S.Amdt. 3199

SA 3199. Mr. CORKER submitted an amendment intended to be proposed to
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr.
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal
Revenue Code of 1986 to modify the first-time homebuyers credit in the
case of members of the Armed Forces and certain other Federal
employees, and for other purposes; which was ordered to lie on the
table; as follows:

Beginning on page 399, strike line 10 and all that follows
through page 403, line 17, and insert the following:
``(y) Increased FMAP for Medical Assistance for Newly
Eligible Mandatory Individuals.--
``(1) 100 percent fmap.--Notwithstanding subsection (b),
the Federal medical assistance percentage determined for a
State that is one of the 50 States or the District of
Columbia with respect to amounts expended for medical
assistance for newly eligible individuals described in
subclause (VIII) or (IX) of section 1902(a)(10)(A)(i) shall
be equal to 100 percent.
``(2) Definitions.--In this subsection:

[[Page S13097]]

``(A) Newly eligible.--The term `newly eligible' means an
individual described in subclause (VIII) or (IX) of section
1902(a)(10)(A)(i) who, on the date of enactment of the
Patient Protection and Affordable Care Act, is not eligible
under the State plan or under a waiver of the plan for full
benefits or for benchmark coverage described in section
1937(b)(1) or benchmark equivalent coverage described in
section 1937(b)(2), or is eligible but not enrolled (or is on
a waiting list) for such benefits or coverage through a
waiver under the plan that has a capped or limited enrollment
that is full. Such term includes an individual for whom the
State elects to provide medical assistance prior to January
1, 2014, under section 1902(k)(2).
``(B) Full benefits.--The term `full benefits' means, with
respect to an individual, medical assistance for all services
covered under the State plan under this title that is not
less in amount, duration, or scope, or is determined by the
Secretary to be substantially equivalent, to the medical
assistance available for an individual described in section
1902(a)(10)(A)(i).''.
(4) Medical care access protection act.--
(A) Short title.--This paragraph may be cited as the
``Medical Care Access Protection Act of 2009'' or the ``MCAP
Act''.
(B) Findings and purpose.--
(i) Findings.--

(I) Effect on health care access and costs.--Congress finds
that our current civil justice system is adversely affecting
patient access to health care services, better patient care,
and cost-efficient health care, in that the health care
liability system is a costly and ineffective mechanism for
resolving claims of health care liability and compensating
injured patients, and is a deterrent to the sharing of
information among health care professionals which impedes
efforts to improve patient safety and quality of care.
(II) Effect on interstate commerce.--Congress finds that
the health care and insurance industries are industries
affecting interstate commerce and the health care liability
litigation systems existing throughout the United States are
activities that affect interstate commerce by contributing to
the high costs of health care and premiums for health care
liability insurance purchased by health care system
providers.
(III) Effect on federal spending.--Congress finds that the
health care liability litigation systems existing throughout
the United States have a significant effect on the amount,
distribution, and use of Federal funds because of--

(aa) the large number of individuals who receive health
care benefits under programs operated or financed by the
Federal Government;
(bb) the large number of individuals who benefit because of
the exclusion from Federal taxes of the amounts spent to
provide them with health insurance benefits; and
(cc) the large number of health care providers who provide
items or services for which the Federal Government makes
payments.
(C) Purpose.--It is the purpose of this paragraph to
implement reasonable, comprehensive, and effective health
care liability reforms designed to--
(i) improve the availability of health care services in
cases in which health care liability actions have been shown
to be a factor in the decreased availability of services;
(ii) reduce the incidence of ``defensive medicine'' and
lower the cost of health care liability insurance, all of
which contribute to the escalation of health care costs;
(iii) ensure that persons with meritorious health care
injury claims receive fair and adequate compensation,
including reasonable noneconomic damages;
(iv) improve the fairness and cost-effectiveness of our
current health care liability system to resolve disputes
over, and provide compensation for, health care liability by
reducing uncertainty in the amount of compensation provided
to injured individuals; and
(v) provide an increased sharing of information in the
health care system which will reduce unintended injury and
improve patient care.
(D) Definitions.--In this paragraph:
(i) Alternative dispute resolution system; adr.--The term
``alternative dispute resolution system'' or ``ADR'' means a
system that provides for the resolution of health care
lawsuits in a manner other than through a civil action
brought in a State or Federal court.
(ii) Claimant.--The term ``claimant'' means any person who
brings a health care lawsuit, including a person who asserts
or claims a right to legal or equitable contribution,
indemnity or subrogation, arising out of a health care
liability claim or action, and any person on whose behalf
such a claim is asserted or such an action is brought,
whether deceased, incompetent, or a minor.
(iii) Collateral source benefits.--The term ``collateral
source benefits'' means any amount paid or reasonably likely
to be paid in the future to or on behalf of the claimant, or
any service, product or other benefit provided or reasonably
likely to be provided in the future to or on behalf of the
claimant, as a result of the injury or wrongful death,
pursuant to--

