[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1691 Introduced in House (IH)]

103d CONGRESS
  1st Session
                                H. R. 1691

  To provide universal access for all Americans to basic health care 
                 services and long-term care services.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 5, 1993

Mr. Andrews of Maine introduced the following bill; which was referred 
   jointly to the Committees on Energy and Commerce, Ways and Means, 
Education and Labor, Rules, Armed Services, Veterans' Affairs, and Post 
                        Office and Civil Service

_______________________________________________________________________

                                 A BILL


 
  To provide universal access for all Americans to basic health care 
                 services and long-term care services.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``National Health 
Security Act of 1993''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Statement of principles.
Sec. 3. General definitions.
                  TITLE I--ELIGIBILITY AND ENROLLMENT

Sec. 101. Eligibility and entitlement.
Sec. 102. Enrollment.
Sec. 103. Portability.
                           TITLE II--BENEFITS

                    Subtitle A--Health Care Services

Sec. 201. Covered health care services.
Sec. 202. Limitations and exclusions.
Sec. 203. Patient cost-sharing.
                  Subtitle B--Long-Term Care Services

Sec. 211. Covered long-term care services.
Sec. 212. Long-Term Care Services Assessment Commission.
                  Subtitle C--Modification of Services

Sec. 221. Modification of services covered under this Act.
              TITLE III--FEDERAL AND STATE ADMINISTRATION

                   Subtitle A--Federal Administration

Sec. 301. Federal Health Board.
Sec. 302. Federal Health Advisory Council.
Sec. 303. Federal Health Priorities Council.
Sec. 304. Authorization of appropriations.
                    Subtitle B--State Administration

Sec. 311. State programs.
Sec. 312. Use of fiscal intermediaries.
Sec. 313. State waivers; managed care.
Sec. 314. State regional consortia.
Sec. 315. Grants to States.
Sec. 316. Technical assistance to States.
                          TITLE IV--FINANCING

                       Subtitle A--Health Budgets

Sec. 401. National health budget.
Sec. 402. Payments to States.
Sec. 403. State program budgets.
                   Subtitle B--Payments to Providers

Sec. 411. Payments to hospitals and other health care and long-term 
                            care institutions.
Sec. 412. Payments for practitioners services.
Sec. 413. Special nonphysician practitioner provisions.
Sec. 414. Mandatory assignment.
                          Subtitle C--Revenues

Sec. 421. Federal sources of revenues.
Sec. 422. Tax treatment of American Health Security Plan and private 
                            health and long-term care insurance.
Sec. 423. Federal Health Trust Fund.
Sec. 424. State sources of revenues.
                  TITLE V--CONGRESSIONAL CONSIDERATION

Sec. 501. Rules governing congressional consideration.
                       TITLE VI--PRIVATE OPTIONS

Sec. 601. Private supplemental insurance.
Sec. 602. Option to purchase duplicative private insurance.
Sec. 603. Limits on private insurance.
 TITLE VII--EXPANSION OF OUTCOMES RESEARCH AND DELIVERY OF SERVICES IN 
                           UNDERSERVED AREAS

Sec. 701. Expansion of outcomes research.
Sec. 702. National health service corps.
Sec. 703. Community and migrant health centers.
                     TITLE VIII--MALPRACTICE REFORM

Sec. 801. Grants to States.
Sec. 802. Criteria for State malpractice reforms.
Sec. 803. Authorization of appropriations.
TITLE IX--EFFECTIVE DATES; TERMINATIONS; TRANSITION; RELATION TO ERISA.

Sec. 901. Effective dates.
Sec. 902. Termination of other programs.
Sec. 903. Transition.
Sec. 904. Relation to ERISA.

SEC. 2. STATEMENT OF PRINCIPLES.

    The principles of this Act are--
            (1) to provide universal access to basic health care 
        services for all Americans regardless of their financial and 
        medical conditions;
            (2) to establish the institutional and political capacity 
        to control the Nation's escalating health care costs and 
        eliminate administrative waste;
            (3) to ensure the portability of health care coverage to 
        all regions of the country;
            (4) to build on the strengths of American federalism, with 
        the Federal Government contributing progressive financing and 
        specifying minimum national standards while State governments 
        supply additional funding and administer the program with the 
        flexibility needed to address the specific concerns of each 
        region;
            (5) to maintain the proven advantages of the American 
        health care delivery system, including private practice, the 
        freedom to choose among practitioners, and superiority in 
        biomedical technology;
            (6) to encourage the effective use of preventive and 
        primary care;
            (7) to enhance the autonomy of practitioners by limiting 
        the intrusiveness of government intervention in the actual 
        delivery of care;
            (8) to promote the role of competition among practitioners 
        and to encourage innovation that results in higher quality and 
        more efficient care;
            (9) to reduce the incentives providers face to perform 
        medically unnecessary or inappropriate services;
            (10) to reinforce the public accountability of the health 
        care system, permitting explicit and open deliberation about 
        the allocation of society's resources to health care; and
            (11) to provide that all Americans share in the 
        responsibility of maintaining an efficient health care system.

SEC. 3. GENERAL DEFINITIONS.

    (a) In General.--For purposes of this Act:
            (1) The term ``Board'' means the Federal Health Board 
        established in section 301.
            (2) The term ``Advisory Council'' means the Federal Health 
        Care Advisory Council established in section 302.
            (3) The term ``Priorities Council'' means the Federal 
        Health Priorities Council established in section 303.
            (4) The term ``State program'' means a State health care 
        program approved under section 311.
            (5) The term ``State'' includes the District of Columbia, 
        the Commonwealth of Puerto Rico, the United States Virgin 
        Islands, Guam, American Samoa, and the Commonwealth of the 
        Northern Mariana Islands.
            (6) The term ``Trust Fund'' means the Federal Health Trust 
        Fund established in section 423.
    (b) Other Definitions.--Except as otherwise provided, the 
definitions contained in section 1861 of the Social Security Act (42 
U.S.C. 1395x), as in effect on the day before the date of the enactment 
of this Act, shall apply in this Act.

                  TITLE I--ELIGIBILITY AND ENROLLMENT

SEC. 101. ELIGIBILITY AND ENTITLEMENT.

    (a) In General.--Every individual who is a resident of the United 
States and is a citizen or national of the United States or lawful 
resident alien (as defined in subsection (d)) is entitled to health 
care services and long-term care services covered under this Act in the 
State in which the individual maintains a primary residence.
    (b) Treatment of Certain Nonimmigrants.--
            (1) In general.--The Board may make eligible for health 
        care services and long-term care services covered under this 
        Act such classes of aliens admitted to the United States as 
        nonimmigrants as the Board may provide.
            (2) Consideration.--In providing for eligibility under 
        paragraph (1), the Board shall consider reciprocity in health 
        care and long-term care services offered to United States 
        citizens who are nonimmigrants in other foreign states, and 
        such other factors as the Board determines to be appropriate.
    (c) Treatment of Other Individuals.--The Board may make eligible 
for health care services and long-term care services covered under this 
Act other individuals not described in subsection (a) or (b), and 
regulate the nature of the eligibility of such individuals for the 
purposes of fulfilling the following criteria:
            (1) Preserving the public health of communities.
            (2) Compensating States for the additional health care 
        financing burdens created by such individuals.
            (3) Preventing adverse financial and medical consequences 
        of uncompensated care.
            (4) Inhibiting travel and immigration to the United States 
        for the sole purpose of obtaining health care services or long-
        term care services covered under this Act.
    (d) Lawful Resident Alien Defined.--For purposes of this section, 
the term ``lawful resident alien'' means an alien lawfully admitted for 
permanent residence and any other alien lawfully residing permanently 
in the United States under color of law, including an alien with lawful 
temporary resident status under section 210, 210A, or 245A of the 
Immigration and Nationality Act (8 U.S.C. 1160, 1161, or 1255a).

SEC. 102. ENROLLMENT.

    (a) In General.--Each State program shall provide a mechanism for 
enrollment of individuals entitled to benefits under this Act and, in 
conjunction with such enrollment, the issuance of a State health 
insurance card which may be used for purposes of identification and 
processing of claims for benefits under this Act.
    (b) Enrollment at Birth or Immigration.--The mechanism under 
subsection (a) shall include a process for the automatic enrollment of 
individuals at the time of birth in the State or at the establishment 
of permanent residence in the State, including at the time of 
immigration into the United States, other acquisition of lawful 
resident status in the United States, or eligibility for other 
individuals established under section 101(c).

SEC. 103. PORTABILITY.

    To ensure continuous access to health care services and long-term 
care services covered under this Act, each State program--
            (1) shall utilize a uniform claims form as developed by the 
        Board;
            (2) shall not impose any minimum period of residence in the 
        State, or waiting period, in excess of 3 months before 
        residents of the State are entitled to such services;
            (3) shall provide continuation of payment for such services 
        to individuals who have terminated their residence in the State 
        and established their residence in another State, for the 
        duration of any waiting period imposed in the State of new 
        residency for establishing entitlement to such services; and
            (4) shall provide for the payment for health care services 
        covered under this Act provided to individuals while 
        temporarily absent from the State based on the following 
        principles:
                    (A) Payment for such health care services is at the 
                rate that is approved by the State program in the State 
                in which the services are provided, unless the States 
                concerned agree to apportion the cost between them in a 
                different manner.
                    (B)(i) Except as provided in clause (ii), payment 
                for such health care services provided outside the 
                United States is made on the basis of the amount that 
                would have been paid by the State program for similar 
                services rendered in the State, with due regard, in the 
                case of hospital services, to the size of the hospital, 
                standards of service, and other relevant factors.
                    (ii) Payment for services described under clause 
                (i) which are elective services may be subject to prior 
                consent of the agency that administers and operates the 
                State program if such elective services are available 
                on a substantially similar basis in the State.
                    (iii) For the purposes of this subparagraph, the 
                term ``elective services'' means health care services 
                covered under this Act other than services that are 
                provided in an emergency or in any other circumstance 
                in which medical care is required without delay.

                           TITLE II--BENEFITS

                    Subtitle A--Health Care Services

SEC. 201. COVERED HEALTH CARE SERVICES.

