42 U.S.C. § 280g–15: State demonstration…

Summary

The federal government can give money to states so they can create, try out, and study new ways to settle claims that someone was hurt by a doctor, hospital, or other health care provider instead of using regular lawsuits. Grants can last up to 5 years. The chosen projects must help resolve injury disputes, collect and use patient safety data, make the system more fair and timely, encourage error disclosure, help prevent future mistakes, improve access to liability insurance, fully inform patients about how the alternative works, and let patients opt out or leave the alternative at any time without losing their right to sue. States must say how they will pay claims, set a test area big enough to study the idea (not based on who pays or patient groups), notify patients in that area, and show the plan won’t violate state law or cut patients’ legal rights. The Secretary will favor diverse approaches and projects developed with input from patients, providers, lawyers, insurers, and safety experts. States must apply to the Secretary and their proposals are reviewed with help from a panel of 9–13 experts appointed by the Comptroller General, including patient advocates, providers, attorneys, insurers, state officials, and safety experts. Each grant state must send yearly reports about results, especially patient safety and insurance effects. The Secretary will contract a research group to evaluate all grants, starting no later than 18 months after the first project begins, and will reserve 5% of annual grant funds for that work. Two federal commissions must review effects on Medicare, Medicaid, and CHIP and report by December 31, 2016. The Secretary may give planning grants up to $500,000 per state. Definitions: health care services = diagnosis, treatment, prevention, or health assessment; health care organization = entity that provides or manages health benefits; health care provider = a person or entity licensed or required to be licensed to give care. Up to $50,000,000 was authorized for the five-fiscal-year period starting with fiscal year 2011. The law does not stop states from making their own alternatives or affect state control of their courts.

Title 42, §280g–15

The Public Health and Welfare, Source: USLM XML via OLRC

(a)In general

The Secretary is authorized to award demonstration grants to States for the development, implementation, and evaluation of alternatives to current tort litigation for resolving disputes over injuries allegedly caused by health care providers or health care organizations. In awarding such grants, the Secretary shall ensure the diversity of the alternatives so funded.

(b)Duration

The Secretary may award grants under subsection (a) for a period not to exceed 5 years.

(c)Conditions for demonstration grants

(1)Requirements

Each State desiring a grant under subsection (a) shall develop an alternative to current tort litigation that—

(A)allows for the resolution of disputes over injuries allegedly caused by health care providers or health care organizations; and

(B)promotes a reduction of health care errors by encouraging the collection and analysis of patient safety data related to disputes resolved under subparagraph (A) by organizations that engage in efforts to improve patient safety and the quality of health care.

(2)Alternative to current tort litigation

Each State desiring a grant under subsection (a) shall demonstrate how the proposed alternative described in paragraph (1)(A)—

(A)makes the medical liability system more reliable by increasing the availability of prompt and fair resolution of disputes;

(B)encourages the efficient resolution of disputes;

(C)encourages the disclosure of health care errors;

(D)enhances patient safety by detecting, analyzing, and helping to reduce medical errors and adverse events;

(E)improves access to liability insurance;

(F)fully informs patients about the differences in the alternative and current tort litigation;

(G)provides patients the ability to opt out of or voluntarily withdraw from participating in the alternative at any time and to pursue other options, including litigation, outside the alternative;

(H)would not conflict with State law at the time of the application in a way that would prohibit the adoption of an alternative to current tort litigation; and

(I)would not limit or curtail a patient’s existing legal rights, ability to file a claim in or access a State’s legal system, or otherwise abrogate a patient’s ability to file a medical malpractice claim.

(3)Sources of compensation

Each State desiring a grant under subsection (a) shall identify the sources from and methods by which compensation would be paid for claims resolved under the proposed alternative to current tort litigation, which may include public or private funding sources, or a combination of such sources. Funding methods shall to the extent practicable provide financial incentives for activities that improve patient safety.

(4)Scope

(A)In general

Each State desiring a grant under subsection (a) shall establish a scope of jurisdiction (such as Statewide, designated geographic region, a designated area of health care practice, or a designated group of health care providers or health care organizations) for the proposed alternative to current tort litigation that is sufficient to evaluate the effects of the alternative. No scope of jurisdiction shall be established under this paragraph that is based on a health care payer or patient population.

