Managed Care Plan Accountability Act of 1997

Summary

Managed Care Plan Accountability Act of 1997 - Amends the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code (IRC) with respect to accountability for violations of requirements for managed care group health plans, especially failure to provide health benefits due to improper cost-driven delivery policy decisions. Imposes joint and several liability for actual (including compensatory and consequential) damages, and, in the court's discretion, for punitive damages, on a group health plan, or a plan health insurance issuer, for failure to provide a benefit in accordance with plan terms, insofar as such failure occurs pursuant to a clinically or medically inappropriate decision or determination resulting from application of any cost containment technique, related utilization review, or any other medical care delivery policy decision which restricts the ability of medical care providers to use their full discretion for treatment of patients. Provides for an action for damages in either a State or Federal court. Requires managed care group health plans to provide for full indemnification of medical care providers bound by plan restrictions for any liability incurred for such a failure if it is the direct result of a plan restriction on medical communications. Amends the IRC to establish an excise tax for such cost-driven violations of plan terms.

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Documents

3 official files

• Introduced in House (text)

  Introduced in House · EN · 22 May 1997

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• Introduced in House (PDF)

  Introduced in House · EN · 22 May 1997

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• Introduced in House

  summary · EN · 22 May 1997

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