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Code · BILL · 113th Congress · H.R. 2300 (Introduced in House) — To provide for incentives to encourage health insurance coverage, and for other purposes. · Sec. 502

Sec. 502. State grants to create administrative health care tribunals

1,043 words·~5 min read·/bill/113/hr/2300/ih/section-502

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Part P of title III of the Public Health Service Act ( 42 U.S.C. 280g et seq. ) is amended by adding at the end the following: The Secretary may award grants to States for the development, implementation, and evaluation of administrative health care tribunals that comply with this section, for the resolution of disputes concerning injuries allegedly caused by health care providers. To be eligible to receive a grant under this section, a State shall submit to the Secretary an application at such time, in such manner, and containing such information as may be required by the Secretary.
A grant shall be awarded under this section on such terms and conditions as the Secretary determines appropriate. A State that receives a grant under this section may not preclude any party to a dispute before an administrative health care tribunal operated under such grant from obtaining legal representation during any review by the expert panel under subsection (d), the administrative health care tribunal under subsection (e), or a State court under subsection (f). Prior to the submission of any dispute concerning injuries allegedly caused by health care providers to an administrative health care tribunal under this section, such allegations shall first be reviewed by an expert panel.
The members of each expert panel under this subsection shall be appointed by the head of the State agency responsible for health. Each expert panel shall be composed of no fewer than 3 members and not more than 7 members. At least one-half of such members shall be medical experts (either physicians or health care professionals). Each physician or health care professional appointed to an expert panel under subparagraph
(A)shall— be appropriately credentialed or licensed in one or more States to deliver health care services; and typically treat the condition, make the diagnosis, or provide the type of treatment that is under review. Subject to clause (ii), each individual appointed to an expert panel under this paragraph shall— not have a material familial, financial, or professional relationship with a party involved in the dispute reviewed by the panel; and not otherwise have a conflict of interest with such a party. Nothing in clause
(i)shall be construed to prohibit an individual who has staff privileges at an institution where the treatment involved in the dispute was provided from serving as a member of an expert panel merely on the basis of such affiliation, if the affiliation is disclosed to the parties and neither party objects. In a dispute before an expert panel that involves treatment, or the provision of items or services— by a physician, the medical experts on the expert panel shall be practicing physicians (allopathic or osteopathic) of the same or similar specialty as a physician who typically treats the condition, makes the diagnosis, or provides the type of treatment under review; or by a health care professional other than a physician, at least two medical experts on the expert panel shall be practicing physicians (allopathic or osteopathic) of the same or similar specialty as the health care professional who typically treats the condition, makes the diagnosis, or provides the type of treatment under review, and, if determined appropriate by the State agency, an additional medical expert shall be a practicing health care professional (other than such a physician) of such a same or similar specialty. In this paragraph, the term practicing means, with respect to an individual who is a physician or other health care professional, that the individual provides health care services to individual patients on average at least 2 days a week. In the case of dispute relating to a child, at least 1 medical expert on the expert panel shall have expertise described in subparagraph (D)(i) in pediatrics. After a review under paragraph (1), an expert panel shall make a determination as to the liability of the parties involved and compensation. If the parties to a dispute before an expert panel under this subsection accept the determination of the expert panel concerning liability and compensation, such compensation shall be paid to the claimant and the claimant shall agree to forgo any further action against the health care providers involved. If any party decides not to accept the expert panel’s determination, the matter shall be referred to an administrative health care tribunal created pursuant to this section. Upon the failure of any party to accept the determination of an expert panel under subsection (d), the parties shall have the right to request a hearing concerning the liability or compensation involved by an administrative health care tribunal established by the State involved. In establishing an administrative health care tribunal under this section, a State shall— ensure that such tribunals are presided over by special judges with health care expertise; provide authority to such judges to make binding rulings, rendered in written decisions, on standards of care, causation, compensation, and related issues with reliance on independent expert witnesses commissioned by the tribunal; establish gross negligence as the legal standard for the tribunal; allow the admission into evidence of the recommendation made by the expert panel under subsection (d); and provide for an appeals process to allow for review of decisions by State courts. If any party to a dispute before a health care tribunal under subsection
(e)is not satisfied with the determinations of the tribunal, the party shall have the right to file their claim in a State court of competent jurisdiction. Any party filing an action in a State court in accordance with paragraph
(1)shall forfeit any compensation award made under subsection (e). The determinations of the expert panel and the administrative health care tribunal pursuant to subsections
(d)and
(e)with respect to a State court proceeding under paragraph
(1)shall be admissible into evidence in any such State court proceeding. In this section, the term health care provider means any person or entity required by State or Federal laws or regulations to be licensed, registered, or certified to provide health care services, and being either so licensed, registered, or certified, or exempted from such requirement by other statute or regulation. There are authorized to be appropriated for any fiscal year such sums as may be necessary for purposes of making grants to States under this section. .
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Sec. 502
State grants to create administrative health care tribunals
U.S.C.§ 280g
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