(I) any State or Federal health, sickness, income-
disability, accident, or workers' compensation law;
(II) any health, sickness, income-disability, or accident
insurance that provides health benefits or income-disability
coverage;
(III) any contract or agreement of any group, organization,
partnership, or corporation to provide, pay for, or reimburse
the cost of medical, hospital, dental, or income disability
benefits; and
(IV) any other publicly or privately funded program.

(iv) Compensatory damages.--The term ``compensatory
damages'' means objectively verifiable monetary losses
incurred as a result of the provision of, use of, or payment
for (or failure to provide, use, or pay for) health care
services or medical products, such as past and future medical
expenses, loss of past and future earnings, cost of obtaining
domestic services, loss of employment, and loss of business
or employment opportunities, damages for physical and
emotional pain, suffering, inconvenience, physical
impairment, mental anguish, disfigurement, loss of enjoyment
of life, loss of society and companionship, loss of
consortium (other than loss of domestic service), hedonic
damages, injury to reputation, and all other nonpecuniary
losses of any kind or nature. Such term includes economic
damages and noneconomic damages, as such terms are defined in
this section.
(v) Contingent fee.--The term ``contingent fee'' includes
all compensation to any person or persons which is payable
only if a recovery is effected on behalf of one or more
claimants.
(vi) Economic damages.--The term ``economic damages'' means
objectively verifiable monetary losses incurred as a result
of the provision of, use of, or payment for (or failure to
provide, use, or pay for) health care services or medical
products, such as past and future medical expenses, loss of
past and future earnings, cost of obtaining domestic
services, loss of employment, and loss of business or
employment opportunities.
(vii) Health care goods or services.--The term ``health
care goods or services'' means any goods or services provided
by a health care institution, provider, or by any individual
working under the supervision of a health care provider, that
relates to the diagnosis, prevention, care, or treatment of
any human disease or impairment, or the assessment of the
health of human beings.
(viii) Health care institution.--The term ``health care
institution'' means any entity licensed under Federal or
State law to provide health care services (including but not
limited to ambulatory surgical centers, assisted living
facilities, emergency medical services providers, hospices,
hospitals and hospital systems, nursing homes, or other
entities licensed to provide such services).
(ix) Health care lawsuit.--The term ``health care lawsuit''
means any health care liability claim concerning the
provision of health care goods or services affecting
interstate commerce, or any health care liability action
concerning the provision of (or the failure to provide)
health care goods or services affecting interstate commerce,
brought in a State or Federal court or pursuant to an
alternative dispute resolution system, against a health care
provider or a health care institution regardless of the
theory of liability on which the claim is based, or the
number of claimants, plaintiffs, defendants, or other
parties, or the number of claims or causes of action, in
which the claimant alleges a health care liability claim.
(x) Health care liability action.--The term ``health care
liability action'' means a civil action brought in a State or
Federal Court or pursuant to an alternative dispute
resolution system, against a health care provider or a health
care institution regardless of the theory of liability on
which the claim is based, or the number of plaintiffs,
defendants, or other parties, or the number of causes of
action, in which the claimant alleges a health care liability
claim.
(xi) Health care liability claim.--The term ``health care
liability claim'' means a demand by any person, whether or
not pursuant to ADR, against a health care provider or health
care institution, including third-party claims, cross-claims,
counter-claims, or contribution claims, which are based upon
the provision of, use of, or payment for (or the failure to
provide, use, or pay for) health care services, regardless of
the theory of liability on which the claim is based, or the
number of plaintiffs, defendants, or other parties, or the
number of causes of action.
(xii) Health care provider.--

(I) In general.--The term ``health care provider'' means
any person (including but not limited to a physician (as
defined by section 1861(r) of the Social Security Act (42
U.S.C. 1395x(r)), registered nurse, dentist, podiatrist,
pharmacist, chiropractor, or optometrist) required by State
or Federal law to be licensed, registered, or certified to
provide health care services, and being either so licensed,
registered, or certified, or exempted from such requirement
by other statute or regulation.
(II) Treatment of certain professional associations.--For
purposes of this paragraph, a professional association that
is organized under State law by an individual physician or
group of physicians, a partnership or limited liability
partnership formed by a group of physicians, a nonprofit
health corporation certified under State law, or a company
formed by a group of physicians under State law shall be
treated as a health care provider under clause (I).

