[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1374 Introduced in House (IH)]







105th CONGRESS
  1st Session
                                H. R. 1374

  To establish a United States Health Service to provide high quality 
    comprehensive health care for all Americans and to overcome the 
      deficiencies in the present system of health care delivery.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 17, 1997

 Mr. Dellums introduced the following bill; which was referred to the 
 Committee on Commerce, and in addition to the Committees on Ways and 
 Means, the Judiciary, and the Budget, 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 establish a United States Health Service to provide high quality 
    comprehensive health care for all Americans and to overcome the 
      deficiencies in the present system of health care delivery.

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

                              short title

    Section 1. This Act may be cited as the ``Josephine Butler United 
States Health Service Act''.

                           TABLE OF CONTENTS

Sec. 1. Short title.
Sec. 2. Findings.
Sec. 3. Purposes.
Sec. 4. Definitions.
   TITLE I--ESTABLISHMENT AND OPERATION OF THE UNITED STATES HEALTH 
                                SERVICE

                      Part A--Initial Organization

Sec. 101. Establishment of the Service.
Sec. 102. Appointment of Interim National Health Board.
Sec. 103. Powers and duties of the Interim National Health Board.
Sec. 104. Authorization.
               Part B--Organization of Area Health Boards

Sec. 111. Establishment of health care delivery regions.
Sec. 112. Appointment of interim regional health boards.
Sec. 113. Establishment of health care delivery districts and health 
                            care delivery communities.
Sec. 114. Election of community health boards.
Sec. 115. Appointment of district health boards.
Sec. 116. Appointment of regional health boards.
Sec. 117. Appointment of the National Health Board.
Sec. 118. Subsequent election and appointment of members of health 
                            boards.
Sec. 119. Modification of the boundaries of health care delivery areas.
           Part C--General Provisions Regarding Health Boards

Sec. 121. Definitions.
Sec. 122. Membership of health boards.
Sec. 123. Meetings and records of health boards.
Sec. 124. Procedures for establishment of national guidelines and 
                            standards.
Sec. 125. Assistance to area health board members.
      TITLE II--DELIVERY OF HEALTH CARE AND SUPPLEMENTAL SERVICES

            Part A--Patients Rights in Health Care Delivery

Sec. 201. Basic health rights.
Sec. 202. Right to paid leave to receive health care services.
 Part B--Eligibility for, Nature of, and Scope of Services Provided by 
                              the Service

Sec. 211. Eligibility for services.
Sec. 212. Entitlement to services.
Sec. 213. Provision of health care and supplemental services.
  Part C--Health Care Facilities and Delivery of Health Care Services

Sec. 221. Establishment of health care facilities and distribution of 
                            delivery of health care and other services.
Sec. 222. Operation and inspection of health care facilities.
Sec. 223. Provision of health services relating to reproduction and 
                            child-bearing.
                     TITLE III--HEALTH LABOR FORCE

                Part A--Job Categories and Certification

Sec. 301. Effect of State law.
Sec. 302. Qualifications of health workers.
Sec. 303. Establishment of job categories and certification standards.
                  Part B--Education of Health Workers

Sec. 311. Health team schools.
Sec. 312. Service requirement.
Sec. 313. Payment for certain educational loans.
  Part C--Employment and Labor-Management Relations Within the Service

Sec. 321. Employment, transfer, promotion, and receipt of fees.
Sec. 322. Applicability of laws relating to Federal employees.
Sec. 323. Applicability of Federal labor-management relations laws.
Sec. 324. Defense of certain malpractice and negligence suits.
               TITLE IV--OTHER FUNCTIONS OF HEALTH BOARDS

        Part A--Advocacy, Grievance Procedures, and Trusteeships

Sec. 401. Advocacy and legal services program.
Sec. 402. Grievance procedures and trusteeships.
            Part B--Occupational Safety and Health Programs

Sec. 411. Functions of the National Health Board.
Sec. 412. Community occupational safety and health activities.
Sec. 413. Regional occupational safety and health programs.
Sec. 414. Workplace health facilities.
Sec. 415. Employee rights relating to occupational safety and health.
Sec. 416. Definitions.
            Part C--Health and Health Care Delivery Research

Sec. 421. Principles and guidelines for research.
Sec. 422. Establishment of institutes.
   Part D--Health Planning, Distribution of Drugs and Other Medical 
                 Supplies, and Miscellaneous Functions

Sec. 431. Health planning and budgeting.
Sec. 432. Distribution of drugs and other medical supplies.
Sec. 433. Miscellaneous functions of the National Health Board.
                   TITLE V--FINANCING OF THE SERVICE

                      Part A--Health Service Taxes

Sec. 501. Individual and corporate income taxes.
Sec. 502. Other changes in the Internal Revenue Code of 1954.
Sec. 503. Existing employer-employee health benefit plans.
Sec. 504. Workers compensation programs.
                   Part B--Health Service Trust Fund

Sec. 511. Establishment of health service trust fund.
Sec. 512. Transfer of funds to the health service trust fund.
Sec. 513. Administration of health service trust fund.
                Part C--Preparation of Plans and Budgets

Sec. 521. Determination of fund availability.
Sec. 522. Preparation of area plans and budgets.
              Part D--Allocation and Distribution of Funds

Sec. 531. National budget.
Sec. 532. Regional budgets.
Sec. 533. District budgets.
Sec. 534. Special operating expense fund.
Sec. 535. Distribution of funds.
Sec. 536. Annual statement, records, and audits.
                       Part E--General Provisions

Sec. 541. Issuance of obligations.
Sec. 542. Definitions.
                   TITLE VI--MISCELLANEOUS PROVISIONS

Sec. 601. Effective date of health services.
Sec. 602. Repeal of provisions.
Sec. 603. Transition provisions.
Sec. 604. Amendment to Budget and Accounting Act.
Sec. 605. Separability.

