This is the kind of reform that we need. Too bad our politicans can't actually legislate it and have it stick. This is the first step, and a correct one, in tort reform.

And as far as limints on "pain and suffering," they should be 0, zero, zilch, nada. Payment to cover lost wages over the duration of an illness or loss is fair. "Pain and sufferng" is the lawyer padding his fee.

A simple solution never visit Georgia and you will never have to worry about getting injured or emergency care in their state.

Malpractice laws are intended to discourage gross negligence practices by hospitals and physcians but getting rid of frivolous litigation is a good idea; and in some courts and I assuming maybe all courts a frivilous case can be thrown out. Sounds like politics to me.

In the case of a debilitating condition caused by an omission by a care provider not providing appropriate care, someone who is debilitated by such an omission or negligence can very well end up on SSDI for the rest of their lives which becomes a taxpayer's burden in terms of lifetime care. This is what insurance companies want tort reform for.......let the taxpayers pay for it.

Hello America,

The Fezzy Bear Edited Edition, March 15, 2010, don't worry I knew all of you would be to lazy to read it, never fear Fezzy bear is here.

111

2

TH CONGRESSD SESSION H. R. ll
To provide for reconciliation pursuant to section 202 of the concurrent

resolution on the budget for fiscal year 2010.

IN THE HOUSE OF REPRESENTATIVES

M

1.))))

ARCH --, 2010(3) INSURANCE REFORMS.—This subdivision—
15

forms;

(A) enacts strong insurance market re
17

change, with a public health insurance option

(B) creates a new Health Insurance Ex
19

alongside private plans;
20

(C) includes sliding scale affordability
21

credits; and
22

(D) initiates shared responsibility among
23

workers, employers, and the government;
24

so that all Americans have coverage of essential
25

2.)))) (iii) Such other limited benefits as the

health benefits.
23

Commissioner may specify.
24

In no case shall an employment-based health
25

18

plan in which the coverage consists only of one
•

J. 55–345
1

or more of the coverage or benefits described in
2

clauses (i) through (iii) be treated as acceptable
3

3.)))))(1) I

coverage under this subdivisionN GENERAL.—Individual health insurance
13

coverage that is not grandfathered health insurance
14

coverage under subsection (a) may only be offered
15

ticipating health benefits plan.

on or after the first day of Y1 as an Exchange-par
17

(2) SEPARATE, EXCEPTED COVERAGE PER18
MITTED

.—Excepted benefits (as defined in section
19

2791(c) of the Public Health Service Act) are not
20

included within the definition of health insurance
21

coverage. Nothing in paragraph (1) shall prevent the
22

offering, other than through the Health Insurance
23

fered and priced separately from health insurance

4.)))))A qualified health benefits plan may not impose any

Exchange, of excepted benefits so long as it is of
7

pre-existing condition exclusion (as defined in section
8

2701(b)(1)(A) of the Public Health Service Act) or other9
wise impose any limit or condition on the coverage under

10

the plan with respect to an individual or dependent based
11

on any health status-related factors (as defined in section
12

2791(d)(9) of the Public Health Service Act) in relation
13

5.))))

20

to the individual or dependent.25 in the same manner as such sections apply to employers
•

J. 55–345
1

and health insurance coverage offered in the small group
2

market, except that such section 27 12(b)(1) shall apply
3

only if, before nonrenewal or discontinuation of coverage,
4

the issuer has provided the enrollee with notice of non5
payment of premiums and there is a grace period during

6

which the enrollees has an opportunity to correct such
7

6.)))))

nonpayment. Rescissions of such coverage shall be prohib8(a) IN GENERAL.—The premium rate charged for an
12

insured qualified health benefits plan may not vary except
13

as follows:
14

(1) LIMITED AGE VARIATION PERMITTED.—By
15

age (within such age categories as the Commissioner
16

shall specify) so long as the ratio of the highest such
17

ceed the ratio of 2 to 1.

premium to the lowest such premium does not ex
19

(2) BY AREA.—By premium rating area (as
20

permitted by State insurance regulators or, in the
21

case of Exchange-participating health benefits plans,
22

as specified by the Commissioner in consultation
23

with such regulators).
24

21

(3) BY FAMILY ENROLLMENT.—By family enrollment (such as variations within categories and
•

J. 55–345
1

compositions of families) so long as the ratio of the
2

premium for family enrollment (or enrollments) to
3

the premium for individual enrollment is uniform, as
4

specified under State law and consistent with rules
5

of the Commissioner.
6

(b) STUDY AND REPORTS.—
7

tion with the Secretary of Health and Human Serv

ices and the Secretary of Labor, shall conduct a

(1) STUDY.—The Commissioner, in coordina
10

study of the large group insured and self-insured
11

amine the following:

employer health care markets. Such study shall ex
13

teristics, including size, that purchase insured

(A) The types of employers by key charac
15

products versus those that self-insure.
16

tween typical insured and self-insured health

(B) The similarities and differences be
18

plans.
19

serve levels of employers that self-insure by em

ployer size.