    (a) In General.--Every eligible individual is entitled to have 
payment made for the health care services covered under this Act by a 
participating provider if the service is necessary or appropriate for 
the maintenance of health or for the diagnosis or treatment of, or 
rehabilitation following, injury, disability, or disease.
    (b) Specific Services.--Subject to limitations described in section 
202, health care services covered under this Act are as follows:
            (1) Inpatient and outpatient hospital care, including 24-
        hour per day emergency services.
            (2) Diagnostic and screening tests.
            (3) Medical and other health services furnished by health 
        care professionals who are authorized to provide such services 
        under State law, including medically necessary dental care.
            (4) Preventive health care, including care for well-defined 
        causes of illness and injury (such as breast, cervical, and 
        colon cancer), immunizations (for children, according to an 
        immunization schedule issued by the American Academy of 
        Pediatrics), prenatal and postnatal care (according to 
        guidelines of the American College of Obstetrics and 
        Gynecology, and including prenatal and postnatal care 
        coordination, and nutrition education), family planning 
        services, and well-baby and well-child care (including physical 
        examinations and vision, dental, hearing, and developmental 
        examinations).
            (5) Prescription drugs, biologicals, and devices.
            (6) Substance abuse treatment services, including 
        comprehensive residential treatment services for pregnant women 
        and women with children seeking treatment for substance abuse.
            (7) Inpatient and outpatient mental health services to 
        provide an active preventive, diagnostic, therapeutic, or 
        rehabilitative service with respect to emotional or mental 
        disorders.
            (8) Hospice care for patients certified to be terminally 
        ill, provided under a State approved program.
            (9) Habilitation and rehabilitation services, including 
        physical, speech, and occupational therapies.
            (10) Home medical equipment and prosthetic devices 
        prescribed by a licensed practitioner.
            (11) Experimental treatment as deemed necessary by the 
        review of the Board and the State Advisory Boards.

SEC. 202. LIMITATIONS AND EXCLUSIONS.

    (a) No Limits in General.--Except as provided in this section, 
section 203, and section 221, a State program may not limit the amount, 
duration, or scope of health care services covered under this Act.
    (b) Specific Exclusions.--Health care services excluded from 
coverage under this Act include the following:
            (1) Cosmetic surgery, except medically necessary 
        reconstruction.
            (2) Certain amenities in inpatient facilities, such as 
        private rooms and other amenities determined by the Board, 
        unless medically necessary.

SEC. 203. PATIENT COST-SHARING.

    (a) In General.--Except as provided in this section, a State 
program may not impose cost-sharing for services under this Act.
    (b) Establishment of Cost-Sharing Schedule.--
            (1) In general.--Co-payments and out-of-pocket limits shall 
        be established by the Board consistent with paragraph (2). The 
        Board shall base its determinations on the following 
        principles:
                    (A) Assurance of administrative simplicity and 
                efficiency.
                    (B) Maintenance of the fiscal integrity of the 
                public health insurance program.
                    (C) Deterrence of unnecessary use of services.
                    (D) Encouragement of healthy behaviors.
                    (E) Encouragement of the use of preventive 
                services.
                    (F) Maximization of economic fairness.
                    (G) Minimization of financial barriers to 
                appropriate medical care.
            (2) Specifics.--In establishing co-payments and out-of-
        pocket limits under paragraph (1)--
                    (A) there shall be no cost-sharing imposed with 
                respect to preventive health care (described in section 
                201(b)(4)), and
                    (B) there shall no deductible for any services.
            (3) Studies of modifications.--
                    (A) In general.--The Priorities Council shall 
                study--
                            (i) whether the out-of-pocket limits should 
                        be modified to take into account family size 
                        and family composition,
                            (ii) whether the use of co-payments is a 
                        cost-effective means of containing health care 
                        costs and whether the use of co-payments is an 
                        excessive administrative burden on health care 
                        providers and fiscal providers (designated 
                        under section 311(b)(2)),
                            (iii) the effects of the continuation of 
                        duplicative private insurance (as allowed in 
                        section 602), upon the quality, access, and 
                        cost of the public health insurance program,
                            (iv) whether cost sharing requirements 
                        should be different for individuals that engage 
                        in certain practices deemed to increase the 
                        likelihood such individuals will utilize more 
                        health care resources than individuals who do 
                        not engage in such practices.
                    (B) Specific recommendations.--The Priorities 
                Council within 2 years of the date described in section 
                901(b)(1) shall issue recommendations regarding the 
                studies described in subparagraph (A). The 
                recommendations must balance the following goals:
                            (i) Preserve the fiscal integrity of the 
                        public health insurance program.
                            (ii) Minimize the shifting between 
                        individuals and families of the burden of 
                        financing the public program.
                            (iii) Encourage behaviors by governments, 
                        intermediaries, providers, and individuals that 
                        lead to reduced costs to the health care 
                        system.
            (3) Regulations based on recommendations.--
                    (A) In general.--The Board is authorized to 
                promulgate regulations, as it deems appropriate, for 
                implementing the recommendations of the Priorities 
                Council.
                    (B) Modifications.--The Board is also authorized to 
                promulgate regulations to make periodic adjustments for 
                inflation to income categories, co-payments, and 
                deductibles.
                    (C) Effect of regulations.--The regulations 
                incorporating these modifications to the cost sharing 
                and out-of-pocket limits described in this section 
                shall have the force of law, unless within 60 days of 
                the promulgation of the regulations, the Congress 
                enacts a disapproval resolution under the procedures 
                described in section 501.

                  Subtitle B--Long-Term Care Services

SEC. 211. COVERED LONG-TERM CARE SERVICES.

    (a) In General.--The Board, by regulation, shall set standards for 
eligibility, long-term care services covered, cost-sharing, income 
protection, and case coordination, subject to the criteria described in 
the following subsections.
    (b) Eligibility.--
            (1) In general.--The Board shall determine the standards 
        for eligibility for institutional and for home and community-
        based long-term care services based on an individual's ability 
        to perform activities of daily living (ADLs) and instrumental 
        activities of daily living (IADLs), and comparable cognitive or 
        behavioral impairments.
            (2) Determination.--Eligibility for long-term care services 
        shall be based on a determination by a case manager of the 
        individual's ability to perform the minimum level of ADLs and 
        IADLs, according to the standard set by the Board.
            (3) Standard.--The Board shall, pursuant to recommendations 
        by the Advisory Council and the Long-Term Care Services 
        Assessment Commission, periodically make recommendations about 
        the efficacy of using deficits in ADLs and IADLs, or measures 
        of comparable cognitive or behavioral impairment, or both, to 
        determine eligibility for long-term care services.
    (c) Services Covered.--
            (1) In general.--The Board shall determine the long-term 
        care services to be covered under this Act to meet the long-
        term care needs of the eligible population.
            (2) Minimum services.--At a minimum, long-term care 
        services to be covered under this Act, subject to standards set 
        by the Board, shall include:
                    (A) Home and community-based services, such as 
                nursing care and rehabilitative and restorative care.
                    (B) Nursing home care.
                    (C) Hospice care.
                    (D) Home medical equipment.
                    (E) Services for individuals with developmental 
                disabilities and mental illness.
    (d) Cost Sharing.--The Board shall establish an income-related 
cost-sharing schedule for individuals eligible for long-term care 
services covered under this Act, taking into account such factors as 
what out-of-nursing home expenses would have been.
    (e) Income Protection.--
            (1) In general.--The Board shall reduce the cost sharing to 
        ensure that the income and assets of the individual using long-
        term care services covered under this Act are sufficient to 
        enable such individual to retain a personal needs allowance 
        sufficient--
                    (A) to cover all items needed in addition to those 
                provided by the long-term care facility,
                    (B) to maintain such individual's primary 
                residence, and
                    (C) to maintain such individual's independence once 
                the individual no longer needs long-term care services.
            (2) Spousal protection, etc.--The Board shall reduce the 
        cost sharing to ensure that the income of the spouse, 
        dependent, parent, or guardian of the individual using long-
        term care services covered under this Act is not reduced below 
        levels determined appropriate by the Board, but in no case less 
        than the spousal protection levels under title XIX of the 
        Social Security Act, as in effect on the day before the date of 
        the enactment of this Act.
    (f) Case Management.--
            (1) In general.--The Board shall set standards for case 
        coordination of long-term care services covered under this Act.
            (2) Case coordinator.--
                    (A) In general.--Under the case coordination 
                system, services shall be made available to individuals 
                through a case coordinator who will be responsible for 
                matching services to each individual's needs, and 
                coordinating the delivery of services.
                    (B) Specific responsibilities.--The specific 
                responsibilities of the case coordinator include:
                            (i) The assessment and periodic 
                        reassessment of an individual's need for 
                        services, and the availability and efficacy of 
                        informal services.
                            (ii) The development of plan of care for 
                        the individual.
                            (iii) The authorization and coordination of 
                        services designed to meet an individual's unmet 
                        needs.
    (g) Effect of Regulations.--The regulations incorporating the 
standards described in subsection (a) shall have the force of law, 
unless within 60 days of the promulgation of the regulations, the 
Congress enacts a disapproval resolution under the procedures described 
in section 501.

SEC. 212. LONG-TERM CARE SERVICES ASSESSMENT COMMISSION.

    (a) Establishment.--Due to the seriousness of the current problems 
in long-term care, the Director of the Congressional Office of 
Technology Assessment (hereafter in this section referred to as the 
``Director'') shall provide for the appointment of a special task 
force, to be known as the ``Long-Term Care Services Assessment 
Commission'' (hereafter in this section referred to as the 
``Commission'').
    (b) Membership.--The Commission shall consist of 10 individuals 
appointed for a seven-year term, beginning on October 1, 1994. The 
membership of the Commission shall include long-term care service 
providers, other health and social service professionals, individuals 
skilled in the conduct and interpretation of biomedical, health 
services, and health economics research, and representatives of 
consumers, the elderly, and the disabled. The Director shall fill any 
vacancy in the membership of the Commission in the same manner as the 
original appointment. The vacancy shall not affect the power of the 
remaining members to execute the duties of the Commission.
    (c) Compensation.--All members of the Commission shall be 
reimbursed by the Board for travel and per diem in lieu of subsistence 
expenses during the performance of duties of the Commission in 
accordance with subchapter I of chapter 57 of title 5, United States 
Code.
    (d) Organization.--The Commission shall cease to exist at the end 
of the 7-year term described in subsection (b).
    (e) FACA Not Applicable.--The provisions of the Federal Advisory 
Committee Act shall not apply to the Commission.
    (f) Duties.--
            (1) In general.--The Commission shall make recommendations 
        to the Board not later than January 31 of 1995 (and of each 
        subsequent year) regarding--
                    (A) the adequacy and appropriateness of the long-
                term care services covered under this Act,
                    (B) the criteria for eligibility for long-term care 
                services,
                    (C) the effect of the cost sharing requirements for 
                long-term care services,
                    (D) the financial protections provided individuals 
                in the use of such services and the ability of the 
                patient and any spouse, dependent, parent, or guardian 
                of the patient in the community to remain financially 
                independent once the patient no longer needs long-term 
                care services,
                    (E) the effect of the long-term care services 
                covered under this Act on the availability and use of 
                informal long-term care services and private long-term 
                care insurance, and
                    (F) the overall functioning of the provision of 
                long-term care services covered under this Act, once 
                fully implemented.
            (2) Review.--The Commission shall review and analyze any 
        long-term care services regulations or proposed regulations of 
        the Board and report to the Congress its assessment of the 
        appropriateness of the regulations in meeting the statutory 
        criteria established under this Act.
    (g) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary for the establishment and 
operation of the Commission to carry out the purposes of this Act.