                                findings

    Sec. 2. The Congress makes the following findings:
            (1) The health of the Nation's people is a foundation of 
        their well-being.
            (2) High quality health care is a right of all people.
            (3) Many of the Nation's people are unable fully to 
        exercise this right because of the inability of the present 
        health care delivery system to make high quality health care 
        available to all individuals regardless of race, sex, age, 
        national origin, income, marital status, sexual orientation, 
        religion, political belief, place of residence, or previous 
        health status.
            (4) The present health care system has failed to address 
        the basic deterioration in occupational, environmental, and 
        social conditions affecting the health of the people of this 
        Nation.
            (5) Unnecessary and excessive profits and administrative 
        expenses have inflated the cost of health care.
            (6) The health professions have failed to control the cost 
        of their services and the imbalance in the number of health 
        workers among geographic areas or health care specialties.
            (7) The present health care system has failed to make full 
        and efficient use of allied health workers.
            (8) A United States Health Service is the best means to 
        implement the right to high quality health care and to overcome 
        the deficiencies in the present health care delivery system.

                                purposes

    Sec. 3. The purposes of this Act are:
            (1) To create a United States Health Service to provide 
        without charge to all residents, regardless of race, sex, age, 
        national origin, income, marital status, sexual orientation, 
        religion, political belief, place of residence, or previous 
        health status, comprehensive health care services delivered by 
        salaried health workers and emphasizing the promotion and 
        maintenance of health as well as the treatment of illness.
            (2) To establish representative and democratic governance 
        of the Service through community boards chosen through 
        community elections, district and regional boards selected by 
        the community and district boards, respectively, and a National 
        Health Board selected by the regional boards, subject to the 
        approval of the President.
            (3) To provide health workers in the Service with fair and 
        reasonable compensation, secure employment, opportunities for 
        full and equal participation in the governance of health 
        facilities, and opportunities for advancement without regard to 
        race, sex, age, national origin, sexual orientation, religion, 
        or political belief.
            (4) To increase the availability and continuity of health 
        care by linking local health care facilities to hospitals and 
        specialized care facilities.
            (5) To implement local, regional, and national planning for 
        the establishing, equipping, and staffing of health care 
        facilities needed to overcome present shortages and 
        redistribute health resources, especially for currently 
        deprived inner-city and rural populations, minority groups, 
        prisoners, and occupational groups.
            (6) To finance the Service through progressive taxation of 
        individuals and employer contributions, and to distribute these 
        revenues on a capitation basis, supplemented by allocations to 
        meet special health care needs.

                              definitions

    Sec. 4. For the purposes of this Act, unless the context implies 
otherwise:

                                  Service

            (1) The term ``Service'' means the United States Health 
        Service established in section 101.

               National Health Board; Interim National Health

                  Board; Appropriate National Health Board

            (2)(A) The term ``National Health Board'' means the 
        National Health Board of the Service.
            (B) The term ``Interim National Health Board'' means the 
        Interim National Health Board, appointed under section 102, of 
        the Service.
            (C) The term ``appropriate National Health Board'' means--
                    (i) the Interim National Health Board, prior to the 
                initial meeting of the National Health Board under 
                section 117, and
                    (ii) the National Health Board, at and after such 
                meeting.

                      Health Board; Area Health Board

            (3)(A) The term ``health board'' means the Interim National 
        Health Board, National Health Board, an interim regional health 
        board, a regional health board, a district health board, or a 
        community health board established under this Act.
            (B) The term ``area health board'' means a regional health 
        board, a district health board, or a community health board 
        established under this Act.

                   Community; District; Region; Area

            (4)(A) The term ``community'' means a health care delivery 
        community established under title I.
            (B) The term ``district'' means a health care delivery 
        district established under title I.
            (C) The term ``region'' means a health care delivery region 
        established under title I.
            (D) The term ``area'' means, with respect to an area health 
        board or an area health care facility--
                    (i) in the case of a community board or a health 
                care facility established by a community board, the 
                community for which such board is established or in 
                which the facility is located;
                    (ii) in the case of a district board or a health 
                care facility established by a district board, the 
                district for which such board is established or in 
                which the facility is located; and
                    (iii) in the case of a regional board or a health 
                care facility established by a regional board, the 
                region for which such board is established or in which 
                the facility is located.

              Interim Regional Board; Regional Board; District

                           Board; Community Board

            (5)(A) The term ``interim regional board'' means an interim 
        regional health board established in accordance with section 
        112.
            (B) The term ``regional board'' means a regional health 
        board established in accordance with title I.
            (C) The term ``district board'' means a district health 
        board established in accordance with title I.
            (D) The term ``community board'' means a community health 
        board established in accordance with title I.

