[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 684 Introduced in Senate (IS)]

103d CONGRESS
  1st Session
                                 S. 684

      To establish a national health plan, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

               March 31 (legislative day, March 3), 1993

  Mr. Inouye (for himself and Mr. Wellstone) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
      To establish a national health plan, and for other purposes.

    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 
Care Act of 1993''.
    (b) Table of Contents.--The table of contents is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Purpose.
Sec. 3. Definitions.
                 TITLE I--NATIONAL HEALTH CARE PROGRAM

Sec. 101. Establishment.
Sec. 102. Approval of State programs.
Sec. 103. Eligibility for enrollment.
Sec. 104. Enrollment.
Sec. 105. Portability.
              TITLE II--BENEFITS AND PROVISION OF SERVICES

                     Subtitle A--Scope of Services

Sec. 201. Covered services.
Sec. 202. Exclusions.
Sec. 203. Prohibitions on limitations.
Sec. 204. Eligibility.
Sec. 205. Additional and duplicate services.
                   Subtitle B--Provision of Services

Sec. 211. Health care providers.
Sec. 212. Delivery systems.
Sec. 213. State long-term care coordination agencies.
Sec. 214. Incorporation of miscellaneous Medicare-related provisions.
Sec. 215. Nondiscrimination.
                           TITLE III--REVENUE

                       Subtitle A--Budget Process

Sec. 301. National and State health budgets.
Sec. 302. Payments to States.
Sec. 303. Establishment of exchange program.
             Subtitle B--Payments to Health Care Providers

Sec. 311. Payments to health care providers.
Sec. 312. Payments to institutional health care providers.
Sec. 313. Payments for services by individual health care providers.
Sec. 314. Payments to integrated health service plans.
Sec. 315. Payments for prescription drugs.
Sec. 316. Approved devices and equipment.
Sec. 317. Grievance procedure.
                     Subtitle C--Sources of Revenue

Sec. 321. Federal sources of revenue.
Sec. 322. State sources of revenue.
Sec. 323. Cost-sharing.
Sec. 324. National Health Care Trust Fund.
                        TITLE IV--ADMINISTRATION

                   Subtitle A--Federal Administration

Sec. 401. National Health Care Administration.
Sec. 402. National Health Board.
Sec. 403. National Council on Quality Assurance and Consumer 
                            Protection.
Sec. 404. Medical Malpractice Commission.
Sec. 405. Utilization and quality control peer review organizations.
Sec. 406. Public Health Functions and Activities Commission.
Sec. 407. Technical assistance centers.
               Subtitle B--State and Local Administration

Sec. 411. State agency.
Sec. 412. State and local planning boards.
         TITLE V--TRANSITION AND RELATIONSHIP TO OTHER PROGRAMS

Sec. 501. Effective date.
Sec. 502. Repeals and incorporations.
Sec. 503. Transition.
Sec. 504. Rules governing congressional consideration.
Sec. 505. Relation to Employee Retirement Income Security Act of 1974.
                   TITLE VI--MISCELLANEOUS PROVISIONS

Sec. 601. Bill of rights.
Sec. 602. Research and service delivery improvement program grants.
Sec. 603. Prevention, health promotion, and health awareness program 
                            grants.
Sec. 604. Displaced workers.

SEC. 2. PURPOSE.

    The purpose of this Act is to establish a single-payer national 
program of health care services that is administered by the States 
under Federal guidelines and provides--
            (1) a right to health care services for every United States 
        citizen and resident, regardless of race, color, religion, sex, 
        national origin, age, health condition, sexual preference, 
        income, language, or geographic residence in an urban or rural 
        area;
            (2) comprehensive health benefits that--
                    (A) enable consumers to achieve and maintain 
                physical and mental health, maximize potential for 
                enhanced social and physical functioning, and sustain a 
                meaningful quality of life; and
                    (B) provide a major emphasis on primary prevention 
                and health promotion;
            (3) a broad range of involvement on the local level by 
        health care providers, public agencies, consumers, civic 
        organizations, schools, employers, and unions;
            (4) cost-conscious delivery of high-quality services 
        through prospective global budgeting for the States and 
        hospitals, negotiated fee schedules for health care providers, 
        efficient use of health care facilities and equipment, and the 
        elimination of unnecessary medical procedures;
            (5) the right of consumers to participate in the decisions 
        that directly affect their lives, and in the decisions that 
        relate to the design and implementation of covered services;
            (6) a simplified administrative structure that enhances 
        access and reduces administrative waste;
            (7) freedom of choice of consumers to select health care 
        providers within the framework of a national health care 
        program;
            (8) primary financing through progressive Federal taxation;
            (9) an integrated health delivery system that--
                    (A) provides a continuum of care that links all 
                levels of the health care program;
                    (B) addresses the physical, mental, and 
                psychosocial health needs of the consumer and the 
                family; and
                    (C) promotes multidisciplinary collaboration in the 
                delivery of services;
            (10) a health care program that reflects the demographic 
        and sociocultural diversity and needs of the community;
            (11) professional standards linked to performance for all 
        health care providers that ensure the delivery of high-quality 
        health care services and accountability to both health care 
        providers and consumers;
            (12) special resources to address the medical, mental, and 
        social health needs of medically underserved populations and 
        health professional shortage areas;
            (13) education and training programs for professional, 
        allied, and paraprofessional personnel in health professional 
        shortage areas, and the assurance that the programs offer equal 
        access to minorities and women;
            (14) continued commitment to and strengthening of basic 
        public health functions to provide for a safe environment, 
        control of infectious diseases, and promotion of a healthy 
        lifestyle and behavior;
            (15) support of research efforts that will--
                    (A) enhance the physical, mental, and social well-
                being of major segments of society;
                    (B) improve the delivery of cost-conscious, quality 
                health care services; and
                    (C) enable health care providers and consumers to 
                make more informed decisions; and
            (16) continued commitment to basic biomedical and 
        comprehensive mental health research.

SEC. 3. DEFINITIONS.

    As used in this Act:
            (1) Administration.--The term ``Administration'' means the 
        National Health Care Administration, established in section 
        401(a).
            (2) Administrator.--The term ``Administrator'' means the 
        Administrator of the Administration, appointed under section 
        401(b)(1).
            (3) Board.--The term ``Board'' means the National Health 
        Board, established in section 402.
            (4) Consumer.--The term ``consumer'' means an eligible 
        individual who receives covered services.
            (5) Covered service.--The term ``covered service'' means a 
        service described in section 201, provided under a State 
        program.
            (6) Eligible individual.--The term ``eligible individual'' 
        means an individual who is eligible--
                    (A) for enrollment, as described in section 103; 
                and
                    (B) with respect to a covered service, to receive 
                the service, as described in section 204.
            (7) Health care facility.--The term ``health care 
        facility'' means a facility entitled under the law of a State 
        to provide covered services.
            (8) Health care provider.--The term ``health care 
        provider'' means a person entitled under the law of a State to 
        provide covered services, and a health care facility.
            (9) Health professional shortage area.--The term ``health 
        professional shortage area'' has the meaning given the term in 
        section 332(a)(1) of the Public Health Service Act (42 U.S.C. 
        254e(a)(1)).
            (10) Integrated health service plan.--The term ``Integrated 
        Health Service Plan'' means a nonprofit, consumer-controlled, 
        health plan that--
                    (A) provides all covered services; and
                    (B) operates as a single organization in the health 
                care facilities of the organization.
            (11) Local planning area.--The term ``local planning area'' 
        means an area designated under section 412.
            (12) Medically underserved population.--The term 
        ``medically underserved population'' has the meaning given the 
        term in section 330(b)(3) of the Public Health Service Act (42 
        U.S.C. 254c(b)(3).
            (13) National health care data base.--The term ``national 
        health care data base'' means the data base established in 
        section 401(h).
            (14) National health care program.--The term ``national 
        health care program'' means the program established in section 
        101.
            (15) Nursing facility.--The term ``nursing facility'' has 
        the meaning given the term in section 1919(a) of the Social 
        Security Act (42 U.S.C. 1396r(a)).
            (16) State.--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.
            (17) State agency.--The term ``State agency'' means an 
        agency designated under section 411.
            (18) State program.--The term ``State program'' means a 
        program approved under section 102.
            (19) Trust fund.--The term ``Trust Fund'' means, except as 
        otherwise specifically provided, the fund established in 
        section 324.

                 TITLE I--NATIONAL HEALTH CARE PROGRAM

SEC. 101. ESTABLISHMENT.

    The Administrator shall establish and carry out a national health 
care program in accordance with this Act. In carrying out the national 
health care program, the Administrator shall make payments under 
section 302 to assist the States in establishing and carrying out State 
programs that provide covered services to eligible individuals.

SEC. 102. APPROVAL OF STATE PROGRAMS.

    (a) In General.--The Administrator shall provide for the review, 
and approval or disapproval, of programs as State programs under this 
Act.
    (b) Application.--For purposes of obtaining the approval described 
in subsection (a), a State agency shall submit an application to the 
Administrator at such time, in such manner, and containing such 
information as the Administrator may require, including a State plan 
that contains information describing a State program for providing 
covered services to eligible individuals in the State. At a minimum, 
the plan shall specify--
            (1) procedures for enrollment of individuals described in 
        subsection (a) or (b) of section 103 in the State program in 
        accordance with this title;
            (2) covered services to be provided by the State program in 
        accordance with subtitle A of title II, including a description 
        of the manner in which each health care provider shall provide 
        care coordination services;
            (3) requirements for provision of covered services in the 
        State program in accordance with subtitle B of title II;
            (4) procedures for establishing an exchange program in 
        accordance with section 303;
            (5) procedures for making payments to health care providers 
        in accordance with subtitle B of title III;
            (6) sources of State revenues for the State program, and 
        cost-sharing procedures, in accordance with sections 322 and 
        323, respectively;
            (7) an assurance that the State will comply with the State 
        administrative and planning requirements set forth in subtitle 
        B of title IV;
            (8) an assurance that the State program will reflect the 
        demographic and sociocultural diversity and needs of the 
        communities with the State; and
            (9) an assurance that the State agency shall annually 
        prepare and submit to the Administrator a report concerning the 
        operation of the State program.
    (c) Notification of Approval.--Not later than 90 days after the 
date the State agency submits the plan described in subsection (b) the 
Administrator shall notify the State agency of the decision of the 
Administration approving or disapproving the State plan.
    (d) Enforcement.--
            (1) Monitoring.--The Administration shall monitor the 
        compliance of State programs with the applicable requirements 
        of this Act, including the provisions specified in subsection 
        (b).
            (2) Records.--Each State program shall maintain such 
        records regarding the implementation of the State program as 
        the Administrator may by regulation require.
            (3) Access.--Any officer, employee, or representative of a 
        State program shall, upon request of an officer, employee, or 
        representative of the Administration, duly designated by the 
        Administrator, furnish information relating to the 
        implementation of the State program and permit the officer, 
        employee, or representative at all reasonable times to have 
        access to, and to copy, the records described in paragraph (2).
    (e) Withdrawal of Approval.--If the Administrator determines, after 
notice and opportunity for a hearing, that a program that has been 
previously approved as a State program no longer meets the applicable 
requirements of this Act, the Administrator may require corrective 
action or withdraw approval of the program. If the Administrator 
withdraws approval of a program within a State, the Administrator 
shall, by grant or contract, carry out a program that provides covered 
services to eligible individuals in accordance with the requirements, 
within the State served by the State program.

SEC. 103. ELIGIBILITY FOR ENROLLMENT.

    (a) In General.--An individual shall be eligible to enroll in the 
national health care program for covered services under a State 
program, if the individual--
            (1) maintains a primary residence in the State; and
            (2) is--
                    (A) a citizen of the United States;
                    (B) a national of the United States;
                    (C) a lawful resident alien of the United States; 
                or
                    (D) an alien nonimmigrant made eligible under 
                subsection (b).
    (b) Alien Nonimmigrants.--
            (1) In general.--The Administration may make eligible to 
        enroll in the national health care program, as described in 
        subsection (a), individuals within such classes of aliens 
        admitted to the United States as nonimmigrants as the 
        Administrator may provide in regulations prescribed under 
        section 401(e)(1)(A).
            (2) Considerations.--In providing for eligibility under 
        paragraph (1), the Administration shall consider reciprocity in 
        health care services offered to United States citizens who are 
        nonimmigrants to other foreign states, and such other factors 
        as the Administration determines to be appropriate.
    (c) Nondiscrimination.--
            (1) In general.--Any State that receives assistance under 
        this Act shall not discriminate in the enrollment of 
        individuals eligible for enrollment under subsection (a) or (b) 
        in the plan on the basis of race, color, religion, sex, 
        national origin (except in accordance with regulations 
        promulgated under subsection (b)(1)), age, health condition, 
        sexual preference, income, language, or geographic residence in 
        an urban or a rural area within the State.
            (2) Rules and regulations.--
                    (A) In general.--In carrying out this section, a 
                State agency shall implement eligibility procedures in 
                accordance with regulations prescribed under section 
                401(e)(1)(A).
                    (B) Enforcement.--The Administrator shall 
                promulgate rules and regulations to provide for the 
                enforcement of this section, including provisions for 
                summary suspension of assistance for not more than 30 
                days, on an emergency basis, until the Administration 
                can provide notice and an opportunity to be heard.
    (d) Definition.--As used in 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 granted asylum or 
with lawful temporary status under section 210, 210A, or 245A of the 
Immigration and Nationality Act (8 U.S.C. 1160, 1161, or 1255a).

SEC. 104. ENROLLMENT.

    (a) Enrollment Process.--In order to be eligible to receive a 
payment under section 302, each State program shall provide a 
mechanism, in accordance with regulations prescribed under section 
401(e)(1)(B), for the enrollment of individuals described in subsection 
(a) or (b) of section 103 in the national health care program.
    (b) Location.--Enrollment may occur at offices of the State program 
and other locations specified by the State agency.
    (c) Automatic Enrollment.--The mechanism under subsection (a) shall 
include a process for the automatic enrollment of individuals at the 
time of birth in the United States or at the time of immigration into 
the United States or other acquisition of lawful resident status in a 
State. Such mechanism shall also provide for the enrollment of eligible 
individuals as of January 1, 1995.
    (d) Issuance of Card.--On enrollment of an individual in the 
national health care program, the State program shall issue the 
individual a card that may be used for purposes of identification and 
processing of claims for covered services.

SEC. 105. PORTABILITY.

    (a) Reimbursement.--Each State program shall, in accordance with 
regulations issued by the Administrator, include procedures for 
portability of coverage and reimbursement for individuals who are 
enrolled in the State program and require a covered service in another 
State or country.
    (b) Enrollment in Other State Programs.--Each State agency shall 
agree to provide covered services, under such conditions as the 
Administrator shall by regulation specify, to individuals enrolled in 
other State programs.
    (c) Requirements.--Each State program--
            (1) 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 eligible for or entitled to covered 
        services; and
            (2) shall provide for, and be administered and operated, so 
        as to provide for the payments of amounts for the cost of 
        covered services provided to enrolled persons while temporarily 
        absent from the State on the basis that--
                    (A) if covered services are provided within another 
                State with a State program, payment for covered 
                services shall be 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 the States in a different 
                manner; and
                    (B) if the covered services are provided out of the 
                United States, or in a State that does not have a State 
                program, payment shall be made on the basis of the 
                amount that would have been paid by the State in which 
                the enrolled persons reside 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.
    (d) Prior Consent for Services Provided to Temporarily Absent 
Residents Permitted.--Notwithstanding any other provision of this 
section, a State program may require that the prior consent of the 
State program be obtained for elective insured health services provided 
to a resident of the State while temporarily absent from the State if 
the services in question are available on a substantially similar basis 
in the State.
    (e) Definition.--For the purposes of this section, the term 
``elective insured health services'' means covered services other than 
services that are provided in an emergency or in any other circumstance 
in which health care services are required without delay.

              TITLE II--BENEFITS AND PROVISION OF SERVICES

                     Subtitle A--Scope of Services

SEC. 201. COVERED SERVICES.