                  Subtitle C--Modification of Services

SEC. 221. MODIFICATION OF SERVICES COVERED UNDER THIS ACT.

    (a) Recommendations by Priorities Council.--Not later than January 
31 of 1998 (and of each subsequent year), the Priorities Council shall 
issue a report to the Board describing any changes, additions, 
deletions, or clarifications the Priority Council recommends for the 
health care services and long-term care services covered under this 
Act.
    (b) Board Regulations.--
            (1) In general.--The Board is authorized to promulgate 
        regulations, as the Board deems appropriate, for implementing 
        the recommendations of the Priorities Council. Such regulations 
        are to be promulgated within 1 year of the submission of the 
        Priorities Council's report.
            (2) Effect.--The regulations incorporating modifications in 
        the health care services and long-term care services covered 
        under this Act shall have the force of law, unless within 60 
        days of the promulgation of the regulations, the Congress 
        enacts a disapproval resolution under the procedures described 
        in section 501.

              TITLE III--FEDERAL AND STATE ADMINISTRATION

                   Subtitle A--Federal Administration

SEC. 301. FEDERAL HEALTH BOARD.

    (a) In General.--There is hereby established a Federal Health 
Board.
    (b) Appointment and Terms of Members.--
            (1) Appointment.--The Board shall be composed of 9 
        individuals appointed by the President, with the advice and 
        consent of the Senate, not later than October 1, 1994, and 
        shall be chosen on the basis of backgrounds in health policy, 
        health economics, the healing professions, and the 
        administration of health care institutions. At least 1 member 
        of the Board shall represent consumer interests, and due regard 
        must be given to geographic, urban, and rural representation. 
        No more than 5 members may be affiliated with a single 
        political party.
            (2) Terms of members.--The individuals appointed shall 
        serve for a term of 9 years (or until a successor is 
        appointed), except that the terms of individuals initially 
        appointed shall be (as specified by the President) for such 
        fewer number of years as will provide for the expiration of 
        terms on a staggered basis.
            (3) Removal for cause only.--Upon confirmation, members of 
        the Board may not be removed except for cause upon notice and 
        hearing.
    (c) Vacancies.--
            (1) In general.--The President shall fill any vacancy in 
        the membership of the Board in the same manner as the original 
        appointment. The vacancy shall not affect the power of the 
        remaining members to execute the duties of the Board.
            (2) Vacancy appointments.--Any member appointed to fill a 
        vacancy shall serve for the remainder of the term for which the 
        predecessor of the member was appointed.
            (3) Reappointment.--The President may reappoint an 
        appointed member of the Board for a second term in the same 
        manner as the original appointment.
    (d) Chairperson and Vice Chairperson.--The Board shall select a 
Chairperson and a Vice Chairperson from among the members of the Board.
    (e) Compensation.--Members of the Board shall be compensated at a 
level comparable to level II of the Executive Schedule, in accordance 
with section 5313 of title 5, United States Code.
    (f) Staff.--The Board shall employ such staff as the Board may 
determine necessary.
    (g) Applicability of Civil Service Provisions.--The staff of the 
Board may be appointed without regard to the provisions of title 5, 
United States Code, governing appointments in the competitive service 
and be compensated without regard to the provisions of chapter 51, and 
subchapter III of chapter 53 of title 5 relating to classification and 
General Schedule pay rates, except that no individual may receive pay 
less than 120 percent of the minimum rate of basic pay payable for GS-
15 of the General Schedule or more than the rate of basic pay payable 
for level IV of the Executive Schedule.
    (h) Duties.--
            (1) In general.--The Board is responsible for the overall 
        administration of this Act, including such duties specifically 
        designated by this Act.
            (2) Additional duties.--The duties of the Board also 
        include--
                    (A) facilitating the exchange of information among 
                States,
                    (B) establishing, evaluating, and updating national 
                minimum quality standards,
                    (C) establishing uniform reporting requirements,
                    (D) developing a uniform claims form,
                    (E) reviewing and approving interstate consortia,
                    (F) assisting States in developing systems to 
                minimize fragmented care, and
                    (G) developing and evaluating activities combating 
                fraud and abuse within the health care system.
    (i) Reports.--
            (1) Initial report.--Not later than January 1, 1996, the 
        Board shall report to the Congress regarding the implementation 
        of the program established under this Act, including any 
        recommendations for further implementing legislation.
            (2) Annual reports.--Beginning January 1, 1997, the Board 
        shall annually report to Congress on the status of expenditures 
        under this Act and the long-range plans and goals of the Board 
        for the organization and delivery of health care services and 
        long-term care services under this Act.

SEC. 302. FEDERAL HEALTH ADVISORY COUNCIL.

    (a) Appointment.--Not later than January 1, 1995, the Board shall 
provide for appointment of a Federal Health Advisory Council to advise 
the Board on its activities.
    (b) Membership.--Such Advisory Council shall consist of 15 members 
who are representatives of consumers, providers, unions, health care 
experts, senior citizen groups, public health officials, experts in 
long-term care, rural health care and mental illness, and other 
individuals with an interest in the health care system. Such members 
shall serve for terms of 3 years, except that, in the initial 
appointment, 5 members shall be each appointed for terms of 1-year, 2-
years, and 3-years.
    (c) Vacancies.--
            (1) In general.--The Board shall fill any vacancy in the 
        membership of the Advisory Council in the same manner as the 
        original appointment. The vacancy shall not affect the power of 
        the remaining members to execute the duties of the Advisory 
        Council.
            (2) Vacancy appointments.--Any member appointed to fill a 
        vacancy shall serve for the remainder of the term for which the 
        predecessor of the member was appointed.
            (3) Reappointment.--The Board may reappoint an appointed 
        member of the Advisory Council for a second term in the same 
        manner as the original appointment.
    (d) Chairperson and Vice Chairperson.--The Advisory Council shall 
select a Chairperson and a Vice Chairperson from among the members of 
the Advisory Council.
    (e) Compensation.--All members of the Advisory Council shall be 
reimbursed by the Board for travel and per diem in lieu of subsistence 
expenses during the performance of duties of the Advisory Council in 
accordance with subchapter I of chapter 57 of title 5, United States 
Code.
    (f) FACA Not Applicable.--The provisions of the Federal Advisory 
Committee Act shall not apply to the Advisory Council.
    (g) Duties.--The Advisory Council shall conduct studies and make 
recommendations to the Board on the overall functioning of the program 
established under this Act and consumer and provider satisfaction with 
such program.

SEC. 303. FEDERAL HEALTH PRIORITIES COUNCIL.

    (a) In General.--There is hereby established a Federal Health 
Priorities Council.
    (b) Appointment and Terms of Members.--
            (1) Appointment.--The Priorities Council shall be composed 
        of 15 individuals appointed by the President, with the advice 
        and consent of the Senate, not later than October 1, 1994. Such 
        individuals shall be representatives from the fields of 
        medicine, dentistry, mental health care, nursing, social 
        services, ethics, economics, business, and consumer groups.
            (2) Terms of members.--The individuals appointed shall 
        serve for a term of 5 years, except that the terms of 
        individuals initially appointed shall be (as specified by the 
        President) for such fewer number of years as will provide for 
        the expiration of terms on a staggered basis.
    (c) Vacancies.--
            (1) In general.--The President shall fill any vacancy in 
        the membership of the Priorities Council in the same manner as 
        the original appointment. The vacancy shall not affect the 
        power of the remaining members to execute the duties of the 
        Priorities Council.
            (2) Vacancy appointments.--Any member appointed to fill a 
        vacancy shall serve for the remainder of the term for which the 
        predecessor of the member was appointed.
            (3) Reappointment.--The President may reappoint an 
        appointed member of the Priorities Council for a second term in 
        the same manner as the original appointment.
    (d) President and Vice President.--The Priorities Council shall 
select a President and a Vice President from among the members of the 
Priorities Council.
    (e) Compensation.--Members of the Priorities Council shall be 
compensated at a level comparable to level II of the Executive 
Schedule, in accordance with section 5313 of title 5, United States 
Code.
    (f) Staff.--The Priorities Council shall employ such staff as the 
Priorities Council may determine necessary.
    (g) Applicability of Civil Service Provisions.--The staff of the 
Priorities Council may be appointed without regard to the provisions of 
title 5, United States Code, governing appointments in the competitive 
service and be compensated without regard to the provisions of chapter 
51, and subchapter III of chapter 53 of title 5 relating to 
classification and General Schedule pay rates, except that no 
individual may receive pay less than 120 percent of the minimum rate of 
basic pay payable for GS-15 of the General Schedule or more than the 
rate of basic pay payable for level IV of the Executive Schedule.
    (h) Committees.--The Priorities Council may establish such 
committees of its members and other medical, economic, or health 
services advisers as it determines to be necessary to assist the 
Priorities Council in the performance of its duties.
    (i) Functions.--In order to build a consensus on the values to be 
used to guide health resource decisions, the Priorities Council shall 
have the following functions:
            (1) Conduct public hearings and solicit testimony and 
        information from advocates for children, senior citizens, the 
        disabled, consumers of mental health services, low-income 
        people, providers of health care, business leaders, and others.
            (2) Building on outcomes research and the development of 
        practice guidelines, conduct studies and make recommendations 
        for how health care dollars should be allocated in the context 
        of a publicly funded national health insurance plan.
    (j) Reports.--The Priorities Council shall report to the Board a 
list of health services ranked by priority, from the most important to 
the least important, representing the comparative benefits of each 
service to the Nation's population. The recommendation shall be 
accompanied by a report of an independent actuary retained for the 
Board to determine rates necessary to cover the costs of the included 
services in order to establish an appropriate annual global budget. The 
recommendation is to be used in evaluating and modifying the health 
care services and the long-term care services covered under this Act. 
The reports from the Priorities Council to the Board are to be 
submitted by January 31 of 1996 (and of each subsequent year), to be 
acted on by the Board by the following January 31.

SEC. 304. AUTHORIZATION OF APPROPRIATIONS.

    There are authorized to be appropriated such sums as are necessary 
for the establishment and operation of the Board, Advisory Council, and 
Priorities Council to carry out the purposes of this Act.