(C) The financial solvency and capital re
22

(D) The risk of self-insured employers not
23

coming financially

7.))))))(E) The extent to which rating rules are

being able to pay obligations or otherwise be
2

likely to cause adverse selection in the large
3

group market or to encourage small and mid
4

size employers to self-insure
5

(2) REPORTS.—Not later than 18 months after
6

sioner shall submit to Congress and the applicable

the date of the enactment of this Act, the Commis
8

agencies a report on the study conducted under
9

ommendations the Commissioner deems appropriate

paragraph (1). Such report shall include any rec
11

to ensure that the law does not provide incentives
12

for small and mid-size employers to self-insure or
13

8.)))))(a) I

create adverse selection in the risk pools of largeN GENERAL.—A qualified health benefits plan
5

sioner. For any plan year in which the qualified health

shall meet a medical loss ratio as defined by the Commis
7

benefits plan does not meet such medical loss ratio, QHBP
8

offering entity shall provide in a manner specified by the
9

Commissioner for rebates to enrollees of payment suffi10
cient to meet such loss ratio.

9.)))))))(c) N

O RESTRICTIONS ON COVERAGE UNRELATED
6

efits plan may not impose any restriction (other than cost

sharing) unrelated to clinical appropriateness on the cov

TO CLINICAL APPROPRIATENESS.—A qualified health ben9
erage of the health care items and services

10.)))))(1) provides payment for the items and services

17

erally accepted standards of medical or other appro

priate clinical or professional practice;

described in subsection (b) in accordance with gen
20

(2) limits cost-sharing for such covered health
21

efit standards, consistent with subsection (c);

care items and services in accordance with such ben
23

(3) does not impose any annual or lifetime limit
24

on the coverage of covered health care items and
25

11.))))))))(b) M

services;INIMUM SERVICES TO BE COVERED.—The
8

lowing:

items and services described in this subsection are the fol
10

(1) Hospitalization.
11

(2) Outpatient hospital and outpatient clinic
12

services, including emergency department services.
13

(3) Professional services of physicians and other
14

health professionals.
15

dent to the services of a physician’s or a health pro

fessional’s delivery of care in institutional settings,

(4) Such services, equipment, and supplies inci
18

12.))))))))Force on Clinical Preventive Services and those vac

physician offices, patients’ homes2
cines recommended for use by the Director of the

3

Centers for Disease Control and Prevention.
4

(9) Maternity care.
5

(10) Well baby and well child care and oral
6

health, vision, and hearing services, equipment, and
7

supplies at least for children under 21 years of age.
8

(c) REQUIREMENTS RELATING TO COST-SHARING
9

AND MINIMUM ACTUARIAL VALUE.—
10

(1) NO COST-SHARING FOR PREVENTIVE SERV11
ICES

.—There shall be no cost-sharing under the es12
sential benefits package for preventive items

13.))))))(B) A

PPLICABLE LEVEL.—The applicable
22

level specified in this subparagraph for Y1 is
23

$5,000 for an individual and $10,000 for a
24

family. Such levels shall be increased (rounded
25

14.))))))(C) U

to the nearest $100) for each subsequent yearSE OF COPAYMENTS.—In establishing
5

cost-sharing levels for basic, enhanced, and pre6
mium plans under this subsection, the Sec

7
retary shall, to the maximum extent possible,

8

15.)))))) M

sory Committee shall be composed of the following

use only copayments and not coinsuranceEMBERSHIP.—The Health Benefits Advi
12

members, in addition to the Surgeon General:
13

(A) 9 members who are not Federal em14
ployees or officers and who are appointed by

15

the President.
16

ployees or officers and who are appointed by

(B) 9 members who are not Federal em
18

16.))))))))))(2) M

PLOYEES

sory Committee shall not be considered employees of

the Comptroller General of the United StatesEMBERS NOT TREATED AS FEDERAL EM.—Members of the Health Benefits Advi
6

ice on the Committee.