    (a) In General.--The covered services provided under this Act by 
the national health care program are all medically necessary services, 
and any benefit or service described in section 909 of the Civil Rights 
Restoration Act of 1987 (42 U.S.C. 1688), except as provided in section 
202, that contribute to the physical, mental, or psychosocial health of 
an individual or family, as determined in accordance with regulations 
prescribed under section 401(e)(1)(C), including--
            (1) primary prevention and health promotion services;
            (2) primary care services;
            (3) inpatient services, including discharge planning, 
        social services, and emergency and trauma services;
            (4) outpatient hospital services, including emergency and 
        trauma services;
            (5) laboratory and radiology services;
            (6) care coordination services;
            (7) rehabilitation services;
            (8) mental health services;
            (9) substance abuse treatment and rehabilitation services;
            (10) long-term care services provided in accordance with 
        section 213(c);
            (11) hospice care services;
            (12) provision of--
                    (A) prescription drugs and biologicals that are 
                listed in accordance with section 315 and prescribed by 
                a health care provider;
                    (B) such drugs, other than drugs described in 
                subparagraph (A), as are determined by a health care 
                provider to be medically necessary;
                    (C) durable medical equipment, and therapeutic 
                devices and equipment (including eyeglasses, hearing 
                aids, and prosthetic appliances), that are listed in 
                accordance with section 316 and prescribed by a health 
                care provider; and
                    (D) such medical supplies, other than devices and 
                equipment described in subparagraph (C), as are 
                determined by a health care provider to be medically 
                necessary;
            (13) dental care services;
            (14) hearing and speech services;
            (15) vision care services;
            (16) occupational health services;
            (17) organ transplant services; and
            (18) other inpatient and outpatient professional services.
    (b) Definitions.--As used in this title:
            (1) Care coordination services.--The term ``care 
        coordination services'' means services that--
                    (A) are provided through an individual health care 
                provider or a multidisciplinary team of health care 
                providers, including physicians, nurses, social 
                workers, and other nonphysician health care providers; 
                and
                    (B)(i) promote physical, mental, and psychosocial 
                health maintenance;
                    (ii) provide for the coordination and monitoring of 
                health care services for consumers, as well as 
                maintenance of appropriate records; and
                    (iii) provide transition management from inpatient 
                facilities to other needed community-based care 
                services.
            (2) Dental care services.--The term ``dental care 
        services'' means all medically necessary preventive and 
        curative dental care and routine dental examinations, provided 
        as frequently as the Administrator shall by regulation specify 
        for consumers within specified age groups.
            (3) Hearing and speech services.--The term ``hearing and 
        speech services'' means all medically necessary screening, 
        treatment, and provision of devices, relating to promotion of 
        hearing and speech.
            (4) Hospice care services.--The term ``hospice care 
        services'' means--
                    (A) hospice care, as defined in section 1861(dd)(1) 
                of the Social Security Act (42 U.S.C. 1395x(dd)(1))--
                            (i) whether provided in the home, through 
                        community-based services, or on an inpatient 
                        basis; and
                            (ii) except that the reference to ``medical 
                        social services'' in subparagraph (C) of such 
                        section is deemed a reference to ``medical 
                        social work services''; and
                    (B) counseling services, including bereavement 
                counseling.
            (5) Long-term care coordination services.--The term ``long-
        term care coordination services'' means ongoing services that--
                    (A) provide entry to and management of long-term 
                care services and covered services for individuals 
                described in section 204(1); and
                    (B) ensure--
                            (i) effective, cost-efficient, and 
                        coordinated delivery of such services to a 
                        consumer; and
                            (ii) comprehensive, continuous, and 
                        coordinated care that meets the physical, 
                        mental, and psychosocial health needs of such 
                        individuals.
            (6) Long-term care services.--The term ``long-term care 
        services'' means items and services provided to individuals 
        described in section 204(1) under a written plan of care 
        through home and community-based care programs and nursing 
        facilities and constitutes--
                    (A) long-term care coordination services;
                    (B) information and referral services;
                    (C) skilled and intermediate nursing home services;
                    (D) day treatment or partial hospitalization;
                    (E) nursing care;
                    (F) services of a homemaker or home health aide, 
                personal care services, and heavy chore services;
                    (G) social work services;
                    (H) physical, occupational, speech, and any other 
                appropriate therapy services;
                    (I) day health care services and social day care;
                    (J) respite care for caregivers;
                    (K) consumer and health care provider education, 
                training, and counseling, regarding health care 
                services;
                    (L) medical, skilled nursing, and social support 
                services, for residents of foster care programs, board 
                and care facilities, and other assisted living 
                programs;
                    (M) medical supplies and minor remodeling changes 
                to the home required by a health condition;
                    (N) Meals on Wheels;
                    (O) nutrition and dietary counseling;
                    (P) assisted transportation;
                    (Q) emergency alarm response systems;
                    (R) coverage of health care needs of people with 
                chronic illnesses;
                    (S) coverage of acute health care, if required, in 
                a hospital, nursing facility, rehabilitation facility, 
                or other inpatient or outpatient facility; and
                    (T) home and community-based services to assist 
                people recovering from illness, disease, or injury.
            (7) Mental health services.--The term ``mental health 
        services'' means services related to the diagnosis and 
        treatment of mental illnesses and the promotion of mental 
        health, including--
                    (A) inpatient services, including services provided 
                at hospitals and other inpatient facilities, such as 
                residential treatment centers;
                    (B) partial hospitalization and other types of day 
                programs;
                    (C) crisis intervention;
                    (D) outpatient services, with particular emphasis 
                on outpatient services for children and adolescents, 
                provided through--
                            (i) community-based health care facilities 
                        and systems; or
                            (ii) autonomous health care providers, 
                        including psychiatrists, clinical 
                        psychologists, clinical social workers, 
                        psychiatric nurse specialists, or such other 
                        qualified health care providers as the 
                        Administrator shall by regulation specify; and
                    (E) community-based residential programs, 
                particularly programs that prepare individuals for 
                independent living.
            (8) Occupational health services.--The term ``occupational 
        health services'' means--
                    (A) prevention and health promotion activities to 
                be carried out in high risk workplaces and workplaces 
                with sizable work forces; and
                    (B) specific health monitoring activities to be 
                carried out in workplaces that are determined, in 
                consultation with the Occupational Safety and Health 
                Administration, by the Federal Government to pose a 
                significant threat to the health and safety of the 
                workers.
            (9) Organ transplant services.--The term ``organ transplant 
        services'' means organ transplants for which screening 
        indicates a likelihood of significant and sustained improvement 
        in the quality of life of the consumer.
            (10) Primary care services.--The term ``primary care 
        services'' means services provided by a health care provider 
        that provide--
                    (A) comprehensive services focused on the 
                maintenance of physical, mental and psychosocial 
                health; and
                    (B) care coordination services.
            (11) Primary prevention and health promotion services.--The 
        term ``primary prevention and health promotion services'' 
        means--
                    (A) comprehensive well-child care services, 
                including health education services, for consumers 
                below age 22, including immunizations and early, 
                routine assessment, diagnosis, and treatment, that--
                            (i) help to ensure prevention of disease 
                        and early identification before the onset of 
                        illness;
                            (ii) assess a wide array of health 
                        conditions;
                            (iii) provide diagnosis and evaluation of 
                        suspected health, mental health, or 
                        developmental problems; and
                            (iv) provide parent and caregiver training 
                        as appropriate and necessary to support child 
                        health and developmental services for high-risk 
                        children;
                    (B) perinatal and infant health care services, 
                including prenatal care and follow-up for a mother and 
                an infant through the first year of the life of the 
                infant;
                    (C) routine, age-appropriate, clinical health 
                maintenance examinations for consumers age 22 and 
                older;
                    (D) comprehensive family planning and reproductive 
                health care services;
                    (E) school-based primary prevention and health 
                promotion programs, which may include school-based 
                clinics, mobile programs, or satellite clinics serving 
                several schools in close proximity; and
                    (F) home visiting services to provide enhanced 
                risk-appropriate maternal and child health assessment, 
                education, and support.
            (12) Professional services.--The term ``professional 
        services'' means services of physicians, registered nurses, 
        nurse practitioners, nutritionists, podiatrists, physician's 
        assistants, psychologists, social workers, nurse midwives, 
        dietitians, and physical, speech, occupational, and respiratory 
        therapists, and such other health care providers as the 
        Administrator shall approve.
            (13) Rehabilitation services.--The term ``rehabilitation 
        services'' means, except as used within the term ``substance 
        abuse treatment and rehabilitation services''--
                    (A) physical therapy, occupational therapy, speech-
                language therapy, pathology, and audiology, provided by 
                autonomous health care providers or by health care 
                facilities;
                    (B) social work services;
                    (C) provision of medical appliances, including 
                prosthetic devices;
                    (D) community-based residential programs for the 
                disabled, including group homes that prepare consumers 
                for independent living; and
                    (E) such additional services as the Administrator 
                may determine, after consultation with appropriate 
                State review boards, to be necessary to address special 
                cases or circumstances,
        provided on an inpatient or outpatient basis.
            (14) Substance abuse treatment and rehabilitation 
        services.--The term ``substance abuse treatment and 
        rehabilitation programs'' means services to promote recovery 
        from substance abuse, including--
                    (A) inpatient and outpatient hospital services;
                    (B) partial hospitalization and other types of day 
                programs;
                    (C) crisis intervention;
                    (D) residential treatment or rehabilitation 
                programs certified under Federal regulation;
                    (E) outpatient substance abuse treatment services 
                provided through--
                            (i) community-based health care facilities 
                        and treatment programs; or
                            (ii) autonomous health care providers, 
                        including psychiatrists, clinical 
                        psychologists, clinical social workers, 
                        psychiatric nurse specialists, and such other 
                        qualified health care providers as the 
                        Administrator shall by regulation specify; and
                    (F) community-based residential programs, 
                particularly programs that prepare individuals for 
                independent living.
            (15) Vision care services.--The term ``vision care 
        services'' means--
                    (A) routine eye examinations, provided as 
                frequently as the Administrator shall by regulation 
                specify for consumers within specified age groups;
                    (B) provision of glasses and contact lenses, as 
                frequently as the Administrator shall by regulation 
                specify; and
                    (C) all medically necessary vision treatment.

SEC. 202. EXCLUSIONS.

    Covered services do not include--
            (1) cosmetic surgery, except medically necessary 
        reconstructive surgery;
            (2) cosmetic orthodontics;
            (3) such amenities in inpatient facilities as the 
        Administrator shall by regulation specify, such as private 
        rooms, unless the amenities are medically necessary;
            (4) medical examinations and medical reports required for 
        purchasing or renewing life insurance policies, or as part of a 
        civil action for the recovery of settlement or damages; or
            (5) any service that a health care provider determines not 
        to be medically necessary.

SEC. 203. PROHIBITIONS ON LIMITATIONS.

    A State program may not limit the covered services provided to a 
consumer on the basis of a health condition of the individual that 
existed on the date of the enrollment of the consumer in the national 
health care program for services under the State program.

SEC. 204. ELIGIBILITY.

    Persons enrolled under section 104 who are eligible for covered 
services shall include--
            (1) with respect to long-term care services, individuals--
                    (A) over 18 years of age determined (in a manner 
                specified by the Secretary)--
                            (i) to be unable to perform, without the 
                        assistance of an individual, at least 2 of the 
                        following 5 activities of daily living (or who 
                        has a similar level of disability due to 
                        cognitive impairment)--
                                    (I) bathing;
                                    (II) eating;
                                    (III) dressing;
                                    (IV) toileting; and
                                    (V) transferring in and out of a 
                                bed or in and out of a chair; or
                            (ii) due to cognitive or mental 
                        impairments, requires supervision because the 
                        individual behaves in a manner that poses 
                        health or safety hazards to the individual or 
                        others; or
                    (B) under 19 years of age determined (in a manner 
                specified by the Secretary) to meet such alternative 
                standard of disability for children as the Secretary 
                develops;
            (2) with respect to hospice care services, terminally ill 
        individuals, regardless of the cause of illness;
            (3) with respect to services to be provided in schools, 
        workplaces, and assisted living programs, such individuals as 
        may be specified in the State plan described in section 102(b); 
        and
            (4) with respect to covered services not described in 
        paragraphs (1) through (3), all individuals.

SEC. 205. ADDITIONAL AND DUPLICATE SERVICES.

    (a) Additional Services.--
            (1) Construction.--Except as provided in section 202, 
        nothing in this Act shall be construed as limiting the health 
        care services that a State program may provide.
            (2) State financing of additional services.--There shall be 
        no Federal financing available under this Act for health care 
        services other than covered services.
    (b) Coverage of Services.--
            (1) Prohibition on duplicate private insurance.--No person 
        may sell private insurance that provides coverage for health 
        care services that duplicate covered services.
            (2) Coverage of additional benefits.--Nothing in this Act 
        shall be construed as prohibiting the sale of private insurance 
        that provides health care services other than covered services.
    (c) Private Care.--
            (1) Arrangements.--Except as provided in paragraph (2), 
        nothing in this Act shall be construed as prohibiting 
        arrangements between a health care provider and an individual 
        for the provision of covered services.
            (2) Limitation.--Arrangements described in paragraph (1) 
        shall provide for acceptance of payment as described in section 
        311(b)(1).

                   Subtitle B--Provision of Services

SEC. 211. HEALTH CARE PROVIDERS.

    (a) Certification and Licensing.--State programs shall include 
procedures for certification and licensing of health care providers 
participating in the national health care program in accordance with 
regulations prescribed under section 401(e)(1)(H) and other applicable 
Federal and State law.
    (b) Quality Assurance and Consumer Protection Standards.--State 
agencies shall regulate the health care providers, and shall ensure 
compliance with quality assurance standards prescribed under section 
401(e)(1)(G), consumer protection standards prescribed under section 
401(e)(1)(I), and other applicable Federal and State law.
    (c) Enforcement.--A State agency that determines, after notice and 
an opportunity for a hearing, that a health care provider has 
repeatedly violated the quality assurance standards, or has been 
convicted of an offense involving medical malpractice, shall debar the 
provider from receiving payment under the State program. The State 
agency shall develop appropriate procedures for determining the length 
of the debarment and for terminating a debarment in an appropriate 
case.

SEC. 212. DELIVERY SYSTEMS.

    (a) Innovative Delivery Systems.--State programs may implement 
innovative delivery systems of covered services, including private 
health services, State-operated health services, and Integrated Health 
Service Plans, to provide covered services.
    (b) Integrated Health Service Plans.--
            (1) In general.--Each State agency shall provide for the 
        review, and approval or disapproval, of health plans as 
        Integrated Health Service Plans in the State for purposes of 
        this Act.
            (2) Application.--For purposes of obtaining the approval 
        described in paragraph (1), an entity shall submit an 
        application to the head of the State agency at such time, in 
        such manner, and containing such information as the head of the 
        State agency may require.
            (3) Notification of approval.--Not later than 60 days after 
        the date the entity submits the application described in 
        paragraph (2), the head of the State agency shall notify the 
        entity of the decision of the State agency approving or 
        disapproving the plan.
            (4) Withdrawal of approval.--If the head of the State 
        agency determines, after notice and an opportunity for a 
        hearing, that a health plan that has been previously approved 
        as an Integrated Health Service Plan no longer meets the 
        applicable requirements of this Act, the head of the State 
        agency shall withdraw approval of the plan and shall, in 
        accordance with regulations prescribed under section 
        401(e)(1)(B), provide a procedure under which individuals 
        enrolled in the plan may be enrolled in other Integrated Health 
        Service Plans.

SEC. 213. STATE LONG-TERM CARE COORDINATION AGENCIES.

    (a) Establishment.--State agencies shall establish State long-term 
care coordination agencies, to ensure a continuum of care for every 
individual described in section 204(1).
    (b) Services.--Services provided through the agencies shall 
include--
            (1) services of certified public or nonprofit coordination 
        agencies, provided through qualified professionals that meet 
        such professional standards as the Administrator shall 
        prescribe under section 401(e)(1)(H), to serve as resources for 
        health care facilities, physicians, and other health care 
        providers; and
            (2) long-term care coordination services as an integral 
        part of long-term care services, as described in subsection 
        (c), and of home and community-based benefits.
    (c) Long-Term Care Services.--
            (1) In general.--State long-term care coordination agencies 
        shall be responsible for screening all potential recipients of 
        long-term care services and authorizing needed services.
            (2) Requirements.--State long-term care coordination 
        agencies shall provide services in accordance with the 
        following requirements:
                    (A) Setting and level of care.--The setting and 
                level of care to be provided to persons needing long-
                term care services shall be based on an assessment of 
                the severity of cognitive impairment, inability to 
                perform specified activities of daily living (as well 
                as certain functional tasks), the level of disability, 
                the need for regular ongoing care, behavioral and 
                emotional problems, and the ability of family 
                caregivers to care for persons in need.
                    (B) Coordination.--Long-term care services shall be 
                coordinated with the provision of acute health care and 
                other health care and mental health services if needed.
                    (C) Requests.--All requests for services shall be 
                processed in a timely manner.
                    (D) Intensity.--The intensity of care coordination 
                provided under this subsection shall depend on the 
                severity of need and the level of services required to 
                meet the needs.
                    (E) Outpatient emphasis.--The agency shall place 
                priority on maintaining consumers in their homes (with 
                the necessary supports) or in community-based 
                residential programs rather than inpatient facilities 
                and nursing homes.
                    (F)  Emergency situations.--The agency shall make 
                provisions to respond to emergency situations, 
                including first-time requests and consumers who are 
                receiving ongoing services and who have a sudden change 
                of status or condition.
                    (G) Cost-efficient approaches.--States shall have 
                the flexibility to develop cost-efficient approaches to 
                respond to requests for limited home and community-
                based services.
                    (H) Coordination.--State long-term care 
                coordination agencies shall ensure coordination and 
                continuity of care between service levels and different 
                settings if applicable, which includes the ability to 
                respond to crisis situations.
                    (I) Qualification standards.--Care coordination 
                provided under this subsection shall meet defined 
                qualification standards.
                    (J) Other health care disciplines.--Care 
                coordinators shall utilize the services of other health 
                care disciplines, and interdisciplinary teams if 
                appropriate.
                    (K) Consumer involvement.--Consumers shall, to the 
                extent the consumers are able, be involved in all 
                decisions regarding long-term care services. Family or 
                caregiver involvement shall occur if appropriate.
            (3) Contracts and agreements.--
                    (A) In general.--State long-term care coordination 
                agencies shall, with respect to the geographic area 
                served by the agencies--
                            (i) enter into contracts or agreements with 
                        providers of long-term care services; and
                            (ii) authorize and disburse all funds for 
                        long-term care services.
                    (B) Criteria.--The contracts or agreements shall 
                require performance criteria in accordance with Federal 
                guidelines. Criteria shall address such issues as 
                certification and licensure of the health care 
                provider, expected level of service, staff 
                qualifications, supervision, role of the long-term care 
                coordination agency, rights of the consumer and health 
                care providers, and provisions for necessary changes in 
                level of care.
            (4) Independence.--State long-term care coordination 
        agencies shall be independent from any providers of long-term 
        care services.

SEC. 214. INCORPORATION OF MISCELLANEOUS MEDICARE-RELATED PROVISIONS.