                    Subtitle B--State Administration

SEC. 311. STATE PROGRAMS.

    (a) Submission of Programs.--
            (1) In general.--Not later than October 1, 1996, each State 
        shall submit to the Board the State program in the State.
            (2) Regional programs.--Any State may join with neighboring 
        States to submit to the Board a regional program in lieu of a 
        State program, as described in section 314.
    (b) Review and Approval of Programs.--The Board shall review 
programs submitted under subsection (a) and determine whether such 
programs meet the requirements for approval, not later than October 1, 
1997. The Board shall not approve such a program unless it finds that 
the program provides, consistent with the provisions of this Act, for--
            (1) adequate financing of health care services and long-
        term care services covered under this Act through a designated 
        fund, including the annual submission of the State program 
        budget to the Board,
            (2) adequate administration, including the designation of a 
        single nonprofit State agency responsible for administration of 
        the program, and sufficient provisions to ensure against fraud 
        and abuse,
            (3) the establishment of--
                    (A) an institution reimbursement negotiation board 
                to negotiate global operating, capital, and health 
                training budgets with hospitals and other health care 
                and long-term care institutions,
                    (B) a practitioner reimbursement negotiation board 
                (with membership including State government 
                representatives, consumers, general practice 
                physicians, specialists, and nonphysician 
                practitioners) to negotiate reimbursement rates for 
                participating providers, and
                    (C) at the State's option, a State advisory board 
                (with broad representation of health policy experts, 
                institutional providers, practitioners, and consumers) 
                to generally oversee and review the performance of the 
                State program,
            (4) assurances that individuals have the freedom to choose 
        practitioners and other health care providers for services 
        covered under this Act, and
            (5) an organized grievance procedure available to consumers 
        through which complaints about the organization and 
        administration of the State program may be filed, heard, and 
        resolved.
    (c) Operational Status.--A State program in a State shall not be 
considered operational unless it is approved and remains approved under 
subsection (b).
    (d) Failure To Comply With This Act.--Whenever the Board, after 
reasonable notice and opportunity for hearing to the designated State 
agency finds that in the administration of the State program there is a 
failure to comply with any provision of this Act, the Board may--
            (1) withhold further payments to the State under section 
        402 and may limit such withholding to specific portions of such 
        program affected by the failure, or
            (2) place the State program, or specific portions of such 
        program, in receivership under the jurisdiction of the Board,
until such failure has been corrected.
    (e) Judicial Review.--
            (1) In general.--If any State is dissatisfied with the 
        Board's action in denying approval of such State's program or 
        finding a failure under subsection (d) with respect to such 
        program, such State may, within 60 days after notice of such 
        action, file with the United States court of appeals for the 
        circuit in which such State is located a petition for review of 
        that action. A copy of the petition shall be forthwith 
        transmitted by the clerk of the court to the Board. The Board 
        thereupon shall file in the court the record of the proceedings 
        upon which the Board's action was based, as provided in section 
        2112 of title 28, United States Code.
            (2) Findings of fact.--The findings of fact by the Board, 
        if supported by substantial evidence, shall be conclusive; but 
        the court, for good cause shown, may remand the case to the 
        Board to take further evidence, and the Board may thereupon 
        make new or modified findings of fact and may modify the 
        Board's previous action, and shall file in the court the record 
        of the further proceedings. Such new or modified findings of 
        fact shall likewise be conclusive if supported by substantial 
        evidence.
            (3) Jurisdiction of court.--Upon the filing of such 
        petition, the court shall have jurisdiction to affirm the 
        action of the Board or to set it aside, in whole or in part. 
        The judgment of the court shall be subject to review by the 
        Supreme Court of the United States upon certiorari or 
        certification as provided in section 1254 of title 28, United 
        States Code.

SEC. 312. USE OF FISCAL INTERMEDIARIES.

    (a) In General.--Each State program may contract with fiscal 
intermediaries in a process of competitive bidding.
    (b) Role of Fiscal Intermediary.--
            (1) In general.--Subject to paragraph (2) and under 
        continuous State oversight, the fiscal intermediary shall 
        process claims and reimbursements, distribute the allocation of 
        funds as specified in agreements on global operating budgets, 
        and assume general responsibility for the administration of the 
        State program.
            (2) Limitation.--The fiscal intermediary may not 
        participate in, nor administer, the negotiating processes used 
        to establish global operating budgets or practitioner 
        reimbursement rates.
    (c) Type of Organization.--The fiscal intermediary may be any type 
of entity designated by the State, including nonprofit associations and 
private companies, as long as the State or regional program provides 
for public accountability. Such accountability may include review of 
the operations of the fiscal intermediary by the State advisory board.

SEC. 313. STATE WAIVERS; MANAGED CARE.

    (a) State Waivers.--A State program shall be allowed to obtain 
waivers from the Board--
            (1) to implement alternative and innovative--
                    (A) methods of reimbursing health care providers,
                    (B) patient cost-sharing arrangements, and
                    (C) administrative structures, and
            (2) to provide the services covered under this Act through 
        the use of health plans paid through a capitation method in 
        order to allow the freedom of choice of all eligible 
        individuals in the selection of a health plan.
In approving any waiver the Board shall assure itself that the State 
program otherwise complies with the requirements of this Act that are 
not inconsistent with the granting of such waiver.
    (b) Managed Care Option.--No provision of this Act shall be 
construed to prohibit or discourage any State from developing, or 
contracting with, managed care networks for the purpose of delivering 
services covered under this Act of a higher quality and in a more cost-
effective manner, as long as such networks otherwise meet the 
requirements of this Act.
    (c) Organized Approaches to Delivery of Services.--The Board shall 
sponsor efforts to encourage States and providers of services to 
develop and expand organized approaches to the delivery of health care 
services covered under this Act, including health maintenance 
organizations, hospital-based and community-oriented team health 
services, and neighborhood-hospital-home health care plans.

SEC. 314. STATE REGIONAL CONSORTIA.

    (a) In General.--Any group of States may enter into an agreement to 
establish a regional consortium for the purposes of implementing a 
program to be approved by the Board under section 311. Such regional 
consortium shall have jurisdiction over all States that are parties to 
such agreement and that shall be subject to the provisions of section 
311 as if such consortium were established by a single State.
    (b) Consortium Agreement.--Any agreement to establish a State 
regional consortium shall, in addition to providing for the 
requirements specified in section 311(b), provide for--
            (1) a mechanism to resolve any disputes between or among 
        the States that are parties to the agreement, and
            (2) the collection of data and information concerning the 
        operations of the consortium and the submission of such data 
        and information to the Board on an annual basis.
    (c) Congressional Review.--Any consortium agreement described in 
this section which has been approved by the Board, shall be submitted 
to the Congress and shall be considered in effect, unless within 60 
days of the submission of the agreement, the Congress enacts a 
disapproval resolution under the procedures described in section 501.

SEC. 315. GRANTS TO STATES.

    (a) In General.--The Board shall make grants (including cooperative 
agreements) available to States for funding programs and for research 
designed to prevent or minimize the high costs of health care, to treat 
illness, disease, or medical conditions created by conditions in the 
environment or workplace, and to promote health and wellness.
    (b) Specific Program Areas.--Grants under this section shall be 
awarded for initiatives in the areas of--
            (1) environmental health, and
            (2) health promotion and disease prevention.
    (c) Requests for Proposals.--The Board shall issue periodic 
requests each year for proposals for grants under this section.

SEC. 316. TECHNICAL ASSISTANCE TO STATES.

    (a) Grants.--
            (1) In general.--Not later than October 1, 1995, the Board 
        shall award a grant to each State or group of States to assist 
        in paying the costs associated with the establishment and 
        initial operation of the State plan or the State regional 
        consortium agreement.
            (2) Amounts.--Not less than $500,000 shall be provided to 
        each State or group of States under a grant awarded under 
        paragraph (1), and any State or group of States shall remit to 
        the Trust Fund any unspent amount of such grant at the end of 
        the 2-year period beginning with the date of the awarding of 
        such grant.
            (3) Planning functions.--Amounts provided under grants 
        awarded under paragraph (1) shall be utilized for planning 
        functions only.
            (4) Study.--Not later than October 1, 1998, the Board shall 
        prepare and submit to the appropriate committees of Congress, a 
        report that shall contain the results of a study conducted by 
        the Board concerning the use of the grants awarded under 
        paragraph (1), and whether such use was effective preparing 
        State plans and State regional consortia agreements and 
        simplifying administrative procedures.
    (b) Technical Assistance.--The Board shall provide technical 
assistance to States in developing State plans and State regional 
consortia agreements.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section.

                          TITLE IV--FINANCING

                       Subtitle A--Health Budgets

SEC. 401. NATIONAL HEALTH BUDGET.