(xiii) Malicious intent to injure.--The term ``malicious
intent to injure'' means intentionally causing or attempting
to cause physical injury other than providing health care
goods or services.

[[Page S13098]]

(xiv) Noneconomic damages.--The term ``noneconomic
damages'' means damages for physical and emotional pain,
suffering, inconvenience, physical impairment, mental
anguish, disfigurement, loss of enjoyment of life, loss of
society and companionship, loss of consortium (other than
loss of domestic service), hedonic damages, injury to
reputation, and all other nonpecuniary losses of any kind or
nature.
(xv) Punitive damages.--The term ``punitive damages'' means
damages awarded, for the purpose of punishment or deterrence,
and not solely for compensatory purposes, against a health
care provider or health care institution. Punitive damages
are neither economic nor noneconomic damages.
(xvi) Recovery.--The term ``recovery'' means the net sum
recovered after deducting any disbursements or costs incurred
in connection with prosecution or settlement of the claim,
including all costs paid or advanced by any person. Costs of
health care incurred by the plaintiff and the attorneys'
office overhead costs or charges for legal services are not
deductible disbursements or costs for such purpose.
(xvii) State.--The term ``State'' means each of the several
States, the District of Columbia, the Commonwealth of Puerto
Rico, the Virgin Islands, Guam, American Samoa, the Northern
Mariana Islands, the Trust Territory of the Pacific Islands,
and any other territory or possession of the United States,
or any political subdivision thereof.
(E) Encouraging speedy resolution of claims.--
(i) In general.--Except as otherwise provided for in this
section, the time for the commencement of a health care
lawsuit shall be 3 years after the date of manifestation of
injury or 1 year after the claimant discovers, or through the
use of reasonable diligence should have discovered, the
injury, whichever occurs first.
(ii) General exception.--The time for the commencement of a
health care lawsuit shall not exceed 3 years after the date
of manifestation of injury unless the tolling of time was
delayed as a result of--

(I) fraud;
(II) intentional concealment; or
(III) the presence of a foreign body, which has no
therapeutic or diagnostic purpose or effect, in the person of
the injured person.

(iii) Minors.--An action by a minor shall be commenced
within 3 years from the date of the alleged manifestation of
injury except that if such minor is under the full age of 6
years, such action shall be commenced within 3 years of the
manifestation of injury, or prior to the eighth birthday of
the minor, whichever provides a longer period. Such time
limitation shall be tolled for minors for any period during
which a parent or guardian and a health care provider or
health care institution have committed fraud or collusion in
the failure to bring an action on behalf of the injured
minor.
(iv) Rule 11 sanctions.--Whenever a Federal or State court
determines (whether by motion of the parties or whether on
the motion of the court) that there has been a violation of
Rule 11 of the Federal Rules of Civil Procedure (or a similar
violation of applicable State court rules) in a health care
liability action to which this Act applies, the court shall
impose upon the attorneys, law firms, or pro se litigants
that have violated Rule 11 or are responsible for the
violation, an appropriate sanction, which shall include an
order to pay the other party or parties for the reasonable
expenses incurred as a direct result of the filing of the
pleading, motion, or other paper that is the subject of the
violation, including a reasonable attorneys' fee. Such
sanction shall be sufficient to deter repetition of such
conduct or comparable conduct by others similarly situated,
and to compensate the party or parties injured by such
conduct.
(F) Compensating patient injury.--
(i) Unlimited amount of damages for actual economic losses
in health care lawsuits.--In any health care lawsuit, nothing
in this paragraph shall limit the recovery by a claimant of
the full amount of the available economic damages,
notwithstanding the limitation contained in clause (ii).
(ii) Additional noneconomic damages.--

(I) Health care providers.--In any health care lawsuit
where final judgment is rendered against a health care
provider, the amount of noneconomic damages recovered from
the provider, if otherwise available under applicable Federal
or State law, may be as much as $250,000, regardless of the
number of parties other than a health care institution
against whom the action is brought or the number of separate
claims or actions brought with respect to the same
occurrence.
(II) Health care institutions.--