                   Respective Regional and District Board

            (6)(A) The terms ``respective regional board'' and 
        ``respective interim regional board'' mean, with respect to a 
        community board or a district board, the regional board or 
        interim regional board, respectively, for the region which 
        contains the community or district for which such community 
        board or district board is established.
            (B) The term ``respective district board'' means, with 
        respect to a community board, the district board for the 
        district which contains the community for which such community 
        board is established.

                   User; Registered User; Eligible User;

                                User Member

            (7)(A) The term ``user'' means an individual who is 
        eligible under section 211 to receive health care services from 
        the Service under this Act.
            (B) The term ``registered user'' means, with respect to an 
        area, a user who resides in the area and is registered to vote 
        in the area in general elections for Federal, State, or local 
        officials.
            (C) The term ``eligible user'' means, for purposes of 
        sections 114 through 118, with respect to a community, 
        district, or region, an individual who (i) is 18 years of age 
        or older, (ii) resides in the community, district, or region, 
        respectively, and (iii) is not a health worker (as defined in 
        paragraph (8)(A)), an indirect provider of health care (as 
        defined in subparagraph (E)), or a member of the immediate 
        family of such a worker or indirect provider.
            (D) The term ``user member'' means, with respect to a 
        health board, an eligible user elected or appointed by users or 
        user members to the health board under sections 114 through 
        118.
            (E) The term ``indirect provider of health care'' means an 
        individual who--
                    (i) receives (either directly or through his or her 
                spouse) more than one-tenth of his or her gross annual 
                income from any one or combination of--
                            (I) fees or other compensation for 
                        provision of, research into, or instruction in, 
                        the provision of health care,
                            (II) entities engaged in the provision of 
                        health care or in such research or instruction,
                            (III) producing or supplying drugs or other 
                        articles for individuals or entities for use in 
                        the provision of or in research into or 
                        instruction in the provision of health care, or
                            (IV) entities engaged in producing drugs or 
                        such other articles;
                    (ii) holds a fiduciary position with, or has a 
                fiduciary interest in, any entity described in 
                subclause (II) or (IV) of clause (i); or
                    (iii) is engaged in issuing any policy or contract 
                of individual or group health insurance or hospital or 
                medical service benefits.

             Health Worker; Authorized Health Worker; Eligible

                        Health Worker; Worker Member

            (8)(A) The term ``health worker'' includes--
                    (i) any employee of the Service; and
                    (ii) any individual who for remuneration delivers, 
                administers any program in, provides supporting 
                services for, teaches the subject matter of, or 
                performs research in, health care services.
            (B) The term ``authorized health worker'' means, with 
        respect to a specified health care service, an individual who 
        is an employee of the Service and is authorized by a health 
        board to deliver the service.
            (C) The term ``eligible area health worker'' means, for 
        purposes of sections 114 through 118 with respect to a 
        community, district, or region, a health worker who is employed 
        by the community, district, or regional health board 
        (respectively) or, in the case of sections 114 through 117, is 
        scheduled to be employed by such board on the effective date of 
        health services.
            (D) The term ``worker member'' means, with respect to a 
        health board, an eligible area health worker elected or 
        appointed by health workers or worker members to the health 
        board under sections 114 through 118.

                   Health Care Facility; Area Health Care

                                  Facility

            (9)(A) The term ``health care facility'' means an 
        administrative unit composed of specified staff, equipment, and 
        premises and established by a health board as an appropriate 
        unit of organization for the delivery of specified health care 
        or supplemental services under this Act.
            (B) The term ``area health care facility'' means, with 
        respect to an area health board, a health care facility 
        established by the area health board.

                 Health Care Service; Supplemental Services

            (10)(A) The term ``health care services'' means the 
        services described in paragraphs (1) through (5) of section 
        213(a).
            (B) The term ``supplemental services'' means the services 
        described in paragraphs (1), (2), and (3) of section 213(b).

                            Number of Residents

            (11) The term ``number of residents'' means the number of 
        residents in a health care delivery area as determined by the 
        most recent decennial national census.

                     Effective Date of Health Services

            (12) The term ``effective date of health services'' means 
        the effective date of health services under this Act as 
        specified in section 601.

   TITLE I--ESTABLISHMENT AND OPERATION OF THE UNITED STATES HEALTH 
                                SERVICE

                      Part A--Initial Organization

                      establishment of the service

    Sec. 101. (a) There is established, as an independent establishment 
of the executive branch of the United States, the United States Health 
Service.
    (b)(1) The authority of the Service shall be exercised by the 
appropriate National Health Board and, in accordance with this Act and 
guidelines established by such Board, by area health boards.
    (2) The Service shall have the authority, under the power of 
eminent domain, to acquire by condemnation under judicial process real 
estate for the Service for public purposes whenever it is necessary or 
advantageous to do so.

