Access to Quality Care Act of 1999

TABLE OF CONTENTS:

Title I: Access to Quality Care

Subtitle A: Promoting Quality Care by Ensuring Access

to Health Care Professionals

Subtitle B: Promoting Quality Care by Ensuring Access

to Health Care Services

Subtitle C: Promoting Quality Care by Ensuring Fair

Resolution of Grievances

Subtitle D: Promoting Quality Care by Ensuring Fair

Plan Administration

Subtitle E: Definitions

Title II: Application of Quality Care Standards to Group

Health Plans and Health Insurance Coverage Under Public

Health Service Act

Title III: Amendments to the Employee Retirement Income

Security Act of 1974

Title IV: Effective Dates; Coordination in Implementation

Access to Quality Care Act of 1999 - Title I: Access to Quality Care - Subtitle A: Promoting Quality Care by Ensuring Access to Health Care Professionals - Requires a health care insurer offering health care coverage through a network of contracted professionals and providers to offer at a reasonable premium an enrollment option for non-network coverage unless such option is otherwise available to enrollees.

(Sec. 102) Requires a group health plan and a health insurance issuer to provide for enrollee choice of personal health professional and access to adequate types of care.

Subtitle B: Promoting Quality Care by Ensuring Access to Health Care Services - Requires a group health care plan and a health care insurer to provide for: (1) specialist care; (2) continuity of care; (3) emergency room services; (4) obstetric and gynecological services; and (5) pediatric services.

Subtitle C: Promoting Quality Care by Ensuring Fair Resolution of Grievances - Sets forth internal and external review procedures, including: (1) enrollee notice of adverse coverage determinations; (2) time limits for benefit determinations and internal appeals; (3) physician review of initial coverage determinations; (4) independent medical expert review of initial review determinations, and penalties for denial of such review.

Subtitle D: Promoting Quality Care by Ensuring Fair Plan Administration - Prohibits a group health professional or provider plan from offering incentives to reduce or limit medically necessary services with respect to a specific enrollee.

(Sec. 133) Sets forth specified enrollee information access requirements, including: (1) plan description, limitations, and benefits; (2) enrollee costs; (3) dispute resolution procedures; (4) network characteristics; (5) care management; (6) inclusion of drugs and biologicals in formularies; (7) preauthorization and utilization review procedures; (8) accreditation status of health insurance issuers and service providers; and (9) performance criteria.

(Sec. 138) Requires a group health plan and a health insurance issuer to establish a quality assessment program.

Subtitle E: Definitions - Defines specified terms.

(Sec. 152) States that nothing in this title shall be construed to preempt State law with respect to health insurance issuers or group health plans.

Title II: Application of Quality Care Standards to Group Health Plans and Health Insurance Coverage under Public Health Service Act - Amends the Public Health Service Act to apply quality care provisions under title I of this Act to group health plan and health insurance coverage under such Act.

Title III: Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Income Act of 1974 (ERISA) to apply quality care provisions under title I of this Act to group health plan and health insurance coverage under such Act.

(Sec. 302) Permits certain actions under State law (rather than under ERISA) involving health insurance enrollees, but stipulates that such actions are not authorized against an employer or other plan sponsor, with specified exceptions.

Title IV: Effective Dates; Coordination in Implementation - Sets forth specified effective dates under this Act.