PRINTER'S NO. 2227
No. 1818 Session of 1999
INTRODUCED BY WILLIAMS, YUDICHAK, FRANKEL, SHANER, YOUNGBLOOD,
S. MILLER, SCRIMENTI, JOSEPHS, FREEMAN AND CURRY,
AUGUST 30, 1999
REFERRED TO COMMITTEE ON INSURANCE, AUGUST 30, 1999
AN ACT
1 Authorizing health care providers to negotiate with health care
2 insurers; and providing for the powers and duties of the
3 Attorney General and the Insurance Commissioner.
4 The General Assembly hereby finds and determines that:
5 (1) Active, robust and fully competitive markets for
6 health care services provide the best opportunity for
7 residents of this Commonwealth to receive high-quality health
8 care services at an appropriate cost.
9 (2) A substantial amount of health care services in this
10 Commonwealth is purchased for the benefit of patients by
11 health care insurers engaged in the provision of health care
12 financing services or is otherwise delivered subject to the
13 terms of agreements between health care insurers and
14 providers of the services.
15 (3) Health care insurers are able to control the flow of
16 patients to providers of health care services through
17 compelling financial incentives for patients in their plans
18 to utilize only the services of providers with whom the
1 insurers have contracted.
2 (4) Health care insurers also control the health care
3 services rendered to patients through utilization review
4 programs and other managed care tools and associated coverage
5 and payment policies.
6 (5) The power of health care insurers in markets of this
7 Commonwealth for health care services has become great enough
8 to create a competitive imbalance, reducing levels of
9 competition and threatening the availability of high-quality,
10 cost-effective health care.
11 (6) In many areas of this Commonwealth, the health care
12 financing market is dominated by one or two health care
13 insurers, with some insurers controlling over 50% of the
14 market.
15 (7) Health care insurers often are able to virtually
16 dictate the terms of the provider contracts that they offer
17 physicians and other health care providers and commonly offer
18 provider contracts on a take-it-of-leave-it basis.
19 (8) The power of health care insurers to unilaterally
20 impose provider contract terms jeopardizes the ability of
21 physicians and other health care providers to deliver the
22 superior quality health care services that have been
23 traditionally available in this Commonwealth.
24 (9) Physicians and other health care providers do not
25 have sufficient market power to reject unfair provider
26 contract terms that impede their ability to deliver medically
27 appropriate care without undue delay or hassle.
28 (10) Inequitable reimbursement and other unfair payment
29 terms adversely affect quality patient care and access by
30 reducing the resources that health care providers can devote
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1 to patient care and decreasing the time that physicians are
2 able to spend with their patients.
3 (11) Inequitable reimbursement and other unfair payment
4 terms also endanger the health care infrastructure and
5 medical advancement by diverting capital needed for
6 reinvestment in the health care delivery system, curtailing
7 the purchase of state-of-the-art technology, the pursuit of
8 medical research and expansion of medical services, all to
9 the detriment of the residents of this Commonwealth.
10 (12) The inevitable collateral reduction and migration
11 of the health care work force also will have negative
12 consequences for this Commonwealth's economy.
13 (13) Empowering independent health care providers to
14 jointly negotiate with health care insurers as provided in
15 this act will help restore the competitive balance and
16 improve competition in the markets for health care services
17 in this Commonwealth, thereby providing benefits for
18 consumers, health care providers and less dominant health
19 care insurers.
20 (14) Allowing independent health care providers to
21 jointly negotiate with health care insurers through a common
22 joint negotiation representative will improve the efficiency
23 and effectiveness of communications between the parties and
24 result in provider contracts that better reflect the mutual
25 areas of agreement.
26 (15) This act is necessary, proper and constitutes an
27 appropriate exercise of the authority of this Commonwealth to
28 regulate the business of insurance and the delivery of health
29 care services.
30 (16) The procompetetive and other benefits of the joint
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1 negotiations and related joint activity authorized by this
2 act, including, but not limited to, restoring the competitive
3 balance in the market for health care services, protecting
4 access to quality patient care, promoting the health care
5 infrastructure and medical advancement and improving
6 communications, outweigh any anticompetitive effects.
7 (17) It is the intention of the General Assembly to
8 authorize independent health care providers to jointly
9 negotiate with health care insurers and to qualify such joint
10 negotiations and related joint activities for the State-
11 action exemption to the Federal antitrust laws through the
12 articulated State policy and active supervision provided in
13 this act.