              appointment of interim national health board

    Sec. 102. (a) The President shall, no later than 30 days after the 
date of enactment of this Act, appoint 21 individuals-- 
            (1) who are 18 years of age or older,
            (2) who are concerned about the health care problems of the 
        Nation,
            (3) who approximate the Nation's population by race, sex, 
        income, language, and region of residence, and
            (4) no more than seven of whom are or have been health 
        workers, indirect providers of health care, or members of the 
        immediate family of such workers or indirect providers within 
        24 months of the date of such nomination.
To serve as members of the Interim National Health Board of the 
Service.
    (b) The President shall, at the time of such appointments, 
designate two nominees to the Interim National Health Board who are not 
and have not been health workers, indirect providers of health care, or 
members of the immediate family of such workers or indirect providers 
within 24 months of the date of such appointment as chairperson and 
vice chairperson of such Board.

         powers and duties of the interim national health board

    Sec. 103. (a) The members of the Interim National Health Board 
shall serve as the National Health Board of the Service until the 
National Health Board holds its initial meeting in accordance with 
section 117(c)(2).
    (b) The Interim National Health Board shall-- 
            (1) establish the boundaries of health care delivery 
        regions, in accordance with section 111;
            (2) select interim regional health boards in accordance 
        with section 111;
            (3) assist interim regional health boards in the 
        performance of their functions;
            (4) coordinate the initial election of community health 
        boards, under section 114; and
            (5) carry out such duties of the National Health Board as 
        it deems necessary and consistent with the timetable given 
        under this Act and the purposes of the Service, except that no 
        staff member may be appointed and no employee may be hired by 
        the Interim National Health Board for a period extending beyond 
        90 days after the appointment of the National Health Board 
        under section 117.
    (c) The Interim National Health Board shall operate in a manner 
consistent with the provisions of part C.
    (d) The Interim National Health Board shall submit a report to 
Congress on its performance under this Act no later than 30 days after 
the appointment of the National Health Board under section 117.

                             authorization

    Sec. 104. There are authorized to be appropriated to the Service 
$4,000,000,000 to carry out the provisions of this Act with respect to 
the establishment of the Service. Funds appropriated under this section 
shall remain available until expended.

               Part B--Organization of Area Health Boards

             establishment of health care delivery regions

    Sec. 111. (a) No later than 6 months after the appointment of 
members of the Interim National Health Board, such Board shall 
establish, in accordance with this section, health care delivery 
regions throughout the United States.
    (b) Each health care delivery region shall meet the following 
requirements:
            (1) The region shall be a contiguous geographic area 
        appropriate for the effective governance, planning, and 
        delivery of all health care and supplemental services under 
        this Act for residents of the region.
            (2) The region shall have a population of not less than 
        500,000 and of not more than 3,000,000 individuals, except 
        that--
                    (A) the population of a region may be more than 
                3,000,000 if the region includes a standard 
                metropolitan statistical area (as determined by the 
                Office of Management and Budget) with a population of 
                more than three million; and
                    (B) the population of a region may be less than 
                500,000 if the Interim National Health Board determines 
                that this is necessary to facilitate the delivery of 
                health care and supplemental services or the effective 
                governance of the health program within such region.
            (3) The boundaries of each region shall take into account--
                    (A) any economic or geographic barrier to the 
                receipt of health care and supplemental services in 
                nonmetropolitan areas, and
                    (B) the differences in needs between 
                nonmetropolitan and metropolitan areas in the planning, 
                development, and delivery of health care and 
                supplemental services.
    (c) At least 60 days prior to the establishment of the boundaries 
of any region, the Interim National Health Board shall provide for--
            (1) notice in the area which would be affected by the 
        establishment of such boundaries of the boundaries proposed to 
        be established, and of the date, time, and location of the 
        public hearing on such establishment as provided in paragraph 
        (2); and
            (2) a public hearing at which individuals can speak or 
        present written statements relating to the establishment of 
        such boundaries.
    (d) The boundaries of regions shall be modified in accordance with 
section 119.

             appointment of interim regional health boards

    Sec. 112. (a) No later than 60 days after the establishment of 
health care delivery regions under section 111, the Interim National 
Health Board shall appoint an interim regional board for each such 
region.
    (b) Each interim regional board shall be composed of nine members--
            (1) who are 18 years of age or older;
            (2) who are concerned about the health care problems of 
        their region;
            (3) who approximate the region's population by race, sex, 
        income, and language; and
            (4) no more than three of whom are or have been health 
        workers, indirect providers or health care, or members of the 
        immediate family of such workers or indirect providers within 
        24 months of the date of such appointment.
    (c) The Interim National Health Board shall, at the time of 
appointment of each interim regional board, designate two members of 
the board who are not and have not been health workers, indirect 
providers of health care, or members of the immediate family of such 
workers or indirect providers within 24 months of the date of such 
appointment as chairperson and vice chairperson of such board.
    (d) A vacancy in the membership of an interim regional board shall 
be filled in the same manner as the original appointment.
    (e) The members of an interim regional board shall serve until the 
certification of appointment of a regional board in its region in 
accordance with section 116.
    (f) Each interim regional board shall--
            (1) establish the boundaries of health care delivery 
        districts and of health care delivery communities within its 
        region in accordance with section 113;
            (2) conduct elections for voting members of community 
        boards within its region, in accordance with section 114; and
            (3) carry out such functions of a regional board, set out 
        under this Act, as the Interim National Health Board deems 
        appropriate for the purposes of this Act.
    (g) Each interim regional board shall operate in a manner in 
accordance with part C of this title.