    (a) In General.--
            (1) Annual budgets.--Except as provided in paragraph (2), 
        the Board shall establish an annual fiscal year budget of 
        expenditures that estimates the total expenditures to be made 
        in such fiscal year by the Federal Government and States for 
        health care services and long-term care services covered under 
        this Act, including the administrative costs associated with 
        such services.
            (2) Biennial budgets.--The Board may establish biennial 
        fiscal year budgets in lieu of annual budgets.
    (b) National Average Per Capita Costs.--
            (1) In general.--At least 6 months before the beginning of 
        the first fiscal year of the program under this Act, the Board 
        shall compute the national average per capita cost for each of 
        the services described in subsection (a) using data the Board 
        deems to be appropriate.
            (2) Adjustments for risk groups.--
                    (A) In general.--The Board shall develop an 
                adjustment factor to the national average per capita 
                costs computed under paragraph (1) for each risk group 
                (as designated under subparagraph (B)) to reflect the 
                national average per capita costs for that risk group.
                    (B) Risk groups.--The Board shall designate a 
                series of risk groups, determined by age, sex, and 
                other factors that represent distinct patterns of 
                health care services and long-term care services 
                utilization and costs.
            (3) State adjustments to national average per capita 
        costs.--The Board shall develop for each State a factor to 
        adjust the national average per capita costs for each risk 
        group to reflect--
                    (A) average labor and nonlabor costs that are 
                necessary to produce the services described in 
                subsection (a),
                    (B) any special social, environmental, 
                epidemiological, or other condition affecting health 
                status or the need for health care services and long-
                term care services,
                    (C) the geographic distribution of the State's 
                population, particularly the proportion of the 
                population residing in rural or medically underserved 
                areas,
                    (D) the quality and availability of the State's 
                existing health care resources needed for delivering 
                health care services and long-term care services, and
                    (E) any other economic, geographic, and sociologic 
                factors.
    (c) State Total Expenditures.--The Board shall compute for each 
State total projected expenditures in the next fiscal year for each of 
the services described in subsection (a), by multiplying--
            (1) the national average per capita costs of each risk 
        group designated in subsection (b)(2)(B), by
            (2) the product of the State adjustment factors described 
        in subsection (b)(3) and the number of persons in the State 
        estimated by the Bureau of the Census to be resident members of 
        each risk group at the beginning of the next fiscal year.
    (d) Federal Contributions.--
            (1) In general.--The Board shall determine the appropriate 
        Federal contribution for each State, constituting the Federal 
        percentage share of each State's total projected expenditures 
        for the services described in section (a). The Federal share 
        shall be determined by subtracting the State share from 100 
        percent of the total projected expenditures for such State (as 
        described under subsection (c)), but in no event shall such 
        Federal contribution be less than 75 percent nor more than 85 
        percent of such expenditures. The Federal share for all States 
        shall equal 80 percent of the aggregate of such expenditures 
        for all States.
            (2) Adjustments in state share.--In determining each State 
        share, the Board shall develop a formula that considers a 
        State's--
                    (A) per capita income,
                    (B) total taxable resources,
                    (C) economic performance relative to the national 
                economy as it affects the availability of taxable 
                resources, and
                    (D) other relevant economic and demographic 
                indicators.
    (e) Subsequent Calculations.--For each subsequent fiscal year, the 
Board shall recompute under subsections (a), (b), (c), and (d) at least 
6 months before the beginning of such fiscal year. In making such a 
recomputation, the Board shall take into account--
            (1) changes in medical technology, outcomes research 
        evidence concerning the efficacy and safety of health care 
        services and long-term care services, needs for health 
        personnel, professional practice guidelines, and changing 
        health care priorities, after reviewing recommendations of the 
        Advisory Council and the Priorities Council, and
            (2) changes in the services described in subsection (a) 
        under regulations promulgated by the Board and accepted by the 
        Congress under section 204.
    (f) Effect of Board Actions.--Any determination made by the Board 
under this section with respect to any fiscal year shall be submitted 
to the Congress at least 6 months before the beginning of such fiscal 
year, and shall have the force of law, unless within 60 days of the 
submission of such determination, the Congress enacts a disapproval 
resolution under the procedures described in section 501.

SEC. 402. PAYMENTS TO STATES.

    (a) In General.--For each fiscal year, each State with a State 
program approved under section 311, is entitled to receive (subject to 
section 311(d)), from amounts in the Trust Fund, a Federal contribution 
in an amount equal to the product of--
            (1) the Federal share for such State (computed under 
        section 401(d), and
            (2) such State's total projected expenditures (computed 
        under section 401(c)).
    (b) Use of Dedicated Funds.--
            (1) In general.--All revenues, including the Federal 
        contribution and State revenues provided to finance a State 
        program under this Act shall be allocated to a dedicated fund 
        specified by the State. Payments for health care services and 
        long-term care services covered under this Act shall be made 
        from such fund.
            (2) Special accounts.--Each State shall establish within 
        its designated fund special accounts, the amount of revenues 
        deposited in each to be determined by the State. The various 
        special accounts shall include the following:
                    (A) An Institutional Global Operating Budget 
                Account shall be used to fund total expenditures for 
                the operating costs of hospitals and other health care 
                and long-term care institutions, allocated according to 
                the method specified in section 411(b).
                    (B) An Institutional Capital Account shall be used 
                to fund total expenditures for capital-related items in 
                hospitals and other health care and long-term care 
                institutions, allocated according to the method 
                specified in section 411(c).
                    (C) A Health Training Account shall be used to fund 
                direct and indirect graduate medical education in 
                hospitals and other health care and long-term care 
                institutions to cover excess operating and capital 
                costs associated with teaching and related research 
                activities, allocated according to the method specified 
                in section 411(d).
                    (D) A Practitioner Reimbursement Account shall be 
                used to fund the reimbursement of services provided by 
                health care practitioners, allocated according to the 
                method specified in section 412.

SEC. 403. STATE PROGRAM BUDGETS.

    (a) In General.--Each State program shall establish an annual 
fiscal year State program budget which provides for--
            (1) the total expenditures to be made under the State 
        program in such fiscal year for health care services and long-
        term care services covered under this Act (including 
        administrative and associated costs), and
            (2) the revenues to meet such expenditures.
    (b) Coordination.--Each State program budget shall be coordinated, 
in a manner specified by the Board, with the national health budget 
established under section 401(a).
    (c) State Share.--
            (1) In general.--Each State program shall cover the State 
        share of program costs through the use of tax revenues and 
        other financing methods allowed under section 424.
            (2) Additions to state share.--Each State shall raise the 
        revenues necessary to cover at least the State share specified 
        in the national health budget established by the Board 
        (computed under section 401(d)). Each State is permitted to 
        raise additional revenues and to increase such State's health 
        program expenditures beyond the amount specified in the State 
        share specified for the national health budget--
                    (A) to cover the costs of benefits for health care 
                services or long-term care services the State program 
                authorizes in addition to the services covered in this 
                Act or as amended by the Board and the Congress,
                    (B) to provide for increased global operating, 
                capital, or health training budgets for hospitals and 
                other health care and long-term care institutions,
                    (C) to provide for any unexpected increase in 
                health care costs identified by the State program, and
                    (D) for other purposes that may be identified by 
                the Board.
    (d) Barriers to Access Prohibited.--No State, either by intention 
or as an unstated consequence of budget allocations, may restrict or 
cause to be restricted timely access to the medically necessary and 
appropriate health care services and long-term care services covered 
under this Act, or permit queues for services to form that have the 
potential of being life threatening.
    (e) Annual Publication.--The State program shall provide for the 
publication annually of the most recent State program budget 
established under this section.

                   Subtitle B--Payments to Providers

SEC. 411. PAYMENTS TO HOSPITALS AND OTHER HEALTH CARE AND LONG-TERM 
              CARE INSTITUTIONS.

    (a) In General.--Each State program shall be responsible for--
            (1) allocating from the State program budget the aggregate 
        amount of money to be directed to hospitals and other health 
        care and long-term care institutions for the global operating, 
        capital, and health training budgets of such institutions, and
            (2) devising mechanisms for the allocation from such budget 
        of capital expenditures in non-institutional settings.
    (b) Global Budgets for Operating Expenses for Hospitals and Other 
Health Care and Long-Term Care Institutions.--The following principles 
shall guide a State institution reimbursement negotiation board in 
negotiating institutional global operating budgets:
            (1) Each State program budget shall include a separate 
        account for global operating expenses to provide for total 
        State expenditures for the operating expenses of hospitals and 
        other health care and long-term care institutions.
            (2) Payment shall be based on an annual prospective global 
        budget for operating expenses submitted by an institution, in a 
        manner specified by the State program, to the agency designated 
        by the State program.
            (3) The budgets shall take into account amounts that are 
        reasonable and necessary in the efficient provision of 
        necessary hospital and other institutional services covered 
        under this Act.
            (4) The operating budgets shall not include capital-related 
        and health training expenses.
            (5) Adjustments may later be made in the budget to reflect 
        significant changes in the volume or types of services assumed 
        in the approval of the budget.
            (6) A State should encourage innovation by permitting any 
        institution to include in its budget for the immediate year any 
        programs designed to increase efficiency in later years, if 
        those improvements can be demonstrated to the satisfaction of 
        the designated State agency.
    (c) Capital Budgets for Hospitals and Other Health Care and Long-
Term Care Institutions.--The following principles shall guide a State 
institution reimbursement negotiation board in negotiating 
institutional capital budgets:
            (1) Each State program budget shall include a separate 
        account for capital expenses to provide for total State 
        expenditures for the capital-related items in hospitals and 
        other health care and long-term care institutions.
            (2) Each State program budget shall specify the general 
        manner in which such expenditures for capital-related items are 
        to be distributed among different types of institutions and the 
        different areas of the State to take into account the need for 
        capital expenditures throughout the State.
            (3) Capital expenditures are those authorized by the State 
        for the provision of insured health services, regardless of 
        whether the source of funds for the capital expenditure is 
        derived from accumulated depreciation charges, operating 
        surpluses or retained earnings, expenditure of accumulated fund 
        balances, issuance of bonds, notes, debentures or other 
        evidence of indebtedness, borrowed funds, or any other source 
        including equity capitalization.
            (4) Unless otherwise provided in this Act regarding 
        underserved areas, or waived by the designated State agency if 
        necessary to provide equitable resource allocation and access 
        to quality care, hospitals and other health care and long-term 
        care institutions shall furnish a 15 percent match for funds 
        allocated from the Institutional Capital Account of the budget.
    (d) Health Training for Hospitals and Other Health Care and Long-
Term Care Institutions.--The following principles shall guide a State 
institution reimbursement negotiation board in negotiating 
institutional health training budgets:
            (1) Each State program budget shall include a separate 
        account for direct and indirect graduate medical education-
        related expenses in hospitals and other health care and long-
        term care institutions.
            (2) Each state program budget shall specify the general 
        manner in which such expenditures for direct and indirect 
        graduate medical education are to be distributed among 
        different types of institutions and the different areas of the 
        State.
            (3) The distribution of funds to hospitals and other health 
        care and long-term care institutions from the Health Training 
        Account must conform to the following principles:
                    (A) At least 50 percent of the funding from the 
                Health Training Account is to be directed to primary 
                care training programs.
                    (B) For each 5-year period beginning after the date 
                which is 5 years after the date of the enactment of 
                this Act, the Advisory Board will evaluate the required 
                minimum percentage of funds that States must direct to 
                primary care and recommend whether the percentage 
                should be changed to ensure consistency with the goal 
                of encouraging primary care residency training 
                programs.
                    (C) The State is to develop a methodology for 
                funding nonhospital-based residency programs and to 
                establish opportunities for residencies in community-
                based health care facilities.
                    (D) The distribution of funds from the Health 
                Training Account must take into account the potentially 
                higher costs of placing medical students in rural 
                residency programs.
                    (E) The distribution of funds from the Health 
                Training Account must accommodate the education and 
                training needs of nonphysician practitioners.

SEC. 412. PAYMENTS FOR PRACTITIONERS SERVICES.

    The State practitioner reimbursement negotiation board shall 
negotiate with the State organizations representing each of the 
practitioner disciplines in order to derive a relative value scale fee 
schedule that fulfills each of the following principles:
            (1) Appropriate levels of payment are provided primary care 
        services, including general, family, and preventive procedures.
            (2) The same compensation is given for the same procedures 
        even when performed by different types of practitioners 
        licensed to offer those procedures.
            (3) Reimbursement rates for different procedures performed 
        by practitioners in different disciplines reflect the relative 
        value of those procedures.
            (4) Urban and rural practitioners receive the same 
        reimbursement rates for the same services, unless the State 
        determines that a differential rate is required to increase the 
        access to health care practitioners in underserved areas.
            (5) A process is established that keeps overall 
        reimbursements in line with the amount of funding budgeted for 
        practitioner reimbursements.