14 The General Assembly of the Commonwealth of Pennsylvania
15 hereby enacts as follows:
16 Section 1. Short title.
17 This act shall be known and may be cited as the Health Care
18 Provider Joint Negotiation Act.
19 Section 2. Definitions.
20 The following words and phrases when used in this act shall
21 have the meanings given to them in this section unless the
22 context clearly indicates otherwise:
23 "Attorney General." The Attorney General of the
24 Commonwealth.
25 "Covered lives." The total number of individuals who are
26 entitled to benefits under a health care insurance plan,
27 including, but not limited to, beneficiaries, subscribers and
28 members of the plan.
29 "Health care insurer." An entity, subject to the insurance
30 laws of this Commonwealth or otherwise subject to the
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1 jurisdiction of the Insurance Commissioner, which contracts or
2 offers to contract to provide, deliver, arrange for, pay for or
3 reimburse any of the costs of health care services, including,
4 but not limited to, an entity licensed under any of the
5 following:
6 (1) The act of May 17, 1921 (P.L.682, No.284), known as
7 The Insurance Company Law of 1921.
8 (2) The act of December 29, 1972 (P.L.1701, No.364),
9 known as the Health Maintenance Organization Act.
10 (3) The act of December 14, 1992 (P.L.835, No.134),
11 known as the Fraternal Benefit Societies Code.
12 (4) 40 Pa.C.S. Ch. 61 (relating to hospital plan
13 corporations).
14 (5) 40 Pa.C.S. Ch. 63 (relating to professional health
15 services plan corporations).
16 except as provided in section 14. For purposes of this act, a
17 third party administrator shall be considered a health care
18 insurer when interacting with health care providers and
19 enrollees on behalf of a health care insurer.
20 "Health care insurer affiliate." A health care insurer that
21 is affiliated with another entity by either the insurer or
22 entity having a 5% or greater, direct or indirect, ownership or
23 investment interest in the other through equity, debt or other
24 means.
25 "Health care provider." A licensed hospital or health care
26 facility, medical equipment supplier or person who is licensed,
27 certified or otherwise regulated to provide health care services
28 under the laws of this Commonwealth, including, but not limited
29 to, a physician, dentist, podiatrist, optometrist, pharmacist,
30 psychologist, chiropractor, physical therapist, certified nurse
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1 practitioner or nurse midwife.
2 "Health care services." Services for the diagnosis,
3 prevention, treatment, cure or relief of a health condition,
4 injury, disease or illness, including, but not limited to, the
5 professional and technical component of professional services,
6 supplies, drugs and biologicals, diagnostic X-ray, laboratory
7 and other diagnostic tests, preventive screening services and
8 tests, such as pap smears and mammograms, X-ray, radium and
9 radioactive isotope therapy, surgical dressings, devices for the
10 reduction of fractures, durable medical equipment, braces,
11 trusses, artificial limbs and eyes, dialysis services, home
12 health services and hospital and other facility services.
13 "HMO." A health maintenance organization. The term includes
14 any health care insurer product that requires enrollees to use
15 health care providers in a designated provider network to obtain
16 covered services except in limited circumstances such as
17 emergencies.
18 "Insurance Commissioner." The Insurance Commissioner of the
19 Commonwealth.
20 "Joint negotiation." Negotiation with a health care insurer
21 by two or more independent health care providers acting together
22 as part of a formal entity or group or otherwise.
23 "Joint negotiation representative." A representative
24 selected by a group of independent health care providers to be
25 the group's representative in joint negotiations with a health
26 care insurer under this act.
27 "Office of Attorney General." The Office of Attorney General
28 of the Commonwealth.
29 "POS." A point-of-service plan, including, but not limited
30 to, a variation of an HMO that provides limited coverage for
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1 certain out-of-network services.
2 "PPO." A preferred provider organization. The term includes
3 any health care insurer product, other than an HMO or POS
4 product, that provides financial incentives for enrollees to use
5 health care providers in a designated provider network for
6 covered services.
7 "Provider contract." An agreement between a health care
8 provider and a health care insurer which set forth the terms and
9 conditions under which the provider is to deliver health care
10 services to enrollees of the insurer. The term does not include
11 employment contracts between a health care insurer and a health
12 care professional.
13 "Provider network." A group of health care providers who
14 have provider contracts with a health care insurer.
15 "Self-funded health benefit plan." A plan that provides for
16 the assumption of the cost of or spreading the risk of loss
17 resulting from health care services of covered lives by an
18 employer, union or other sponsor, substantially out of the
19 current revenues, assets or any other funds of the sponsor.