    establishment of health care delivery districts and health care 
                          delivery communities

    Sec. 113. (a) No later than 6 months after its appointment under 
section 112, each interim regional board shall establish, in accordance 
with this section, health care delivery districts and health care 
delivery communities throughout its region.
    (b) Each region shall be divided into three or more health care 
delivery districts. Each such district shall meet the following 
requirements:
            (1) The district shall be a contiguous geographic area 
        appropriate for the effective governance, planning, and 
        delivery of all health care services, except for highly 
        specialized health services, for residents of such district.
            (2) The district shall have a population of not less than 
        100,000 and of not more than 500,000 individuals, except that a 
        district may have a population of less than 100,000 if the 
        interim regional board or regional board (as appropriate) 
        determines that a lesser population would facilitate the 
        delivery of health care and supplemental services or the 
        effective governance of the health program within such district 
        or its region.
    (c) Each district shall be divided into three or more health care 
delivery communities. Each such community shall meet the following 
requirements:
            (1) The community shall be a contiguous geographic area 
        appropriate for the effective governance, planning, and 
        delivery of comprehensive primary health care services, 
        described in section 221(a)(2), for residents of such 
        community.
            (2) The residents of the community shall, to the maximum 
        extent feasible, have a commonality of interest, language, and 
        ethnic and racial composition sufficient to support and 
        maintain a community health program under this Act.
            (3) The community shall have a population of not less than 
        25,000 and of not more than 50,000 individuals, except in the 
        case of Indian reservations and, except that a community may 
        have a population of less than 25,000 if the interim regional 
        board or regional board (as appropriate) determines that a 
        lesser population would facilitate the delivery of health care 
        and supplemental services or the effective governance of the 
        health program within such community or the district in which 
        it is located.
    (d) At least 60 days prior to the establishment of the boundaries 
of any district or community within its region, the interim regional 
board shall provide for--
            (1) notice in the district or community which would be 
        affected by the establishment of such boundaries of the 
        boundaries proposed to be established and of the date, time, 
        and location of the public hearing on such establishment as 
        provided in paragraph (2); and
            (2) a public hearing at which individuals residing within 
        the region can speak or present written statements relating to 
        the establishment of such boundaries.
    (e) The boundaries of districts and communities shall be modified 
in accordance with section 119.

                  election of community health boards

    Sec. 114. (a)(1) The Interim National Health Board shall arrange 
with State and local governments for the initial elections for user 
members of each community board to be held on a date not later than 9 
months after the appointment of interim regional boards under section 
112.
    (2) Elections for worker members of each community board shall 
first be held as soon as possible after the selection of health workers 
for employment by the user members of such community boards. Such 
elections shall be held, to the extent feasible, in accordance with 
subsection (c)(2)(B).
    (b)(1) The number of user members to be elected in an election in a 
community under subsection (a) shall be six, plus one user member for 
each 5,000 individuals residing in such community in excess of 30,000 
residents.
    (2) The number of worker members to be elected in an election in a 
community under subsection (a) shall be three, plus one member for each 
10,000 individuals residing in such community in excess of 30,000 
residents.
    (c)(1) The Interim National Health Board shall establish procedures 
for the nomination and election under this section of user members of 
community boards and worker members of area health boards. Each interim 
regional board shall conduct and supervise such nominations and 
elections in its region in accordance with such procedures.
    (2)(A) Such procedures for election of user members shall provide, 
except as otherwise provided in this part, for--
            (i) the nomination for election as a user member to a 
        community board of any eligible user, upon presentation to the 
        respective interim regional board of a petition or petitions 
        signed by at least one percent of the registered users in the 
        community;
            (ii) the full disclosure by each nominee, at the time of 
        presentation of a petition or petitions under clause (i), to 
        the respective interim regional board of any financial interest 
        of the nominee and such nominee's family in the delivery of 
        health care services, in research on health or health care 
        services, or in the provision of drugs or medical supplies;
            (iii) the opportunity, regardless of race, sex, language, 
        income level, or health condition, for all registered users in 
        each such community to nominate eligible users for, and for all 
        eligible users in each such community to run for and to serve 
        as user members of, such users' community board;
            (iv) the right of all registered users in each such 
        community, regardless of race, sex, language, income level, or 
        health condition, to vote in elections for user members of such 
        users' community board, and the right of registered users who 
        are not physically or mentally capable of voting themselves to 
        designate other registered users to vote proxies on their 
        behalf;
            (v) public meetings sponsored by the respective interim 
        regional board in each such community within its region, at 
        which all users nominated for election to the community board 
        in the community may present their views;
            (vi) the preparation and distribution within each such 
        community by the respective interim regional board of 
        literature presenting the qualifications and views of, and 
        disclosing information described in clause (ii) for, each 
        nominee for election as a user member of the community board in 
        the community; and
            (vii) the election of the nominees receiving the greatest 
        number of votes.
    (B) Such procedures for election of worker members shall provide 
for--
            (i) the nomination for election as a worker member of an 
        area health board of any eligible area health worker, upon 
        presentation to the respective interim regional board of a 
        petition (or petitions) signed by at least 1 percent of the 
        eligible area health workers, and
            (ii) the full participation of eligible area health workers 
        of all job categories and skill levels in the nomination and 
        election process.
    (d)(1) Unless an election is set aside under section 402(d)(1) 
(relating to grievance procedures), individuals who have been elected 
to a community board for a community under this section, including user 
members until worker members have been elected, shall be certified by 
the interim regional board as constituting, on the date of such 
certification, the community board for the community.
    (c) With respect to each group of individuals constituting a 
community board under paragraph (1), the respective interim regional 
board shall select a time, date, and location within the community of 
such community board for the holding of the initial meeting of such 
community board, which date shall not be later than 30 days after the 
date of the election, and shall notify the newly elected and approved 
members of such board and the residents of such community of the time, 
date, and location of such meeting.

