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H.R. 3235Became Law

Health Maintenance Organization Amendments of 1988

(Conference report filed in House, H. Rept. 100-1056)

Health Maintenance Organization Amendments of 1988 - Amends the Public Health Service Act to revise the definition of "health maintenance organization" (HMO) to include public and private entities meeting certain criteria. (Current law includes legal entities meeting such criteria.)

Allows HMOs, in certain circumstances, to require a reasonable deductible to be paid by a member.

Requires that at least 90 percent of an HMO's services of a physician which are provided as basic health services be provided through members of the HMO's staff, medical groups, individual practice associations, health professionals under contract with the HMO, or any combination of such sources. (Current law requires all of an HMO's services to be provided through such sources.) Requires, when employee benefit plans allow employees a choice between two types of HMOs (described in current law), that: (1) one type provide at least 90 percent of its basic health services through physicians associated with such sources; and (2) the other type provide not more than ten percent of its basic health services through physicians not associated with such sources.

Requires the Secretary of Health and Human Services to issue regulations stating the circumstances under which the Secretary will consider the resources of an organization which owns or controls an HMO when evaluating the fiscal soundness of the HMO. Provides for the period prior to the effective date of the regulations.

Repeals a provision relating to the membership on the policymaking body of a private HMO and the advisory board to the policymaking body of a public entity operating a public HMO.

Continues in effect (by repealing its termination date) a provision which restricts from being included in the definition of "basic health service" those health services directly associated with an organ transplant, unless such organ transplant was required to be included in basic health services on April 15, 1985.

Creates an optional method for fixing payment rates for individuals and families by groups which requires fixing the rates on the basis of the organization's revenue requirements for providing services to the group, subject to certain limitations. Requires an HMO which uses this option for fixing payment rates, on request, to disclose the method and data used in calculating the payment rates.

Revises provisions relating to employees' health benefit plans to make those provisions applicable to employees of States or political subdivisions as well as to employees of private employers. Requires, for health benefits plans which include contributions for services, that the employer or State make contributions under plans for services offered by HMOs in an amount which does not financially discriminate against an employee who enrolls in an HMO.

Declares that provisions concerning financial discrimination shall not be construed to supersede collective bargaining agreements in effect on the date of enactment of this Act.

Repeals, seven years after this Act's enactment, the requirement that employee health benefit plans include the option of membership in an HMO. Requires employers which do offer such option to abide by financial discrimination prohibitions.

Adds to current provisions relating to State laws and practices which prevent entities from operating as HMOs, a provision declaring inapplicable State provisions which would prohibit an entity from complying with the title of the Public Health Service Act relating to HMOs.

Prohibits the Secretary from issuing any regulations, policy statements, or interpretations concerning the performance of medically necessary abortion procedures inconsistent with regulations, policy statements, interpretations, or practices in effect on the date of enactment of this Act.

Became Public Law No: 100-517.

Rep. Waxman, Henry A. [D-CA-24](D-CA)Sponsor
2committees44actions2amendments14subjects
  • Public LawOct 25, 1988
  1. PresidentE40000

    Became Public Law No: 100-517.

  2. BecameLaw36000

    Became Public Law No: 100-517.

  3. PresidentE30000

    Signed by President.

  4. BecameLaw36000

    Signed by President.

  5. FloorE20000

    Presented to President.

  6. President28000

    Presented to President.

  7. Floor

    Measure Signed in Senate.

  8. Floor

    Message on Senate action sent to the House.

  9. ResolvingDifferences

    Senate agreed to conference report by Voice Vote.

  10. ResolvingDifferences23000

    Conference report agreed to in Senate: Senate agreed to conference report by Voice Vote.

  11. ResolvingDifferences

    Conference papers: Senate report and managers' statement held at the desk in Senate.

  12. ResolvingDifferences

    Conference papers: message on House action held at the desk in Senate.

  13. ResolvingDifferencesH42510

    House Agreed to Conference Report by Voice Vote.