SEC. 413. SPECIAL NONPHYSICIAN PRACTITIONER PROVISIONS.

    The following principles shall guide the State practitioner 
reimbursement negotiation board in negotiating reimbursement rates for 
nonphysician practitioners:
            (1) When the same services covered under this Act are 
        provided by practitioners licensed by the State, reimbursement 
        rates for those same services shall be the same regardless of 
        the type of practitioner providing such services.
            (2) For procedures covered under this Act, services 
        provided by all practitioners licensed in the State for those 
        services are to be included in the reimbursement fee schedule.

SEC. 414. MANDATORY ASSIGNMENT.

    (a) In General.--Except with respect to patient cost-sharing 
provisions under section 203 of this Act, no individual shall be liable 
for payment of any amount for health care services or long-term care 
services covered under this Act, and payment by a State program shall 
constitute payment in full for such services.
    (b) Enforcement.--The State program shall apply appropriate 
sanctions against the entity if such entity knowingly and willfully 
charges for an item or service or accepts payment in violation of 
subsection (a).

                          Subtitle C--Revenues

SEC. 421. FEDERAL SOURCES OF REVENUES.

    (a) American Health Security Plan Premiums.--The Board, in 
consultation with the Secretary of the Treasury, shall develop a 
mechanism for determining and collecting a premium from individuals and 
employers for health care services and long-term care services covered 
under this Act, to be known as the American Health Security Plan 
premium.
    (b) Determination of Premium Amount.--The Board shall determine the 
American Health Security Plan premium for each taxable year beginning 
after December 31, 1996, by estimating the total amount necessary to 
equal the excess of--
            (1) expenditures described in section 423(c) for the fiscal 
        year beginning in such taxable year, over
            (2) receipts described in section 423(b) (other than 
        paragraph (1)) for such fiscal year.
    (c) Collection of Premium.--
            (1) Individuals.--The Board shall collect the American 
        Health Security Plan premium from individuals using a mechanism 
        with the following characteristics:
                    (A) Income-based (including earned and unearned 
                income).
                    (B) Progressive.
                    (C) Payable in increments during the course of the 
                year.
                    (D) Payable by individuals or by employers on 
                behalf of employees (at the option of the employer), as 
                described in paragraph (2)(C).
                    (E) Subject to the provisions of subtitle F of the 
                Internal Revenue Code of 1986.
            (2) Employers.--The Board shall collect the American Health 
        Security Plan premium from employers using a mechanism with the 
        following characteristics:
                    (A) Aggregate employer contributions would equal an 
                amount necessary to prevent an increase in the 
                percentage of 1993 aggregate household health care 
                expenditures.
                    (B) Contribution rate based on each employer's 
                ability to pay as indicated by factors such as the size 
                of the employer's workforce and profitability.
                    (C) Any employer would have the option of paying 
                all or part of the American Health Security Plan 
                premium otherwise payable by such employer's employees.
                    (D) Subject to the provisions of subtitle F of the 
                Internal Revenue Code of 1986.
    (d) Effect of Board Actions.--Any premium determination made by the 
Board under this subsection with respect to any taxable year shall be 
submitted to the Congress at least 6 months before the beginning of 
such taxable year, and shall have the force of law, unless within 60 
days of the submission of such determination, the Congress enacts a 
disapproval resolution under the procedures described in section 501.
    (e) Effective Date.--The provisions of this section shall apply 
with respect to remuneration paid after December 31, 1996, and with 
respect to earnings from self-employment attributable to taxable years 
beginning after such date.

SEC. 422. TAX TREATMENT OF AMERICAN HEALTH SECURITY PLAN AND PRIVATE 
              HEALTH AND LONG-TERM CARE INSURANCE.

    (a) Tax Exclusions for Amounts Received From, and Employer 
Contributions To, the Plan.--
            (1) Amounts received.--Subsection (e) of section 105 of the 
        Internal Revenue Code of 1986 (relating to amounts received 
        under accident and health plans) is amended to read as follows:
    ``(e) Accident or Health Insurance.--For purposes of this section, 
section 104, and section 106, the term `accident or health insurance' 
means an approved State program under section 311 of the American 
Health Security Plan Act of 1993.''.
            (2) Employer contributions.--Section 106 of such Code 
        (relating to contributions by employer to accident and health 
        plans) is amended by striking ``an accident or health plan'' 
        and inserting ``accident or health insurance''.
            (3) Conforming amendment.--Section 105 of such Code is 
        amended by striking subsection (h).
    (b) Business Expense Deduction for Health Insurance.--Section 162 
of the Internal Revenue Code of 1986 (relating to trade or business 
expenses) is amended by redesignating subsection (m) as subsection (n) 
and by inserting after subsection (l) the following new subsection:
    ``(m) Group Health Plans.--The expenses paid or incurred by an 
employer for a group health plan shall not be allowed as a deduction 
under this section unless the plan is an approved State program under 
section 311 of the American Health Security Plan Act of 1993.''.
    (c) Rules Relating to Deductions for Individuals.--
            (1) Same treatment for self-employed individuals and 
        businesses.--Section 162(l) of the Internal Revenue Code of 
        1986 (relating to special rules for health insurance costs of 
        self-employed individuals) is amended--
                    (A) by striking ``25 percent of'' in paragraph (1), 
                and
                    (B) by striking paragraph (6).
            (2) Similar treatment for other individuals.--Subsection 
        (d) of section 213 of such Code (relating to medical, dental, 
        etc., expenses) is amended--
                    (A) by striking paragraph (1) and inserting the 
                following new paragraph:
            ``(1) Medical care.--The term `medical care' means American 
        Health Security Plan premiums and cost-sharing amounts paid for 
        coverage under an approved State program under section 311 of 
        the American Health Security Plan Act of 1993.'',
                    (B) by striking paragraphs (2), (6), (7), and (9), 
                and by redesignating paragraphs (3), (4), (5), and (8) 
                as paragraphs (2), (3), (4), and (5), respectively.
    (d) Termination of Child Health Insurance Credit.--Clause (i) of 
section 32(b)(2)(A) of such Code is amended by inserting ``(0 percent 
for taxable years beginning after December 31, 1999)'' after ``6 
percent''.
    (e) Effective Date.--The amendments made by this section shall 
apply with respect to any taxable year beginning after December 31, 
1999.

SEC. 423. FEDERAL HEALTH TRUST FUND.

    (a) Trust Fund Established.--There is hereby created on the books 
of the Treasury of the United States a trust fund to be known as the 
``Federal Health Care Trust Fund''. The Trust Fund shall consist of 
such gifts and bequests as may be made and such amounts as may be 
deposited in, or appropriated to, such Trust Fund as provided in this 
Act.
    (b) Receipts.--
            (1) Transfer of amounts equivalent to certain taxes.--
                    (A) In general.--There are hereby appropriated to 
                the Trust Fund amounts equivalent to 100 percent of the 
                American Health Security Plan premiums received in the 
                Treasury as the result of the mechanism described in 
                section 421 of this Act.
                    (B) Additional revenues.--There are appropriated to 
                the Trust Fund amounts equivalent to the additional 
                revenues received in the Treasury as the result of the 
                amendments made by section 422 of this Act.
                    (C) Transfers based on estimates.--The amounts 
                appropriated by subparagraphs (A) and (B) shall be 
                transferred from time to time (not less frequently than 
                monthly) from the general fund in the Treasury to the 
                Trust Fund, such amounts to be determined on the basis 
                of estimates by the Secretary of the Treasury of the 
                taxes and premiums, specified in such subparagraphs, 
                paid to or deposited into the Treasury; and proper 
                adjustments shall be made in amounts subsequently 
                transferred to the extent prior estimates were in 
                excess of or were less than the taxes and premiums 
                specified in such subparagraphs.
            (2) Transfer of funds.--All amounts, not otherwise 
        obligated, that remain in the Federal Hospital Insurance Trust 
        Fund and the Federal Supplemental Medical Insurance Trust Fund 
        on the first day of the fiscal year 2000 shall be transferred 
        to the Trust Fund.
            (3) Appropriation of additional sums.--For fiscal years 
        beginning after September 30, 1999, there are hereby authorized 
        to be appropriated, and are appropriated, to the Trust Fund 
        such additional sums as equal the amounts appropriated with 
        respect to title XIX of the Social Security Act, section 1079 
        of title 10, United States Code (CHAMPUS), and chapter 89 of 
        title 5, United States Code, as in effect for fiscal year 1999. 
        Such amount shall be adjusted each fiscal year by the increase 
        in the Consumer Price Index (as determined by the Department of 
        Labor) for the previous fiscal year.
            (4) Appropriation of sums for administrative costs.--For 
        fiscal years 1995, 1996, and 1997, there are hereby authorized 
        to be appropriated, and are appropriated, to the Trust Fund 
        such additional sums as may be required to make expenditures 
        referred to in subsection (c)(2).
            (5) Returned grant funds.--Any returned grant funds as 
        described in section 316(a)(2) of this Act shall be transferred 
        to the Trust Fund.
    (c) Expenditures.--
            (1) To states.--Payments in each fiscal year to each State 
        from the Trust Fund as determined under section 402 are hereby 
        authorized and appropriated.
            (2) Administrative expenses and grants.--There are hereby 
        authorized and appropriated such sums as are necessary for the 
        administrative expenses and grants described in sections 
        212(g), 304, 315, 316(c) and 803 of this Act for each fiscal 
        year.
            (3) Contingency account.--There are hereby authorized and 
        appropriated such sums as determined necessary by the Board to 
        cover unanticipated events that affect the health care needs of 
        individuals described in section 101(a), to be available 
        without fiscal year limitation.
    (d) Incorporation of Trust Fund Provisions.--The provisions of 
subsections (b) through (e) of section 1841 of the Social Security Act 
(42 U.S.C. 1395t), as in effect on the day before the date of the 
enactment of this Act, shall apply to the Trust Fund in the same manner 
as such provisions apply to the Federal Supplemental Medical Insurance 
Trust Fund, except that any reference to the Secretary of Health and 
Human Services or the Administrator of the Health Care Financing 
Administration shall be deemed a reference to the Board.
    (e) Trust Fund Off-Budget.--The receipts and disbursements of the 
Trust Fund and the taxes described in subsection (b)(1) shall not be 
included in the totals of the budget of the United States Government as 
submitted by the President or of the congressional budget and shall be 
exempt from any general budget limitation imposed by statute on 
expenditures and net lending (budget outlays) of the United States 
Government.

