[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 23 Introduced in House (IH)]







104th CONGRESS
  1st Session
                                 H. R. 23

  To direct the Secretary of Health and Human Services to establish a 
schedule of preventive health care services and to provide for coverage 
of such services in accordance with such schedule under private health 
insurance plans and health benefit programs of the Federal Government, 
                        and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 4, 1995

  Mr. Gilman introduced the following bill; which was referred to the 
 Committee on Commerce, and in addition to the Committees on Ways and 
Means, Government Reform and Oversight, Veterans' Affairs and National 
Security, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned.

_______________________________________________________________________

                                 A BILL


 
  To direct the Secretary of Health and Human Services to establish a 
schedule of preventive health care services and to provide for coverage 
of such services in accordance with such schedule under private health 
insurance plans and health benefit programs of the Federal Government, 
                        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.

    This Act may be cited as the ``Comprehensive Preventive Health and 
Promotion Act of 1995''.

SEC. 2. ESTABLISHMENT OF SCHEDULE OF PREVENTIVE HEALTH CARE SERVICES.

    (a) Initial Schedule.--
            (1) Proposed schedule.--Not later than 6 months after the 
        date of the enactment of this Act, the Secretary of Health and 
        Human Services, in consultation with representatives of 
        individuals described in subsection (d), shall establish a 
        proposed initial schedule of recommended preventive health care 
        services. In accordance with section 553 of title 5, United 
        States Code, the Secretary shall publish such proposed schedule 
        in the Federal Register and provide for a 90-day period for 
        receiving public comment on the schedule.
            (2) Final schedule.--The proposed schedule of recommended 
        preventive health care services established under paragraph (1) 
        shall become effective for the first calendar year that begins 
        90 or more days after the expiration of the period for 
        receiving public comment described in paragraph (1).
    (b) Annual Adjustment.--Not later than October 1 of every year 
(beginning with the first year for which the schedule established under 
subsection (a) is in effect), the Secretary, in consultation with 
representatives of individuals described in subsection (d) and in 
accordance with section 553 of title 5, United States Code, may revise 
the schedule of preventive health care services established under this 
section for the following calendar year.
    (c) Use of Sources for Establishing Schedule.--In establishing the 
initial schedule of recommended preventive health care services under 
subsection (a) and in revising the schedule for subsequent years under 
subsection (b), the Secretary shall take into consideration the 
recommendations for preventive health care services contained in the 
Guide to Clinical Preventive Services presented to the Department of 
Health and Human Services by the United States Preventive Services Task 
Force and the Year 2000 Health Objectives of the United States Public 
Health Service.
    (d) Individuals Serving as Consultants.--The individuals described 
in this subsection are as follows:
            (1) Hospital administrators.
            (2) Administrators of health benefit plans.
            (3) General practice physicians.
            (4) Mental health practitioners.
            (5) Pediatricians.
            (6) Chiropractors.
            (7) Physicians practicing in medical specialty areas.
            (8) Nutritionists.
            (9) Nurses.
            (10) Experts in scientific research.
            (11) Dentists.
            (12) Representatives of manufacturers of prescription 
        drugs.
            (13) Health educators.

SEC. 3. APPLICATION TO INDIVIDUALS ENROLLED IN PRIVATE HEALTH INSURANCE 
              PLANS.