  14. ResolvingDifferences21000

    Conference report agreed to in House: House Agreed to Conference Report by Voice Vote.

  15. ResolvingDifferencesH25200

    Conference Report 100-1056 Filed in House.

  16. ResolvingDifferences20900

    Conference report filed: Conference Report 100-1056 Filed in House.

  17. ResolvingDifferencesH41800

    House Agreed to Request for Conference and Speaker Appointed Conferees: Dingell, Waxman, Wyden, Lent, Madigan.

  18. ResolvingDifferencesH41610

    House Disagreed to Senate Amendments by Unanimous Consent.

  19. NotUsed19500

    Resolving differences -- House actions: House Disagreed to Senate Amendments by Unanimous Consent.

  20. Floor

    Message on Senate action sent to the House.

  21. ResolvingDifferences

    Senate insists on its amendments, asks for a conference, appoints conferees Kennedy; Simon; Adams; Matsunaga; Hatch; Quayle; Humphrey.

  22. Floor

    Passed Senate with an amendment by Voice Vote.

  23. Floor17000

    Passed/agreed to in Senate: Passed Senate with an amendment by Voice Vote.

  24. Floor

    Measure laid before Senate.

  25. Calendars

    Placed on Senate Legislative Calendar under General Orders. Calendar No. 594.

  26. Committee

    Committee on Labor and Human Resources. Reported to Senate by Senator Kennedy with an amendment in the nature of a substitute. With written report No. 100-304. Additional views filed.

    Health, Education, Labor, and Pensions Committee
  27. Committee14000

    Committee on Labor and Human Resources. Reported to Senate by Senator Kennedy with an amendment in the nature of a substitute. With written report No. 100-304. Additional views filed.

    Health, Education, Labor, and Pensions Committee
  28. Committee

    Committee on Labor and Human Resources. Ordered to be reported with an amendment in the nature of a substitute favorably.

    Health, Education, Labor, and Pensions Committee
  29. IntroReferral

    Received in the Senate and read twice and referred to the Committee on Labor and Human Resources.

    Health, Education, Labor, and Pensions Committee
  30. FloorH37100

    Passed House (Amended) by Voice Vote.

  31. Floor8000

    Passed/agreed to in House: Passed House (Amended) by Voice Vote.

  32. FloorH30000

    Called up by House Under Suspension of Rules.

  33. CalendarsH12410

    Placed on Union Calendar No: 270.

  34. CommitteeH12200

    Reported to House (Amended) by House Committee on Energy and Commerce. Report No: 100-417.

    Energy and Commerce Committee
  35. Committee5000

    Reported to House (Amended) by House Committee on Energy and Commerce. Report No: 100-417.

    Energy and Commerce Committee
  36. CommitteeH19000

    Ordered to be Reported (Amended).

    Energy and Commerce Committee
  37. CommitteeH15000-B

    Committee Consideration and Mark-up Session Held.

    Energy and Commerce Committee
  38. CommitteeH23000

    Forwarded by Subcommittee to Full Committee.

    Health and Environment Subcommittee
  39. CommitteeH22000

    Subcommittee Consideration and Mark-up Session Held.

    Health and Environment Subcommittee
  40. CommitteeH21000

    Subcommittee Hearings Held.

    Health and Environment Subcommittee
  41. CommitteeH11000

    Referred to Subcommittee on Health and the Environment.

    Health and Environment Subcommittee
  42. IntroReferralH11100

    Referred to House Committee on Energy and Commerce.

    Energy and Commerce Committee
  43. IntroReferralIntro-H

    Introduced in House

  44. IntroReferral1000

    Introduced in House

Oct 5, 198848
(Conference report filed in House, H. Rept. 100-1056)

Health Maintenance Organization Amendments of 1988 - Amends the Public Health Service Act to revise the definition of "health maintenance organization" (HMO) to include public and private entities meeting certain criteria. (Current law includes legal entities meeting such criteria.)