SEC. 424. STATE SOURCES OF REVENUES.

    (a) In General.--Each State shall be responsible for establishing a 
financing program for the implementation of the State program in the 
State. Such financing program may include--
            (1) funds used to finance the State share of medicaid under 
        title XIX of the Social Security Act as in effect on the day 
        before the date described in section 902(f) of this Act,
            (2) State and local funding for public hospitals and other 
        indigent care programs, and
            (3) State funding from general revenues, earmarked taxes, 
        payroll taxes, sales taxes, and such other measures consistent 
        with this Act as the State may provide.
    (b) On-Going Entitlement.--Each State with a State program approved 
by the Commission is entitled to funding from the Commission in the 
amounts provided under section 402.

                  TITLE V--CONGRESSIONAL CONSIDERATION

SEC. 501. RULES GOVERNING CONGRESSIONAL CONSIDERATION.

    (a) Rules of House of Representatives and Senate.--This section is 
enacted by the Congress--
            (1) as an exercise of the rulemaking power of the House of 
        Representatives and the Senate, respectively, and as such is 
        deemed a part of the rules of each House, respectively, but 
        applicable only with respect to the procedure to be followed in 
        that House in the case of disapproval resolutions described in 
        subsection (b), and supersedes other rules only to the extent 
        that such rules are inconsistent therewith; and
            (2) with full recognition of the constitutional right of 
        either House to change the rules (so far as relating to the 
        procedure of that House) at any time, in the same manner and to 
        the same extent as in the case of any other rule of that House.
    (b) Terms of the Resolution.--For purposes of this Act, the term 
``disapproval resolution'' means only a joint resolution of the two 
Houses of the Congress, providing in--
            (1) the matter after the resolving clause of which is as 
        follows: ``That the Congress disapproves the action of the 
        Federal Health Board as submitted by the Board on 
        ____________________________'', the blank space being filled in 
        with the appropriate date; and
            (2) the title of which is as follows: ``Joint Resolution 
        disapproving the action of the Federal Health Board''.
    (c) Introduction and Referral.--On the day on which the action of 
the Board is transmitted to the House of Representatives and the 
Senate, a disapproval resolution with respect to such action shall be 
introduced (by request) in the House of Representatives by the Majority 
Leader of the House, for himself and the Minority Leader of the House, 
or by Members of the House designated by the Majority Leader of the 
House, for himself and the Minority Leader of the House, or by Members 
of the House designated by the Majority Leader and Minority Leader of 
the House; and shall be introduced (by request) in the Senate by the 
Majority Leader of the Senate, for himself and the Minority Leader of 
the Senate, or by Members of the Senate designated by the Majority 
Leader and Minority Leader of the Senate. If either House is not in 
session on the day on which such an action is transmitted, the 
disapproval resolution with respect to such action shall be introduced 
in the House, as provided in the preceding sentence, on the first day 
thereafter on which the House is in session. The disapproval resolution 
introduced in the House of Representatives and the Senate shall be 
referred to the appropriate committees of each House.
    (d) Amendments Prohibited.--No amendment to a disapproval 
resolution shall be in order in either the House of Representatives or 
the Senate; and no motion to suspend the application of this subsection 
shall be in order in either House, nor shall it be in order in either 
House for the Presiding Officer to entertain a request to suspend the 
application of this subsection by unanimous consent.
    (e) Period for Committee and Floor Consideration.--
            (1) In general.--Except as provided in paragraph (2), if 
        the committee or committees of either House to which a 
        disapproval resolution has been referred have not reported it 
        at the close of the 45th day after its introduction, such 
        committee or committees shall be automatically discharged from 
        further consideration of the disapproval resolution and it 
        shall be placed on the appropriation calendar. A vote on final 
        passage of the disapproval resolution shall be taken in each 
        House on or before the close of the 45th day after the 
        disapproval resolution is reported by the committees or 
        committee of that House to which it was referred, or after such 
        committee or committees have been discharged from further 
        consideration of the disapproval resolution. If prior to the 
        passage by one House of a disapproval resolution of that House, 
        that House receives the same disapproval resolution from the 
        other House then--
                    (A) the procedure in that House shall be the same 
                as if no disapproval resolution had been received from 
                the other House; but
                    (B) the vote on final passage shall be on the 
                disapproval resolution of the other House.
            (2) Computation of days.--For purposes of paragraph (1), in 
        computing a number of days in either House, there shall be 
        excluded any day on which the House is not in session.
    (f) Floor Consideration in the House of Representatives.--
            (1) Motion to proceed.--A motion in the House of 
        Representatives to proceed to the consideration of a 
        disapproval resolution shall be highly privileged and not 
        debatable. An amendment to the motion shall not be in order, 
        nor shall it be in order to move to reconsider the vote by 
        which the motion is agreed to or disagreed to.
            (2) Debate.--Debate in the House of Representatives on a 
        disapproval resolution shall be limited to not more than 20 
        hours, which shall be divided equally between those favoring 
        and those opposing the disapproval resolution. A motion further 
        to limit debate shall not be debatable. It shall not be in 
        order to move to recommit a disapproval resolution or to move 
        to reconsider the vote by which a disapproval resolution is 
        agreed to or disagreed to.
            (3) Motion to postpone.--Motions to postpone, made in the 
        House of Representatives with respect to the consideration of a 
        disapproval resolution, and motions to proceed to the 
        consideration of other business, shall be decided without 
        debate.
            (4) Appeals.--All appeals from the decisions of the Chair 
        relating to the application of the Rules of the House of 
        Representatives to the procedure relating to a disapproval 
        resolution shall be decided without debate.
            (5) General rules apply.--Except to the extent specifically 
        provided in the preceding provisions of this subsection, 
        consideration of a disapproval resolution shall be governed by 
        the Rules of the House of Representatives applicable to other 
        bills and resolutions in similar circumstances.
    (g) Floor Consideration in the Senate.--
            (1) Motion to proceed.--A motion in the Senate to proceed 
        to the consideration of a disapproval resolution shall be 
        privileged and not debatable. An amendment to the motion shall 
        not be in order, nor shall it be in order to move to reconsider 
        the vote by which the motion is agreed to or disagreed to.
            (2) General debate.--Debate in the Senate on a disapproval 
        resolution, and all debatable motions and appeals in connection 
        therewith, shall be limited to not more than 20 hours. The time 
        shall be equally divided between, and controlled by, the 
        Majority Leader and the Minority Leader or their designees.
            (3) Debate of motions and appeals.--Debate in the Senate on 
        any debatable motion or appeal in connection with a disapproval 
        resolution shall be limited to not more than 1 hour, to be 
        equally divided between, and controlled by, the mover and the 
        manager of the disapproval resolution, except that in the event 
        the manager of the disapproval resolution is in favor of any 
        such motion or appeal, the time in opposition thereto, shall be 
        controlled by the Minority Leader or his designee. Such 
        leaders, or either of them, may, from time under their control 
        on the passage of a disapproval resolution, allot additional 
        time to any Senator during the consideration of any debatable 
        motion or appeal.
            (4) Other motions.--A motion in the Senate to further limit 
        debate is not debatable. A motion to recommit a disapproval 
        resolution is not in order.
    (h) Point of Order Requiring Supermajority for Modifications to 
Actions Once Approved.--
            (1) In general.--It shall not be in order in the House of 
        Representatives or the Senate to consider any amendment to the 
        actions of the Federal Health Board except as provided in 
        paragraph (2).
            (2) Waiver.--The point of order described in paragraph (1) 
        may be waived or suspended in the House of Representatives or 
        the Senate only, by the affirmative vote of three-fifths of the 
        Members duly chosen and sworn.

                       TITLE VI--PRIVATE OPTIONS

SEC. 601. PRIVATE SUPPLEMENTAL INSURANCE.

    Except as provided in section 603, nothing in this Act shall be 
construed to prohibit the purchase of private insurance that provides 
coverage of health care and long-term care services supplementing the 
services covered under this Act.

SEC. 602. OPTION TO PURCHASE DUPLICATIVE PRIVATE INSURANCE.

    Except as provided in section 603, nothing in this Act shall be 
construed to prohibit the purchase of private insurance that provides 
coverage of health care and long-term care services covered under this 
Act.

SEC. 603. LIMITS ON PRIVATE INSURANCE.

    (a) In General.--No insurer may issue a private insurance policy if 
such policy provides coverage for the cost-sharing requirements for 
health care services and other non-long-term care services covered 
under this Act.
    (b) Certification of Notification.--At the time of sale, the issuer 
of any private insurance policy shall secure in writing a certification 
by the purchaser that the purchaser has been informed of any 
duplication in coverage of the services covered under this Act.
    (c) Review of Practices.--No later than 2 years after the full 
implementation of the provisions of this Act, the Comptroller General 
of the United States shall review the practices of the private 
insurance industry and make such recommendations as necessary to the 
Congress in order to prevent fraud and abuse in the sale of duplicative 
or supplemental private health insurance and to protect the integrity 
of the American Health Security Plan.
    (d) Obligation To Pay Premium Remains.--The purchase of any type of 
private health insurance policy shall not relieve the purchaser of the 
payment of the American Health Security Plan premium imposed under 
section 421.

 TITLE VII--EXPANSION OF OUTCOMES RESEARCH AND DELIVERY OF SERVICES IN 
                           UNDERSERVED AREAS

SEC. 701. EXPANSION OF OUTCOMES RESEARCH.

    Paragraph (1) of section 1142(i) of the Social Security Act (42 
U.S.C. 1320b-12(i)) is amended by striking ``and'' at the end of 
subparagraph (D) and by striking (E) and inserting the following:
                    ``(E) $225,000,000 for fiscal year 1994;
                    ``(F) $275,000,000 for fiscal year 1995; and
                    ``(G) $325,000,000 for fiscal year 1996.''.

SEC. 702. NATIONAL HEALTH SERVICE CORPS.

    (a) Increase in Authorization of Appropriations.--There are 
authorized to be appropriated to carry out subpart II of part D of 
title III of the Public Health Services Act (42 U.S.C. 254d et seq.) 
for fiscal year 1994, an amount equal to--
            (1) the amount appropriated under such subpart for fiscal 
        year 1993; and
            (2) an additional amount equal to 40 percent of the amount 
        described in paragraph (1).
When making loans under such subpart, priority should be given to 
students from schools that have primary care programs and that stress 
underserved practices.
    (b) Community Financing Program.--Subpart II of part D of title III 
of the Public Health Service Act (42 U.S.C. 254d et seq.) is amended by 
inserting after section 336A, the following new section:

``SEC. 336B. COMMUNITY FINANCING PROGRAMS.

