an adverse coverage decision and reconsideration of the initial review decision.Sets forth: (1) permitted alternatives to required internal reviews and required external reviews; (2) review requirements; and (3) a fiduciary standards compliance requirement.Title VII: Small Business Access and Choice for Entrepreneurs - Establishes rules governing health plans sponsored by certain associations, including requirements for: (1) certification; (2) sponsors and boards of trustees, and treatment of franchised networks and collectively bargained plans; (3) participation and coverage of employers and individuals and of previously uninsured employees; (4) plan documents, contribution rates, and benefit options; (5) maintenance of reserves, excess-stop loss insurance, and solvency indemnification for plans providing health benefits in addition to health insurance coverage; (6) applications and related reporting; (7) notice for voluntary termination; and (8) corrective actions and mandatory termination.(Sec. 701) Directs the Secretary of Labor to apply, to the appropriate Federal district court, to be appointed trustee of certain insolvent association health plans which provide health benefits in addition to health insurance coverage.Allows a State to impose a contribution tax on an association health plan that begins operations in such State after the enactment of this Act.Directs the Secretary to report to specified congressional committees on the effect association health plans have had, if any, on reducing the number of uninsured individuals.(Sec. 702) Revises requirements for treatment of single employer arrangements.(Sec. 703) Revises requirements for certain collectively bargained arrangements.(Sec. 704) Sets forth enforcement requirements relating to association health plans.(Sec. 705) Sets forth State responsibilities, and requirements for cooperation between Federal and State authorities, with respect to association health plans.(Sec. 706) Prescribes special rules for certain existing health benefits programs.Title VIII: Health Care Access, Affordability, and Quality Commission - Establishes the Health Care Access, Affordability, and Quality Commission to: (1) establish model guidelines for independent expert external review programs, consumer friendly information programs, systems for measuring patient satisfaction and patient outcomes, and systems to ensure the timely processing of claims; and (2) evaluate, upon congressional request, existing and proposed benefit requirements for group health plans, taking into consideration the overall cost effect, availability of treatment, and the effect on the health of the general population.(Sec. 801) Authorizes appropriations.
People & committees
Rep. Boehner, John A. [R-OH-8] · R–OH
Legislative record
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Referred to the Subcommittee on Employer-Employee Relations.
Referred to the House Committee on Education and the Workforce.
Introduced in House
Introduced in House
Primary sources
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Source last updated: Mar 23, 2026. Consult Congress.gov for the current record.
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