20 "Third party administrator." An entity that provides
21 utilization review, provider network credentialing or other
22 administrative services for a health care insurer or a self-
23 funded health benefit plan.
24 Section 3. Negotiations regarding nonfee-related terms.
25 Independent health care providers may jointly negotiate with
26 a health care insurer and engage in related joint activity, as
27 provided in sections 6 and 7, regarding nonfee-related matters
28 which can effect patient care, including, but not limited to any
29 of the following:
30 (1) The definition of medical necessity and other
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1 conditions of coverage.
2 (2) Utilization review criteria and procedures.
3 (3) Clinical practice guidelines.
4 (4) Preventive care and other medical management
5 policies.
6 (5) Patient referral standards and procedures,
7 including, but not limited to, those applicable to out-of-
8 network referrals.
9 (6) Drug formularies and standards and procedures for
10 prescribing off-formulary drugs.
11 (7) Quality assurance programs.
12 (8) Respective health care provider and health care
13 insurer liability for the treatment or lack of treatment of
14 plan enrollees.
15 (9) The methods and timing of payments, including, but
16 not limited to, interest and penalties for late payments.
17 (10) Other administrative procedures, including, but not
18 limited to, enrollee eligibility verification systems and
19 claim documentation requirements.
20 (11) Credentialing standards and procedures for the
21 selection, retention and termination of participating health
22 care providers.
23 (12) Mechanisms for resolving disputes between the
24 health care insurer and health care providers, including, but
25 not limited to, the appeals process for utilization review
26 and credentialing determination.
27 (13) The health insurance plans sold or administered by
28 the insurer in which the health care providers are required
29 to participate.
30 Section 4. Negotiation regarding fees and fee-related terms.
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1 When a health care insurer has substantial market power over
2 independent health care providers, the providers may jointly
3 negotiate with health care insurer and engage in related joint
4 activity, as provided in sections 6 and 7 regarding fees and
5 fee-related matters, including, but not limited to, any of the
6 following:
7 (1) The amount of payment or the methodology for
8 determining the payment for a health care service.
9 (2) The conversion factor for a resource-based relative
10 value scale or similar reimbursement methodology for health
11 care services.
12 (3) The amount of any discount on the price of a health
13 care service.
14 (4) The procedure code or other description of the
15 health care service or services covered by a payment.
16 (5) The amount of a bonus related to the provision of
17 health care services or a withhold from the payment due for a
18 health care service.
19 (6) The amount of any other component of the
20 reimbursement methodology for a health care service.
21 Section 5. Substantial market power.
22 (a) Standard.--A health care insurer has substantial market
23 power over health care providers when:
24 (1) the insurer's market share in the comprehensive
25 health care financing market or a relevant segment of that
26 market, alone or in combination with the market shares of
27 affiliates, exceeds either 15% of the covered lives in the
28 geographic service area of the providers seeking to jointly
29 negotiate or 25,000 covered lives; or
30 (2) the Attorney General determines that the market
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1 power of the insurer in the relevant product and geographic
2 markets for the services of the providers seeking to jointly
3 negotiate significantly exceeds the countervailing market
4 power of the providers acting individually.
5 (b) Comprehensive health care financing market.--The
6 comprehensive health care financing market includes:
7 (1) All health care insurer products which provide
8 comprehensive coverage, alone or in combination with other
9 products sold together as a package, including, but not
10 limited to, indemnity, HMO, PPO and POS products and
11 packages.
12 (2) Self-funded health benefit plans which provide
13 comprehensive coverage.
14 (c) Relevant market segments.--Relevant market segments in
15 the comprehensive health care financing market shall include the
16 following:
17 (1) Health care insurer products and self-funded health
18 benefit plans.
19 (2) Within the health care insurer product category,
20 private health insurance, Medicare HMO, PPO and POS and
21 Medicaid HMO.
22 (3) Within the private health insurance category,
23 indemnity, HMO, PPO and POS products.
24 (4) Such other segments as the Attorney General
25 determines are appropriate for purposes of determining
26 whether a health care insurer has substantial market power.
27 (d) Annual calculation by Insurance Commissioner.--
28 (1) By March 31 of each year, the Insurance Commissioner
29 shall calculate the number of covered lives of each health
30 care insurer and its affiliates in the comprehensive health
19990H1818B2227 - 10 -
1 care financing market and in each relevant market segment for
2 each county of the Commonwealth. The Insurance Commissioner
3 shall make these calculations by averaging quarterly data
4 from the preceding year unless the Insurance Commissioner
5 determines that it would be more appropriate to use other
6 data and information. The Insurance Commissioner may
7 recalculate covered lives determinations earlier than the
8 required annual recalculation when the Insurance Commissioner
9 deems appropriate.