    (a) Provisions in Title XVIII.--Except as otherwise specifically 
provided in this Act, the following provisions of the Social Security 
Act shall apply to this Act in the same manner as the provisions 
applied to title XVIII of the Social Security Act as of the day before 
the date of the enactment of this Act:
            (1) Section 1819 (relating to requirements for, and 
        assuring quality of care in, skilled nursing facilities), 
        except that any reference in the section to a ``skilled nursing 
        facility'' is deemed a reference to a ``nursing facility''.
            (2) Section 1846 (relating to intermediate sanctions for 
        providers of clinical diagnostic laboratory tests).
            (3) Sections 1863 through 1865 (relating to consultation 
        with State agencies and other organizations to develop 
        conditions of participation for providers of services, use of 
        State agencies to determine compliance by providers of services 
        with conditions of participation, and effect of accreditation).
            (4)(A) Subject to subparagraph (B), section 1866 (relating 
        to agreements with providers of services).
            (B)(i) The provisions of section 1866(a)(1)(N) shall not 
        apply.
            (ii) Under section 1866(a)(2), a health care provider may 
        not impose any charge for covered services under this Act.
            (iii) In the case of a hospital, the provider agreement 
        under section 1866 shall prohibit a hospital from denying care 
        to any eligible individual on any ground other than the 
        hospital's inability to provide the care required.
            (5) Section 1867 (relating to examination and treatment for 
        emergency medical conditions and women in labor).
            (6) Section 1869 (relating to determinations and appeals).
            (7) Section 1870 (relating to overpayment on behalf of 
        individuals and settlement of claims for covered services on 
        behalf of deceased individuals).
            (8) Sections 1871 through 1874 (relating to regulations, 
        application of certain provisions of title II of the Social 
        Security Act, designation of organization or publication by 
        name, and administration).
            (9)(A) Subject to subparagraph (B), section 1876 (relating 
        to payments to health maintenance organizations and competitive 
        medical plans) shall apply to eligible individuals under this 
        Act in the same manner as it applies to individuals entitled to 
        benefits under part A, and enrolled under part B, of title 
        XVIII of the Social Security Act.
            (B) In applying section 1876 under this Act--
                    (i) the provisions of such section relating only to 
                individuals enrolled under part B of title XVIII of the 
                Social Security Act shall not apply;
                    (ii) subject to subparagraph (C), any reference to 
                a Trust Fund established under title XVIII of such Act 
                and to benefits under such title is deemed a reference 
                to the National Health Care Trust Fund and to covered 
                services under this Act;
                    (iii) subject to subparagraph (C), the adjusted 
                average per capita cost and adjusted community rate 
                shall be determined on the basis of covered services 
                under this Act; and
                    (iv) subsection (f) shall not apply.
            (C) For purposes of subparagraph (B), covered services 
        under this Act may, at the option of an eligible organization, 
        not include benefits for nursing facility services that are not 
        post-hospital extended care services and benefits for home and 
        community-based services.
            (10) Section 1877 (relating to limitation on certain 
        physician referrals).
            (11) Section 1878 (relating to the provider reimbursement 
        review board), except that the hearings pursuant to such 
        section shall be on the approval of budgets under section 312 
        rather than the determination of payment amounts under title 
        XVIII of the Social Security Act.
            (12) Section 1891 (relating to conditions of participation 
        for home health agencies; home health quality).
            (13) Section 1892 (relating to offset of payments to 
        individuals to collect past-due obligations arising from breach 
        of scholarship and loan contract).
    (b) Title XI Provisions.--The following provisions of the Social 
Security Act shall apply to this Act in the same manner as they applied 
to title XVIII of the Social Security Act:
            (1) Sections 1124, 1126, and 1128 through 1128B (relating 
        to fraud and abuse).
            (2) Section 1134 (relating to nonprofit hospital 
        philanthropy).
            (3) Section 1138 (relating to hospital protocols for organ 
        procurement and standards for organ procurement agencies).
            (4) Section 1142 (relating to research on outcomes of 
        health care services and procedures), except that any reference 
        in such section to a Trust Fund is deemed a reference to the 
        National Health Care Trust Fund.
            (5) Part B of title XI of the Social Security Act (relating 
        to peer review of the utilization and quality of health care 
        services).

SEC. 215. NONDISCRIMINATION.

    (a) In General.--No individual with responsibility for the 
administration of a State plan that receives assistance under this Act 
shall discriminate in the provision of covered services to eligible 
individuals on the basis of race, color, religion, sex, national 
origin, age, health condition, sexual preference, income, language, or 
geographic residence in an urban or rural area within the State.
    (b) Rules and Regulations.--The Administrator shall promulgate 
rules and regulations to provide for the enforcement of this section, 
including provisions for summary suspension of assistance for not more 
than 30 days, on an emergency basis, until the Administration can 
provide notice and an opportunity to be heard.

                           TITLE III--REVENUE

                       Subtitle A--Budget Process

SEC. 301. NATIONAL AND STATE HEALTH BUDGETS.

    (a) In General.--
            (1) Expenditures and revenues.--For each calendar year the 
        Administrator shall establish a national health budget and, for 
        each State, a State health budget that specifies--
                    (A) the level and application of expenditures to be 
                made under this Act in the year in the United States 
                and in the State, respectively; and
                    (B) the amount in and source of revenues of the 
                Trust Fund in such year.
            (2) Basis.--Each State health budget established by the 
        Administrator under this subsection shall--
                    (A) be based on--
                            (i) the population of the State;
                            (ii) reasonable differences in the prices 
                        for goods and services;
                            (iii) any special social, environmental, or 
                        other condition affecting health conditions or 
                        the need for health care services; and
                            (iv) the geographic distribution of the 
                        population of the State population, including 
                        the proportion of the population residing in 
                        rural or health professional shortage areas;
                    (B) be adjusted to account for States--
                            (i) with large populations;
                            (ii) with substantial numbers of residents 
                        in age categories that make disproportionately 
                        greater use of covered services;
                            (iii) with substantial numbers of residents 
                        below the income official poverty line, as 
                        defined by the Office of Management and Budget, 
                        and revised annually in accordance with section 
                        673(2) of the Omnibus Budget Reconciliation Act 
                        of 1981 (42 U.S.C. 9902(2)); and
                            (iv) whose residents exhibit a high 
                        incidence of certain health conditions, such as 
                        a high incidence of Acquired Immune Deficiency 
                        Syndrome or infant mortality; and
                    (C) not disproportionately discriminate against 
                States with substantial rural populations.
    (b) Expenditure Level.--The total level of expenditures to be 
specified in the national health budget under subsection (a) for a year 
may not exceed the level of expenditures for covered services under 
this Act made in the year preceding the effective date of this Act 
increased in a compounded manner for each succeeding year (up to the 
year involved) by the annual percentage increase in the gross national 
product for the preceding year.
    (c) Institutional Capital Budget.--
            (1) In general.--Each national health budget established 
        under subsection (a) shall include an amount for total 
        expenditures for capital-related items, provide for State 
        capital budgets and specify the general manner in which such 
        expenditures for capital-related items are to be distributed 
        among the different types of health care facilities.
            (2) Factors.--Each State capital budget under this section 
        shall be established based solely on--
                    (A) the factors described in subparagraphs (A) and 
                (C) of subsection (a)(2); and
                    (B) reasonable differences in the prices for goods 
                and services, as such differences affect the prices of 
                the appropriate capital goods.
    (d) Health Training Budget.--Each national health budget 
established under subsection (a) shall include an amount for total 
expenditures for direct medical education expenses for institutions 
receiving payments under section 312. Such budgets shall specify the 
general manner in which such expenditures are to be taken into account, 
shall be based on a national plan for training of medical personnel 
developed by the Administrator that shall emphasize training for 
primary and preventive care, and shall provide for State budgets for 
direct medical education expenses. Payments under such budgets for such 
expenditures shall take into account the method for payment for direct 
medical education expenses as described in section 1886(h) of the 
Social Security Act.

SEC. 302. PAYMENTS TO STATES.

    The Administrator shall make payments from amounts in the Trust 
Fund to States with approved State programs.

SEC. 303. ESTABLISHMENT OF EXCHANGE PROGRAM.

    The Administration shall establish a program under which a State 
that furnishes covered services to residents of another State receives 
credit for payments for the services against the amounts to which the 
other State is otherwise entitled to receive.

             Subtitle B--Payments to Health Care Providers

SEC. 311. PAYMENTS TO HEALTH CARE PROVIDERS.

    (a) In General.--Each State program shall provide for a timely and 
administratively simple mechanism for the payment and reimbursement of 
health care providers in a manner consistent with this subtitle and in 
accordance with regulations prescribed under section 401(e)(1)(E).
    (b) Mandatory Assignment.--
            (1) Acceptance of payments.--Each health care provider that 
        receives funding under the national health care program shall 
        accept the payment amount recognized under the State program 
        for covered services as payment in full for such services, 
        provided to consumers, or to individuals entering into an 
        arrangement described in section 205(c).
            (2) Prohibition on additional charges.--Health care 
        providers shall only impose charges on consumers--
                    (A) as provided in section 323; or
                    (B) with respect to services that are not covered 
                services.
    (c) Continuum of Health Care Services.--State programs, in order to 
avoid fragmented care and promote a continuum of health care services, 
shall develop financial incentives in the payment and reimbursement 
mechanisms provided under this subtitle.
    (d) Equipment and Construction.--
            (1) Limitations.--A State program shall, in accordance with 
        regulations prescribed by the Administrator--
                    (A) limit acquisition of highly specialized or 
                expensive medical equipment, which shall be carefully 
                regulated to ensure appropriate and equitable 
                utilization and distribution; and
                    (B) eliminate acquisition of expensive, highly 
                specialized equipment by individual physicians and 
                group practices, although the State program may make 
                exceptions in rural health professional shortage areas.
            (2) Approval.--Approval for construction and renovation 
        funds shall only be considered on the basis of utilization data 
        and within the context of the State planning process under 
        section 412.
    (e) Rural and Health Professional Shortage Areas.--In establishing 
the mechanism for payment and reimbursement of health care providers 
under this subtitle, the State program shall establish schedules and 
incentives in a manner that will encourage health care providers to 
practice or locate in rural and health professional shortage areas.

SEC. 312. PAYMENTS TO INSTITUTIONAL HEALTH CARE PROVIDERS.

    (a) In General.--Except as provided in subsection (c), payment for 
institutional care, including hospital services, shall be made in each 
State on the basis of an annual prospective budgeting system, 
established by the State consistent with the State health budget 
established under section 301 and after negotiations with institutional 
health care providers.
    (b) Hospitals.--
            (1) Budget.--
                    (A) In general.--Each hospital shall receive 
                prospectively a global budget. The budget will be 
                developed through annual negotiations between the State 
                agency and the hospital.
                    (B) Factors.--In developing the budget, the State 
                agency shall consider the health needs of the area, the 
                past expenditures of the hospital, inflation, previous 
                financial and clinical performance (based on 
                utilization data collected through the national health 
                care data base), projected levels of services, 
                technological advances or changes, wages and other 
                costs, proposed new programs, type of hospital, and 
                costs associated with meeting Federal and State 
                regulations.
                    (C) Adjustments.--End-of-the-year adjustments may 
                be made to hospital budgets based on unforeseen 
                factors, such as an increase or decrease in consumer 
                load.
            (2) Operating expenses.--Global hospital budgets shall be 
        used for operating expenses. Operating expenses shall include 
        replacement of standard equipment and funds to promote 
        innovation in health services. None of the operating budget may 
        be used for physical expansion, profit, marketing, or the 
        purchase of expensive, highly specialized equipment.
            (3) Capital expansion and equipment.--Separate funds for 
        capital expansion and purchase of expensive equipment shall be 
        subject to approval by the State agency, and consistent with 
        the State capital budgets described in section 301(c)(1).
            (4) Fundraising.--Under Federal guidelines, hospitals may 
        raise funds from private sources to pay for special services. 
        Such additional funds may not change the operating budget. Any 
        anticipated changes in the operating budget as a result of 
        special services shall be negotiated with the State agency.
            (5) Health professional shortage areas.--State programs 
        shall provide subsidies to rural and urban hospitals in health 
        professional shortage areas, including teaching hospitals, to 
        ensure the viability of the health care facilities.
    (c) Other Health Care Facilities.--
            (1) Definition.--As used in this subsection, the term 
        ``other health care facilities'' shall include community 
        clinics, migrant health centers, nursing homes, community-based 
        programs, home health agencies, rehabilitation facilities, 
        renal dialysis facilities, birthing centers, and health 
        facilities operated by public health departments.
            (2) Payment.--States may determine whether other health 
        care facilities shall be paid on the basis of a prospective 
        global budget or per capita fee. Certain services, such as day 
        health care centers, may be reimbursed on a per diem basis. The 
        Administration shall determine whether the States may determine 
        the per capita fee rates, or whether the rates shall be set by 
        the Administration with regional variations.
            (3) Limitations.--The same limitations described in 
        subsection (b) regarding capital expenditures and operating 
        expenses for hospitals shall apply to other health care 
        facilities.
            (4) Health care providers.--Health care providers employed 
        in other health care facilities shall be salaried. Contractual 
        arrangements shall be permitted for specialists that are not on 
        the staff of such a facility.
            (5) Rural facilities.--State programs shall provide special 
        State subsidies for other health care facilities that are 
        essential facilities in rural areas, to ensure the viability of 
        the facilities.

SEC. 313. PAYMENTS FOR SERVICES BY INDIVIDUAL HEALTH CARE PROVIDERS.

    (a) Fee Schedules.--
            (1) In general.--Except as otherwise provided in this 
        section, payment for services by individual health care 
        providers shall be on a fee-for-service basis and based on 
        payment schedules established by each State program in 
        accordance with regulations prescribed under section 
        401(e)(1)(E).
            (2) Schedules.--Such schedules--
                    (A) shall be established after negotiations with 
                organizations representing physicians and other health 
                care providers;
                    (B) shall be based on a national relative value 
                scale, developed by the Administration taking into 
                account the relative value scale developed under 
                section 1848 of the Social Security Act (42 U.S.C. 
                1395w-4), as in effect on the day before the date of 
                the enactment of this Act;
                    (C) shall take into consideration regional 
                variations; and
                    (D) shall be in amounts consistent with the State 
                health budget adopted under section 301.
            (3) Targets.--Expenditure targets on the annual State 
        allocation of fee-for-service payments for each category of 
        health care provider shall be established under the State 
        programs. If a group of health care providers exceeds the 
        annual expenditure target, State agencies shall have the 
        flexibility to negotiate with the Administration and the health 
        care provider group to modify the fee schedule for the 
        following year to correct for overspending in the previous 
        budget year.
    (b) Alternative Payment Mechanisms.--Payment for services by 
individual health care providers may be based on alternative payment 
methodologies, including capitation methods, annual salary and hourly 
payments, so long as the amount of payments under such methodology do 
not exceed, in the aggregate, the amount of payments that would 
otherwise be made under the methodology described in subsection (a).
    (c) Billing.--Individual health care providers shall submit bills 
to the State agency.
    (d) Covered Expenses.--Payment to individual health care providers 
shall cover health care provider earnings and basic operating expenses, 
and shall not include reimbursement for expensive, highly specialized 
equipment. Operating expenses shall include administrative overhead, 
employee wages, and replacement of standard equipment.
    (e) Group Practices.--Group practices may elect to be paid 
prospectively on a per capita basis rather than on a fee-for-service 
basis.

SEC. 314. PAYMENTS TO INTEGRATED HEALTH SERVICE PLANS.

    (a) Payment.--Integrated Health Service Plans shall be paid 
prospectively on a per capita basis or by means of a negotiated global 
budget, as determined by the State agency.
    (b) Inpatient Care.--Such payment shall not cover inpatient care 
services. Inpatient facilities operated by the Integrated Health 
Service Plans will be paid for covered services on the same basis as 
all other inpatient facilities.
    (c) Hospitals.--Integrated Health Service Plan- operated hospitals 
shall be paid for covered services on the same basis as all other 
hospitals under section 312.
    (d) Health Care Providers.--All health care providers employed by 
the Integrated Health Service Plans shall be salaried. An Integrated 
Health Service Plan may enter into contractual arrangements with 
specialty health care providers not available on staff.
    (e) Development.--State programs shall provide incentives for the 
development of Integrated Health Service Plans.

SEC. 315. PAYMENTS FOR PRESCRIPTION DRUGS AND BIOLOGICALS.

    (a) Establishment of List.--
            (1) In general.--The Administrator shall establish a list 
        of approved prescription drugs and biologicals that the 
        Administrator determines are necessary for the maintenance or 
        restoration of health or of employability or self-management 
        and eligible to be provided as covered services.
            (2) Exclusions.--The Administrator may exclude from the 
        list described in paragraph (1) ineffective, unsafe, or 
        overpriced drugs or biologicals if better alternatives are 
        determined to be available.
    (b) Prices.--For each such listed prescription drug or biological 
that may be provided as a covered service under this Act, the 
Administrator shall from time to time, by regulation promulgated under 
section 401(e)(1)(F), determine a product price or prices that shall 
constitute the maximum to be recognized under this Act as the cost of 
the drug or biological to a health care provider. The Administrator may 
conduct negotiations, on behalf of State programs, with manufacturers 
and distributors of drugs or biologicals in determining the applicable 
product price or prices.
    (c) Charges by Independent Pharmacies.--Each State program shall 
provide for payment for such a listed prescription drug or biological 
furnished by an independent pharmacy based on the cost of the drug or 
biological to the pharmacy (not in excess of the applicable product 
price established under subsection (b)) plus a dispensing fee. In 
accordance with standards established by the Administrator under 
section 401(e)(1)(F), each State program, after consultation with 
representatives of the pharmaceutical profession, shall establish 
schedules of dispensing fees, designed to afford reasonable 
compensation to independent pharmacies after taking into account 
variations in their cost of operation resulting from regional 
differences, differences in the volume of prescription drugs and 
biologicals dispensed, differences in services provided, and other 
relevant factors.
    (d) Definitions.--As used in this section, the terms ``prescription 
drug'' and ``biological'' mean a drug and a biological, respectively, 
described in section 1861(t) of the Social Security Act (42 U.S.C. 
1395x(t)).

SEC. 316. APPROVED DEVICES AND EQUIPMENT.

    (a) Establishment of List.--
            (1) In general.--The Administrator shall establish a list 
        of approved durable medical equipment and therapeutic devices 
        and equipment (including eyeglasses, hearing aids, and 
        prosthetic appliances), that the Administrator determines are 
        necessary for the maintenance or restoration of health or of 
        employability or self-management and eligible to be provided as 
        covered services.
            (2) Exclusions.--The Administrator may exclude from the 
        list described in paragraph (1) ineffective, unsafe, or 
        overpriced equipment or devices if better alternatives are 
        determined to be available.
    (b) Considerations and Conditions.--In establishing the list under 
subsection (a), the Administrator shall take into consideration the 
efficacy, safety, and cost of each item contained on such list, and 
shall attach to any item such conditions as the Administrator 
determines to be appropriate with respect to the circumstances under 
which, or the frequency with which, the item may be prescribed.
    (c) Prices.--For each such listed item that may be provided as a 
covered service under this Act, the Administrator shall from time to 
time, by regulation promulgated under section 401(e)(1)(F), determine a 
product price or prices that shall constitute the maximum to be 
recognized under this Act as the cost of the item to a health care 
provider. The Administrator may conduct negotiations, on behalf of 
State programs, with manufacturers and distributors of the equipment or 
devices described in subsection (a) in determining the applicable 
product price or prices.
    (d) Definition.--As used in this section, the terms ``durable 
medical equipment'' has the meaning given the term in section 1861(n) 
of the Social Security Act (42 U.S.C. 1395x(n)).