                 appointment of district health boards

    Sec. 115. (a)(1) Not later than 60 days after the initial meeting 
of each community board, called pursuant to section 114(d)(2), the user 
members of each such board shall appoint two eligible users in the 
community to serve as user members of their respective district board.
    (2) As soon as feasible, the worker members of each such board 
shall appoint an eligible community health worker to serve as a worker 
member of their respective district board.
    (3) As soon as feasible, the eligible district health workers 
shall, in accordance with section 114(c)(2)(B), elect an eligible 
district health worker to serve as a worker member of their respective 
district board.
    (4) The user and worker members of each such community board shall 
promptly notify their respective interim regional board of appointments 
under this subsection.
    (b)(1) Not later than 15 days after the date a majority of the 
initial community boards within a district have notified their 
respective interim regional board of the appointment of user members 
for their respective district boards under subsection (a)(1), such 
interim regional board shall certify the users so appointed as 
constituting, on the date of such certification, the district board for 
the district.
    (2) With respect to each district board certified under paragraph 
(1), its respective interim regional board shall select a time, date, 
and location within the district of such district board for the holding 
of the initial meeting of such district board, which date shall not be 
later than 15 days after the date of such certification, and shall 
notify the approved members of such board and the residents of such 
district of the time, date, and location of such meeting.

                 appointment of regional health boards

    Sec. 116. (a)(1) Not later than 60 days after the initial meeting 
of each district board, called pursuant to section 115(b)(2), the user 
members of each such board shall appoint two eligible users in the 
district to serve as user members of their respective regional board.
    (2) As soon as feasible, the worker members of each such board 
shall appoint an eligible district (or community, in the district) 
health worker to serve as a worker member of their respective regional 
board.
    (3) As soon as feasible, the eligible regional health workers 
shall, in accordance with section 114(c)(2)(B), elect an eligible 
regional health worker to serve as a worker member of their respective 
regional board.
    (4) The user and worker members of each such district board shall 
promptly notify their respective interim regional board and the Interim 
National Health Board of such appointments.
    (b) Not later than 15 days after the date a majority of the initial 
certified district boards within a region have notified their 
respective interim regional board of the appointment of user members 
for their respective regional board under subsection (a)(1), such 
interim regional board shall certify the users so appointed as 
constituting, on the date of such certification, the regional board for 
the region.
    (2) With respect to each regional board certified under paragraph 
(1), the interim regional board that certified such board shall select 
a time, date, and location within its region for the holding of the 
initial meeting of such regional board, which date shall not be later 
than 15 days after the date of such certification, and shall notify the 
appointed and approved members of such board and the residents of its 
region of the time, date, and location of such meeting.

                appointment of the national health board

    Sec. 117. (a) The Interim National Health Board shall, for purposes 
of appointing members of the National Health Board, assign each region 
to one of three groups of regions, each group having (to the extent 
possible) an equal number and balanced geographic distribution of 
regions.
    (b)(1) Not later than 60 days after the initial meeting of each 
regional board, called pursuant to section 116(b)(2), each such board 
for a region in the first two groups of regions (established under 
subsection (a)) shall appoint (subject to the approval of the 
President) an eligible user in the region to serve as a user member of 
the National Health Board.
    (2) As soon as feasible, each such board for any other region shall 
appoint (subject to approval of the President) an eligible regional (or 
community or district, in the region) health worker to serve as a 
worker member of the National Health Board.
    (3) Each regional board shall promptly notify the Interim National 
Health Board and the President of each appointment under this 
subsection. The President shall approve or disapprove the appointment 
of such a member within the 10-day period beginning on the date of his 
notification of the appointment; and the appointment of such a member 
shall be considered as having been approved by the President unless he 
disapproves the appointment of the member within such time period.
    (c)(1) No later than 15 days after the date a majority of the 
appointments under subsection (b)(1) by initially certified regional 
boards have been approved by the President, the Interim National Health 
Board shall certify the individuals so approved as constituting, on the 
date of such certification, the National Health Board, and shall 
promptly notify the President and the Congress of such certification.
    (2) The Interim National Health Board shall select a time, date, 
and location for the holding of the initial meeting of the National 
Health Board, which date shall not be later than 15 days after the date 
of the certification under paragraph (1), and shall notify appointed 
and approved members and the public of the time, date, and location of 
such meeting.