(B)Notification of patients

A State shall demonstrate how patients would be notified that they are receiving health care services that fall within such scope, and the process by which they may opt out of or voluntarily withdraw from participating in the alternative. The decision of the patient whether to participate or continue participating in the alternative process shall be made at any time and shall not be limited in any way.

(5)Preference in awarding demonstration grants

In awarding grants under subsection (a), the Secretary shall give preference to States—

(A)that have developed the proposed alternative through substantive consultation with relevant stakeholders, including patient advocates, health care providers and health care organizations, attorneys with expertise in representing patients and health care providers, medical malpractice insurers, and patient safety experts;

(B)that make proposals that are likely to enhance patient safety by detecting, analyzing, and helping to reduce medical errors and adverse events; and

(C)that make proposals that are likely to improve access to liability insurance.

(d)Application

(1)In general

Each State desiring a grant under subsection (a) shall submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require.

(2)Review panel

(A)In general

In reviewing applications under paragraph (1), the Secretary shall consult with a review panel composed of relevant experts appointed by the Comptroller General.

(B)Composition

(i)Nominations

The Comptroller General shall solicit nominations from the public for individuals to serve on the review panel.

(ii)Appointment

The Comptroller General shall appoint, at least 9 but not more than 13, highly qualified and knowledgeable individuals to serve on the review panel and shall ensure that the following entities receive fair representation on such panel:

(I)Patient advocates.

(II)Health care providers and health care organizations.

(III)Attorneys with expertise in representing patients and health care providers.

(IV)Medical malpractice insurers.

(V)State officials.

(VI)Patient safety experts.

(C)Chairperson

The Comptroller General shall designate a member of the review panel to be the chairperson of the review panel.

(D)Availability of information

The Secretary shall make available to the review panel such information, personnel, and administrative services and assistance as the review panel may reasonably require to carry out its duties.

(E)Information from agencies

The review panel may request directly from any department or agency of the United States any information that such panel considers necessary to carry out its duties. To the extent consistent with applicable laws and regulations, the head of such department or agency shall furnish the requested information to the review panel.

(e)Reports

(1)By State

Each State receiving a grant under subsection (a) shall submit to the Secretary an annual report evaluating the effectiveness of activities funded with grants awarded under such subsection. Such report shall, at a minimum, include the impact of the activities funded on patient safety and on the availability and price of medical liability insurance.

(2)By Secretary

The Secretary shall submit to Congress an annual compendium of the reports submitted under paragraph (1) and an analysis of the activities funded under subsection (a) that examines any differences that result from such activities in terms of the quality of care, number and nature of medical errors, medical resources used, length of time for dispute resolution, and the availability and price of liability insurance.

(f)Technical assistance

(1)In general

The Secretary shall provide technical assistance to the States applying for or awarded grants under subsection (a).

(2)Requirements

Technical assistance under paragraph (1) shall include—

(A)guidance on non-economic damages, including the consideration of individual facts and circumstances in determining appropriate payment, guidance on identifying avoidable injuries, and guidance on disclosure to patients of health care errors and adverse events; and

(B)the development, in consultation with States, of common definitions, formats, and data collection infrastructure for States receiving grants under this section to use in reporting to facilitate aggregation and analysis of data both within and between States.

(3)Use of common definitions, formats, and data collection infrastructure

States not receiving grants under this section may also use the common definitions, formats, and data collection infrastructure developed under paragraph (2)(B).

(g)Evaluation

(1)In general

The Secretary, in consultation with the review panel established under subsection (d)(2), shall enter into a contract with an appropriate research organization to conduct an overall evaluation of the effectiveness of grants awarded under subsection (a) and to annually prepare and submit a report to Congress. Such an evaluation shall begin not later than 18 months following the date of implementation of the first program funded by a grant under subsection (a).

(2)Contents

The evaluation under paragraph (1) shall include—

(A)an analysis of the effects of the grants awarded under subsection (a) with regard to the measures described in paragraph (3);

(B)for each State, an analysis of the extent to which the alternative developed under subsection (c)(1) is effective in meeting the elements described in subsection (c)(2);

(C)a comparison among the States receiving grants under subsection (a) of the effectiveness of the various alternatives developed by such States under subsection (c)(1);

(D)a comparison, considering the measures described in paragraph (3), of States receiving grants approved under subsection (a) and similar States not receiving such grants; and

(E)a comparison, with regard to the measures described in paragraph (3), of—

(i)States receiving grants under subsection (a);

(ii)States that enacted, prior to March 23, 2010, any cap on non-economic damages; and

(iii)States that have enacted, prior to March 23, 2010, a requirement that the complainant obtain an opinion regarding the merit of the claim, although the substance of such opinion may have no bearing on whether the complainant may proceed with a case.