    (a) Requirement for Carriers and Plans.--
            (1) In general.--Each carrier and employer health benefit 
        plan shall include in the services covered for each individual 
        enrolled with the carrier or plan the preventive health care 
        services applicable to the individual under the schedule of 
        preventive health care services established under section 2.
            (2) Definitions.--In this section:
                    (A) The term ``carrier'' means any entity which 
                provides health insurance or health benefits in a 
                State, and includes a licensed insurance company, a 
                prepaid hospital or medical service plan, a health 
                maintenance organization, the plan sponsor of a 
                multiple employer welfare arrangement or an employee 
                benefit plan (as defined under the Employee Retirement 
                Income Security Act of 1974), or any other entity 
                providing a plan of health insurance subject to State 
                insurance regulation, but such term does not include 
                for purposes of section 103 an entity that provides 
                health insurance or health benefits under a multiple 
                employer welfare arrangement.
                    (B)(i) Subject to clause (ii), the term ``employer 
                health benefit plan'' means a health benefit plan 
                (including an employee welfare benefit plan, as defined 
                in section 3(1) of the Employee Retirement Income 
                Security Act of 1974) which is offered to employees 
                through an employer and for which the employer provides 
                for any contribution to such plan or any premium for 
                such plan are deducted by the employer from 
                compensation to the employee.
                    (ii) A State may provide (for a plan in a State) 
                that the term ``employer health benefit plan'' does not 
                include an association plan (as defined in clause 
                (iii)).
                    (iii) For purposes of clause (ii), the term 
                ``association plan'' means a health benefit plan 
                offered by an organization to its members if the 
                organization was formed other than for purposes of 
                purchasing insurance.
                    (C) The term ``full-time employee'' means, with 
                respect to an employer, an individual who normally is 
                employed for at least 30 hours per week by the 
                employer.
                    (D) The term ``health benefit plan'' means any 
                hospital or medical expense incurred policy or 
                certificate, hospital or medical service plan contract, 
                or health maintenance subscriber contract, or a 
                multiple employer welfare arrangement or employee 
                benefit plan (as defined under the Employee Retirement 
                Income Security Act of 1974) which provides benefits 
                with respect to health care services, but does not 
                include--
                            (i) coverage only for accident, dental, 
                        vision, disability income, or long-term care 
                        insurance, or any combination thereof,
                            (ii) medicare supplemental health 
                        insurance,
                            (iii) coverage issued as a supplement to 
                        liability insurance,
                            (iv) worker's compensation or similar 
                        insurance, or
                            (v) automobile medical-payment insurance,
                or any combination thereof.
                    (E) The term ``small employer carrier'' means a 
                carrier with respect to the issuance of an employer 
                health benefit plan which provides coverage to one or 
                more full-time employees of an entity actively engaged 
                in business which, on at least 50 percent of its 
                working days during the preceding year, employed at 
                least 2, but fewer than 36, full-time employees. For 
                purposes of determining if an employer is a small 
                employer, rules similar to the rules of subsection (b) 
                and (c) of section 414 of the Internal Revenue Code of 
                1986 shall apply.
    (b) Enforcement Through Excise Tax.--
            (1) In general.--Chapter 43 of the Internal Revenue Code of 
        1986 (relating to qualified pension, etc., plans) is amended by 
        adding at the end thereof the following new section:

``SEC. 4980C. FAILURE TO COMPLY WITH EMPLOYER HEALTH BENEFIT PLAN 
              STANDARDS REGARDING PREVENTIVE HEALTH CARE.

    ``(a) Imposition of Tax.--
            ``(1) In general.--There is hereby imposed a tax on the 
        failure of a carrier or an employer health benefit plan to 
        comply with section 3(a)(1) of the Comprehensive Preventive 
        Health and Promotion Act of 1995.
            ``(2) Exception.--Paragraph (1) shall not apply to a 
        failure by a small employer carrier or plan in a State if the 
        Secretary of Health and Human Services determines that the 
        State has in effect a regulatory enforcement mechanism that 
        provides adequate sanctions with respect to such a failure by 
        such a carrier or of such a plan.
    ``(b) Amount of Tax.--
            ``(1)  In general.--Subject to paragraph (2), the tax 
        imposed by subsection (a) shall be an amount not to exceed 25 
        percent of the amounts received by the carrier or under the 
        plan for coverage during the period such failure persists.
            ``(2) Limitation in case of individual failures.--In the 
        case of a failure that only relates to specified individuals or 
        employers (and not to the plan generally), the amount of the 
        tax imposed by subsection (a) shall not exceed the aggregate of 
        $100 for each day during which such failure persists for each 
        individual to which such failure relates. A rule similar to the 
        rule of section 4980B(b)(3) shall apply for purposes of this 
        section.
    ``(c) Liability for Tax.--The tax imposed by this section shall be 
paid by the carrier.
    ``(d) Exceptions.--
            ``(1) Corrections within 30 days.--No tax shall be imposed 
        by subsection (a) by reason of any failure if--
                    ``(A) such failure was due to reasonable cause and 
                not to willful neglect, and
                    ``(B) such failure is corrected within the 30-day 
                period beginning on earliest date the carrier knew, or 
                exercising reasonable diligence would have known, that 
                such failure existed.
            ``(2) Waiver by secretary.--In the case of a failure which 
        is due to reasonable cause and not to willful neglect, the 
        Secretary may waive part or all of the tax imposed by 
        subsection (a) to the extent that payment of such tax would be 
        excessive relative to the failure involved.
    ``(e) Definitions.--For purposes of this section, the terms 
`carrier', `employer health benefit plan', and `small employer carrier' 
have the respective meanings given such terms in section 3(a)(2) of the 
Comprehensive Preventive Health and Promotion Act of 1995.''
            (2) Clerical amendment.--The table of sections for chapter 
        43 of such Code is amended by adding at the end thereof the 
        following new items:

                              ``Sec. 4980C. Failure to comply with 
                                        employer health plan standards 
                                        regarding preventive health 
                                        care.''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply to plan years beginning after December 31, 1995.

SEC. 4. COVERAGE OF PREVENTIVE HEALTH CARE SERVICES UNDER MEDICARE.

    (a) In General.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) by striking ``and'' at the end of subparagraph (O);
            (2) by striking the semicolon at the end of subparagraph 
        (P) and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
            ``(Q) in the case of an individual, services applicable to 
        the individual under the schedule of preventive health care 
        services established under the Comprehensive Preventive Health 
        and Promotion Act of 1995 (to the extent such services are not 
        otherwise covered with respect to the individual under this 
        title);''.
    (b) Conforming Amendments.--Section 1862(a) of such Act (42 U.S.C. 
1395y(a)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (E), by striking ``and'' at the 
                end,
                    (B) in subparagraph (F), by striking the semicolon 
                at the end and inserting ``, and'', and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(G) in the case of items or services described in section 
        1861(s)(2)(Q), which are not provided in accordance with the 
        schedule of preventive health care services established under 
        the Comprehensive Preventive Health and Promotion Act of 1995 
        ;''; and
            (2) in paragraph (7), by striking ``paragraph (1)(B) or 
        under paragraph (1)(F)'' and inserting ``subparagraphs (B), 
        (F), or (G) of paragraph (1)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 1995.

SEC. 5. COVERAGE UNDER STATE MEDICAID PLANS.

    (a) In General.--
            (1) Inclusion in medical assistance.--Section 1905(a) of 
        the Social Security Act (42 U.S.C. 1396d(a)) is amended--
                    (A) by striking ``and'' at the end of paragraph 
                (21);
                    (B) in paragraph (24), by striking the comma at the 
                end and inserting a semicolon;
                    (C) by redesignating paragraphs (22), (23), and 
                (24) as paragraphs (25), (22), and (23), respectively, 
                and by transferring and inserting paragraph (25) after 
                paragraph (23), as so redesignated; and
                    (D) by inserting after paragraph (23) the following 
                new paragraph:
            ``(24) services applicable to the individual under the 
        schedule of preventive health care services established under 
        the Comprehensive Preventive Health and Promotion Act of 1995 
        (to the extent such services are not otherwise covered with 
        respect to the individual under the State plan under this 
        title); and''.
            (2) Coverage made mandatory.--(A) Section 1902(a)(10)(A) of 
        such Act (42 U.S.C. 1396a(a)(10)(A)) is amended by striking 
        ``(17) and (21)'' and inserting ``(17), (21), and (24)''.
            (B) Section 1902(a)(10)(C)(iv) of such Act (42 U.S.C. 
        1396a(a)(10)(C)(iv)) is amended--
                    (i) by striking ``(5) and (17)'' and inserting 
                ``(5), (17), and (24)''; and
                    (ii) by striking ``through (21)'' and inserting 
                ``through (24)''.
            (C) Section 1902(j) of such Act (42 U.S.C. 1396a(j)) is 
        amended by striking ``through (22)'' and inserting ``through 
        (24)''.
    (b) Effective Date.--(1) Except as provided in paragraph (2), the 
amendments made by subsection (a) shall apply to calendar quarters 
beginning on or after January 1, 1995, without regard to whether or not 
final regulations to carry out such amendments have been promulgated by 
such date.
    (2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation (other than legislation 
appropriating funds) in order for the plan to meet the additional 
requirements imposed by the amendments made by subsections (a) and (b), 
the State plan shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its failure to meet 
these additional requirements before the first day of the first 
calendar quarter beginning after the close of the first regular session 
of the State legislature that begins after the date of the enactment of 
this Act. For purposes of the previous sentence, in the case of a State 
that has a 2-year legislative session, each year of such session shall 
be deemed to be a separate regular session of the State legislature.