SEC. 317. GRIEVANCE PROCEDURE.

    (a) Board.--The head of each State agency shall establish a State 
Payment Grievance Board. In selecting members of the State Payment 
Grievance Board, the head of the State agency shall ensure that members 
shall not perform duties inconsistent with their duties and 
responsibilities as members, and shall ensure that an employee or agent 
engaged in the performance of investigative or prosecuting functions 
for the State agency in a case shall not, in the case or a factually 
related case, participate or advise in the decision, recommended 
decision, or State agency review of the decision, except as witness or 
counsel in public proceedings.
    (b) Appeals.--
            (1) Health care providers.--A health care provider who is 
        denied payment by an employee of a State agency, or a State 
        long-term care coordination agency, for covered services may 
        appeal the decision of the State agency, not later than 30 days 
        after the decision, to a State Payment Grievance Board.
            (2) Patients.--In any case in which a health care provider 
        determines that a requested service is not medically necessary 
        with respect to a consumer, the health care provider shall 
        inform the consumer of the opportunity to appeal the decision 
        of the health care provider, not later than 30 days after the 
        decision, to a State Payment Grievance Board.
    (c) Procedures.--Each State agency shall provide for effective 
procedures for the State Payment Grievance Board for hearing and 
resolving appeals brought under subsection (b) and for State agency 
review of the appeals.

                     Subtitle C--Sources of Revenue

SEC. 321. FEDERAL SOURCES OF REVENUE.

    (a) Personal Income Tax Rate Increase.--
            (1) In general.--Subsections (a) through (e) of section 1 
        of the Internal Revenue Code of 1986 (relating to tax imposed) 
        are each amended by striking ``15%'', ``28%'', and ``31%'' each 
        place they appear and inserting ``20%'', ``31%'', and ``39%'', 
        respectively.
            (2) Technical amendments.--
                    (A) Subsection (f) of section 1 of such Code is 
                amended--
                            (i) by striking ``1990'' in paragraph (1) 
                        and inserting ``1994'', and
                            (ii) by striking ``1989'' in paragraph 
                        (3)(B) and inserting ``1993''.
                    (B) Subparagraph (B) of section 32(i)(1) of such 
                Code is amended by striking ``1989'' and inserting 
                ``1993''.
                    (C) Subparagraph (C) of section 41(e)(5) of such 
                Code is amended by striking ``1989'' each place it 
                appears and inserting ``1993''.
                    (D) Subparagraph (B) of section 63(c)(4) of such 
                Code is amended by striking ``1989'' and inserting 
                ``1993''.
                    (E) Clause (ii) of section 135(b)(2)(B) of such 
                Code is amended by striking ``1989'' and inserting 
                ``1993''.
                    (F) Subparagraphs (A)(ii) and (B)(ii) of section 
                151(d)(4) of such Code are each amended by striking 
                ``1989'' and inserting ``1993''.
                    (G) Clause (ii) of section 513(h)(2)(C) of such 
                Code is amended by striking ``1989'' each place it 
                appears and inserting ``1993''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply to taxable years beginning after December 31, 1993.
    (b) Corporate Income Tax Rate Increase.--
            (1) In general.--Subsection (b) of section 11 of the 
        Internal Revenue Code of 1986 (relating to tax imposed on 
        corporations) is amended by striking ``34 percent'' each place 
        it appears and inserting ``39 percent''.
            (2) Conforming amendments.--
                    (A) Section 852(b)(3)(D)(iii) of such Code is 
                amended by striking ``66 percent'' and inserting ``61 
                percent''.
                    (B) Section 1201(a) of such Code is amended by 
                striking ``34 percent'' each place it appears and 
                inserting ``39 percent''.
                    (C) Paragraphs (1) and (2) of section 1445(e) of 
                such Code are each amended by striking ``34 percent'' 
                and inserting ``39 percent''.
                    (D) Section 7518(g)(6)(A) of such Code and section 
                607(h)(6)(A) of the Merchant Marine Act, 1936 are each 
                amended by striking ``34 percent'' and inserting ``39 
                percent''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply to taxable years beginning after December 31, 1993.
    (c) Alternative Minimum Tax Increase.--
            (1) General rule.--Subparagraph (A) of section 55(b)(1) 
        (relating to tentative minimum tax) is amended by striking ``20 
        percent (24 percent'' and inserting ``23 percent (27 percent''.
            (2) Conforming amendment.--Paragraph (2) of section 897(a) 
        is amended by striking ``21'' in the heading of such paragraph 
        and in subparagraph (A) and inserting ``27''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply to taxable years beginning after December 31, 1993.
    (d) Increase in Tax on Cigarettes.--
            (1) Rate of tax.--Subsection (b) of section 5701 of the 
        Internal Revenue Code of 1986 (relating to rate of tax on 
        cigarettes) is amended--
                    (A) by striking ``$12 per thousand ($10 per 
                thousand on cigarettes removed during 1991 or 1992)'' 
                in paragraph (1) and inserting ``$20 per thousand''; 
                and
                    (B) by striking ``$25.20 per thousand ($21 per 
                thousand on cigarettes removed during 1991 or 1992)'' 
                in paragraph (2) and inserting ``$42 per thousand''.
            (2) Effective date.--The amendments made by this subsection 
        shall apply with respect to articles removed after December 31, 
        1993.
            (3) Floor stocks.--
                    (A) Imposition of tax.--On cigarettes manufactured 
                in or imported into the United States which are removed 
                before January 1, 1994, and held on such date for sale 
                by any person, there shall be imposed the following 
                taxes:
                            (i) Small cigarettes.--On cigarettes, 
                        weighing not more than 3 pounds per thousand, 
                        $10 per thousand;
                            (ii) Large cigarettes.--On cigarettes, 
                        weighing more than 3 pounds per thousand, $21 
                        per thousand; except that, if more than 6\1/2\ 
                        inches in length, they shall be taxable at the 
                        rate prescribed for cigarettes weighing not 
                        more than 3 pounds per thousand, counting each 
                        2\3/4\ inches, or fraction thereof, of the 
                        length of each as one cigarette.
                    (B) Liability for tax and method of payment.--
                            (i) Liability for tax.--A person holding 
                        cigarettes on January 1, 1994, to which any tax 
                        imposed by subparagraph (A) applies shall be 
                        liable for such tax.
                            (ii) Method of payment.--The tax imposed by 
                        subparagraph (A) shall be treated as a tax 
                        imposed under section 5701 of the Internal 
                        Revenue Code of 1986 and shall be due and 
                        payable on February 15, 1994, in the same 
                        manner as the tax imposed under such section is 
                        payable with respect to cigarettes removed on 
                        January 1, 1994.
                    (C) Cigarette.--For purposes of this paragraph, the 
                term ``cigarette'' shall have the meaning given to such 
                term by subsection (b) of section 5702 of the Internal 
                Revenue Code of 1986.
                    (D) Exception for retail stocks.--The taxes imposed 
                by subparagraph (A) shall not apply to cigarettes in 
                retail stocks held on January 1, 1994, at the place 
                where intended to be sold at retail.
                    (E) Foreign trade zones.--Notwithstanding the Act 
                of June 18, 1934 (19 U.S.C. 81a et seq.) or any other 
                provision of law--
                            (i) cigarettes--
                                    (I) on which taxes imposed by 
                                Federal law are determined, or customs 
                                duties are liquidated, by a customs 
                                officer pursuant to a request made 
                                under the first proviso of section 3(a) 
                                of the Act of June 18, 1934 (19 U.S.C. 
                                81c(a)) before January 1, 1994, and
                                    (II) which are entered into the 
                                customs territory of the United States 
                                on or after January 1, 1994, from a 
                                foreign trade zone, and
                            (ii) cigarettes which--
                                    (I) are placed under the 
                                supervision of a customs officer 
                                pursuant to the provisions of the 
                                second proviso of section 3(a) of the 
                                Act of June 18, 1934 (19 U.S.C. 81c(a)) 
                                before January 1, 1994, and
                                    (II) are entered into the customs 
                                territory of the United States on or 
                                after January 1, 1994, from a foreign 
                                trade zone,
                shall be subject to the tax imposed by subparagraph (A) 
                and such cigarettes shall, for purposes of subparagraph 
                (A), be treated as being held on January 1, 1994, for 
                sale.
    (e) Increase in Excise Taxes on Distilled Spirits, Wine, and 
Beer.--
            (1) Distilled spirits.--
                    (A) In general.--Paragraphs (1) and (3) of section 
                5001(a) of the Internal Revenue Code of 1986 (relating 
                to rate of tax on distilled spirits) are each amended 
                by striking ``$13.50'' and inserting ``$29.00''.
                    (B) Technical amendment.--Paragraphs (1) and (2) of 
                section 5010(a) of such Code (relating to credit for 
                wine content and for flavors content) are each amended 
                by striking ``$13.50'' and inserting ``$29.00''.
            (2) Wine.--
                    (A) Wines containing not more than 14 percent 
                alcohol.--Paragraph (1) of section 5041(b) of such Code 
                (relating to rates of tax on wines) is amended by 
                striking ``$1.07'' and inserting ``$6.00''.
                    (B) Wines containing more than 14 (but not more 
                than 21) percent alcohol.--Paragraph (2) of section 
                5041(b) of such Code is amended by striking ``$1.57'' 
                and inserting ``$8.50''.
                    (C) Wines containing more than 21 (but not more 
                than 24) percent alcohol.--Paragraph (3) of section 
                5041(b) of such Code is amended by striking ``$3.15'' 
                and inserting ``$11.00''.
                    (D) Artificially carbonated wines.--Paragraph (5) 
                of section 5041(b) of such Code is amended by striking 
                ``$3.30'' and inserting ``$11.00''.
            (3) Beer.--
                    (A) In general.--Paragraph (1) of section 5051(a) 
                of such Code (relating to imposition and rate of tax on 
                beer) is amended by striking ``$18'' and inserting 
                ``$81''.
                    (B) Small brewers.--Subparagraph (A) of section 
                5051(a)(2) of such Code (relating to reduced rate for 
                certain domestic production) is amended by striking 
                ``$7'' each place it appears and inserting ``$31.50''.
            (4) Effective date.--The amendments made by this subsection 
        shall take effect on January 1, 1994.
            (5) Floor stocks taxes.--
                    (A) Imposition of tax.--
                            (i) In general.--In the case of any tax-
                        increased article--
                                    (I) on which tax was determined 
                                under part I of subchapter A of chapter 
                                51 of the Internal Revenue Code of 1986 
                                or section 7652 of such Code before 
                                January 1, 1994, and
                                    (II) which is held on such date for 
                                sale by any person,
                        there shall be imposed a tax at the applicable 
                        rate on each such article.
                            (ii) Applicable rate.--For purposes of 
                        clause (i), the applicable rate is--
                                    (I) $15.50 per proof gallon in the 
                                case of distilled spirits,
                                    (II) $4.93 per wine gallon in the 
                                case of wine described in paragraph (1) 
                                of section 5041(b) of such Code, and
                                    (III) $6.93 per wine gallon in the 
                                case of wine described in paragraph (2) 
                                of section 5041(b) of such Code, and
                                    (IV) $7.85 per wine gallon in the 
                                case of wine described in paragraph (3) 
                                of section 5041(b) of such Code, and
                                    (V) $7.70 per wine gallon in the 
                                case of wine described in paragraph (5) 
                                of section 5041(b) of such Code,
                                    (VI) $63 per barrel in the case of 
                                beer described in paragraph (1) of 
                                section 5051(a) of such Code, and
                                    (VII) $13.50 per barrel in the case 
                                of beer described in subparagraph (A) 
                                of section 5051(a)(2) of such Code.
                        In the case of a fraction of a gallon or 
                        barrel, the tax imposed by clause (i) shall be 
                        the same fraction as the amount of such tax 
                        imposed on a whole gallon or barrel.
                            (iii) Tax-increased article.--For purposes 
                        of this paragraph, the term ``tax-increased 
                        article'' means distilled spirits, wine 
                        described in paragraph (1), (2), (3), or (5) of 
                        section 5041(b) of such Code, and beer.
                    (B) Exception for certain small wholesale or retail 
                dealers.--No tax shall be imposed by subparagraph (A) 
                on tax-increased articles held on January 1, 1994, by 
                any dealer if--
                            (i) the aggregate liquid volume of tax-
                        increased articles held by such dealer on such 
                        date does not exceed 500 wine gallons, and
                            (ii) such dealer submits to the Secretary 
                        (at the time and in the manner required by the 
                        Secretary) such information as the Secretary 
                        shall require for purposes of this 
                        subparagraph.
                    (C) Liability for tax and method of payment.--
                            (i) Liability for tax.--A person holding 
                        any tax-increased article on January 1, 1994, 
                        to which the tax imposed by subparagraph (A) 
                        applies shall be liable for such tax.
                            (ii) Method of payment.--The tax imposed by 
                        subparagraph (A) shall be paid in such manner 
                        as the Secretary shall prescribe by 
                        regulations.
                            (iii) Time for payment.--The tax imposed by 
                        subparagraph (A) shall be paid on or before 
                        June 30, 1994.
                    (D) Controlled groups.--
                            (i) Corporations.--In the case of a 
                        controlled group the 500 wine gallon amount 
                        specified in subparagraph (B), shall be 
                        apportioned among the dealers who are component 
                        members of such group in such manner as the 
                        Secretary shall by regulations prescribe. For 
                        purposes of the preceding sentence, the term 
                        ``controlled group'' has the meaning given to 
                        such term by subsection (a) of section 1563 of 
                        such Code; except that for such purposes the 
                        phrase ``more than 50 percent'' shall be 
                        substituted for the phrase ``at least 80 
                        percent'' each place it appears in such 
                        subsection.
                            (ii) Nonincorporated dealers under common 
                        control.--Under regulations prescribed by the 
                        Secretary, principles similar to the principles 
                        of clause (i) shall apply to a group of dealers 
                        under common control where 1 or more of such 
                        dealers is not a corporation.
                    (E) Other laws applicable.--
                            (i) In general.--All provisions of law, 
                        including penalties, applicable to the 
                        comparable excise tax with respect to any tax-
                        increased article shall, insofar as applicable 
                        and not inconsistent with the provisions of 
                        this paragraph, apply to the floor stocks taxes 
                        imposed by subparagraph (A) to the same extent 
                        as if such taxes were imposed by the comparable 
                        excise tax.
                            (ii) Comparable excise tax.--For purposes 
                        of clause (i), the term ``comparable excise 
                        tax'' means--
                                    (I) the tax imposed by section 5001 
                                of such Code in the case of distilled 
                                spirits,
                                    (II) the tax imposed by section 
                                5041 of such Code in the case of wine, 
                                and
                                    (III) the tax imposed by section 
                                5051 of such Code in the case of beer.
                    (F) Definitions.--For purposes of this paragraph--
                            (i) In general.--Terms used in this 
                        paragraph which are also used in subchapter A 
                        of chapter 51 of such Code shall have the 
                        respective meanings such terms have in such 
                        part.
                            (ii) Person.--The term ``person'' includes 
                        any State or political subdivision thereof, or 
                        any agency or instrumentality of a State or 
                        political subdivision thereof.
                            (iii) Secretary.--The term ``Secretary'' 
                        means the Secretary of the Treasury or his 
                        delegate.
                    (G) Treatment of imported perfumes containing 
                distilled spirits.--For purposes of this paragraph, any 
                article described in section 5001(a)(3) of such Code 
                shall be treated as distilled spirits; except that the 
                tax imposed by subparagraph (A) shall be imposed on a 
                wine gallon basis in lieu of a proof gallon basis. To 
                the extent provided by regulations prescribed by the 
                Secretary, the preceding sentence shall not apply to 
                any article held on January 1, 1994, on the premises of 
                a retail establishment.
    (f) Payroll Taxes.--
            (1) Tax on employees.--Section 3101 of the Internal Revenue 
        Code of 1986 (relating to rate of tax on employees) is amended 
        by redesignating subsections (c) and (d) as subsections (d) and 
        (e) and by inserting after subsection (b) the following new 
        subsection:
    ``(c) National Health Care Program.--In addition to the taxes 
imposed by the preceding subsections, there is hereby imposed on the 
income of every individual a tax equal to 1.45 percent of the wages (as 
defined in section 3121(a)) received by such individual after December 
31, 1994, with respect to employment (as defined in section 
3121(b)).''.
            (2) Tax on employers.--Section 3111 of such Code (relating 
        to rate of tax on employers) is amended by redesignating 
        subsection (c) as subsection (d) and by inserting after 
        subsection (b) the following new subsection:
    ``(c) National Health Care Program.--In addition to the taxes 
imposed by the preceding subsections, there is hereby imposed on every 
employer an excise tax, with respect to having individuals in such 
employer's employ, equal to 7.45 percent of the wages (as defined in 
section 3121(a)) paid by such employer during each calendar year 
beginning after December 31, 1994, with respect to employment (as 
defined in section 3121(b)).''.
            (3) Tax on self-employment income.--Section 1401 of such 
        Code (relating to rate of tax on self-employment income for 
        hospital insurance) is amended by redesignating subsection (c) 
        as subsection (d) and by inserting after subsection (b) the 
        following new subsection:
    ``(c) National Health Care Program.--In addition to the taxes 
imposed by the preceding subsections, there shall be imposed for each 
taxable year, on the self-employment income of every individual, a tax 
equal to the sum of--
            ``(1) 1.45 percent, plus
            ``(2) 7.45 percent
of the amount of the self-employment income for such taxable year.''.
            (4) Railroad retirement taxes.--Sections 3201(a), 3211(a), 
        and 3221(a) of such Code (relating to tier 1 taxes) are each 
        amended by striking ``subsections (a) and (b)'' each place it 
        appears and inserting ``subsections (a), (b), and (c)''.
            (5) Elimination of limit on employer-portion of wages or 
        self-employment income subject to national health care program 
        tax.--
                    (A) Wages.--Subsection (x) of section 3121 of the 
                Internal Revenue Code of 1986 (relating to applicable 
                contribution base) is amended by adding at the end 
                thereof the following new paragraph:
            ``(3) National health care program.--For purposes of the 
        taxes imposed by section 3111(c), the applicable contribution 
        base for any calendar year is equal to the remuneration for 
        employment paid to an individual for such calendar year.''.
                    (B) Self-employment income.--Subsection (k) of 
                section 1402 of such Code (relating to applicable 
                contribution base) is amended by adding at the end 
                thereof the following new paragraph:
            ``(3) National health care program.--For purposes of the 
        tax imposed by section 1401(c)(2), the applicable contribution 
        base for any calendar year is equal to the individual's net 
        earnings from self-employment for such calendar year.''.
                    (C) Conforming amendments.--
                            (i) Paragraph (2) of section 3121(x) of 
                        such Code is amended--
                                    (I) by striking ``section 3101(b) 
                                and 3111(b)'' and inserting ``sections 
                                3101(b), 3111(b), and 3101(c)'', and
                                    (II) by striking ``Hospital 
                                insurance'' in the heading and 
                                inserting ``Health care''.
                            (ii) Paragraph (2) of section 1402(k) of 
                        such Code is amended--
                                    (I) by striking ``section 1401(b)'' 
                                and inserting ``sections 1401(b) and 
                                1401(c)(1)'', and
                                    (II) by striking ``Hospital 
                                insurance'' in the heading and 
                                inserting ``Health care''.
                            (iii) Clause (i) of section 3231(e)(2)(B) 
                        of such Code is amended--
                                    (I) by striking ``subclause (II)'' 
                                in subclause (I) and inserting 
                                ``subclauses (II) and (III)'', and
                                    (II) by adding at the end thereof 
                                the following new subclauses:
                                    ``(III) Employer-portion of 
                                national health care program.--For 
                                purposes of applying so much of the 
                                rate applicable under section 3221(a) 
                                as does not exceed the rate of tax in 
                                effect under section 3111(c), and for 
                                purposes of applying so much of the 
                                rate of tax applicable under section 
                                3211(a)(1) as does not exceed the rate 
                                of tax in effect under section 
                                1401(c)(2), the term `applicable base' 
                                means for any calendar year the 
                                applicable contribution base determined 
                                under section 3121(x)(3) or 1401(k)(3) 
                                (as the case may be) for such calendar 
                                year.
                                    ``(IV) Employee-portion of national 
                                health care program.--For purposes of 
                                applying so much of the rate applicable 
                                under section 3201(a) as does not 
                                exceed the rate of tax in effect under 
                                section 3101(c), and for purposes of 
                                applying so much of the rate of tax 
                                applicable under section 3211(a)(1) as 
                                does not exceed the rate of tax in 
                                effect under section 1401(c)(1), the 
                                term `applicable base' means for any 
                                calendar year the applicable 
                                contribution base determined under 
                                section 3121(x)(2) or 1401(k)(2) (as 
                                the case may be) for such calendar 
                                year.''.
                            (iv) Subsection (c) of section 6413 of such 
                        Code is amended by adding at the end thereof 
                        the following new paragraph:
            ``(4) Separate application for national health care program 
        taxes.--In applying this subsection with respect to--
                    ``(A) the tax imposed by section 3101(c) (or any 
                amount equivalent to such tax), and
                    ``(B) so much of the tax imposed by section 3201 as 
                is determined at a rate not greater than the rate in 
                effect under section 3101(c),
        the applicable contribution base determined under section 
        3121(x)(3) for any calendar year shall be substituted for 
        `contribution and benefit base (as determined under section 230 
        of the Social Security Act)' each place it appears.''.
            (6) Additional state and local employees subject to 
        national health care program taxes.--Paragraph (2) of section 
        3121(u) of such Code is amended by striking subparagraphs (C) 
        and (D).
            (7) Effective date.--The amendments made by this subsection 
        shall apply with respect to remuneration paid after December 
        31, 1994, and with respect to earnings from self-employment 
        attributable to taxable years beginning after such date.
    (g) Termination of Hospital Insurance Payroll Taxes.--
            (1) Tax on employees.--Section 3101(b) of the Internal 
        Revenue Code of 1986 (relating to rate of tax on employees for 
        hospital insurance) is amended--
                    (A) by striking ``and'' at the end of paragraph 
                (5), and
                    (B) by striking paragraph (6) and inserting the 
                following new paragraphs:
            ``(6) with respect to wages received during the calendar 
        years 1986 through 1994, the rate shall be 1.45 percent; and
            ``(7) with respect to wages received after December 31, 
        1994, the rate shall be 0 percent.''.
            (2) Tax on employers.--Section 3111(b) of such Code 
        (relating to rate of tax on employers for hospital insurance) 
        is amended--
                    (A) by striking ``and'' at the end of paragraph 
                (5), and
                    (B) by striking paragraph (6) and inserting the 
                following new paragraphs:
            ``(6) with respect to wages received during the calendar 
        years 1986 through 1994, the rate shall be 1.45 percent;
            ``(7) with respect to wages received after December 31, 
        1994, the rate shall be 0 percent.''.
            (3) Tax on self-employment income.--Section 1401(b) of such 
        Code (relating to rate of tax on self-employment income for 
        hospital insurance) is amended by striking the table and 
        inserting the following new table:

``In the case of a taxable year

             Beginning after:        And before:                Percent:
             December 31, 1985.....  January 1, 1995.......      2.90   
             December 31, 1994.....  ......................     0.''.   
                                                                        

            (4) Effective date.--The amendments made by this subsection 
        shall apply with respect to remuneration paid after December 
        31, 1994, and with respect to earnings from self-employment 
        attributable to taxable years beginning after such date.
    (i) Employers' Maintenance of Effort for Retirees.--
            (1) In general.--Subchapter A of chapter 1 of the Internal 
        Revenue Code of 1986 (relating to normal taxes and surtaxes) is 
        amended by adding at the end thereof the following new part:

                     ``PART VIII--HEALTH CARE TAXES

                              ``Sec. 59B. Employers health care tax.

``SEC. 59B. EMPLOYERS HEALTH CARE TAX.

    ``(a) In General.--In the case of an employer, there is imposed (in 
addition to any other tax imposed by this subtitle) a tax equal to the 
actuarially equivalent aggregate amount which would have been paid or 
incurred by the employer (or predecessor employer) during the taxable 
year for individual or family coverage of retired employees with 
respect to whom such employer had a contractual obligation on December 
31, 1993, under group health plans (as defined in section 5000(b)(1)) 
in existence on such date.
    ``(b) Termination.--This section shall not apply in any taxable 
year beginning after December 31, 2012.''.
            (2) Conforming amendment.--The table of parts of subchapter 
        A of chapter 1 of such Code is amended by adding at the end 
        thereof the following new item:

                              ``Part VIII. Health care taxes.''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply to taxable years beginning after December 31, 1993.
    (j) Treatment of Health Care Deductions, Exclusions, and Credits.--
            (1) Limitation on exclusion of compensation for injuries or 
        sickness.--Subsection (a) of section 104 of the Internal 
        Revenue Code of 1986 (relating to compensation for injuries or 
        sickness) is amended--
                    (A) by striking paragraph (3) and inserting the 
                following new paragraph:
            ``(3) amounts received through the national health care 
        program for personal injuries or sickness;'', and
                    (B) by striking the second sentence thereof.
            (2) Termination of exclusion for amounts received under 
        accident and health plans.--
                    (A) In general.--Section 105 of such Code (relating 
                to amounts received under accident and health plans) is 
                amended--
                            (i) by striking ``income'' and all that 
                        follows in subsection (a) and inserting 
                        ``income.'',
                            (ii) by striking subsections (b), (e), (f), 
                        (g), and (h), and
                            (iii) by redesignating subsections (c) and 
                        (i) as subsections (b) and (c), respectively.
                    (B) Conforming amendment.--Paragraph (6) of section 
                7871(a)(6) of such Code is amended by striking 
                subparagraph (A) and by redesignating subparagraphs 
                (B), (C), and (D) as subparagraphs (A), (B), and (C), 
                respectively.
            (3) Termination of exclusion for contributions by employer 
        to accident and health plans.--
                    (A) In general.--Section 106 of such Code (relating 
                to contributions by employer to accident and health 
                plans) is repealed.
                    (B) Conforming amendments.--
                            (i) Subsection (c) of section 104 of such 
                        Code is amended to read as follows:
    ``(c) Cross Reference.--

                                ``For exclusion of part of disability 
retirement pay from the application of subsection (a)(4) of this 
section, see section 1403 of title 10, United States Code (relating to 
career compensation laws).''.
                            (ii) Sections 414(n)(3)(C), 414(t)(2), and 
                        6039D(d)(1) of such Code are each amended by 
                        striking ``106,''.
            (4) Limitation on cafeteria plans.--Subsection (g) of 
        section 125 of such Code (relating to cafeteria plans) is 
        amended by striking paragraph (2) and by redesignating 
        paragraphs (3) and (4) as paragraphs (2) and (3), respectively.
            (5) Business expense deduction for employer-provided first 
        aid assistance.--Subsection (l) of section 162 of such Code 
        (relating to trade or business expenses) is amended to read as 
        follows:
    ``(l) First Aid Assistance.--The expenses paid or incurred by an 
employer for on-site first aid assistance provided to the employees of 
such employer shall be allowed as a deduction under this section.''.
            (6) Termination of deduction for medical expenses.--
                    (A) In general.--Section 213 of such Code (relating 
                to medical, dental, etc., expenses) is repealed.
                    (B) Conforming amendments.--
                            (i) Paragraph (1) of section 56 of such 
                        Code is amended by striking subparagraph (B) 
                        and by redesignating subparagraphs (C), (D), 
                        (E), and (F) as subparagraphs (B), (C), (D), 
                        and (E), respectively.
                            (ii) Subsection (b) of section 67 of such 
                        Code is amended by striking paragraph (5) and 
                        by redesignating paragraphs (6) through (13) as 
                        paragraphs (5) through (12), respectively.
                            (iii) Subsection (t) of section 72 of such 
                        Code is amended--
                                    (I) in paragraph (2), by striking 
                                subparagraph (B) and by redesignating 
                                subparagraph (C) as subparagraph (B), 
                                and
                                    (II) by striking ``(B), and (C)'' 
                                in paragraph (3)(A) and inserting ``and 
                                (B)''.
                            (iv) Subsection (e) of section 152 of such 
                        Code is amended by striking paragraph (6).
            (7) Termination of pension payment of medical benefits.--
        Subsection (h) of section 401 of such Code (relating to 
        qualified pension, profit-sharing, and stock bonus plans) is 
        repealed.
            (8) Termination of child health insurance credit.--Clause 
        (i) of section 32(b)(2)(A) of such Code (relating to health 
        insurance credit) is amended by inserting ``(0 percent for 
        taxable years beginning after December 31, 1993)'' after ``6 
        percent''.
            (9) Effective date.--The amendments made by this subsection 
        shall apply with respect to taxable years beginning after 
        December 31, 1993.
    (k) Increase in Income Taxes on Social Security Benefits.--
            (1) Increase in amount of benefits taken into account.--
        Subsections (a) and (b) of section 86 of such Code (relating to 
        social security and tier 1 railroad retirement benefits) are 
        each amended by striking ``one-half'' each place it appears and 
        inserting ``85 percent''.
            (2) Income thresholds reduced.--Subsection (c) of section 
        86 of such Code (defining base amount) is amended--
                    (A) by striking ``$25,000'' in paragraph (1) and 
                inserting ``$8,000'', and
                    (B) by striking ``$32,000'' in paragraph (2) and 
                inserting ``$16,000''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply to taxable years beginning after December 31, 1993.
    (l) Section 15 Not To Apply.--No amendment made by this section 
shall be treated as a change in a rate of tax for purposes of section 
15 of the Internal Revenue Code of 1986.
    (m) National Health Care Program Premium for the Elderly.--
            (1) In general.--Except as provided in paragraph (2), each 
        individual who at any time in a month beginning after December 
        31, 1994, is 65 years of age or older and is eligible for 
        benefits under this Act in the month shall pay a national 
        health care program premium equal to the sum of:
                    (A) the amount of the premium for such month 
                determined under section 1839 of the Social Security 
                Act, determined as if such section had not been 
                repealed under this Act, plus
                    (B) $25.
            (2) Reduction for low-income elderly.--Individuals with an 
        adjusted gross income (as defined in section 62 of the Internal 
        Revenue Code of 1986) which does not exceed 120 percent of the 
        income official poverty line (as defined by the Office of 
        Management and Budget, and revised annually in accordance with 
        section 673(2) of the Omnibus Budget Reconciliation Act of 
        1981) are not liable for the premium imposed under paragraph 
        (1)(B).
            (3) Collection of premium.--The premium imposed under this 
        subsection shall be collected in the same manner (including 
        deduction from Social Security checks) as the premium imposed 
        under part B of title XVIII of the Social Security Act was 
        collected under section 1840 of such Act as of the date of the 
        enactment of this Act.

SEC. 322. STATE SOURCES OF REVENUE.

    (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 State funding from general 
revenues, earmarked taxes, sales taxes, and such other measures 
consistent with this Act, including regulations prescribed under 
section 401(e)(1)(D), as the State may provide.
    (b) Maintenance of Effort.--
            (1) Condition of coverage.--Notwithstanding any other 
        provision of this Act, no individual who is a resident of a 
        State is eligible for covered services under this Act for a 
        month in a calendar year, unless the State makes available 
        under the financing program (in a manner and at a time 
        specified by the Administrator), in addition to funds made 
        available under subsection (c), in the month of the sum of--
                    (A) the product of $7.083 and the number of 
                residents who are residents of the State and otherwise 
                eligible for covered services under this Act in the 
                month; and
                    (B) 85 percent of \1/12\ of the amount specified in 
                paragraph (2) for the year;
        or, if less, \1/12\ of the limiting amount specified in 
        paragraph (3).
            (2) Maintenance of effort amount.--The amount of payment 
        specified in this paragraph for a State for a year is equal to 
        the amount of payment (net of Federal payments) made by a State 
        under its State plan under title XIX of the Social Security Act 
        for the year preceding the effective date of this Act, 
        increased for the year involved by the compounded sum of the 
        percentage increase in the gross national product of the State 
        for each year after that year and up to the year before the 
        year involved.
            (3) Limiting amount.--For purposes of paragraph (1), the 
        limiting amount specified in this paragraph--
                    (A) for 1995, is the total amount of payment made 
                by a State (net of any Federal payments made to the 
                State) for health care services in 1994; or
                    (B) for any subsequent year, is the amount 
                specified in this paragraph for the State for the 
                previous year increased for the year involved by the 
                compounded sum of the percentage increase in the gross 
                national product of the State for each year after 1992 
                and up to the year before the year involved.

SEC. 323. COST-SHARING.

    (a) Minimum Cost-Sharing Requirements.--Except as provided in 
subsection (b), each State program shall impose cost-sharing for 
payment to a health care facility of a portion (not to exceed 25 
percent) of the cost of room and board for consumers receiving--
            (1) the long-term care services described in section 
        201(b)(6)(C);
            (2) the mental health services described in section 
        201(b)(7)(E);
            (3) the rehabilitation services described in subparagraphs 
        (D) and (E) of section 201(b)(13); and
            (4) the substance abuse treatment and rehabilitation 
        services described in section 201(b)(14)(F).
    (b) Waiver.--Each State agency shall waive the cost-sharing 
requirements described in subsection (a) for consumers below the income 
official poverty line, as defined by the Office of Management and 
Budget, and revised annually in accordance with section 673(2) of the 
Omnibus Budget Reconciliation Act of 1981 (42 U.S.C. 9902(2)).

SEC. 324. NATIONAL HEALTH CARE TRUST FUND.

    (a) Trust Fund Established.--
            (1) In general.--There is hereby created on the books of 
        the Treasury of the United States a trust fund to be known as 
        the ``National 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.
            (2) Transfer of amounts equivalent to certain taxes and 
        premiums.--
                    (A) Tax and premium revenues.--There are hereby 
                appropriated to the Trust Fund amounts equivalent to 
                the additional revenues received in the Treasury as the 
                result of the provisions of, and amendments made by, 
                section 321.
                    (B) Transfers based on estimates.--The amounts 
                appropriated by subparagraph (A) 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 subparagraph, 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 
                subparagraph.
            (3) 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 January 1, 1995 shall be transferred to the Trust Fund.
            (4) Incorporation of trust fund provisions.--The provisions 
        of subsections (b) through (i) 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 Administration.
            (5) Appropriation of additional sums.--There are hereby 
        authorized to be appropriated to the Trust Fund such additional 
        sums as may be required to make expenditures referred to in 
        subsection (b).
    (b) Expenditures.--
            (1) To states.--Payments in each calendar year to each 
        State from the Trust Fund under section 302 are hereby 
        authorized and appropriated.
            (2) Other grant programs.--Amounts in the Trust Fund shall 
        be available, as provided by appropriation Acts, for grant 
        programs relating to health care services.
            (3) Administrative expenses.--There are hereby authorized 
        and appropriated such sums as are necessary for the 
        administrative expenses of the Administration for each fiscal 
        year, not to exceed 3 percent of the total payments made to the 
        States for such fiscal year under section 302.
    (c) Trust Fund Off-Budget.--The receipts and disbursements of the 
Trust Fund and the taxes described in subsection (a)(2) 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.

                        TITLE IV--ADMINISTRATION

                   Subtitle A--Federal Administration

SEC. 401. NATIONAL HEALTH CARE ADMINISTRATION.

