02-HR3897 on Mar 7, 2002

OFFICIAL CONGRESSIONAL SUMMARY:

• Delineates the relationship between the antitrust laws and negotiations between groups of health care professionals and health plans and health care insurance issuers.
• Applies the "rule of reason" standard to negotiations between a health plan and two or more physicians.
• Awards attorneys' fees to a substantially prevailing plaintiff only when the defendant's conduct was unreasonable or in bad faith.
• Prohibits tying arrangements (linking the participation in one product line to participation in another) between a health plan and health care professional.
• Excludes from this Act any negotiations or agreements including Medicare, Medicaid, SCHIP, or other federal programs.

EXCERPTS FROM CONGRESSIONAL FINDINGS:

Congress finds the following:
1. A large number of Americans receive their health care coverage from managed health care plans.
2. The market power of insurance companies has increased

tremendously since the early 1990's, due to mergers and acquisitions.

Health plans improperly manipulate the practice of medicine through such mechanisms as inappropriately making medical necessity determinations, and knowingly denying and delaying payment.

The intent of the antitrust laws is to encourage competition and protect the consumer, and the current per se standard for enforcing the antitrust laws in the health care field frequently does not achieve these objectives.

An application of the "rule of reason" will tend to promote both competition and high-quality patient care.

In any action under the antitrust laws challenging a health plan, conduct shall not be deemed illegal per se, but shall be judged on the basis of its reasonableness, taking into account all relevant factors affecting competition and proposed contract terms.

LEGISLATIVE OUTCOME: Referred to the House Committee on the Judiciary; never called for a House vote.

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