(aa) Single institution.--In any health care lawsuit where
final judgment is rendered against a single health care
institution, the amount of noneconomic damages recovered from
the institution, if otherwise available under applicable
Federal or State law, may be as much as $250,000, regardless
of the number of parties against whom the action is brought
or the number of separate claims or actions brought with
respect to the same occurrence.
(bb) Multiple institutions.--In any health care lawsuit
where final judgment is rendered against more than one health
care institution, the amount of noneconomic damages recovered
from each institution, if otherwise available under
applicable Federal or State law, may be as much as $250,000,
regardless of the number of parties against whom the action
is brought or the number of separate claims or actions
brought with respect to the same occurrence, except that the
total amount recovered from all such institutions in such
lawsuit shall not exceed $500,000.
(iii) No discount of award for noneconomic damages.--In any
health care lawsuit--

(I) an award for future noneconomic damages shall not be
discounted to present value;
(II) the jury shall not be informed about the maximum award
for noneconomic damages under clause (ii);
(III) an award for noneconomic damages in excess of the
limitations provided for in clause (ii) shall be reduced
either before the entry of judgment, or by amendment of the
judgment after entry of judgment, and such reduction shall be
made before accounting for any other reduction in damages
required by law; and
(IV) if separate awards are rendered for past and future
noneconomic damages and the combined awards exceed the
limitations described in clause (ii), the future noneconomic
damages shall be reduced first.

(iv) Fair share rule.--In any health care lawsuit, each
party shall be liable for that party's several share of any
damages only and not for the share of any other person. Each
party shall be liable only for the amount of damages
allocated to such party in direct proportion to such party's
percentage of responsibility. A separate judgment shall be
rendered against each such party for the amount allocated to
such party. For purposes of this subparagraph, the trier of
fact shall determine the proportion of responsibility of each
party for the claimant's harm.
(G) Maximizing patient recovery.--
(i) Court supervision of share of damages actually paid to
claimants.--

(I) In general.--In any health care lawsuit, the court
shall supervise the arrangements for payment of damages to
protect against conflicts of interest that may have the
effect of reducing the amount of damages awarded that are
actually paid to claimants.
(II) Contingency fees.--

(aa) In general.--In any health care lawsuit in which the
attorney for a party claims a financial stake in the outcome
by virtue of a contingent fee, the court shall have the power
to restrict the payment of a claimant's damage recovery to
such attorney, and to redirect such damages to the claimant
based upon the interests of justice and principles of equity.
(bb) Limitation.--The total of all contingent fees for
representing all claimants in a health care lawsuit shall not
exceed the following limits:
(AA) 40 percent of the first $50,000 recovered by the
claimant(s).
(BB) 33\1/3\ percent of the next $50,000 recovered by the
claimant(s).
(CC) 25 percent of the next $500,000 recovered by the
claimant(s).
(DD) 15 percent of any amount by which the recovery by the
claimant(s) is in excess of $600,000.
(ii) Applicability.--

(I) In general.--The limitations in clause (i) shall apply
whether the recovery is by judgment, settlement, mediation,
arbitration, or any other form of alternative dispute
resolution.
(II) Minors.--In a health care lawsuit involving a minor or
incompetent person, a court retains the authority to
authorize or approve a fee that is less than the maximum
permitted under this subparagraph.

(iii) Expert witnesses.--

(I) Requirement.--No individual shall be qualified to
testify as an expert witness concerning issues of negligence
in any health care lawsuit against a defendant unless such
individual--

(aa) except as required under subclause (II), is a health
care professional who--
(AA) is appropriately credentialed or licensed in 1 or more
States to deliver health care services; and
(BB) typically treats the diagnosis or condition or
provides the type of treatment under review; and
(bb) can demonstrate by competent evidence that, as a
result of training, education, knowledge, and experience in
the evaluation, diagnosis, and treatment of the disease or
injury which is the subject matter of the lawsuit against the
defendant, the individual was substantially familiar with
applicable standards of care and practice as they relate to
the act or omission which is the subject of the lawsuit on
the date of the incident.

