[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H. Res. 498 Introduced in House (IH)]

103d CONGRESS
  2d Session
H. RES. 498

 Making in order, in the consideration by the House of Representatives 
of H.R. 3600 (the ``Health Security Act''), an amendment providing for 
  an AMCARE plan that makes available a government-sponsored, fee-for-
 service nationwide health plan to almost all eligible individuals not 
                covered under large group health plans.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 28, 1994

    Mr. Scott (for himself, Mr. Stark, Mr. McDermott, Mr. Miller of 
     California, Mr. Owens, Ms. McKinney, Ms. Pelosi, Mr. Farr of 
California, Mr. Tucker, Ms. Woolsey, Mr. Dellums, Mr. Watt, Mr. Stokes, 
     Mr. Hilliard, and Mr. Romero-Barcelo) submitted the following 
        resolution; which was referred to the Committee on Rules

_______________________________________________________________________

                               RESOLUTION


 
 Making in order, in the consideration by the House of Representatives 
of H.R. 3600 (the ``Health Security Act''), an amendment providing for 
  an AMCARE plan that makes available a government-sponsored, fee-for-
 service nationwide health plan to almost all eligible individuals not 
                covered under large group health plans.

    Resolved, That in the consideration of the bill (H.R. 3600), to 
ensure individual and family security through health care coverage for 
all Americans in a manner that contains the rate of growth in health 
care costs and promotes responsible insurance practices, to promote 
choice in health care, and to ensure and protect the health care of all 
Americans, in the Committee of the Whole, the following amendment, if 
offered by Mr. Scott of Virginia (or his designee), shall be made in 
order to the amendment-in-the-nature-of-a-substitute to title I, as 
reported by the Committee on Education and Labor and that any points of 
order against this amendment are hereby waived.
    At the end of subtitle E of title I, add the following new part 
(and conform the table of contents of title I accordingly):

                         ``PART 5--AMCARE PLAN

``SEC. 1497. ESTABLISHMENT, ELIGIBILITY, AND ENROLLMENT.

    ``(a) Establishment.--
            ``(1) In general.--The Secretary of Health and Human 
        Services shall establish and operate in accordance with this 
        part a government-sponsored health care plan (in this part 
        referred to as the `AMCARE plan') for eligible individuals 
        described in subsection (b).
            ``(2) Deadline for initial operation.--The Secretary shall 
        establish the AMCARE plan in a manner that permits eligible 
        individuals to first obtain benefits under the plan on January 
        1, 1996.
    ``(b) Eligibility.--
            ``(1) Eligible individuals.--Except as provided in 
        paragraph (2), each eligible individual (as defined in section 
        1001(c)) is eligible to enroll in the AMCARE plan.
            ``(2) Exception for certain individuals.--An individual is 
        not eligible to enroll in the AMCARE plan if the individual--
                    ``(A) is an experience-rated individual; or
                    ``(B) resides in a State operating a State single-
                payer program under subpart B of part 1 of subtitle C.
    ``(c) Enrollment Procedures.--The Secretary shall establish 
procedures for the enrollment of individuals described in subsection 
(a) in the AMCARE plan. Such procedures shall be based on the 
procedures used with respect to the enrollment of community-rated 
individuals under community-rated plans.
    ``(d) Treatment as Community-Rated Plan.--For purposes of this Act 
(including titles VI and IX), except as may otherwise be provided in 
this part or under rules established by the Board--
            ``(1) the AMCARE plan offered in a community-rating area 
        shall be treated as a community-rated plan offered in such 
        area; and
            ``(2) the AMCARE plan and the Secretary shall comply with 
        the requirements of this Act applicable to community-rated 
        plans and the carriers offering such plans.

``SEC. 1498. REQUIREMENTS FOR PLAN.