10 (2) Recipients of Medicare, Medicaid and other
11 governmental programs shall not be counted as covered lives
12 in the health care financing market unless they receive their
13 governmental program coverage through an HMO or another
14 health care insurer product.
15 (3) When calculating the market power of a health care
16 insurer or affiliate that has third party administration
17 products, the covered lives of the health care insurers and
18 self-funded health benefit plans for whom the insurer or
19 affiliate provides administrative services shall be treated
20 as the covered lives of the insurer or affiliate.
21 (4) The Insurance Commissioner's covered lives
22 calculations shall be used for purposes of determining the
23 market power of health care insurers in the comprehensive
24 health care financing market from the date of the
25 determination until the next annual determination or until
26 the Insurance Commissioner recalculates the determination,
27 whichever is earlier.
28 (5) In cases where the relevant geographic market is
29 multiple counties, the Insurance Commissioner's calculations
30 for those counties shall be aggregated when counting the
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1 covered lives of the health care insurer whose market power
2 is being evaluated.
3 (6) The Insurance Commissioner shall collect and
4 investigate information necessary to calculate the covered
5 lives of health care insurers and their affiliates.
6 Section 6. Conduct of negotiations.
7 The following requirements shall apply to the exercise of
8 joint negotiation rights and related activity under this act:
9 (1) Health care providers shall select the members of
10 their joint negotiation group by mutual agreement.
11 (2) Health care providers shall designate a joint
12 negotiation representative as the sole party authorized to
13 negotiate with the health care insurer on behalf of the
14 health care providers as a group.
15 (3) Health care providers may communicate with each
16 other and their joint negotiation representative with respect
17 to the matters to be negotiated with the health care insurer.
18 (4) Health care providers may agree upon a proposal to
19 be presented by their joint negotiation representative to the
20 health care insurer.
21 (5) Health care providers may agree to be bound by the
22 terms and conditions negotiated by their joint negotiation
23 representative.
24 (6) The health care providers' joint negotiation
25 representative may provide the health care providers with the
26 results of negotiations with the health care insurer and an
27 evaluation of any offer made by the health care insurer.
28 (7) The health care providers' joint negotiation
29 representative may reject a contract proposal by a health
30 care insurer on behalf of the health care providers as long
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1 as the health care providers remain free to individually
2 contract with the health care insurer.
3 (8) The health care providers may not jointly coordinate
4 any cessation of health care services by them.
5 (9) The health care providers' joint negotiation
6 representative shall advise the health care providers of the
7 provisions of this act and shall inform the health care
8 providers of the potential for legal action against health
9 care providers who violate the Federal antitrust laws.
10 (10) Health care providers may not negotiate the
11 inclusion or alteration of terms and conditions to the extent
12 the terms or conditions are required or prohibited by
13 government regulation. This paragraph shall not be construed
14 to limit the right of health care providers to jointly
15 petition government for a change in such regulation.
16 Section 7. Attorney General oversight.
17 (a) Petition for approval of joint negotiations.--Before
18 engaging in any joint negotiation with a health care insurer,
19 health care providers shall obtain the Attorney General's
20 approval to proceed with the negotiations. The petition seeking
21 approval shall include:
22 (1) The name and business address of the health care
23 providers' joint negotiation representative.
24 (2) The names and business addresses of the health care
25 providers petitioning to jointly negotiate.
26 (3) The name and business address of the health care
27 insurer or insurers with which the petitioning providers seek
28 to jointly negotiate.
29 (4) The proposed subject matter of the negotiations or
30 discussions with the health care insurer or insurers.
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1 (5) The proportionate relationship of the health care
2 providers to the total population of health care providers in
3 the relevant geographic service area of the providers by
4 providers by provider type and specialty.
5 (6) In the case of a petition seeking approval of joint
6 negotiations regarding one or more fee or fee-related terms,
7 a statement of the reasons why the health care insurer has
8 substantial market power over the health care providers.
9 (7) A statement of the procompetitive and other benefits
10 of the proposed negotiations.
11 (8) The health care provider's joint negotiation
12 representative's plan of operation and procedures to ensure
13 compliance with this act.
14 (9) Such other data, information and documents that the
15 petitioners desire to submit in support of their petition.