    subsequent election and appointment of members of health boards

    Sec. 118. (a) Members of health boards elected or appointed in 
accordance with sections 114 through 117 shall serve until their 
successors are certified in accordance with this section.
    (b)(1) The National Health Board shall arrange with State and local 
governments for an election for user members of each community board to 
be held on the date of, and in conjunction with, each election for 
Members of the United States House of Representatives that occurs after 
the effective date of health services.
    (2) An election for worker members of each community board shall be 
held on or about the date of each election specified in paragraph (1) 
and shall be held, to the extent feasible and consistent with section 
114(c)(2)(B), in conjunction with the election under paragraph (1).
    (3) The provisions of section 114 (other than subsection (a) 
thereof) shall apply to elections of members of community boards under 
this subsection, except that for purposes of this subsection--
            (A) the term of each member elected under this subsection 
        shall be 4 years, except that, in the case of the elections 
        first held under this section, the term of half of the user 
        members and of half of the worker members or, in the case of an 
        odd number of user or worker members, the term of half plus one 
        of such members shall be 2 years;
            (B) the individuals whose term of office does not expire 
        following an election, as well as individuals elected in the 
        election, are deemed to constitute the community board under 
        section 114(d)(1); and
            (C) any reference to an interim regional board or to the 
        Interim National Health Board in section 114 shall be 
        considered as a reference to a regional board or to the 
        National Health Board.
    (c)(1) Each regional board shall, for purposes of appointing worker 
members of district boards within its region, assign each community to 
one of two groups of communities within each district, each group 
having (to the extent possible) an equal number and balanced geographic 
distribution of communities.
    (2) Not later than 60 days after the initial meeting of each 
community board (newly certified after an election under subsection 
(b))--
            (A) in the case of the first new certification of such a 
        board--
                    (i) user members of each such board shall appoint 
                two eligible users in the community, one of whom shall 
                serve a 4-year term as a user member of their 
                respective district board and the other a 2-year term 
                on such board; and
                    (ii) worker members of each such board for a 
                community in the first group of communities 
                (established under paragraph (1)) shall appoint an 
                eligible community health worker to serve a 4-year term 
                as a worker member of their respective district board, 
                and worker members of each such board for a community 
                in the second group of communities shall appoint an 
                eligible community health worker to serve a 2-year term 
                on such board;
            (B) in the case of a subsequent new certification of such a 
        board--
                    (i) user members of each such board shall appoint 
                an eligible user for a 4-year term; and
                    (ii) worker members of each such board for a 
                community in a group of communities that did not 
                appoint a worker member to serve a 4-year term after 
                the previous certification shall appoint an eligible 
                community health worker to serve a 4-year term; and
            (C) beginning with the first new certification of such a 
        board, and every 4 years thereafter, the eligible district 
        health workers shall, in accordance with section 114(c)(2)(B), 
        elect an eligible district health worker to serve a 4-year term 
        as a worker member of their respective district board.
The user and worker members of each such community board shall promptly 
notify their respective regional board of such appointments.
    (3) Not later than 15 days after the date a majority of the newly 
certified community boards within a district have notified their 
respective regional board of the appointment or election of individuals 
for their respective district boards under paragraph (2), such regional 
board shall certify the users and workers whose term of office does not 
expire at the time of such appointments or elections, as well as 
individuals newly appointed or elected, as constituting, on the date of 
such certification, the district board for the district.
    (4) For each district board certified under paragraph (3), the 
respective regional board shall select a time, date, and location 
within the district of such district board for the holding of the 
initial meeting of such new board, which date shall be not later than 
15 days after the date of such certification, and shall notify the 
members of such board appointed under this subsection and the residents 
of the district of the time, date, and location of such meeting.
    (d)(1) The National Health Board shall, for purposes of appointing 
worker members of regional boards, assign each district to one of two 
groups of districts within each region, each group having (to the 
extent possible) an equal number and balanced geographic distribution 
of districts.
    (2) Not later than 60 days after the initial meeting of each newly 
certified district board (held pursuant to subsection (c)(4))--
            (A) in the case of the first new certification of such a 
        board--
                    (i) user members of each such board shall appoint 
                two eligible users in the district, one of whom shall 
                serve a 4-year term as a user member of their 
                respective regional board and the other a 2-year term 
                on such board; and
                    (ii) worker members of each such board for a 
                district in the first group of districts (established 
                under paragraph (1)) shall appoint an eligible district 
                (or community, within the district) health worker to 
                serve a 4-year term as a worker member of their 
                respective regional board, and worker members of each 
                such board for a district in the second group of 
                districts shall appoint an eligible district (or 
                community, within the district) health worker to serve 
                a 2-year term on such board;
            (B) in the case of a subsequent new certification of such a 
        board--
                    (i) user members of each such board shall appoint 
                an eligible user for a 4-year term; and
                    (ii) worker members of each such board for a 
                district in a group of districts that did not appoint a 
                worker member to serve a 4-year term after the previous 
                certification shall appoint an eligible district (or 
                community, within the district) health worker to serve 
                a 4-year term; and
            (C) beginning with the first new certification of such a 
        board, and every 4 years thereafter, the eligible regional 
        health workers shall, in accordance with section 114(c)(2)(B), 
        elect an eligible regional healthworker to serve a 4-year term 
        as a worker member of their respective regional board.
The user and worker members of each such district board shall promptly 
notify the National Health Board of such appointments.
    (3) Not later than 15 days after the date a majority of the newly 
certified district boards within a region have notified the National 
Health Board of the appointment or election of individuals for their 
respective regional boards under paragraph (2), the National Health 
Board shall certify the users and workers whose term of office does not 
expire at the time of such appointments or elections, as well as 
individuals newly appointed or elected, as constituting, on the date of 
such certification, the regional board for the region.
    (4) For each regional board newly certified under paragraph (3), 
the previously certified regional board shall select a time, date, and 
location within the region for the holding of the initial meeting of 
such new board, which date shall not be later than 15 days after the 
date of such certification, and shall notify the members of such board 
appointed and approved under this subsection and the residents of the 
region of the time, date, and location of such meeting.
    (e)(1) Not later than 60 days after the initial meeting of each 
newly certified regional board, held pursuant to subsection (d)(4)--
            (A) in the case of the first new certification of such a 
        board--
                    (i) each such board for a region in the first group 
                of regions (established under section 117(a)) shall 
                appoint (subject to the approval of the President) an 
                eligible regional (or community or district, in the 
                region) health worker, and
                    (ii) each such board for any other region shall 
                appoint (subject to the approval of the President) an 
                eligible user in the region,
        to serve a 4-year term as a member of the National Health 
        Board; and
            (B) in the case of a subsequent new certification of such a 
        board occurring when the terms of office of members of the 
        National Health Board are expiring--
                    (i) each such board for a region in a group of 
                regions that has appointed an eligible user to serve as 
                a member of the National Board for the previous two 
                appointments under this subsection or section 117(b) 
                shall appoint (subject to the approval of the 
                President) an eligible regional (or community or 
                district, in the region) health worker, and
                    (ii) each such board for any other region shall 
                appoint (subject to the approval of the President) an 
                eligible user in the region,
to serve a 4-year term as a member of the National Health Board. Each 
such board shall promptly notify the National Health Board and the 
President of such appointment. The President shall approve or 
disapprove the appointment of such a member within the 10-day period 
beginning on the date of his notification of the appointment; and the 
appointment of such a member shall be considered as having been 
approved by the President unless he disapproves the appointment of the 
member within such time period.
    (2) No later than 15 days after the date a majority of the 
appointments under paragraph (1) by newly certified regional boards 
have been approved by the President, the National Health Board shall 
certify the individuals so approved as constituting, on the date of 
such certification, the National Health Board and shall promptly notify 
the President and Congress of such certification.
    (3) The previously certified National Health Board shall select a 
time, date, and location for the holding of the initial meeting of the 
new National Health Board, which date shall not be later than 15 days 
after the date of certification of such Board under paragraph (2), and 
shall notify the members appointed and approved under this subsection 
and the public of the time, date, and location of such meeting.