(II) Physician review.--In a health care lawsuit, if the
claim of the plaintiff involved treatment that is recommended
or provided by a physician (allopathic or osteopathic), an
individual shall not be qualified to be an expert witness
under this subsection with respect to issues of negligence
concerning such treatment unless such individual is a
physician.
(III) Specialties and subspecialties.--With respect to a
lawsuit described in subclause (I), a court shall not permit
an expert in one medical specialty or subspecialty to testify
against a defendant in another medical specialty or
subspecialty unless, in addition to a showing of substantial
familiarity in accordance with subclause (I)(bb), there is a
showing that the standards of care and practice in the two
specialty or subspecialty fields are similar.
(IV) Limitation.--The limitations in this clause shall not
apply to expert witnesses testifying as to the degree or
permanency of medical or physical impairment.

[[Page S13099]]

(H) Additional health benefits.--
(i) In general.--The amount of any damages received by a
claimant in any health care lawsuit shall be reduced by the
court by the amount of any collateral source benefits to
which the claimant is entitled, less any insurance premiums
or other payments made by the claimant (or by the spouse,
parent, child, or legal guardian of the claimant) to obtain
or secure such benefits.
(ii) Preservation of current law.--Where a payor of
collateral source benefits has a right of recovery by
reimbursement or subrogation and such right is permitted
under Federal or State law, clause (i) shall not apply.
(iii) Application of provision.--This subparagraph shall
apply to any health care lawsuit that is settled or resolved
by a fact finder.
(I) Punitive damages.--
(i) Punitive damages permitted.--

(I) In general.--Punitive damages may, if otherwise
available under applicable State or Federal law, be awarded
against any person in a health care lawsuit only if it is
proven by clear and convincing evidence that such person
acted with malicious intent to injure the claimant, or that
such person deliberately failed to avoid unnecessary injury
that such person knew the claimant was substantially certain
to suffer.
(II) Filing of lawsuit.--No demand for punitive damages
shall be included in a health care lawsuit as initially
filed. A court may allow a claimant to file an amended
pleading for punitive damages only upon a motion by the
claimant and after a finding by the court, upon review of
supporting and opposing affidavits or after a hearing, after
weighing the evidence, that the claimant has established by a
substantial probability that the claimant will prevail on the
claim for punitive damages.
(III) Separate proceeding.--At the request of any party in
a health care lawsuit, the trier of fact shall consider in a
separate proceeding--

(aa) whether punitive damages are to be awarded and the
amount of such award; and
(bb) the amount of punitive damages following a
determination of punitive liability.

If a separate proceeding is requested, evidence relevant only
to the claim for punitive damages, as determined by
applicable State law, shall be inadmissible in any proceeding
to determine whether compensatory damages are to be awarded.
(IV) Limitation where no compensatory damages are
awarded.--In any health care lawsuit where no judgment for
compensatory damages is rendered against a person, no
punitive damages may be awarded with respect to the claim in
such lawsuit against such person.

(ii) Determining amount of punitive damages.--

(I) Factors considered.--In determining the amount of
punitive damages under this section, the trier of fact shall
consider only the following:

(aa) the severity of the harm caused by the conduct of such
party;
(bb) the duration of the conduct or any concealment of it
by such party;
(cc) the profitability of the conduct to such party;
(dd) the number of products sold or medical procedures
rendered for compensation, as the case may be, by such party,
of the kind causing the harm complained of by the claimant;
(ee) any criminal penalties imposed on such party, as a
result of the conduct complained of by the claimant; and
(ff) the amount of any civil fines assessed against such
party as a result of the conduct complained of by the
claimant.

(II) Maximum award.--The amount of punitive damages awarded
in a health care lawsuit may not exceed an amount equal to
two times the amount of economic damages awarded in the
lawsuit or $250,000, whichever is greater. The jury shall not
be informed of the limitation under the preceding sentence.

(iii) Liability of health care providers.--

(I) In general.--A health care provider who prescribes, or
who dispenses pursuant to a prescription, a drug, biological
product, or medical device approved by the Food and Drug
Administration, for an approved indication of the drug,
biological product, or medical device, shall not be named as
a party to a product liability lawsuit invoking such drug,
biological product, or medical device and shall not be liable
to a claimant in a class action lawsuit against the
manufacturer, distributor, or product seller of such drug,
biological product, or medical device.
(II) Medical product.--The term ``medical product'' means a
drug or device intended for humans. The terms ``drug'' and
``device'' have the meanings given such terms in sections
201(g)(1) and 201(h) of the Federal Food, Drug and Cosmetic
Act (21 U.S.C. 321), respectively, including any component or
raw material used therein, but excluding health care
services.