    (a) Establishment.--There is established a National Health Care 
Administration that shall administer the programs established under 
this Act. The Administration shall be an independent establishment, as 
defined in section 104 of title 5, United States Code.
    (b) Administrator of Health Care.--
            (1) Appointment.--There shall be in the Administration an 
        Administrator of Health Care who shall be appointed by the 
        President, with the advice and consent of the Senate.
            (2) Compensation.--The Administrator shall be compensated 
        at the rate provided for level I of the Executive Schedule.
            (3) Term.--The Administrator shall be appointed for a term 
        of 4 years coincident with the term of the President, or until 
        the appointment of a qualified successor.
            (4) Qualifications.--The Administrator shall be selected on 
        the basis of proven competence as a manager.
            (5) Powers.--The Administrator shall be responsible for the 
        exercise of all powers and the discharge of all duties of the 
        Administration, and shall have authority and control over all 
        personnel and activities of the Administration.
            (6) Delegation.--The Administrator may, with respect to the 
        administration of the national health care program, assign 
        duties, and delegate, or authorize successive redelegations of, 
        authority to act and to render decisions, to such officers and 
        employees as the Administrator may find necessary. Within the 
        limitations of such delegations, redelegations, or assignments, 
        all official acts and decisions of such officers and employees 
        shall have the same force and effect as though performed or 
        rendered by the Administrator.
            (7) Coordination.--The Administrator and the Secretary of 
        Health and Human Services shall consult, on an ongoing basis, 
        to ensure the coordination of the programs administered by the 
        Administrator under this Act with the programs administered by 
        the Secretary under the Social Security Act (42 U.S.C. 301 et 
        seq.) and the Public Health Service Act (42 U.S.C. 201 et 
        seq.).
    (c) Personnel.--The Administrator shall appoint such additional 
officers and employees as the Administrator considers necessary to 
carry out the functions of the Administration under this Act. Except as 
otherwise provided in any other provision of law, such officers and 
employees shall be appointed, and their compensation shall be fixed, in 
accordance with title 5, United States Code.
    (d) Experts and Consultants.--The Administrator may procure the 
services of experts and consultants in accordance with the provisions 
of section 3109 of title 5, United States Code.
    (e) Regulations.--
            (1) In general.--The Administrator may prescribe such 
        policies and regulations regarding the national health care 
        program as the Administrator determines to be necessary or 
        appropriate, including policies and regulations relating to--
                    (A) eligibility;
                    (B) enrollment;
                    (C) covered services;
                    (D) State funding levels;
                    (E) payment of health care providers, including fee 
                schedules for health care providers;
                    (F)(i) standards for dispensing fees for 
                prescription drugs and biologicals (as defined in 
                section 315); and
                    (ii) prices for such prescription drugs and 
                biologicals, for durable medical equipment (as defined 
                in section 316), and for therapeutic devices and 
                equipment (including eyeglasses, hearing aids, and 
                prosthetic appliances);
                    (G) quality assurance standards for health care 
                facilities, other health care providers, and covered 
                services;
                    (H) certification and licensing of health care 
                providers;
                    (I) consumer protection standards;
                    (J) cost-sharing, as described in section 323;
                    (K) health care goals and priorities in 
                consultation with the Public Health Service; and
                    (L) education and training programs for health care 
                providers.
            (2) Quality assurance, certification, and licensing.--
                    (A) Basis.--
                            (i) Information.--In developing regulations 
                        under paragraph (1)(G), the Administrator shall 
                        take into consideration information from the 
                        national health care data base.
                            (ii) Professional opinions.--In developing 
                        regulations under subparagraphs (G) and (H) of 
                        paragraph (1), the Administrator shall consider 
                        the opinions of all appropriate professional 
                        organizations.
                            (iii) Peer review organizations.--In 
                        developing regulations under paragraph (1)(G), 
                        the Administrator shall consider the 
                        recommendations of utilization and quality 
                        control peer review organizations established 
                        under section 1152 of the Social Security Act 
                        (42 U.S.C. 1320c-1).
                            (iv) Council.--In developing regulations 
                        under subparagraphs (G) and (I) of paragraph 
                        (1), the Administrator shall consider the 
                        recommendations of the National Council on 
                        Quality Assurance and Consumer Protection.
                    (B) Facilities and services.--The Administrator 
                shall prescribe regulations under paragraph (1)(G) 
                covering all covered services and all health care 
                facilities and other health care providers 
                participating in the national health care program, 
                including individual and group practitioners, 
                hospitals, other inpatient and outpatient facilities, 
                ambulatory facilities and services, home health 
                agencies, care coordination services, and hospital 
                discharge planning services.
    (f) Planning Functions.--The Administration shall--
            (1) ensure that State health budgets under section 301 
        reflect the goals and priorities recommended by State and local 
        planning boards; and
            (2) meet at least biannually with representatives of State 
        and local planning boards to--
                    (A) assess implementation;
                    (B) assist the boards in determining the goals and 
                priorities for meeting health care needs; and
                    (C) assist the boards in planning, on the basis of 
                cost and utilization data available through the 
                national health care data base, for the efficient and 
                effective use of existing health resources,
        within each State and local planning area.
    (g) Programs.--The Administration shall establish and carry out, 
directly or through grants or contracts, Federal--
            (1) ombudsman programs;
            (2) hotlines for complaints; and
            (3) consumer and health care provider information and 
        education programs designed to increase public understanding of 
        the national health care program, including programs to 
        distribute information from the national health care data base.
    (h) National Health Care Data Base.--The Administration shall 
establish and maintain a national health care data base, which shall 
include information regarding the quality, effectiveness, utilization, 
and cost of all covered services.

SEC. 402. NATIONAL HEALTH BOARD.

    (a) Establishment of Board.--There shall be established in the 
Administration a National Health Board.
    (b) Functions of the Board.--
            (1) In general.--The Board shall advise the Administrator 
        on policies related to the national health care program 
        established under this Act.
            (2) Specific functions.--Specific functions of the Board 
        shall include--
                    (A) studying and making recommendations regarding 
                implementation of this Act and the most effective 
                methods of providing covered services under this Act;
                    (B) studying and making recommendations relating to 
                the coordination of other programs that provide health 
                care services;
                    (C) reviewing and assessing the quality of service 
                that the Administration provides to the public;
                    (D) reviewing and assessing the progress of the 
                Administration in developing needed improvements in the 
                management of programs;
                    (E) in consultation with the Administrator, 
                reviewing the development and implementation of a long-
                range research and program evaluation plan for the 
                Administration;
                    (F) reviewing and assessing any major studies of 
                health care services as may come to the attention of 
                the Board;
                    (G) assessing, for each region of the country, the 
                information described in section 412(b)(1); and
                    (H) conducting such other reviews and assessments 
                as the Board determines to be appropriate.
    (c) Structure and Membership of the Board.--The Board shall be 
composed of 25 members who shall be appointed by the President, with 
the advice and consent of the Senate, including--
            (1) 4 members representing consumers;
            (2) 4 members representing health care providers, each of 
        whom shall represent a different provider group;
            (3) 4 representatives of Federal departments and agencies, 
        including at least one individual representing a public health 
        agency;
            (4) 4 representatives of State and local governments, 
        including at least one individual representing a public health 
        agency;
            (5) 1 member of the National Council on Quality Assurance 
        and Consumer Protection;
            (6) 1 member representing the business community; and
            (7) 1 member representing organized labor.
    (d) Terms of Appointment.--Each member of the Board shall serve for 
a term of 5 years, except that--
            (1) a member appointed to fill a vacancy occurring prior to 
        the expiration of the term for which a predecessor was 
        appointed, shall be appointed for the remainder of such term; 
        and
            (2) the terms of service of the members 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.
    (e) Vacancies.--Any vacancy occurring in the membership of the 
Board shall be filled 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.
    (f) Chairperson.--The Board shall select a Chairperson from among 
its members.
    (g) Compensation and Expenses.--
            (1) Compensation.--Each member of the Board who is not an 
        employee of the Federal Government shall receive compensation 
        at the daily equivalent of 120 percent of the rate specified 
        for GS-15 of the General Schedule under section 5332 of title 
        5, United States Code, for each day the member is engaged in 
        the performance of duties for the Board, including attendance 
        at meetings and conferences of the Board, and travel to conduct 
        the duties of the Board.
            (2) Travel expenses.--Each member of the Board shall 
        receive travel expenses, including per diem in lieu of 
        subsistence, at rates authorized for employees of agencies 
        under subchapter I of chapter 57 of title 5, United States 
        Code, for each day the member is engaged in the performance of 
        duties away from the home or regular place of business of the 
        member.
    (h) Personnel.--
            (1) Staff director.--The Chairperson of the Board shall, 
        without regard to title 5, United States Code, appoint a staff 
        director who shall be paid at a rate equivalent to the rate for 
        the Senior Executive Service.
            (2) Additional staff.--The Chairperson of the Board is 
        authorized, without regard to title 5, United States Code, to 
        appoint and fix the compensation of such staff as the Board 
        determines to be necessary to carry out the functions of the 
        Board.
            (3) Limitations.--The rate of compensation for each staff 
        member appointed under paragraph (2) shall not exceed the daily 
        equivalent of 120 percent of the rate specified for GS-15 of 
        the General Schedule under section 5332 of title 5, United 
        States Code, for each day the staff member is engaged in the 
        performance of duties for the Board. The Board may otherwise 
        appoint and determine the compensation of staff without regard 
        to the provisions of title 5, United States Code, that govern 
        appointments in the competitive service, and the provisions of 
        chapter 51 and subchapter III of chapter 53 of title 5, United 
        States Code, that relate to classification and General Schedule 
        pay rates.
    (i) Termination.--Section 14 of the Federal Advisory Committee Act 
(5 U.S.C. App.) shall not apply with respect to the Commission.

SEC. 403. NATIONAL COUNCIL ON QUALITY ASSURANCE AND CONSUMER 
              PROTECTION.

    (a) In General.--The Administrator shall establish a National 
Council on Quality Assurance and Consumer Protection (referred to in 
this section as the ``Council''), to conduct studies and oversight, and 
prepare recommendations concerning quality assurance and consumer 
protection procedures.
    (b) Duties.--
            (1) Study and report.--The Council shall conduct a study of 
        quality assurance and consumer protection procedures. The 
        Council shall submit a report to the Administrator containing 
        the results of the study, including recommendations for 
        regulations prescribed under subparagraphs (G) and (I) of 
        section 401(e)(1).
            (2) Oversight.--The Council shall collect information 
        regarding the implementation of the regulations on a regular 
        basis. The Council shall submit a report to the Administrator 
        containing the information and recommendations for reform.
    (c) Membership.--The Council shall be composed of 18 members 
appointed by the Administrator, including--
            (1) 6 individuals with expertise regarding quality 
        assurance in medical and mental health fields;
            (2) 6 individuals representing consumers; and
            (3) 4 individuals representing health care providers.
    (d) Term of Office.--Each member of the Council shall serve for a 
term of 5 years, except that--
            (1) a member appointed to fill a vacancy occurring prior to 
        the expiration of the term for which a predecessor was 
        appointed, shall be appointed for the remainder of such term; 
        and
            (2) the term of service of the members initially appointed 
        shall be (as specified by the Administrator) for such fewer 
        number of years as will provide for the expiration of terms on 
        a staggered basis.
    (e) Vacancies.--Any vacancy occurring in the membership of the 
Council shall be filled in the same manner as the original appointment 
for the position being vacated. The vacancy shall not affect the power 
of the remaining members to execute the duties of the Council.
    (f) Chairperson.--The Council shall select a Chairperson from among 
its members.
    (g) Compensation and Expenses.--
            (1) Compensation.--Each member of the Council who is not an 
        employee of the Federal Government shall receive compensation 
        at the daily equivalent of 120 percent of the rate specified 
        for GS-15 of the General Schedule under section 5332 of title 
        5, United States Code, for each day the member is engaged in 
        the performance of duties for the Council, including attendance 
        at meetings and conferences of the Council, and travel to 
        conduct the duties of the Council.
            (2) Travel expenses.--Each member of the Council shall 
        receive travel expenses, including per diem in lieu of 
        subsistence, at rates authorized for employees of agencies 
        under subchapter I of chapter 57 of title 5, United States 
        Code, for each day the member is engaged in the performance of 
        duties away from the home or regular place of business of the 
        member.
    (h) Powers.--The Council is authorized to--
            (1) hold such hearings and sit and act at such times;
            (2) take such testimony;
            (3) have such printing and binding done;
            (4) enter into such contracts and other arrangements;
            (5) make such expenditures; and
            (6) take such other actions,
as the Council may determine to be necessary to carry out the duties of 
the Council.
    (i) Oaths.--Any member of the Council may administer oaths or 
affirmations to witnesses appearing before the Council.
    (j) Obtaining Information From Federal Agencies.--The Chairperson 
of the Council may secure directly from any Federal agency, information 
necessary to enable the Council to carry out the duties of the Council, 
if the information may be disclosed under section 552 of title 5, 
United States Code. Subject to the previous sentence, on the request of 
the Chairperson, the head of the agency shall furnish the information 
to the Council.
    (k) Voluntary Service.--Notwithstanding section 1342 of title 31, 
United States Code, the Chairperson of the Council may accept for the 
Council voluntary services provided by a member of the Council.
    (l) Gifts and Donations.--The Council may accept, use, and dispose 
of gifts or donations of property in order to carry out the duties of 
the Council.
    (m) Use of Mail.--The Council may use the United States mails in 
the same manner and under the same conditions as Federal agencies.
    (n) Staff.--
            (1) Appointment and compensation.--The Council may appoint 
        and determine the compensation of such staff as the Council 
        determines to be necessary to carry out the duties of the 
        Council.
            (2) Limitations.--The rate of compensation for each staff 
        member shall not exceed the daily equivalent of 120 percent of 
        the rate specified for GS-15 of the General Schedule under 
        section 5332 of title 5, United States Code, for each day the 
        staff member is engaged in the performance of duties for the 
        Council. The Council may otherwise appoint and determine the 
        compensation of staff without regard to the provisions of title 
        5, United States Code, that govern appointments in the 
        competitive service, and the provisions of chapter 51 and 
        subchapter III of chapter 53 of title 5, United States Code, 
        that relate to classification and General Schedule pay rates.
    (o) Experts and Consultants.--The Chairperson of the Council may 
obtain such temporary and intermittent services of experts and 
consultants and compensate the experts and consultants in accordance 
with section 3109(b) of title 5, United States Code, as the Council 
determines to be necessary to carry out the duties of the Council.
    (p) Detail of Federal Employees.--On the request of the Chairperson 
of the Council, the head of any Federal agency shall detail, without 
reimbursement, any of the personnel of the agency to the Council to 
assist the Council in carrying out its duties. Any detail shall not 
interrupt or otherwise affect the civil service status or privileges of 
the Federal employee.
    (q) Technical Assistance.--On the request of the Chairperson of the 
Council, the head of a Federal agency shall provide such technical 
assistance to the Council as the Council determines to be necessary to 
carry out its duties.
    (r) Authorization of Appropriations.--There are authorized to be 
appropriated to the Council such sums as may be necessary to carry out 
the provisions of this subtitle. The sums shall remain available until 
expended, without fiscal year limitation.
    (s) Termination.--Section 14 of the Federal Advisory Committee Act 
(5 U.S.C. App.) shall not apply with respect to the Council.

SEC. 404. MEDICAL MALPRACTICE COMMISSION.

    (a) In General.--The Administrator shall establish a Medical 
Malpractice Commission (referred to in this section as the 
``Commission''), to conduct a study and prepare recommendations 
concerning medical malpractice.
    (b) Malpractice Study.--
            (1) Study.--The Commission shall conduct a study of medical 
        malpractice. In conducting the study, the Commission shall 
        examine methods for--
                    (A) reducing costs associated with malpractice 
                insurance;
                    (B) reducing the basis for malpractice claims;
                    (C) targeting physicians and other health care 
                providers who are incompetent; and
                    (D) developing mechanisms that will protect 
                consumers who are victims of malpractice.
            (2) Report.--Not later than 18 months after the date of the 
        enactment of this subtitle, the Commission shall prepare and 
        submit to the President and the appropriate committees of 
        Congress a written report containing--
                    (A) the findings and conclusions of the Commission 
                resulting from the study conducted under paragraph (1); 
                and
                    (B) recommendations for medical malpractice reform, 
                based on the findings and conclusions described in 
                subparagraph (A).
    (c) Membership.--The Commission shall be composed of 18 members 
appointed by the Administrator, including--
            (1) 3 individuals with expertise regarding health care 
        services;
            (2) 3 individuals representing persons receiving health 
        care services;
            (3) 3 individuals representing public payers;
            (4) 3 individuals representing private payers; and
            (5) 3 individuals representing providers of health care 
        services.
    (d) Term of Office.--Members shall be appointed for the life of the 
Commission.
    (e) Vacancies.--Any vacancy occurring in the membership of the 
Commission shall be filled in the same manner as the original 
appointment for the position being vacated. The vacancy shall not 
affect the power of the remaining members to execute the duties of the 
Commission.
    (f) Chairperson.--The Commission shall select a Chairperson from 
among its members.
    (g) Compensation and Expenses.--
            (1) Compensation.--Each member of the Commission who is not 
        an employee of the Federal Government shall receive 
        compensation at the daily equivalent of 120 percent of the rate 
        specified for GS-15 of the General Schedule under section 5332 
        of title 5, United States Code, for each day the member is 
        engaged in the performance of duties for the Commission, 
        including attendance at meetings and conferences of the 
        Commission, and travel to conduct the duties of the Commission.
            (2) Travel expenses.--Each member of the Commission shall 
        receive travel expenses, including per diem in lieu of 
        subsistence, at rates authorized for employees of agencies 
        under subchapter I of chapter 57 of title 5, United States 
        Code, for each day the member is engaged in the performance of 
        duties away from the home or regular place of business of the 
        member.
    (h) Powers.--The Commission is authorized to--
            (1) hold such hearings and sit and act at such times;
            (2) take such testimony;
            (3) have such printing and binding done;
            (4) enter into such contracts and other arrangements;
            (5) make such expenditures; and
            (6) take such other actions,
as the Commission may determine to be necessary to carry out the duties 
of the Commission.
    (i) Oaths.--Any member of the Commission may administer oaths or 
affirmations to witnesses appearing before the Commission.
    (j) Obtaining Information From Federal Agencies.--The Chairperson 
of the Commission may secure directly from any Federal agency, 
information necessary to enable the Commission to carry out the duties 
of the Commission, if the information may be disclosed under section 
552 of title 5, United States Code. Subject to the previous sentence, 
on the request of the Chairperson, the head of the agency shall furnish 
the information to the Commission.
    (k) Voluntary Service.--Notwithstanding section 1342 of title 31, 
United States Code, the Chairperson of the Commission may accept for 
the Commission voluntary services provided by a member of the 
Commission.
    (l) Gifts and Donations.--The Commission may accept, use, and 
dispose of gifts or donations of property in order to carry out the 
duties of the Commission.
    (m) Use of Mail.--The Commission may use the United States mails in 
the same manner and under the same conditions as Federal agencies.
    (n) Staff.--
            (1) Appointment and compensation.--The Commission may 
        appoint and determine the compensation of such staff as the 
        Commission determines to be necessary to carry out the duties 
        of the Commission.
            (2) Limitations.--The rate of compensation for each staff 
        member shall not exceed the daily equivalent of 120 percent of 
        the rate specified for GS-15 of the General Schedule under 
        section 5332 of title 5, United States Code for each day the 
        staff member is engaged in the performance of duties for the 
        Commission. The Commission may otherwise appoint and determine 
        the compensation of staff without regard to the provisions of 
        title 5, United States Code, that govern appointments in the 
        competitive service, and the provisions of chapter 51 and 
        subchapter III of chapter 53 of title 5, United States Code, 
        that relate to classification and General Schedule pay rates.
    (o) Experts and Consultants.--The Chairperson of the Commission may 
obtain such temporary and intermittent services of experts and 
consultants and compensate the experts and consultants in accordance 
with section 3109(b) of title 5, United States Code, as the Commission 
determines to be necessary to carry out the duties of the Commission.
    (p) Detail of Federal Employees.--On the request of the Chairperson 
of the Commission, the head of any Federal agency shall detail, without 
reimbursement, any of the personnel of the agency to the Commission to 
assist the Commission in carrying out its duties. Any detail shall not 
interrupt or otherwise affect the civil service status or privileges of 
the Federal employee.
    (q) Technical Assistance.--On the request of the Chairperson of the 
Commission, the head of a Federal agency shall provide such technical 
assistance to the Commission as the Commission determines to be 
necessary to carry out its duties.
    (r) Authorization of Appropriations.--There are authorized to be 
appropriated to the Commission such sums as may be necessary to carry 
out the provisions of this subtitle. The sums shall remain available 
until expended, without fiscal year limitation.
    (s) Termination.--Notwithstanding section 14 of the Federal 
Advisory Committee Act (5 U.S.C. App.), the Commission shall terminate 
3 years after the date of the enactment of this Act.

