H.R. 2758 (106^th): Common Ground Healthcare Security Act of 1999

Requires group health plans to: (1) provide written notice to participants or beneficiaries and providers of adverse coverage decisions; and (2) meet specified time limits for responding to routine and emergency benefit payment requests, coverage advance determinations, and medical necessity determinations. Provides for internal and, in certain circumstances, external review of initial coverage decisions. Sets forth permitted alternatives to required internal or external reviews in certain cases. Provides for expedited Federal court review, in an action to obtain appropriate equitable relief, where an appropriate physician certifies that exhaustion of administrative remedies is not reasonably attainable under the facts and circumstances without undue risk of irreparable harm to the health of the participant or beneficiary.

Provides for availability of court remedies, establishing a cause of action relating to provision of health benefits. Makes a plan's fiduciary liable for actual damages (including compensatory and consequential damages) for a participant or beneficiary personal injury or wrongful death proximately caused by the fiduciary's failing to exercise ordinary care: (1) in making an incorrect determination that an item or service is excluded from coverage under the terms of the plan based on the fact that the item or service does not meet the plan's requirements for medical appropriateness or necessity, or would constitute experimental treatment or technology; or (2) to ensure that any initial coverage decision on which the cause of action is based, or any decision by the plan on a request, made in writing by a participant or beneficiary for a reversal or modification of an earlier decision of the plan on which the cause of action is based, is issued to the participant or beneficiary before the end of the applicable period. Exempts employers and other plan sponsors from such liability, unless they participate directly in the final decision of the plan on the claim, which decision resulted in the personal injury or wrongful death. Allows such a civil action only after exhaustion of administrative remedies, including external review, except where an appropriate physician certifies that such exhaustion is not reasonably attainable under the facts and circumstances without undue risk of irreparable harm to the health of the participant or beneficiary. Establishes a rebuttable presumption in favor of the decision of the independent expert rendered upon completion of certain reviews. Sets standards for the award of punitive damages in specified cases involving conscious, flagrant indifference to the rights or safety of others. Limits the amount of such awards. Provides for the court to award an additional amount of punitive damages if there is an insufficient award in a case of egregious conduct. Sets time limits for such civil actions. Preempts similar civil actions under State law.