17.)))) (1) I

tablish an external review process (including proce

dures for expedited reviews of urgent claims) that

38

the Federal government solely by reason of any servN GENERAL.—The Commissioner shall es
•

J. 55–345
1

provides for an impartial, independent, and de novo
2

18.))))(1) I

review of denied claims under this subdivision.N GENERAL.—A qualified health benefits
17

plan shall comply with standards established by the
18

Commissioner for the accurate and timely disclosure
19

of plan documents, plan terms and conditions,
20

nancial disclosure, data on enrollment, data on

claims payment policies and practices, periodic fi
22

disenrollment, data on the number of claims denials,
23

data on rating practices, information on cost-sharing
24

and payments with respect to any out-of-network
25

19.)))))) (2) P

coverageLAIN LANGUAGE.—In this subsection, the
5

term ‘‘plain language’’ means language that the in6
tended audience, including individuals with limited

7

English proficiency, can readily understand and use
8

nized, and follows other best practices of plain lan

guage writing.

because that language is clean, concise, well-orga
11

velop and issue guidance on best practices of plain

(3) GUIDANCE.—The Commissioner shall de
13

20.))))))

language writing.SEC. 134. APPLICATION TO QUALIFIED HEALTH BENEFITS
2

PLANS NOT OFFERED THROUGH THE
3

HEALTH INSURANCE EXCHANGE.
4

The requirements of the previous provisions of this
5

subtitle shall apply to qualified health benefits plans that
6

change only to the extent specified by the Commissioner.

21.)))))))F) VA.—Coverage under the veteran’s

are not being offered through the Health Insurance Ex
8

health care program under chapter 17 of title
9

erage for the individual involved is determined

38, United States Code, but only if the cov
11

by the Commissioner in coordination with the
12

Secretary of Treasury to be not less than a level
13

specified by the Commissioner and Secretary of
14

retary of Treasury, based on the individual’s

Veteran’s Affairs, in coordination with the Sec
16

22.))))))))(G) O

priority for servicesTHER COVERAGE.—Such other health
19

fits risk pool, as the Commissioner, in coordina

tion with the Secretary of the Treasury, recog

nizes for purposes of this paragraph.

benefits coverage, such as a State health bene
23

The Commissioner shall make determinations under
24

this paragraph in coordination with the Secretary of
25

23.)))))(3) T

the Treasury.REATMENT OF CERTAIN NON-TRADI2
TIONAL MEDICAID ELIGIBLE INDIVIDUALS

vidual who is a non-traditional Medicaid eligible in

dividual (as defined in section 205(e) (4)(C)) in a

.—An indi
5

State may be an Exchange-eligible individual if the
6

individual was enrolled in a qualified health benefits
7

plan, grandfathered health insurance coverage, or
8

fore the individual became a non-traditional Med

icaid eligible individual.

24.)))))(1) S

graph (4), smallest employers described in this para

graph are employers with 10 or fewer employees.

current group health plan during the 6 months beMALLEST EMPLOYER.—Subject to para
4

graph (4), smaller employers described in this para

graph are employers that are not smallest employers

(2) SMALLER EMPLOYERS.—Subject to para
7

ployees.

described in paragraph (1) and have 20 or fewer em
9

(3) LARGER EMPLOYERS.—
10

(A) IN GENERAL.—Beginning with Y3, the
11

scribed in paragraph (1) or (2) to be Exchange

eligible employers.

Commissioner may permit employers not de
25.))))))))

ployer is permitted to be an Exchange-eligible em

ployer under this subsection and enrolls employees

(4) CONTINUING ELIGIBILITY.—Once an em
23

ployer shall continue to be treated as an Exchange

eligible employer for each subsequent plan year re

through the Health Insurance Exchange, the em
•

J. 55–345
1

gardless of the number of employees involved unless
2

and until the employer meets the requirement of sec3
tion 311(a) through paragraph (1) of such section

26.))))))(A) S

SIBILITY

ATISFACTION OF EMPLOYER RESPON.—For any year in which an employer
11

is an Exchange-eligible employer, such employer
12

may meet the requirements of section 312 with
13

ing such employees the option of enrolling with

respect to employees of such employer by offer
15

Exchange-participating health benefits plans
16

27.))))))))(6) A

through the Health Insurance ExchangeFFILIATED GROUPS.—Any employer which
2

is part of a group of employers who are treated as
3

a single employer under subsection (b), (c), (m), or
4

(o) of section 414 of the Internal Revenue Code of
5

1986 shall be treated, for purposes of this subtitle,
6

28.)))))))) (ii) E

as a single employer.XCEPTION FOR IMMINENT AND
13

SERIOUS RISK TO HEALTH.—Clause (i)
14

mines that a delay in termination, result

ing from compliance with the procedures

shall not apply if the Commissioner deter
17

nation, would pose an imminent and seri

ous risk to the health of individuals en

rolled under the qualified health benefits

specified in such clause prior to termi
21

29.))))))))(b) P

sioner shall pay from time to time from the Trust Fund

plan of the QHBP offering entity.AYMENTS FROM TRUST FUND.—The Commis
18

essary to make payments to operate the Health Insurance

such amounts as the Commissioner determines are nec
20

Exchange, including payments under subtitle C (relating
21

30.)))))) (A) T

to affordability credits). AXES ON INDIVIDUALS NOT OBTAIN2
ING ACCEPTABLE COVERAGE

ceived in the Treasury under section 59B of the

.—The amounts re
4

quirement of health insurance coverage for indi

viduals).