Allows HMOs, in certain circumstances, to require a reasonable deductible to be paid by a member.

Requires that at least 90 percent of an HMO's services of a physician which are provided as basic health services be provided through members of the HMO's staff, medical groups, individual practice associations, health professionals under contract with the HMO, or any combination of such sources. (Current law requires all of an HMO's services to be provided through such sources.) Requires, when employee benefit plans allow employees a choice between two types of HMOs (described in current law), that: (1) one type provide at least 90 percent of its basic health services through physicians associated with such sources; and (2) the other type provide not more than ten percent of its basic health services through physicians not associated with such sources.

Requires the Secretary of Health and Human Services to issue regulations stating the circumstances under which the Secretary will consider the resources of an organization which owns or controls an HMO when evaluating the fiscal soundness of the HMO. Provides for the period prior to the effective date of the regulations.

Repeals a provision relating to the membership on the policymaking body of a private HMO and the advisory board to the policymaking body of a public entity operating a public HMO.

Continues in effect (by repealing its termination date) a provision which restricts from being included in the definition of "basic health service" those health services directly associated with an organ transplant, unless such organ transplant was required to be included in basic health services on April 15, 1985.

Creates an optional method for fixing payment rates for individuals and families by groups which requires fixing the rates on the basis of the organization's revenue requirements for providing services to the group, subject to certain limitations. Requires an HMO which uses this option for fixing payment rates, on request, to disclose the method and data used in calculating the payment rates.

Revises provisions relating to employees' health benefit plans to make those provisions applicable to employees of States or political subdivisions as well as to employees of private employers. Requires, for health benefits plans which include contributions for services, that the employer or State make contributions under plans for services offered by HMOs in an amount which does not financially discriminate against an employee who enrolls in an HMO.

Declares that provisions concerning financial discrimination shall not be construed to supersede collective bargaining agreements in effect on the date of enactment of this Act.

Repeals, seven years after this Act's enactment, the requirement that employee health benefit plans include the option of membership in an HMO. Requires employers which do offer such option to abide by financial discrimination prohibitions.

Adds to current provisions relating to State laws and practices which prevent entities from operating as HMOs, a provision declaring inapplicable State provisions which would prohibit an entity from complying with the title of the Public Health Service Act relating to HMOs.

Prohibits the Secretary from issuing any regulations, policy statements, or interpretations concerning the performance of medically necessary abortion procedures inconsistent with regulations, policy statements, interpretations, or practices in effect on the date of enactment of this Act.

Aug 11, 198835
(Measure passed Senate, amended)

Health Maintenance Organization Amendments of 1987 - Amends the Public Health Service Act to revise the definition of "health maintenance organization" (HMO) to include public and private entities meeting certain criteria. (Current law includes legal entities meeting such criteria.)

Allows HMOs, in certain circumstances, to require a reasonable deductible to be paid by a member.

Requires that at least 90 percent of an HMO's services of a physician which are provided as basic health services be provided through members of the HMO's staff, medical groups, individual practice associations, health professionals under contract with the HMO, or any combination of such sources. (Current law requires all of an HMO's services to be provided through such sources.) Requires, when employee benefit plans allow employees a choice between two types of HMOs (described in current law), that: (1) one type provide at least 90 percent of its basic health services through physicians associated with such sources; and (2) the other type provide not more than ten percent of its basic health services through physicians not associated with such sources.

Requires the Secretary of Health and Human Services to issue regulations stating the circumstances under which the Secretary will consider the resources of an organization which owns or controls an HMO when evaluating the fiscal soundness of the HMO. Provides for the period prior to the effective date of the regulations.

Repeals a provision relating to the membership on the policymaking body of a private HMO and the advisory board to the policymaking body of a public entity operating a public HMO.

Continues in effect (by repealing its termination date) a provision which restricts from being included in the definition of "basic health service" those health services directly associated with an organ transplant, unless such organ transplant was required to be included in basic health services on April 15, 1985.