SEC. 6. COVERAGE OF PREVENTIVE HEALTH CARE SERVICES FOR VETERANS.

    (a) In General.--Section 1701(6) of title 38, United States Code is 
amended--
            (1) by striking ``and'' at the end of subparagraph (A);
            (2) by striking the period at the end of subparagraph (B) 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
            ``(C) with respect to any veteran, any preventive care 
        services applicable under the schedule of preventive health 
        care services established under the Comprehensive Preventive 
        Health and Promotion Act of 1995, to the extent such services 
        are not otherwise treated as medical services under this 
        paragraph.''.
    (b) Providing Services in Outpatient Setting.--Section 
1712(a)(5)(A) of such title is amended--
            (1) in the first sentence, by striking the period at the 
        end and inserting the following: ``, or any other medical 
        services applicable to the veteran under the schedule of 
        preventive health care services established under the 
        Comprehensive Preventive Health and Promotion Act of 1995.''; 
        and
            (2) in the second sentence, by inserting after 
        ``admission'' the following: ``or any services applicable to 
        the veteran under the schedule of preventive health care 
        services established under the Comprehensive Preventive Health 
        and Promotion Act of 1995 (other than services applicable under 
        such schedule that are reasonably necessary in preparation for 
        hospital admission)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 1995.

SEC. 7. COVERAGE OF PREVENTIVE HEALTH CARE SERVICES UNDER FEDERAL 
              EMPLOYEES HEALTH BENEFIT PLANS.

    (a) In General.--Paragraphs (1) and (2) of section 8904(a) of title 
5, United States Code, are each amended by adding at the end the 
following new subparagraph:
                    ``(G) With respect to an individual, any preventive 
                health care services applicable to the individual under 
                the schedule of preventive health care services 
                established under the Comprehensive Preventive Health 
                and Promotion Act of 1995.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply with respect to services furnished on or after January 1, 1995.

SEC. 8. COVERAGE OF PREVENTIVE HEALTH CARE SERVICES FOR DEPENDENTS OF 
              MEMBERS OF THE UNIFORMED SERVICES.

    (a) Preventive Health Care Services Included in Authorized Care.--
Section 1077(a) of title 10, United States Code, is amended by adding 
at the end the following new paragraph:
            ``(13) Any preventive care services applicable under the 
        schedule of preventive health care services established under 
        the Comprehensive Preventive Health and Promotion Act of 1995, 
        to the extent such services are not otherwise authorized as 
        health care services under this subsection.''.
    (b) Effective Date.--Paragraph (13) of section 1077(a) of title 10, 
United States Code (as added by subsection (a)), shall apply with 
respect to health care services furnished on or after January 1, 1995, 
to dependents of members or former members of the uniformed services 
authorized to receive such services.

SEC. 9. PREVENTIVE HEALTH CARE DEMONSTRATION PROJECT.