SEC. 405. UTILIZATION AND QUALITY CONTROL PEER REVIEW ORGANIZATIONS.

    (a) Organization.--Section 1152 of the Social Security Act (42 
U.S.C 1320c-1) is amended by striking paragraph (1) and inserting the 
following new paragraph:
            ``(1)(A) is composed of a substantial number of licensed 
        health care providers who are--
                    ``(i) engaged in the practice of providing covered 
                services under the National Health Care Act of 1993;
                    ``(ii) representative of the practicing health care 
                providers in the area, designated by the Secretary 
                under section 1153, with respect to which the entity 
                shall perform services under this part; and
                    ``(iii) representative of the groups of health care 
                providers providing services under the Act, with no 
                group providing a majority of the membership of the 
                organization; or
            ``(B) has available to it, by arrangement or otherwise, the 
        services of a sufficient number of the licensed health care 
        providers described in subparagraph (A) to ensure adequate peer 
        review of the services provided by the various medical 
        specialties and subspecialties of health care providers under 
        the Act;''.
    (b) Functions.--Section 1154(a) of the Social Security Act (42 
U.S.C. 1320c-2(a)) is amended by adding at the end the following new 
paragraphs:
            ``(17) The organization shall make recommendations to the 
        Administrator of the National Health Care Administration 
        regarding establishment and revision of regulations prescribed 
        under section 401(e)(1)(G) of the National Health Care Act of 
        1993.
            ``(18) The organization shall submit such reports to a 
        Consumer Board established under section 1165(a) as the 
        Secretary may by regulation require.''.
    (c) Consumer Boards.--Part B of title XI of the Social Security Act 
(42 U.S.C. 1301 et seq.) is amended by adding at the end the following 
new section:

``SEC. 1165. CONSUMER BOARDS.

    ``(a) Establishment.--The Administrator shall establish Peer Review 
Organization Consumer Boards (referred to individually within this 
section as a `Board') within geographic regions specified by the 
Administrator.
    ``(b) Duties.--
            ``(1) Study and report.--A Board shall conduct annual 
        evaluations of the organizations described in section 1152 
        within the geographic region served by the Board. The Board 
        shall submit a report to the Administrator of the National 
        Health Care Administration (hereafter in this section referred 
        to as the `Administrator'), the National Board on Quality 
        Assurance and Consumer Protection, and each Governor of a State 
        within the region, containing the results of the evaluation, 
        including recommendations for awards of contracts under this 
        part.
            ``(2) Education programs.--A Board shall establish and 
        carry out education programs for consumers to provide 
        information related to--
                    ``(A) implementation of the quality assurance 
                regulations prescribed under section 401(e)(1)(G) of 
                the National Health Care Act of 1993; and
                    ``(B) availability of assistance for consumers.
    ``(c) Membership.--
            ``(1) In general.--The Board shall be composed of 5 to 11 
        members, depending on the size of the region, appointed by the 
        Administrator.
            ``(2) Representation.--In appointing members to the Board, 
        the Administrator shall ensure that the members are 
        representative of the racial and ethnic composition of the 
        geographic region served by the Board.
            ``(3) Organization representatives.--The Administrator 
        shall appoint to each Board not fewer than two members who 
        shall serve on the Board of Directors of an organization 
        described in section 1152 within the region and who shall not 
        be health care providers.
    ``(d) Term of Office.--Each member of the Board shall serve for a 
term of 3 years, except that--
            ``(1) a member appointed to fill a vacancy occurring prior 
        to the expiration of the term for which a predecessor was 
        appointed, shall be appointed for the remainder of such term; 
        and
            ``(2) the terms of service of the members initially 
        appointed shall be (as specified by the Administrator) for such 
        fewer number of years as will provide for the expiration of 
        terms on a staggered basis.
    ``(e) Vacancies.--Any vacancy occurring in the membership of the 
Board shall be filled in the same manner as the original appointment 
for the position being vacated. The vacancy shall not affect the power 
of the remaining members to execute the duties of the Board.
    ``(f) Chairperson.--The Board shall select a Chairperson from among 
its members.
    ``(g) Compensation and Expenses.--
            ``(1) Compensation.--Each member of the Board who is not an 
        employee of the Federal Government shall receive compensation 
        at the daily equivalent of 120 percent of the rate specified 
        for GS-15 of the General Schedule under section 5332 of title 
        5, United States Code, for each day the member is engaged in 
        the performance of duties for the Board, including attendance 
        at meetings and conferences of the Board, and travel to conduct 
        the duties of the Board.
            ``(2) Travel expenses.--Each member of the Board shall 
        receive travel expenses, including per diem in lieu of 
        subsistence, at rates authorized for employees of agencies 
        under subchapter I of chapter 57 of title 5, United States 
        Code, for each day the member is engaged in the performance of 
        duties away from the home or regular place of business of the 
        member.
    ``(h) Powers.--The Board is authorized to--
            ``(1) hold such hearings and sit and act at such times;
            ``(2) take such testimony;
            ``(3) have such printing and binding done;
            ``(4) enter into such contracts and other arrangements;
            ``(5) make such expenditures; and
            ``(6) take such other actions,
as the Board may determine to be necessary to carry out the duties of 
the Board.
    ``(i) Oaths.--Any member of the Board may administer oaths or 
affirmations to witnesses appearing before the Board.
    ``(j) Obtaining Information From Federal Agencies.--The Chairperson 
of the Board may secure directly from any Federal agency, information 
necessary to enable the Board to carry out the duties of the Board, if 
the information may be disclosed under section 552 of title 5, United 
States Code. Subject to the previous sentence, on the request of the 
Chairperson, the head of the agency shall furnish the information to 
the Board.
    ``(k) Voluntary Service.--Notwithstanding section 1342 of title 31, 
United States Code, the Chairperson of the Board may accept for the 
Board voluntary services provided by a member of the Board.
    ``(l) Gifts and Donations.--The Board may accept, use, and dispose 
of gifts or donations of property in order to carry out the duties of 
the Board.
    ``(m) Use of Mail.--The Board may use the United States mails in 
the same manner and under the same conditions as Federal agencies.
    ``(n) Staff.--
            ``(1) Appointment and compensation.--The Board may appoint 
        and determine the compensation of such staff as the Board 
        determines to be necessary to carry out the duties of the 
        Board.
            ``(2) Limitations.--The rate of compensation for each staff 
        member shall not exceed the daily equivalent of 120 percent of 
        the rate specified for GS-15 of the General Schedule under 
        section 5332 of title 5, United States Code, for each day the 
        staff member is engaged in the performance of duties for the 
        Board. The Board may otherwise appoint and determine the 
        compensation of staff without regard to the provisions of title 
        5, United States Code, that govern appointments in the 
        competitive service, and the provisions of chapter 51 and 
        subchapter III of chapter 53 of title 5, United States Code, 
        that relate to classification and General Schedule pay rates.
    ``(o) Experts and Consultants.--The Chairperson of the Board may 
obtain such temporary and intermittent services of experts and 
consultants and compensate the experts and consultants in accordance 
with section 3109(b) of title 5, United States Code, as the Board 
determines to be necessary to carry out the duties of the Board.
    ``(p) Detail of Federal Employees.--On the request of the 
Chairperson of the Board, the head of any Federal agency shall detail, 
without reimbursement, any of the personnel of the agency to the Board 
to assist the Board in carrying out its duties. Any detail shall not 
interrupt or otherwise affect the civil service status or privileges of 
the Federal employee.
    ``(q) Technical Assistance.--On the request of the Chairperson of 
the Board, the head of a Federal agency shall provide such technical 
assistance to the Board as the Board determines to be necessary to 
carry out its duties.
    ``(r) Authorization of Appropriations.--There are authorized to be 
appropriated to the Board such sums as may be necessary to carry out 
the provisions of this subtitle. The sums shall remain available until 
expended, without fiscal year limitation.
    ``(s) Termination.--Section 14 of the Federal Advisory Committee 
Act (5 U.S.C. App.) shall not apply with respect to the Board.''.
    (d) Technical and Conforming Amendments.--
            (1) Except as otherwise specifically provided in this 
        subsection, sections 1153, 1154, 1155, 1160, and 1164 of the 
        Social Security Act (42 U.S.C. 1320c-2, 1320c-3, 1320c-4, 
        1320c-9, and 1320c-13) are amended by striking ``title XVIII'' 
        each place the term appears and inserting ``the National Health 
        Care Act of 1993''.
            (2) Section 1153(a)(2)(B) of the Social Security Act (42 
        U.S.C. 1320c-2(a)(2)(B)) is amended by striking ``title XIX'' 
        and inserting ``the National Health Care Act of 1993''.
            (3) Section 1154(a)(3)(A) of the Social Security Act (42 
        U.S.C. 1320c-3(a)(3)(A)) is amended by striking ``title XVIII 
        of this Act'' and inserting ``the National Health Care Act of 
        1993''.
            (4) Section 1154(a)(14) of the Social Security Act (42 
        U.S.C. 1320c-3(a)(14)) is amended by striking ``under such 
        title'' and inserting ``under the National Health Care Act of 
        1993''.
            (5) Section 1156 of the Social Security Act (42 U.S.C. 
        1320c-5) is amended by striking ``under this Act'' each place 
        the term appears and inserting ``under the National Health Care 
        Act of 1993''.
            (6) Section 1158(a) of the Social Security Act (42 U.S.C. 
        1320c-7(a)) is amended by striking ``title XIX of this Act'' 
        and inserting ``the National Health Care Act of 1993''.
            (7) Section 1161(5) of the Social Security Act (42 U.S.C. 
        1320c-12(5)) is amended by striking ``title XVIII and XIX of 
        this Act'' and inserting ``the National Health Care Act of 
        1993''.
            (8) Section 1164(c)(2) of the Social Security Act (42 
        U.S.C. 1320c-13(c)(2)) is amended by striking ``part A or part 
        B of title XVIII'' and inserting ``the National Health Care Act 
        of 1993''.

SEC. 406. PUBLIC HEALTH FUNCTIONS AND ACTIVITIES COMMISSION.

    (a) In General.--The Administrator shall establish a Public Health 
Functions and Activities Commission (referred to in this section as the 
``Commission'').
    (b) Duties.--
            (1) Study and recommendations.--Not later than 6 months 
        after the members of the Commission are appointed under 
        subsection (c), the Commission shall conduct studies and 
        prepare recommendations concerning--
                    (A) public health functions and activities that 
                should remain separate from the national health care 
                program;
                    (B) the integration of public health programs, 
                including any appropriate programs funded through the 
                maternal and child health block grant funds made 
                available under title V of the Social Security Act (42 
                U.S.C. 701 et seq.), into the national health care 
                program;
                    (C) increased program and funding needs for the 
                training of health and allied health professionals, 
                including professionals trained through the National 
                Health Service Corps Scholarship Program, and the 
                National Health Service Corps Loan Repayment Program, 
                authorized under subpart III of part D of title III of 
                the Public Health Service Act (42 U.S.C. 254l et seq.) 
                and the education and training programs authorized 
                under titles VII and VIII of the Public Health Service 
                Act (42 U.S.C. 292 et seq. and 296k et seq.);
                    (D) increased funding needs for--
                            (i) payments to States under the maternal 
                        and child health block grants under title V of 
                        the Social Security Act;
                            (ii) preventive health block grants under 
                        part A of title XIX of the Public Health 
                        Service Act (42 U.S.C. 300w et seq.);
                            (iii) grants to States for community mental 
                        health services under subpart I of part B of 
                        title XIX of the Public Health Service Act (42 
                        U.S.C. 300x-1 et seq.);
                            (iv) grants to States for prevention and 
                        treatment of substance abuse under subpart II 
                        of part B of title XIX of the Public Health 
                        Service Act (42 U.S.C. 300x-21 et seq.); and
                            (v) grants for HIV health care services 
                        under parts A, B, and C of title XXVI of the 
                        Public Health Service Act (42 U.S.C. 300ff-11 
                        et seq., 300ff-21 et seq., and 300ff-41 et 
                        seq.); and
                    (E) the continued need for programs and activities 
                operated by local and State public health departments.
            (2) Report.--The Commission shall prepare and submit to the 
        Administrator a report containing the recommendations described 
        in paragraph (1).
    (c) Membership.--The Commission shall be composed of 9 members 
appointed by the Administrator, including--
            (1) 4 individuals representing public health agencies at 
        the Federal, State, and local levels;
            (2) 1 health economist; and
            (3) 3 other health professionals.
    (d) Term of Office.--Each member of the Commission shall serve for 
the life of the Commission.
    (e) Vacancies.--Any vacancy occurring in the membership of the 
Commission shall be filled in the same manner as the original 
appointment for the position being vacated. The vacancy shall not 
affect the power of the remaining members to execute the duties of the 
Commission.
    (f) Chairperson.--The Commission shall select a Chairperson from 
among its members.
    (g) Compensation and Expenses.--
            (1) Compensation.--Members of the Commission shall not 
        receive compensation for service on the Commission.
            (2) Travel expenses.--Each member of the Commission shall 
        receive travel expenses, including per diem in lieu of 
        subsistence, at rates authorized for employees of agencies 
        under subchapter I of chapter 57 of title 5, United States 
        Code, for each day the member is engaged in the performance of 
        duties away from the home or regular place of business of the 
        member.
    (h) Powers.--The Commission is authorized to--
            (1) hold such hearings and sit and act at such times;
            (2) take such testimony;
            (3) have such printing and binding done;
            (4) enter into such contracts and other arrangements;
            (5) make such expenditures; and
            (6) take such other actions,
as the Commission may determine to be necessary to carry out the duties 
of the Commission.
    (i) Oaths.--Any member of the Commission may administer oaths or 
affirmations to witnesses appearing before the Commission.
    (j) Obtaining Information From Federal Agencies.--The Chairperson 
of the Commission may secure directly from any Federal agency, 
information necessary to enable the Commission to carry out the duties 
of the Commission, if the information may be disclosed under section 
552 of title 5, United States Code. Subject to the previous sentence, 
on the request of the Chairperson, the head of the agency shall furnish 
the information to the Commission.
    (k) Voluntary Service.--Notwithstanding section 1342 of title 31, 
United States Code, the Chairperson of the Commission may accept for 
the Commission voluntary services provided by a member of the 
Commission.
    (l) Gifts and Donations.--The Commission may accept, use, and 
dispose of gifts or donations of property in order to carry out the 
duties of the Commission.
    (m) Use of Mail.--The Commission may use the United States mails in 
the same manner and under the same conditions as Federal agencies.
    (n) Staff.--
            (1) Appointment and compensation.--The Commission may 
        appoint and determine the compensation of such staff as the 
        Commission determines to be necessary to carry out the duties 
        of the Commission.
            (2) Limitations.--The rate of compensation for each staff 
        member shall not exceed the daily equivalent of 120 percent of 
        the rate specified for GS-15 of the General Schedule under 
        section 5332 of title 5, United States Code for each day the 
        staff member is engaged in the performance of duties for the 
        Commission. The Commission may otherwise appoint and determine 
        the compensation of staff without regard to the provisions of 
        title 5, United States Code, that govern appointments in the 
        competitive service, and the provisions of chapter 51 and 
        subchapter III of chapter 53 of title 5, United States Code, 
        that relate to classification and General Schedule pay rates.
    (o) Experts and Consultants.--The Chairperson of the Commission may 
obtain such temporary and intermittent services of experts and 
consultants and compensate the experts and consultants in accordance 
with section 3109(b) of title 5, United States Code, as the Commission 
determines to be necessary to carry out the duties of the Commission.
    (p) Detail of Federal Employees.--On the request of the Chairperson 
of the Commission, the head of any Federal agency shall detail, without 
reimbursement, any of the personnel of the agency to the Commission to 
assist the Commission in carrying out its duties. Any detail shall not 
interrupt or otherwise affect the civil service status or privileges of 
the Federal employee.
    (q) Technical Assistance.--On the request of the Chairperson of the 
Commission, the head of a Federal agency shall provide such technical 
assistance to the Commission as the Commission determines to be 
necessary to carry out its duties.
    (r) Authorization of Appropriations.--There are authorized to be 
appropriated to the Commission such sums as may be necessary to carry 
out the provisions of this subtitle. The sums shall remain available 
until expended, without fiscal year limitation.
    (s) Termination.--The Commission shall terminate on submission of 
the report described in subsection (b)(2).

SEC. 407. TECHNICAL ASSISTANCE CENTERS.