Creates an optional method for fixing payment rates for individuals and families by groups which requires fixing the rates on the basis of the organization's revenue requirements for providing services to the group, subject to certain limitations. Requires an HMO which uses this option for fixing payment rates, on request, to disclose the method and data used in calculating the payment rates.

Revises provisions relating to employees' health benefit plans to make those provisions applicable to employees of States or political subdivisions as well as to employees of private employers. Requires, for health benefits plans which include contributions for services, that the employer or State make contributions under plans for services offered by HMOs in an amount which does not financially discriminate against an employee who enrolls in an HMO.

Declares that provisions concerning financial discrimination shall not be construed to supersede collective bargaining agreements in effect on the date of enactment of this Act.

Adds to current provisions relating to State laws and practices which prevent entities from operating as HMOs, a provision declaring inapplicable State provisions which would prohibit an entity from complying with the title of the Public Health Service Act relating to HMOs.

Prohibits the Secretary from issuing any regulations, policy statements, or interpretations concerning the performance of medically necessary procedures inconsistent with regulations, policy statements, interpretations, or practices in effect on the date of enactment of this Act.

Repeals provisions of the Public Health Service Act relating to Employees' Health Benefits Plans, effective October 1, 1993.

Mar 22, 198801
(Reported to senate from the Committee on Labor and Human Resources with amendment, S. Rept. 100-304)

Health Maintenance Organization Amendments of 1987 - Amends the Public Health Service Act to revise the definition of "health maintenance organization" (HMO) to include public and private entities meeting certain criteria. (Current law includes legal entities meeting such criteria.)

Allows HMOs, in certain circumstances, to require a reasonable deductible to be paid by a member.

Requires that at least 90 percent of an HMO's services of a physician which are provided as basic health services be provided through members of the HMO's staff, medical groups, individual practice associations, health professionals under contract with the HMO, or any combination of such sources. (Current law requires all of an HMO's services to be provided through such sources.) Requires, when employee benefit plans allow employees a choice between two types of HMOs (described in current law), that: (1) one type provide at least 90 percent of its basic health services through physicians associated with such sources; and (2) the other type provide not more than ten percent of its basic health services through physicians not associated with such sources.

Requires the Secretary of Health and Human Services to consider the fiscal soundness of any affiliated organization which owns an HMO when evaluating the fiscal soundness of the HMO.

Repeals a provision relating to the membership on the policymaking body of a private HMO and the advisory board to the policymaking body of a public entity operating a public HMO.

Continues in effect (by repealing its termination date) a provision which restricts from being included in the definition of "basic health service" those health services directly associated with an organ transplant, unless such organ transplant was required to be included in basic health services on April 15, 1985.

Creates an optional method for fixing payment rates for individuals and families by groups which requires fixing the rates on the basis of the organization's revenue requirements for providing services to the group, subject to certain limitations. Requires an HMO which uses this option for fixing payment rates, on request, to disclose the method and data used in calculating the payment rates.

Revises provisions relating to employees' health benefit plans to make those provisions applicable to employees of States or political subdivisions as well as to employees of private employers. Requires, for health benefits plans which include contributions for services, that the employer or State make contributions under plans for services offered by HMOs in an amount which does not financially discriminate against an employee who enrolls in an HMO.

Declares that provisions concerning financial discrimination shall not be construed to supersede collective bargaining agreements in effect on the date of enactment of this Act.

Adds to current provisions relating to State laws and practices which prevent entities from operating as HMOs, a provision declaring inapplicable State provisions which would prohibit an entity from complying with the title of the Public Health Service Act relating to HMOs.

Nov 3, 198736
(Measure passed House, amended)

Health Maintenance Organization Amendments of 1987 - Amends the Public Health Service Act to revise the definition of "health maintenance organization" (HMO) to include public and private entities meeting certain criteria. (Current law includes legal entities meeting such criteria.)