31.)))))

Subtitle A—Medicaid and Health Reform

Internal Revenue Code of 1986 (relating to reTITLE VII—MEDICAID AND CHIP
230

•

J. 55–345
Sec. 1701. Eligibility for individuals with income below 133

Federal poverty level.

Sec. 1702. Requirements and special rules for certain Medicaid eligible individuals.

Sec. 1703. CHIP and Medicaid maintenance of effort.

Sec. 1704. Reduction in Medicaid DSH.

Sec. 1705. Expanded outstationing.

Subtitle B—Prevention

Sec. 1711. Required coverage of preventive services.

Sec. 1712. Tobacco cessation.

Sec. 1713. Optional coverage of nurse home visitation services.

Sec. 1714. State eligibility option for family planning services.

32.)))))))))))))))))))))Subtitle D—Coverage

Sec. 1731. Optional medicaid coverage of low-income HIV-infected individuals.

Sec. 1732. Extending transitional Medicaid Assistance (TMA).

Sec. 1733. Requirement of 12-month continuous coverage under certain CHIP

programs.

Subtitle E—Financing

Sec. 1741. Payments to pharmacists.

Sec. 1742. Prescription drug rebates.

Sec. 1743. Extension of prescription drug discounts to enrollees of medicaid

managed care organizations.

Sec. 1744. Payments for graduate medical education.

33.))))))))))))

1⁄3 percent of the(ii) RFP CONTRACT DESCRIBED.—
21

The RFP contract described in this section
22

retary and a sponsor of a prescription drug

is a contract entered into between the Sec
24

plan pursuant to the Centers for Medicare
25

408

& Medicaid Services’ request for proposals
•

J. 55–345
1

issued on February 17, 2009, relating to
2

Medicare part D retroactive coverage for
3

34.)))))))))))))))

certain low income beneficiaries, or a simi1 amounts authorized to be appropriated for such purpose,
2

there are authorized to be appropriated, out of any monies
3

in the Public Health Investment Fund, the following:
4

‘‘(1) $51,000,000 for fiscal year 2010.
5

‘‘(2) $54,000,000 for fiscal year 2011.
6

‘‘(3) $57,000,000 for fiscal year 2012.
7

‘‘(4) $59,000,000 for fiscal year 2013.
8

‘‘(5) $62,000,000 for fiscal year 2014.
9

‘‘(6) $65,000,000 for fiscal year 2015.
10

‘‘(7) $68,000,000 for fiscal year 2016.
11

‘‘(8) $72,000,000 for fiscal year 2017.
12

‘‘(9) $75,000,000 for fiscal year 2018.
13

I Hope the Seniors are reassured? sincerely Fezzy Bear

‘‘(10) $79,000,000 for fiscal year 2019.’’.

looks like Fezzy will be paying for all these Letigous Suits too Boot, sincerely Fezzy Bear

Any time lawyers get involved, truth, equity, and fairness go out the window. The Georgia law is a step in the right direction, but only a baby step. The real solution is to prohibit lawyers from getting involved in the practice of medicine.

"could discourage many victims from bringing legitimate claims to court"

If the claims are legitimate then what is the worry?

Those who think we need "absolute" tort reform for medical care providers (no liability at all for anything) have never had a loved one injured by reckless, uncaring treatment. And there is plenty of it in American medical care today. When courts and legislatures remove all recourse for victims of medical malpractice, some of those those injured will resort to taking matters into their own hands and settle scores personally. Yes, that's a frightening scenario, but it is definitely coming.

With scientific progress is the normal error of the rules which result in medical harm is the basis of responsibility of the physician The responsibility to establish gross negligence is to safeguard the investment of the project, medical and contrary to a fundamental responsibility Asesas in economic activity, carrying risks of the activity

It's unfortunate that Georgia decided to address a problem with a sledge hammer instead of a reasoned approach. ER docs are faced every day with problems ranging from hang nails to heart attacks, with symptoms often very non-specific. Their choices are to over test everyone with full EKG's and CT's or test none. They can admit a patient and send them "upstairs" to the specialist, but then they face the wrath of the specialist being bothered on a weekend. They can discharge the patient and tell them to see their family doc the next day - but he or she may be just as ill prepared to diagnose. So that's why we have a medically recognized standard of care - what would the average physician trained in emergency medicine do in a similar situation? Hospitals and physician groups are constantly developing and refining treatment protocols both to provide better care and to give direction in specific cases. Georgia would be better served by encouraging development of these protocols and giving them legal weight, rather than forcing the patient to prove that his or her doc was a falling down drunk.