16 (b) Petition for approval of modification of joint
17 negotiations.--The health care providers shall supplement a
18 petition under section 7(a) or (b) as new information becomes
19 available that indicates that the subject matter of the proposed
20 negotiations with the health care insurer has or will materially
21 change and must obtain the Attorney General's approval of
22 material changes. The petition seeking approval shall include:
23 (1) The Attorney General's file reference for the
24 original petition for approval of joint negotiations.
25 (2) The proposed new subject matter.
26 (3) The information required by subsection (a)(6) and
27 (7) with respect to the proposed new subject matter.
28 (4) Such other data, information and documents that the
29 health care providers desire to submit in support of their
30 petition.
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1 (c) Petition for approval of provider contract terms.--No
2 provider contract terms negotiated under this act shall be
3 effective until the terms are approved by the Attorney General.
4 The petition seeking approval shall be jointly submitted by the
5 health care providers and the health care insurer who are
6 parties to the contract. The petition shall include:
7 (1) The Attorney General's file reference for the
8 original petition for approval of joint negotiations.
9 (2) The negotiated provider contract terms.
10 (3) A statement of the procompetitive and other benefits
11 of the negotiated provider contract terms.
12 (4) Such other data, information and documents that the
13 health care providers desire to submit in support of their
14 petition.
15 (d) Resumption of negotiations.--Joint negotiations approved
16 under this act may continue until the health care insurer
17 notifies the joint negotiation representative for the health
18 care providers that it declines to negotiate or is terminating
19 negotiations. If the health care insurer notifies the joint
20 negotiation representative for health care providers that it
21 desires to resume negotiations within 60 days of the end of
22 prior negotiations, the health care providers may renew the
23 previously approved negotiations without obtaining a separate
24 approval of the renewal from the Attorney General.
25 Section 8. Attorney General determinations.
26 (a) Time period for review.--The Office of Attorney General
27 shall either approve or disapprove a petition under section 7
28 within 30 days after the filing. If disapproved, the Attorney
29 General shall furnish a written explanation of any deficiencies
30 along with a statement of specific remedial measures as to how
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1 such deficiencies may be corrected.
2 (b) Standards for reviewing petitions.--
3 (1) The Office of Attorney General shall approve a
4 petition under section 7(a) and (b) if:
5 (i) The procompetitive and other benefits of the
6 joint negotiations outweigh any anticompetitive effects.
7 (ii) In the case of a petition seeking approval to
8 jointly negotiate one or more fee or fee-related terms,
9 the health care insurer has substantial market power over
10 the health care providers.
11 (2) The Office of Attorney General shall approve a
12 petition under section 7(c) if:
13 (i) The procompetitive and other benefits of the
14 contract terms outweigh any anticompetitive effects.
15 (ii) The contract terms are consistent with other
16 applicable laws and regulations.
17 (3) The procompetitive and other benefits of joint
18 negotiations or negotiated provider contract terms may
19 include, but shall not be limited to:
20 (i) restoration of the competitive balance in the
21 market for health care services.
22 (ii) protections for access to quality patient care.
23 (iii) promotion of the health care infrastructure
24 and medical advancement.
25 (iv) improved communications between health care
26 providers and health care insurers.
27 (4) When weighing the anticompetitive effects of
28 provider contract terms, the Attorney General may consider
29 whether the terms:
30 (i) provide for excessive payments; or
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1 (ii) contribute to the escalation of the cost of
2 providing health care services.
3 (c) Supplemental information.--For the purpose of enabling
4 the Attorney General to make the findings and determinations
5 required by this section, the Attorney General may require the
6 submission of such supplemental information as it may deem
7 necessary or proper to enable him to reach a determination.
8 Section 9. Notice and comment.
9 (a) Notice to health insurer.--In the case of a petition
10 under section 7(a) or (b), the Attorney General shall notify the
11 health insurer of the petition and provide the insurer with the
12 opportunity to submit written comments within a specified time
13 frame that does not extend beyond the date on which the Attorney
14 General is required to act on the petition.
15 (b) Public notice not required.--
16 (1) Except as provided in subsection (a), the Attorney
17 General shall not be required to provide public notice of a
18 petition under section 7(a), (b) or (c) to hold a public
19 hearing on the petition or to otherwise accept public comment
20 on the petition.
21 (2) The Attorney General may, at his discretion, publish
22 notice of a petition for approval of provider contract terms
23 in the Pennsylvania Bulletin and receive written comment from
24 interested persons, so long as the opportunity for public
25 comment does not prevent the Attorney General from acting on
26 the petition within the time period set forth in this act.