Allows HMOs, in certain circumstances, to require a reasonable deductible to be paid by a member.

Requires that at least 90 percent of an HMO's services of a physician which are provided as basic health services be provided through members of the HMO's staff, medical groups, individual practice associations, health professionals under contract with the HMO, or any combination of such sources. (Current law requires all of an HMO's services to be provided through such sources.) Requires, when employee benefit plans allow employees a choice between two types of HMOs (described in current law), that: (1) one type provide at least 90 percent of its basic health services through physicians associated with such sources; and (2) the other type provide not more than ten percent of its basic health services through physicians not associated with such sources.

Repeals a provision relating to the membership on the policymaking body of a private HMO and the advisory board to the policymaking body of a public entity operating a public HMO.

Revises provisions relating to employees' health benefit plans to make those provisions applicable to employees of States or political subdivisions as well as to employees of private employers. Requires, for health benefits plans which include contributions for services, that the employer or State make contributions under plans for services offered by HMOs in an amount which does not financially discriminate against an employee who enrolls in an HMO.

Adds to current provisions relating to State laws and practices which prevent entities from operating as HMOs a provision declaring inapplicable State provisions which would prohibit an entity from complying with the title of the Public Health Service Act relating to HMOs.

Oct 30, 198717
(Reported to House from the Committee on Energy and Commerce with amendment, H. Rept. 100-417)

Health Maintenance Organization Amendments of 1987 - Amends the Public Health Service Act to revise the definition of "health maintenance organization" (HMO) to include public and private entities meeting certain criteria. (Current law includes legal entities meeting such criteria.)

Allows HMOs, in certain circumstances, to require a reasonable deductible to be paid by a member.

Requires that at least 90 percent of an HMO's services of a physician which are provided as basic health services be provided through members of the HMO's staff, medical groups, individual practice associations, health professionals under contract with the HMO, or any combination of such sources. (Current law requires all of an HMO's services to be provided through such sources.) Requires, when employee benefit plans allow employees a choice between two types of HMOs (described in current law), that: (1) one type provide at least 90 percent of its basic health services through physicians associated with such sources; and (2) the other type provide not more than ten percent of its basic health services through physicians not associated with such sources.

Repeals a provision relating to the membership on the policymaking body of a private HMO and the advisory board to the policymaking body of a public entity operating a public HMO.

Revises provisions relating to employees' health benefit plans to make those provisions applicable to employees of States or political subdivisions as well as to employees of private employers. Requires, for health benefits plans which include contributions for services, that the employer or State make contributions under plans for services offered by HMOs in an amount which does not financially discriminate against an employee who enrolls in an HMO.

Adds to current provisions relating to State laws and practices which prevent entities from operating as HMOs a provision declaring inapplicable State provisions which would prohibit an entity from complying with the title of the Public Health Service Act relating to HMOs.

Aug 7, 198700

Health Maintenance Organization Amendments of 1987 - Amends the Public Health Service Act to revise the definition of "health maintenance organization" to include public and private entities meeting certain criteria. (Current law includes legal entities meeting such criteria.)

Requires that physician services provided as basic health services e primarily provided through specified sources.

Repeals a provision relating to the membership on the policymaking body of a private health maintenance organization (HMO) and the advisory board to the policymaking body of a public entity operating a public HMO.

Revises provisions relating to employee health benefit plans to make those provisions applicable to employees of States or political subdivisions as well as to employees of private employers. Requires, for health benefits plans which include contributions for services, that the employer or State make contributions under plans for services offered by HMOs in an amount which does not financially discriminate against an employee who enrolls in an HMO.

Adds to current provisions relating to State laws and practices which prevent entities from operating as HMOs a provision declaring inapplicable State provisions which would prohibit an entity from complying with the title of the Public Health Service Act relating to HMOs.

Health Maintenance Organization Amendments of 1988 — Informed