(3)Measures

The evaluations under paragraph (2) shall analyze and make comparisons on the basis of— (A)

(B)the nature and number of claims in which tort litigation was pursued despite the existence of an alternative under subsection (a);

(C)the disposition of disputes and claims, including the length of time and estimated costs to all parties;

(D)the medical liability environment;

(E)health care quality;

(F)patient safety in terms of detecting, analyzing, and helping to reduce medical errors and adverse events;

(G)patient and health care provider and organization satisfaction with the alternative under subsection (a) and with the medical liability environment; and

(H)impact on utilization of medical services, appropriately adjusted for risk.

(4)Funding

The Secretary shall reserve 5 percent of the amount appropriated in each fiscal year under subsection (k) to carry out this subsection.

(h)MedPAC and MACPAC reports

(1)MedPAC

The Medicare Payment Advisory Commission shall conduct an independent review of the alternatives to current tort litigation that are implemented under grants under subsection (a) to determine the impact of such alternatives on the Medicare program under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.], and its beneficiaries.

(2)MACPAC

The Medicaid and CHIP Payment and Access Commission shall conduct an independent review of the alternatives to current tort litigation that are implemented under grants under subsection (a) to determine the impact of such alternatives on the Medicaid or CHIP programs under titles XIX and XXI of the Social Security Act [42 U.S.C. 1396 et seq., 1397aa et seq.], and their beneficiaries.

(3)Reports

Not later than December 31, 2016, the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission shall each submit to Congress a report that includes the findings and recommendations of each respective Commission based on independent reviews conducted under paragraphs (1) and (2), including an analysis of the impact of the alternatives reviewed on the efficiency and effectiveness of the respective programs.

(i)Option to provide for initial planning grants

Of the funds appropriated pursuant to subsection (k), the Secretary may use a portion not to exceed $500,000 per State to provide planning grants to such States for the development of demonstration project applications meeting the criteria described in subsection (c). In selecting States to receive such planning grants, the Secretary shall give preference to those States in which State law at the time of the application would not prohibit the adoption of an alternative to current tort litigation.

(j)Definitions

In this section: (1) Health care services

(2)Health care organization

The term “health care organization” means any individual or entity which is obligated to provide, pay for, or administer health benefits under any health plan.

(3)Health care provider

The term “health care provider” means any individual or entity—

(A)licensed, registered, or certified under Federal or State laws or regulations to provide health care services; or

(B)required to be so licensed, registered, or certified but that is exempted by other statute or regulation.

(k)Authorization of appropriations

There are authorized to be appropriated to carry out this section, $50,000,000 for the 5-fiscal year period beginning with fiscal year 2011.

(l)Current State efforts to establish alternative to tort litigation

Nothing in this section shall be construed to limit any prior, current, or future efforts of any State to establish any alternative to tort litigation.

(m)Rule of construction

Nothing in this section shall be construed as limiting states’ authority over or responsibility for their state justice systems.

Notes & Related Subsidiaries

Editorial Notes

References in Text

The Social Security Act, referred to in subsec. (h)(1), (2), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XVIII, XIX, and XXI of the Act are classified generally to subchapters XVIII (§ 1395 et seq.), XIX (§ 1396 et seq.), and XXI (§ 1397aa et seq.), respectively, of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.

Amendments

2016—Subsec. (d)(2)(C). Pub. L. 114–301, § 3(d)(1), substituted “shall designate a member of the review panel to” for “, or an individual within the Government Accountability Office designated by the Comptroller General, shall”. Subsec. (d)(2)(D). Pub. L. 114–301, § 3(d)(2), substituted “Secretary” for “Comptroller General”.

§280g–15 State Demonstration Programs to Evaluate Alternatives to Current Medical Tort Litigation

Summary

Title 42, §280g–15

Notes & Related Subsidiaries

Editorial Notes

References in Text

Amendments

Citations & Metadata