(J) Authorization of payment of future damages to claimants
in health care lawsuits.--
(i) In general.--In any health care lawsuit, if an award of
future damages, without reduction to present value, equaling
or exceeding $50,000 is made against a party with sufficient
insurance or other assets to fund a periodic payment of such
a judgment, the court shall, at the request of any party,
enter a judgment ordering that the future damages be paid by
periodic payments in accordance with the Uniform Periodic
Payment of Judgments Act promulgated by the National
Conference of Commissioners on Uniform State Laws.
(ii) Applicability.--This subparagraph applies to all
actions which have not been first set for trial or retrial
before the effective date of this Act.
(K) Effect on other laws.--
(i) General vaccine injury.--

(I) In general.--To the extent that title XXI of the Public
Health Service Act establishes a Federal rule of law
applicable to a civil action brought for a vaccine-related
injury or death--

(aa) this paragraph shall not affect the application of the
rule of law to such an action; and
(bb) any rule of law prescribed by this paragraph in
conflict with a rule of law of such title XXI shall not apply
to such action.

(II) Exception.--If there is an aspect of a civil action
brought for a vaccine-related injury or death to which a
Federal rule of law under title XXI of the Public Health
Service Act does not apply, then this paragraph or otherwise
applicable law (as determined under this paragraph) will
apply to such aspect of such action.

(ii) Smallpox vaccine injury.--

(I) In general.--To the extent that part C of title II of
the Public Health Service Act establishes a Federal rule of
law applicable to a civil action brought for a smallpox
vaccine-related injury or death--

(aa) this paragraph shall not affect the application of the
rule of law to such an action; and
(bb) any rule of law prescribed by this paragraph in
conflict with a rule of law of such part C shall not apply to
such action.

(II) Exception.--If there is an aspect of a civil action
brought for a smallpox vaccine-related injury or death to
which a Federal rule of law under part C of title II of the
Public Health Service Act does not apply, then this paragraph
or otherwise applicable law (as determined under this
paragraph) will apply to such aspect of such action.

(iii) Other federal law.--Except as provided in this
subparagraph, nothing in this paragraph shall be deemed to
affect any defense available, or any limitation on liability
that applies to, a defendant in a health care lawsuit or
action under any other provision of Federal law.
(L) State flexibility and protection of states' rights.--
(i) Health care lawsuits.--The provisions governing health
care lawsuits set forth in this paragraph shall preempt,
subject to clauses (ii) and (iii), State law to the extent
that State law prevents the application of any provisions of
law established by or under this paragraph. The provisions
governing health care lawsuits set forth in this paragraph
supersede chapter 171 of title 28, United States Code, to the
extent that such chapter--

(I) provides for a greater amount of damages or contingent
fees, a longer period in which a health care lawsuit may be
commenced, or a reduced applicability or scope of periodic
payment of future damages, than provided in this paragraph;
or
(II) prohibits the introduction of evidence regarding
collateral source benefits.

(ii) Preemption of certain state laws.--No provision of
this paragraph shall be construed to preempt any State law
(whether effective before, on, or after the date of the
enactment of this Act) that specifies a particular monetary
amount of compensatory or punitive damages (or the total
amount of damages) that may be awarded in a health care
lawsuit, regardless of whether such monetary amount is
greater or lesser than is provided for under this paragraph,
notwithstanding subparagraph (F)(i).
(iii) Protection of state's rights and other laws.--

(I) In general.--Any issue that is not governed by a
provision of law established by or under this paragraph
(including the State standards of negligence) shall be
governed by otherwise applicable Federal or State law.
(II) Rule of construction.--Nothing in this paragraph shall
be construed to--

(aa) preempt or supersede any Federal or State law that
imposes greater procedural or substantive protections (such
as a shorter statute of limitations) for a health care
provider or health care institution from liability, loss, or
damages than those provided by this paragraph;
(bb) preempt or supercede any State law that permits and
provides for the enforcement of any arbitration agreement
related to a health care liability claim whether enacted
prior to or after the date of enactment of this Act;
(cc) create a cause of action that is not otherwise
available under Federal or State law; or
(dd) affect the scope of preemption of any other Federal
law.
(M) Applicability; effective date.--This paragraph shall
apply to any health care lawsuit brought in a Federal or
State court, or subject to an alternative dispute resolution
system, that is initiated on or after the date of the
enactment of this Act, except that any health care lawsuit
arising from an injury occurring prior to the date of
enactment of this Act shall be governed by the applicable
statute of limitations provisions in effect at the time the
injury occurred.
______