27 Section 10. Attorney General proceedings and appellate review.
28 (a) Request for hearing.--Within 30 days from the mailing of
29 a notice of disapproval of a petition under section 7, the
30 petitioners may make a written application to the Attorney
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1 General for a hearing.
2 (b) Hearing to be conducted.--Upon receipt of a timely
3 written application for a hearing, the Attorney General shall
4 schedule and conduct a hearing as provided for in 2 Pa.C.S. Ch.
5 5 Subch. A (relating to practice and procedure of Commonwealth
6 agencies) and Ch. 7 Subch. A (relating to judicial review of
7 Commonwealth agency action). The hearing shall be held within 30
8 days of the application unless the petitioner seeks an
9 extension.
10 (c) Mandamus action.--If the Attorney General does not issue
11 a written approval or disapproval of a petition under section 7
12 within the required time period, the parties to the petition
13 shall have the right to petition the Commonwealth Court for a
14 mandamus order requiring the Attorney General to approve or
15 disapprove the petition.
16 (d) Parties to proceedings.--The sole parties with respect
17 to any petition under section 7 shall be the petitioners and the
18 Attorney General. Notwithstanding any otherwise applicable
19 provision of 2 Pa.C.S. Ch. 5 Subch. A and Ch. 7 Subch. A, the
20 Attorney General shall not be required to treat any other person
21 as a party and no other person shall be entitled to appeal the
22 Attorney General's determination.
23 Section 11. Confidentiality and disclosure.
24 (a) General rule.--All information, documents and copies
25 thereof obtained by or disclosed to the Attorney General or any
26 other person in a petition under section 7 or pursuant to a
27 request for supplemental information under section 8(c) shall be
28 given confidential treatment, shall not be subject to subpoena
29 and shall not be made public or otherwise disclosed by the
30 Attorney General or any other person without the written consent
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1 of the petitioners to whom the information pertains, except as
2 provided in subsection (b).
3 (b) Exceptions.--
4 (1) In the case of a petition under section 7(a) or (b),
5 the Attorney General may disclose the information required to
6 be submitted pursuant to section 7(a)(1) through (4) and
7 (b)(1) and (2).
8 (2) The Attorney General may disclose provider contracts
9 negotiated under this act provided that the Attorney General
10 removes or redacts those provider contract provisions that
11 contain payment rates and fees. The Attorney General may
12 disclose payment rates and fees to the Insurance
13 Commissioner, the insurance department of another state, a
14 law enforcement official of this Commonwealth or any other
15 state or agency of the Federal Government, so long as the
16 agency or office receiving the information agrees in writing
17 to hold it confidential and in a manner consistent with this
18 act.
19 Section 12. Good faith negotiations.
20 A health care insurer shall negotiate in good faith with
21 health care providers regarding the terms of provider contracts.
22 Section 13. Construction.
23 Nothing contained in this act shall be construed:
24 (1) To prohibit or restrict activity by health care
25 providers that is sanctioned under the Federal or State laws.
26 (2) To prohibit or require governmental approval of or
27 otherwise restrict activity by health care providers that is
28 not prohibited under the Federal antitrust laws.
29 (3) To require approval of provider contracts terms to
30 the extent that the terms are exempt from State regulation
19990H1818B2227 - 19 -
1 under section 514 of the Employee Retirement Income Security
2 Act of 1974 (Public Law (93-406, 88 Stat. 829).
3 (4) To expand a health care provider's scope of practice
4 or to require a health care insurer to contract with any type
5 or specialty of health care providers.
6 Section 14. Exclusions.
7 Nothing contained in this act shall authorize joint
8 negotiations regarding health care services covered under the
9 following insurance policies or coverage programs:
10 (1) Workers' compensation.
11 (2) Medical payment coverage issued as part of a motor
12 vehicle insurance policy.
13 (3) Medicare supplemental.
14 (4) Civilian Health and Medial Program of the Uniformed
15 Services (CHAMPUS).
16 (5) Accident only.
17 (6) Specified disease.
18 (7) Long-term care insurance.
19 (8) Disability insurance.
20 (9) Credit insurance.
21 Section 15. Regulations.
22 The Attorney General may promulgate such regulations as are
23 reasonably necessary to implement the purposes of this act.
24 Section 16. Repeals.
25 All acts and parts of acts are repealed insofar as they are
26 inconsistent with this act.
27 Section 17. Effective date.
28 This act shall take effect in 60 days.
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