    ``(a) Establishment.--The Secretary may award grants under this 
section to local communities to enable such communities to establish 
programs to finance the health-related education of residents of such 
communities.
    ``(b) Application.--To be eligible to receive a grant under 
subsection (a), a community shall prepare and submit to the Secretary 
an application, at such time, in such manner and containing such 
information as the Secretary may require.
    ``(c) Use.--A community that receives a grant under subsection (a), 
shall use amounts received under such grant to provide assistance to 
local residents with respect to the health-related educational expenses 
of such residents. Such community shall not provide assistance under a 
grant under this section to a local resident unless such resident 
agrees to practice in a health-related field in such community for not 
less than 4 years after graduation. In providing assistance to such 
residents, the community should give priority to residents attending 
schools that have primary care programs and that stress underserved 
practices.
    ``(d) Amounts.--The amount of a grant awarded to a community under 
this section shall not exceed 75 percent of the cost to such community 
in administering and implementing a community financing program under 
this section.
    ``(e) Authorization of Appropriations.--There are authorized to 
carry out this section, $10,000,000 for each of the fiscal year 1994 
through 1996.''.

SEC. 703. COMMUNITY AND MIGRANT HEALTH CENTERS.

    Subpart I of part D of title III of the Public Health Service Act 
(42 U.S.C. 254d et seq.) is amended by inserting after section 330, the 
following new section:

``SEC. 330A. NEW COMMUNITY AND MIGRANT HEALTH CENTERS.

    ``(a) New Community and Migrant Health Centers.--
            ``(1) In general.--The Secretary shall award grants to 
        eligible entities to expand the availability of comprehensive 
        primary health services (as defined in section 330(b)(1)) in 
        medically underserved areas.
            ``(2) Eligibility.--To be eligible to receive a grant under 
        this section an entity shall--
                    ``(A) be an entity that--
                            ``(i) meets the requirements of section 
                        329(a) or 330(a) for being a migrant or 
                        community health center, though not a recipient 
                        of a grant under either section;
                            ``(ii) does not meet the requirements of 
                        section 329(a) or 330(a) for being a migrant or 
                        community health center, but that provides 
                        assurances satisfactory to the Secretary, 
                        including subsequent demonstrable evidence, 
                        that such entity will meet the requirements of 
                        either section not later than 2 years after 
                        receiving a grant under this section;
                            ``(iii) is eligible for a planning grant 
                        under sections 329(c) or 330(c); or
                            ``(iv) is able to provide a subset of the 
                        required services, be able to prove that it 
                        cannot meet the requirements of section 329(a) 
                        or 330(a), and demonstrate that it is the most 
                        qualified entity in the service area; and
                    ``(B) prepare and submit to the Secretary an 
                application at such time, in such manner and containing 
                such information as the Secretary may require.
    ``(b) Expansion of Current Community and Migrant Health Centers.--
            ``(1) In general.-- Community and migrant health centers in 
        existence on the date of enactment of this section may utilize 
        any increase in revenue experienced as a result of the increase 
        in the number of insured patients treated for the expansion of 
        the amounts and types of services furnished, to serve 
        additional patients or areas, or to promote the recruitment, 
        training or retention of personnel.
            ``(2) Recommendations.--Not later than 3 years after the 
        date of enactment of this section, the Secretary shall prepare 
        and submit to the appropriate committees of Congress 
        recommendations concerning the provision of paragraph (1).
    ``(c) Report.--Not later than 3 years after the date of enactment 
of this section, the Secretary shall prepare and submit to the 
appropriate committees of Congress a report concerning the need for 
further migrant and community health center primary care service 
capacity development and recommendations concerning the appropriate 
level of support needed for activities to address such capacity 
development.
    ``(d) Authorizations of Appropriations.--
            ``(1) In general.--There are authorized to be appropriated 
        to carry out this section, $300,000,000 for fiscal years 1994 
        through 1996.
            ``(2) Additional amounts.--Amounts provided under this 
        section shall be in addition to any amounts appropriated under 
        sections 329 and 330.''.

                     TITLE VIII--MALPRACTICE REFORM

SEC. 801. GRANTS TO STATES.

    (a) In General.--The Board shall make grants to States for the 
development and implementation of medical malpractice reforms, as 
described in section 802. A State shall use a grant made under this 
section to develop, implement, and evaluate the effectiveness of such 
reforms.
    (b) Compliance With Federal Standards.--Beginning 2 years after the 
implementation of the reforms, each State shall annually submit a 
report to the Board containing such information as the Board may 
require to determine whether the State is in compliance with the terms 
of the grant made under this section.

SEC. 802. CRITERIA FOR STATE MALPRACTICE REFORMS.

    (a) In General.--Each State must demonstrate to the Board that the 
reforms to the State medical malpractice system that the State develops 
or has already adopted or intends to adopt meet the criteria described 
in subsection (b).
    (b) Criteria.--The criteria for medical malpractice reforms are as 
follows:
            (1) Costs.--Decrease administrative costs and reduce 
        incentives for filing non-meritorious claims.
            (2) Efficiency.--Reduce the time between the filing of 
        medical malpractice claims and case resolutions using 
        procedures which may include the establishment of voluntary 
        alternative dispute resolution mechanisms, such as mediation, 
        arbitration, minitrials, and summary judgments, to facilitate 
        earlier case resolutions.
            (3) Access.--Develop mechanisms to ensure that victims of 
        malpractice or medically injured patients have the meaningful 
        ability to seek compensation, including voluntary alternative 
        dispute resolution mechanisms designed for small claims.
            (4) Quality.--Improve the quality of health care by 
        strengthening mechanisms that reduce the occurrence of medical 
        injury, and detect and sanction health care professionals who 
        commit health care malpractice.
            (5) Equity.--Enhance the fairness of compensation provided 
        to injured individuals for both medically and non-medically-
        related damages, and increase incentives for experience rating 
        of insurance premiums.
    (c) Board Study of Criteria.--
            (1) Study.--The Board shall collect data from the States 
        awarded grants under section 801 on the effects of the reforms 
        established to meet the criteria described in subsection (b) on 
        the medical malpractice systems of such States. The data shall 
        be used to evaluate the effectiveness and appropriateness of 
        the criteria described in subsection (b) in addressing the 
        problems of the medical malpractice systems of such States. The 
        Board may modify such criteria based on such study.
            (2) Report.--The Board shall report the results of the 
        study described in paragraph (1) to the Congress on a periodic 
        basis.

SEC. 803. AUTHORIZATION OF APPROPRIATIONS.

    There are authorized to be appropriated for grants under this title 
such sums as may be necessary for fiscal years 1994 through 1997.

TITLE IX--EFFECTIVE DATES; TERMINATIONS; TRANSITION; RELATION TO ERISA.

SEC. 901. EFFECTIVE DATES.

    (a) Federal Administration.--Not later than October 1, 1995, the 
Board shall promulgate regulations regarding the health care and long-
term care services covered under this Act and the related patient cost-
sharing schedules under title II, develop the means for computing the 
National Health Budget and Federal contributions to the States under 
subtitle A of title IV, and establish the procedures for reviewing and 
approving State plans under section 311.
    (b) Provision of Services.--
            (1) Preventive and primary care services.--The provision of 
        preventive and primary care services under approved State 
        plans, as established under section 201, shall take effect with 
        respect to services furnished on or after October 1, 1997.
            (2) Acute care services.--The provision of acute care 
        services under approved State plans, as established under 
        section 201, shall take effect with respect to services 
        furnished on or after October 1, 1998.
            (3) Long-term care services.--The provision of long-term 
        care services under approved State plans, as established under 
        section 202, shall take effect with respect to services 
        furnished on or after October 1, 1999.
    (c) Modification of Transition Period.--
            (1) In general.--Notwithstanding any other provision of 
        this Act and to the extent the Board determines it is 
        appropriate and fiscally responsible, the Board may promulgate 
        regulations to reduce the period between the date of the 
        enactment of this Act and the effective dates otherwise 
        provided in this Act.
            (2) Effect of board actions.--Any determination made by the 
        Board under this subsection to change an effective date under 
        this Act shall be submitted to the Congress at least 6 months 
        before the new effective date, and shall have the force of law, 
        unless within 60 days of the submission of such determination, 
        the Congress enacts a disapproval resolution under the 
        procedures described in section 501.

SEC. 902. TERMINATION OF OTHER PROGRAMS.

    (a) Medicare and Medicaid.--
            (1) In general.--Titles XVIII and XIX of the Social 
        Security Act are repealed.
            (2) Repeal of hospital insurance taxes upon full 
        implementation of plan.--Sections 1401(b), 1402(k)(2), 3101(b), 
        3111(b), 3121(x)(2), 3231(e)(2)(B)(i)(II), and 6413(c)(3) of 
        the Internal Revenue Code of 1986 are repealed.
    (b) Repeal of CHAMPUS Provisions.--
            (1) Amendments to chapter 55 of title 10.--Sections 1079 
        through 1083, 1086, and 1097 through 1100 of title 10, United 
        States Code, are repealed.
            (2) Table of sections.--The table of sections at the 
        beginning of chapter 55 of title 10, United States Code, is 
        amended by striking out the items relating to the sections 
        referred to in paragraph (1).
            (3) Conforming amendments.--Chapter 55 of title 10, United 
        States Code, is amended as follows:
                    (A) Definition.--Section 1072 is amended by 
                striking out paragraph (4).
                    (B) Reimbursement of the department of veterans 
                affairs.--Section 1104(b) is amended--
                            (i) in the subsection heading, by striking 
                        out ``From CHAMPUS Funds''; and
                            (ii) by striking out ``from funds'' and all 
                        that follows and inserting in lieu thereof 
                        ``for medical care provided by the Department 
                        of Veterans Affairs pursuant to such 
                        agreement.''.
    (c) Repeal of Federal Employees Health Benefits Program.--Chapter 
89 of title 5, United States Code, is repealed.
    (d) Effective Date.--The repeals and amendments made by this 
section shall take effect on October 1, 1999.

SEC. 903. TRANSITION.

    (a) In General.--The Board shall issue such regulations as are 
necessary to provide for a transition to the American Health Security 
Plan established under this Act from the programs repealed under 
section 902.
    (b) Relation to Other Programs.--The Board shall recommend to the 
Congress appropriate legislative proposals for the amendment or repeal 
of any other Federal program inconsistent with, or duplicative of, the 
principles of the American Health Security Plan established under this 
Act.

SEC. 904. RELATION TO ERISA.

    The provisions of the Employee Retirement Income Security Act are 
superseded to the extent inconsistent with the requirements of this 
Act.

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