    ``(a) In General.--Except as provided in this section, the AMCARE 
plan shall meet the requirements applicable for a community-rated, fee-
for-service, higher cost sharing plan.
    ``(b) Additional Specifications.--
            ``(1) National coverage.--The plan shall provide coverage 
        for the items and services covered in the comprehensive benefit 
        package on a nationwide basis.
            ``(2) Payment to providers.--Instead of applying an 
        applicable fee-for-service fee schedule, the Secretary may base 
        payments for services furnished under the AMCARE plan on 
        alternative market-based payment rates for classes and types of 
        services provided in various market areas.
            ``(3) Application of cost-sharing reduction provisions.--
        Under rules established by the Board, the Secretary shall apply 
        the provisions of part 5 of subtitle C to families enrolled in 
        the AMCARE plan in the same manner as States apply such 
        provisions to families enrolled in community-rated plans in the 
        State.
            ``(4) Supplemental benefits.--
                    ``(A) In general.--With the approval of the 
                trustees of the AMCARE Trust Fund (established under 
                section 1499(e)), the Secretary may offer benefits 
                under the AMCARE plan in addition to those provided 
                under the comprehensive benefit package in the same 
                manner as community-rated plans may offer supplemental 
                benefits to enrollees under part 3.
                    ``(B) Premium charged.--The premium charged for 
                supplemental benefits offered under subparagraph (A) 
                shall be in an amount sufficient to cover the costs of 
                offering such benefits (as determined by the Secretary 
                in consultation with the trustees of the AMCARE Trust 
                Fund).
    ``(c) Administration.--
            ``(1) In general.--The Secretary shall provide for the 
        administration of the AMCARE plan in a manner similar to the 
        administration of the medicare program. For this purpose, the 
        Secretary may enter into administrative agreements and 
        contracts with fiscal agents (which may or may not be the same 
        fiscal agents through which the Secretary administers the 
        medicare program).
            ``(2) Quality assurance; utilization review; claims 
        processing.--In administering the AMCARE plan, the Secretary 
        shall take such steps as the Secretary considers necessary--
                    ``(A) to assure the quality and appropriate 
                utilization of the items and services furnished under 
                the plan, including the use of peer review 
                organizations described in title XI of the Social 
                Security Act;
                    ``(B) to assure the timely and accurate payment of 
                claims for items and services furnished under the plan; 
                and
                    ``(C) to otherwise assure that the plan provides 
                high quality services in an efficient and cost-
                effective manner.
            ``(3) Limitation on expenditures for administration.--The 
        percentage of expenditures under the AMCARE plan in a year 
        attributable to program administration may not exceed 3 
        percent.
    ``(d) Optional Primary Care Case Management.--Nothing in this part 
shall be construed as preventing the plan from implementing a primary 
care case management program to manage the delivery of the 
comprehensive benefit package to plan enrollees.
    ``(e) Referral of Subsidy-Eligible Individuals.--Under rules 
established by the Board, individuals enrolled in the AMCARE plan who 
are provided a cost-sharing reduction under subsection (b)(3) or a 
premium discount or limitation of liability described in section 
1499(b)(3) shall be referred for employment, job search, job training, 
and other workforce support services as are available to them through 
the Secretary or the Secretary of Labor for development of family self-
sufficiency.

``SEC. 1499. FINANCING.

