To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to protect consumers in managed care plans and other health coverage.


Bipartisan Consensus Managed Care Improvement Act of 2007 - Sets forth standards for group health plans, including: (1) requiring plans to conduct utilization review activities in accordance with this Act; (2) establishing internal and external appeals processes; (3) requiring a grievance system; (4) requiring the plans to offer out-of network coverage; (5) prohibiting plans from requiring prior authorization for emergency services; (6) prohibiting prior authorization requirements for access to obstetrical or gynecological care; (7) requiring plans to provide for continuity of care during a transition period; (8) requiring plans to provide exceptions to formulary limitations; (9) prohibiting plans from restricting a health care professional from advising patients about health status or medical care; and (10) requiring prompt payment of claims.

Amends the Public Health Service Act, the Employee Retirement Income Security Act (ERISA), and the Internal Revenue Code to require group health plans to comply with the patient protection requirements of this Act. Requires health insurance issuers offering individual health insurance coverage to comply with such requirements.

Sets forth effective dates and provisions regarding application of this Act to collective bargaining agreements.

Requires the Secretaries of Labor, Health and Human Services, and Treasury to ensure coordination of the administration of this Act.

Establishes the Health Care Panel to Devise a Uniform Explanation of Benefits to devise a single form for use by third-party health care payers for the remittance of claims to providers.

View comments | (Close Window)