    (a) Establishment.--There is hereby established a demonstration 
project to demonstrate the effectiveness in providing preventive health 
care services in improving the health of individuals and reducing the 
aggregate costs of providing health care, under which the Secretary of 
Health and Human Services shall--
            (1) make grants over a 5-year period to 50 eligible 
        counties to assist the counties in providing preventive health 
        care services (in accordance with subsection (b)) to 
        individuals who would otherwise be unable to pay (or have 
        payment made on their behalf) for such services;
            (2) conduct the study described in subsection (c); and
            (3) carry out the educational program described in 
        subsection (d).
    (b) Grants to Counties.--
            (1) Services described.--A county receiving a grant under 
        subsection (a)(1) shall provide preventive health care services 
        to individuals at clinics in accordance with the schedule of 
        preventive health care services established under the 
        Comprehensive Preventive Health and Promotion Act of 1995, 
        except that--
                    (A) the county may furnish services to individuals 
                residing in rural areas at locations other than clinics 
                if no clinics that are able to provide such services 
                are located in the area; and
                    (B) the Secretary may revise the schedule of 
                services otherwise required to be provided to take into 
                account the special needs of a participating county.
            (2) Eligibility of counties.--A county is eligible to 
        receive a grant under subsection (a)(1) if it submits to the 
        Secretary, at such time and in such form as the Secretary may 
        require, an application containing such information and 
        assurances as the Secretary may require.
            (3) Geographic balance among counties selected.--In 
        selecting counties to receive grants under subsection (a)(1), 
        the Secretary shall consider the need to select counties 
        representing urban, rural, and suburban areas and counties 
        representing various geographic regions of the United States.
    (c) Study of State Preventive Care Requirements.--
            (1) Study.--The Secretary shall conduct a study of the 
        requirements regarding preventive health care services that are 
        imposed by each State on health benefit plans offered to 
        individuals residing in the State.
            (2) Report.--Not later than 1 year after the date of the 
        enactment of this Act, the Secretary shall submit a report to 
        Congress on the study conducted under paragraph (1).
    (d) Dissemination of Information on Preventive Health Care.--Not 
later than 2 years after the date of the enactment of this Act, the 
Secretary, in consultation with experts in preventive medicine and 
representatives of providers of health care services, shall publish and 
disseminate information on the benefits of practicing preventive health 
care, the importance of undergoing periodic health examinations, and 
the need to establish and maintain a family medical history to 
businesses, providers of health care services, and other appropriate 
groups and individuals.
    (e) State Defined.--In this section, the term ``State'' means each 
of the 50 States and the District of Columbia.

SEC. 10. PROGRAMS TO ESTABLISH ON-SITE WORKSHOPS ON HEALTH PROMOTION.

    (a) Grants to Businesses.--
            (1) In general.--The Secretary of Health and Human Services 
        shall establish a program under which the Secretary shall make 
        grants over a 5-year period to 300 eligible employers to 
        establish and conduct on-site workshops on health care 
        promotion for employees.
            (2) Eligibility.--An employer is eligible to receive a 
        grant under paragraph (1) if the employer submits an 
        application (at such time and in such form as the Secretary may 
        require) containing such information and assurances as the 
        Secretary may require, including assurances that the employer 
        shall use funds received under the grant only to provide 
        services that the employer does not otherwise provide (either 
        directly or through a carrier) to its employees.
            (3) Information and services provided.--On-site workshops 
        on health care promotion conducted with grants received under 
        paragraph (1) shall include the presentation of such 
        information and the provision of such services as the Secretary 
        considers appropriate, including counseling on nutrition and 
        weight management, clinical sessions on avoiding back injury, 
        programs on smoking cessation, and information on stress 
        management.
    (b) Establishment of Programs for Federal Employees.--The Secretary 
of Labor shall establish a program under which the Secretary shall 
conduct on-site workshops on health care promotion for employees of the 
Federal Government, and shall include in such workshops the 
presentation of such information and the provision of such services as 
the Secretary (in consultation with the Secretary of Health and Human 
Services) considers appropriate, including counseling on nutrition and 
weight management, clinical sessions on avoiding back injury, programs 
on smoking cessation, and information on stress management.
                                 <all>
HR 23 IH ----2