    (a) Centers.--The Administration shall provide on a regional basis 
(either directly or through contracts with nonprofit organizations) 
technical assistance centers for States and localities in--
            (1) health program planning, development, and 
        implementation;
            (2) training;
            (3) quality assurance, monitoring, and evaluation;
            (4) budgeting;
            (5) payment procedures; and
            (6) development of integrated automated data processing 
        systems.
    (b) States With Limited Capacity.--The technical assistance centers 
shall provide resources to assist States that lack the capacity to 
implement certain aspects of the national health care program.

               Subtitle B--State and Local Administration

SEC. 411. STATE AGENCY.

    (a) In General.--In order for a State to be eligible to receive 
payments under section 302, the State shall, in accordance with 
regulations established by the Administration, designate a State agency 
to be the sole State agency to carry out a State program under this 
Act.
    (b) Planning Functions.--The State agency shall develop, on the 
basis of recommendations made by State and local planning boards under 
section 412(c)--
            (1) goals and priorities for developing health policy and 
        programs;
            (2) a plan for the equitable distribution of health 
        resources, including the development of specialty health 
        centers that--
                    (A) concentrate highly specialized medical 
                procedures, equipment, and trained specialists; and
                    (B) avoid duplication of services;
            (3) a plan for the integration of health services with 
        appropriate social and human services; and
            (4) a plan to ensure that quality discharge planning and 
        social services are available to consumers in all inpatient 
        facilities to provide for care coordination and continuity of 
        care.

SEC. 412. STATE AND LOCAL PLANNING BOARDS.

    (a) Planning Boards.--
            (1) State board.--Each State agency shall establish, in 
        accordance with regulations established by the Administration, 
        a State planning board, which shall be composed of 12 members 
        who shall be appointed by the head of the State program, 
        including--
                    (A) 4 members representing consumers, who shall be 
                representative of the population of the State;
                    (B) 3 members representing health care providers;
                    (C) 1 member representing the business community;
                    (D) 1 member representing organized labor; and
                    (E) 2 representatives of appropriate State 
                agencies, including health, public health, social 
                services, education, public welfare, and employment 
                agencies.
            (2) Local boards.--Each State shall establish, in 
        accordance with regulations established by the Administration, 
        local planning boards, which shall be composed of 7 members who 
        shall be appointed by the head of the State program, 
        including--
                    (A) 2 members representing consumers, who shall be 
                representative of the population of the local planning 
                area;
                    (B) 2 members representing health care providers; 
                and
                    (C) 2 representatives of appropriate local 
                agencies, including health, public health, social 
                services, education, public welfare, and employment 
                agencies.
            (3) Terms of appointment.--Each member of a State or local 
        planning board shall serve for a term of 3 years, except that a 
        member appointed to fill a vacancy occurring prior to the 
        expiration of the term for which a predecessor was appointed, 
        shall be appointed for the remainder of such term.
            (4) Vacancies.--Any vacancy occurring in the membership of 
        a State or local planning board shall be filled 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.
    (b) Assessment.--
            (1) Information.--The State and local planning boards shall 
        assess, for each State or local planning area, respectively--
                    (A) the demand for, and quality, supply, and 
                distribution of, health resources, including--
                            (i) acute care hospitals;
                            (ii) specialized inpatient facilities;
                            (iii) outpatient facilities;
                            (iv) health care providers;
                            (v) specialized medical equipment; and
                            (vi) home and community-based health 
                        programs; and
                    (B) the medical, mental, and psychosocial health 
                needs.
            (2) Emphasis.--In conducting the assessment described in 
        paragraph (1), the State and local planning boards shall give 
        special attention to health professional shortage areas and 
        special populations of consumers.
            (3) Data.--The Administration shall make available all 
        appropriate data from the national health care data base, and 
        each State with a State program shall make available all 
        appropriate data from any State health care data base, for use 
        by State and local planning boards in conducting the 
        assessment. In conducting the assessment, the State and local 
        planning boards shall consider such data.
    (c) Recommendations.--The State and local planning boards shall 
make recommendations to the State agency regarding the goals, 
priorities, and plans described in section 411(b), and shall make 
recommendations to the Administration regarding the State budget 
described in section 301.

         TITLE V--TRANSITION AND RELATIONSHIP TO OTHER PROGRAMS

SEC. 501. EFFECTIVE DATE.

    The national health care program shall first apply to covered 
services furnished after January 1, 1995.

SEC. 502. REPEALS AND INCORPORATIONS.

    (a) Repeal of Medicare and Medicaid.--
            (1) Repeal.--Titles XVIII and XIX of the Social Security 
        Act (42 U.S.C. 1395 et seq. and 1396 et seq.) are repealed.
    (b) Repeal of CHAMPUS Provisions.--
            (1) In general.--
                    (A) Amendments to chapter 55 of title 10.--Sections 
                1079 through 1083, 1086, and 1097 through 1100 of title 
                10, United States Code, are repealed.
                    (B) Table of sections.--The table of sections at 
                the beginning of chapter 55 of title 10, United States 
                Code, is amended by striking the items relating to the 
                sections referred to in subparagraph (A).
            (2) Conforming amendments.--Chapter 55 of title 10, United 
        States Code, is amended as follows:
                    (A) Definition.--Section 1072 is amended by 
                striking paragraph (4).
                    (B) Reimbursement of the department of veterans 
                affairs.--Section 1104(b) is amended--
                            (i) in the subsection heading, by striking 
                        ``from CHAMPUS funds''; and
                            (ii) by striking ``from funds'' and all 
                        that follows and inserting ``for medical care 
                        provided by the Department of Veterans Affairs 
                        pursuant to such agreement.''.
            (3) Implementation.--
                    (A) Termination of health care.--No health care may 
                be provided under a CHAMPUS contract on or after the 
                effective date of this section.
                    (B) Savings provision.--Payments for health care 
                provided pursuant to a CHAMPUS contract before such 
                date shall be made in accordance with such contract and 
                the provisions of law referred to in paragraphs (1)(A) 
                and (2), as such provisions of law were in effect on 
                the day before such effective date.
                    (C) Definition.--As used in this subsection, the 
                term ``CHAMPUS contract'' means--
                            (i) a contract for an insurance, medical 
                        service, or health care plan entered into 
                        pursuant to section 1079(a) of title 10, United 
                        States Code;
                            (ii) a contract for health benefits under 
                        such a plan entered into pursuant to section 
                        1086(a) of such title; and
                            (iii) a contract for the delivery of health 
                        care entered into pursuant to section 1097 of 
                        such title.
    (c) Repeal of Department of Veterans Affairs Medical Care 
Provisions.--
            (1) In general.--Title 38, United States Code, is amended 
        as follows:
                    (A) Chapter 17.--Chapter 17 is repealed.
                    (B) Chapter 73.--Chapter 73 is repealed.
                    (C) Chapter 81.--Chapter 81 is repealed.
                    (D) Chapter 82.--Chapter 82 is repealed.
            (2) Conforming amendments.--
                    (A) Relating to chapter 17.--The table of chapters 
                at the beginning of title 38, United States Code, and 
                part II of such title are amended by striking out the 
                item relating to chapter 17.
                    (B) Relating to chapter 73.--The table of chapters 
                at the beginning of such title and part V of such title 
                are amended by striking out the item relating to 
                chapter 73.
                    (C) Relating to chapters 81 and 82.--The table of 
                chapters at the beginning of such title and part VI of 
                such title are amended by striking out the items 
                relating to chapter 81 and 82.
            (3) Implementation.--
                    (A) Termination of health care and other 
                assistance.--No health care, nursing home care, 
                domiciliary care, other medical care, or financial or 
                other assistance related to such care may be provided 
                by contract or otherwise under chapter 17, 73, 81, or 
                82 of title 38, United States Code, on or after the 
                effective date of this section.
                    (B) Savings provision.--
                            (i) In general.--Payments pursuant to 
                        contracts and agreements referred to in clause 
                        (ii) before such date shall be made in 
                        accordance with such contracts and agreements 
                        and the provisions of law referred to in 
                        paragraph (1) as such provisions were in effect 
                        on the day before such effective date.
                            (ii) Contracts and agreements.--Contracts 
                        and agreements referred to in clause (i) are 
                        contracts and agreements under title 38, United 
                        States Code that are:
                                    (I) contracts for hospital care and 
                                medical services in non-Department of 
                                Veterans Affairs facilities under 
                                section 603;
                                    (II) contracts with organizations 
                                for emergency medical services under 
                                section 611;
                                    (III) contracts for medical 
                                treatment in such facilities under 
                                section 612(a)(6);
                                    (IV) contracts for counseling and 
                                related medical health services under 
                                section 612A(e);
                                    (V) contracts for prosthetic 
                                appliances under section 614(a);
                                    (VI) contracts for therapeutic and 
                                rehabilitative services under section 
                                618(b);
                                    (VII) contracts for nursing home 
                                care and adult day health care under 
                                section 620(d)(1);
                                    (VIII) contracts for treatment of 
                                alcohol, drug abuse, or abuse 
                                disabilities under section 620A(a)(1);
                                    (IX) contracts for hospital care, 
                                medical services and nursing home care 
                                abroad under section 624(c);
                                    (X) contracts to provide care and 
                                treatment by the Veterans Memorial 
                                Medical Center of the Philippines under 
                                section 632(a);
                                    (XI) contracts for activities 
                                conducted by employees of the Federal 
                                Government other than employees of the 
                                Department of Veterans Affairs under 
                                section 5010(c);
                                    (XII) sharing agreements with the 
                                Department of Defense under section 
                                5011(d);
                                    (XIII) contracts for furnishing 
                                health-care services to members of the 
                                Armed Forces under section 5011(b);
                                    (XIV) contracts for prosthetic 
                                appliances under section 5023;
                                    (XV) contracts for procurement of 
                                health-care items under section 
                                5025(b); and
                                    (XVI) contracts for securing 
                                specialized medical resources under 
                                section 5053(a).
    (d) Repeal of Federal Employees Health Benefits Program.--Chapter 
89 of title 5, United States Code, is repealed.
    (e) Provision of Services by Indian Health Service.--
Notwithstanding any other provision of law, the Secretary of Health and 
Human Services shall provide covered services to eligible individuals 
not enrolled in the Program through the Indian Health Service in lieu 
of health services provided by the Service on the date of the enactment 
of this Act, including services provided under sections 201 through 204 
of the Indian Health Care Improvement Act (25 U.S.C. 1621 et seq.).
    (f)  Effective Date.--Except as provided in section 503(b), this 
section and the amendments made by this section shall take effect on 
January 1, 1995.

SEC. 503. TRANSITION.

    (a) State Program Grants.--
            (1) Establishment.--The Administrator shall award grants to 
        States to enable the States--
                    (A) to plan and develop State programs; and
                    (B) to award grants and make loans to nonprofit 
                organizations to assist the organizations in 
                establishing Integrated Health Service Plans.
            (2) Eligibility.--To be eligible to receive a grant under 
        paragraph (1), a State shall submit an application to the 
        Administrator at such time, in such manner, and containing such 
        information as the Administrator may require.
            (3) Authorization of appropriations.--There are authorized 
        to be appropriated to carry out this subsection such sums as 
        may be necessary for each of the 1993 through 1995 fiscal 
        years.
    (b) Study and Report.--
            (1) Study.--The Administrator shall, in consultation with 
        the Secretary of Health and Human Services, the Secretary of 
        Defense, the Secretary of Veterans Affairs, and the Director of 
        the Office of Personnel Management examine possible strategies 
        for accomplishing the transition and provision of services 
        described in section 502.
            (2) Report.--Not later than January 1, 1993, the 
        Administrator shall submit to the appropriate committees of 
        Congress a report containing--
                    (A) the recommendations of the Public Health 
                Functions and Activities Commission set forth in the 
                report described in section 406(b)(2);
                    (B) the findings and conclusions of the 
                Administrator, based on the study described in 
                paragraph (1); and
                    (C) recommendations for legislative reform to 
                accomplish the transition and provision of services 
                described in section 502.
            (3) Modification.--Notwithstanding any other provision of 
        this Act and to the extent the Administration determines it is 
        appropriate and fiscally responsible, the Administration may 
        include in the report recommendations to reduce the period 
        between the date of the enactment of this Act and the effective 
        dates otherwise provided in this Act.
            (4) Effect of recommendations.--Unless the Congress enacts 
        a disapproval resolution under the procedures described in 
        section 504 not later than the date that is 60 days after the 
        submission of the report described in paragraph (2), on such 
        date--
                    (A) the recommendations contained within the report 
                shall have the force of law; and
                    (B) the Secretary shall, in accordance with this 
                Act, provide covered services to all individuals that 
                received the services under the provisions of law 
                specified in section 502.
    (c) Regulations.--
            (1) In general.--The Administrator shall issue such 
        regulations as are necessary to provide for a transition to the 
        national health care program from the programs that are 
        repealed under subsections (a) through (c) of section 502, and 
        the provisions of services by the Indian Health Service under 
        section 502(d).
            (2) Considerations.--In promulgating the regulations 
        described in paragraph (1) the Administrator shall take into 
        consideration the findings and conclusions of the study 
        described in subsection (b)(1).

SEC. 504. 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 
        National Health Care Administration as submitted by the 
        Administration 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 National Health Care 
        Administration''.
    (c) Introduction and Referral.--On the day on which the action of 
the Administration 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) Motions 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 National Health Care Administration 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.

SEC. 505. RELATION TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.

    The provisions of the Employee Retirement Income Security Act (29 
U.S.C. 1001 et seq.) are superseded to the extent inconsistent with the 
requirements of this Act.

                   TITLE VI--MISCELLANEOUS PROVISIONS

SEC. 601. BILL OF RIGHTS.

    (a) Sense of Congress.--It is the sense of Congress that consumers 
in the national health care program shall have the rights specified in 
the bill of rights set forth in subsection (b).
    (b) Bill of Rights.--
            (1) Consumers shall have the right to--
                    (A) receive timely health-related information; and
                    (B) be involved in decisions affecting their 
                health;
                    (C) receive prompt evaluation, humane care, and 
                professional treatment;
                    (D) receive services without regard to race, color, 
                religion, sex, national origin, age, health condition, 
                sexual preference, income, language, or geographic 
                residence in an urban or rural area;
                    (E) refuse treatment or prescribed services and 
                know the consequences of such refusal;
                    (F) be treated with dignity and respect;
                    (G) maintain privacy and confidentiality;
                    (H) maintain confidentiality of financial and 
                health records;
                    (I) obtain access to medical records;
                    (J) obtain treatment in the least restrictive 
                setting;
                    (K) express or file grievances;
                    (L) be informed if treatment or services are 
                denied, reduced, or terminated;
                    (M) obtain information and forms that are easily 
                understood and that are written in a language 
                understood by the consumer or health care provider;
                    (N) obtain health care services that are sensitive 
                to the cultural attitudes of the consumer population 
                being served; and
                    (O) receive quality health care services in any 
                penal institution.

SEC. 602. RESEARCH AND SERVICE DELIVERY IMPROVEMENT PROGRAM GRANTS.

    (a) In General.--The Administrator shall make grants to eligible 
entities to conduct research that will examine, or carry out programs 
that will develop--
            (1)(A) ways of better providing covered services through 
        the national health care program to consumers residing in 
        rural, central city, and other health professional shortage 
        areas; and
            (B) alternative models for delivering primary health and 
        mental health services to medically underserved populations, 
        including the use of outreach mobile services, transportation, 
        home visiting, and systems to promote linkages with essential 
        health and other human services;
            (2) the effectiveness of the national health care program 
        in enabling access to health care services for minorities, 
        women, and other special populations who have traditionally had 
        problems with access to health care (to be initiated 2 years 
        from the date of implementation);
            (3) the relationship between--
                    (A) psychosocial well-being; and
                    (B) prevention of illness and disease;
            (4) successful health education and treatment approaches in 
        avoiding preventable illnesses and diseases;
            (5) innovative prevention, treatment, and service delivery 
        approaches to health and mental health care delivery to 
        mentally impaired persons;
            (6) innovative prevention, treatment, and service delivery 
        approaches to improve the mental health and psychosocial well-
        being of the elderly;
            (7) the impact of interprofessional collaboration on the 
        effectiveness of care coordination in inpatient and outpatient 
        health care settings, including long-term care settings;
            (8) quality assurance and program effectiveness with 
        respect to mental health care services;
            (9) quality indicators for measuring treatment 
        effectiveness;
            (10) the effectiveness of, and reductions of cost in, 
        selective, widely used diagnostic and treatment procedures;
            (11) alternative approaches to continuing education 
        programs for health care personnel in rural areas; and
            (12) innovations in service delivery that enhance 
        continuity of care, care coordination, and service efficiency 
        and effectiveness.
    (b) Application.--To be eligible to receive a grant under this 
section, an entity shall submit an application to the Administrator at 
such time, in such manner, and containing such information as the 
Administrator may require, including an assurance that the entity shall 
submit to the Administrator such information as the Administrator may 
require to comply with subsection (c).
    (c) Annual Report.--The Administrator shall prepare and submit a 
report to Congress by not later than April 1 of each year (beginning 
with 1995) concerning the progress of the research and demonstration 
projects conducted under this section.

SEC. 603. PREVENTION, HEALTH PROMOTION, AND HEALTH AWARENESS PROGRAM 
              GRANTS.

    (a) Establishment.--The Administrator shall make grants to eligible 
entities to establish--
            (1) innovative statewide or local prevention and health 
        promotion programs, such as community-based wellness and 
        outreach programs and school-based programs;
            (2) health awareness programs in schools, workplaces, 
        health and social agencies; and
            (3) community-based programs to prevent community health 
        problems, such as adolescent pregnancy, drug abuse, family 
        violence, and violence in the schools.
    (b) Application.--To be eligible to receive a grant under this 
section, an entity shall submit an application to the Administrator at 
such time, in such manner, and containing such information as the 
Administrator may require.

SEC. 604. DISPLACED WORKERS.

    Section 301(a)(1)(B) of the Job Training Partnership Act (29 U.S.C. 
1651(a)(1)(B)) is amended by adding before the semicolon the following: 
``, or as a result of reductions in health insurance industry jobs due 
to the establishment of the national health care program under the 
National Health Care Act of 1993, as determined in accordance with 
regulations of the Secretary of Health and Human Services''.

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