    ``(a) Determination of Premium Rate.--In the case of a family 
enrolled in the AMCARE plan--
            ``(1) In general.--Subject to paragraph (3), the premium 
        applicable to the individual class of enrollment shall be such 
        amount that (if applied under this Act) will result in the 
        payment of sufficient funds to cover the costs of the AMCARE 
        plan, including a reasonable contingency margin and taking into 
        account risk adjustment under subsection (d).
            ``(2) Family enrollment.--Subject to paragraph (3), the 
        premium applicable to a family class of enrollment shall be 
        equal to the product of--
                    ``(A) the premium amount determined under paragraph 
                (1), and
                    ``(B) the premium class factor established by the 
                Board for that class under section 1531.
            ``(3) Area adjustment.--
                    ``(A) In general.--The Secretary shall adjust the 
                premiums determined under this subsection for each 
                community-rating area for area differences in health 
                care costs.
                    ``(B) Basis for adjustment.--Such adjustment--
                            ``(i) may reflect the final weighted 
                        average per capita premium rate (as defined in 
                        section 6004(a)) for community-rated plans 
                        offered in the area compared to the weighted 
                        average of all such rates, and
                            ``(ii) shall be made in a manner that does 
                        not result in a change in the average of the 
                        premium amounts under this subsection.
    ``(b) Special Rules for Determining Family Share of Premiums.--In 
the case of a family enrolled in the AMCARE plan--
            ``(1) Family share.--The family share of the premium shall 
        be determined by the Secretary in a manner similar to the 
        determination described in section 6101(b), but based upon the 
        plan premium rate determined under subsection (a).
            ``(2) Repayment of family employment credit.--The Secretary 
        shall promulgate rules relating to the repayment of the family 
        employment credit in a manner similar to that provided under 
        subpart B of part 1 of subtitle A of title VI.
            ``(3) Application of low-income subsidy provisions.--In 
        carrying out paragraphs (1) and (2), section 6104 (relating to 
        premium discount based on income) and section 6113 (relating to 
        limitation of liability based on income) shall apply.
    ``(c) Contributions by Employers.--The employer share of the 
premium for an individual enrolled in the AMCARE plan shall be 
determined by the Secretary, based upon the premium rate specified in 
subsection (a) and taking into account the rules applicable to the 
establishment of employer premiums for community-rated employers under 
subpart A of part 2 of subtitle B of title VI.
    ``(d) Application of Risk Adjustment and Reinsurance Methodology.--
            ``(1) In general.--The Board shall establish rules under 
        which transfers are made between the AMCARE Trust Fund 
        (established under subsection (e)) and premium clearinghouses 
        in States (acting on behalf of community-rated plans offered in 
        the State) in a manner that reflects (using the methodology 
        developed under section 1541) the payment adjustments that 
        would have been made with respect to the AMCARE plan and 
        community-rated plans in the State under section 6201(a)(3) if 
        the AMCARE plan were a community-rated plan in the State.
            ``(2) Reinsurance system.--If the Board includes a 
        mandatory reinsurance system under the methodology developed 
        section 1541(c), the Board shall establish rules under which 
        the AMCARE plan is treated as a health plan for purposes of 
        applying such system.
    ``(e) Establishment of AMCARE Trust Fund.--
            ``(1) In general.--There is hereby established in the 
        Treasury of the United States a fund to be known as the `AMCARE 
        Trust Fund' (in this subsection referred to as the `Fund').
            ``(2) Transfers.--
                    ``(A) Premiums collected.--There is hereby 
                deposited into the Fund amounts equivalent to the 
                amounts of the premiums collected under this part.
                    ``(B) Subsidies.--There is hereby transferred to 
                the Fund, an amount equivalent to the amount by which--
                            ``(i) the total amount of premiums payable 
                        (without regard to premium discounts) under 
                        this part, exceeds
                            ``(ii) the total amounts of the premiums 
                        collected under this part.
                    ``(C) Expenditures from fund.--Amounts in the Fund 
                are available to the Secretary for the purpose of 
                carrying out this part. Amounts in the Fund shall 
                remain available until expended.
                    ``(D) Additional transfers.--The Secretary shall 
                make payments from the Trust Fund with respect to the 
                AMCARE plan in the same amounts and in the same manner 
                as States provide for payment to the Secretary under 
                section 1263 with respect to community-rated plans 
                offered in the State. Such payments shall be 
                transferred to the Wrap-Around Fund under section 1803, 
                the annual health professions workforce account under 
                section 3034(a), the annual teaching hospital account 
                under section 3103(a), and the Rural Health Care Fund 
                under section 3901(a) in the same manner as payments 
                made under section 1263 are transferred to such funds 
                under this Act.
            ``(3) Incorporation of provisions.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                provisions of subsections (b) through (e), (h), (i), 
                and (j) of section 1817 of the Social Security Act 
                shall apply to the Fund and this part in the same 
                manner as they apply to the Federal Hospital Insurance 
                Trust Fund and part A of title XVIII of the Social 
                Security Act.
                    ``(B) Exceptions.--In applying subparagraph (A)--
                            ``(i) the Board of Trustees and Managing 
                        Trustee of the Fund shall be composed of the 
                        members of the Board of Trustees and the 
                        Managing Trustee, respectively, of the Federal 
                        Hospital Insurance Trust Fund;
                            ``(ii) any reference in section 1817 of the 
                        Social Security Act to the Federal Hospital 
                        Insurance Trust Fund, to title XVIII of such 
                        Act (or part A thereof), or (in subsection 
                        (f)(1)) to section 3102(b) of the Internal 
                        Revenue Code of 1986 is deemed a reference to 
                        the Fund under this subsection, this part, and 
                        to section 3151(a)(2) of such Code, 
                        respectively; and
                            ``(iii) the authority specified in section 
                        1817(j) of the Social Security Act may be 
                        exercised with respect to the Fund without 
                        regard to any dates or time limitations 
                        specified in such section.''.
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