      modification of the boundaries of health care delivery areas

    Sec. 119. (a) No later than 2 years after each decennial national 
census, and at such other times as it deems necessary, the National 
Health Board shall review the appropriateness of the boundaries of each 
health care delivery region and may, in accordance with subsection (b), 
modify the boundary of any region in which there has been a substantial 
shift of population justifying such modification, if such modification 
is approved in a referendum of registered users residing in an area 
whose regional identification would be changed by making such 
modification.
    (b) At least 60 days before the modification by referendum of the 
boundary of any region, the National Health Board shall provide for--
            (1) notice in the area whose regional identification would 
        be changed by the modification of such boundaries--
                    (A) of existing boundaries and of the proposed 
                modification, and
                    (B) of the date, time, and location of the public 
                hearing on such modification, as required in paragraph 
                (2), and
            (2) a public hearing at which individuals can speak or 
        present written statements relating to the modification of such 
        boundaries.
    (c)(1) After the establishment of regional health boards under 
section 116--
            (A) no later than 2 years after each decennial national 
        census,
            (B) upon receipt of a petition for modification of a 
        boundary of a district or community within the region of such 
        board, which petition is signed by not less than 15 percent of 
        the registered users residing in an area whose district or 
        community identification would be changed by adoption of such 
        petition, and
            (C) at such other times as it deems appropriate,
each regional board shall review the appropriateness of the boundaries 
of districts and communities within its region.
    (2) Any review conducted under paragraph (1) shall comply with the 
procedures of subsection (d) (relating to open hearings and public 
participation).
    (3) A regional board, after reviewing the boundaries of a district 
or community within its region under paragraph (1), may modify the 
boundary of any such district or community if--
            (A) there has been a substantial shift of population 
        justifying such modification, or
            (B) such modification would better carry out the purposes 
        of this Act, and
if such modification is approved in a referendum, held after notice and 
a public hearing in accordance with subsection (d), of registered users 
residing in an area whose district or community identification would be 
changed by adoption of the proposed modification.
    (d) At least 60 days before the modification by referendum of the 
boundary of any district or community, the respective regional board 
shall provide for--
            (1) notice in the area whose district or community 
        identification would be changed by the modification of such 
        boundaries--
                    (A) of existing boundaries and of the boundaries 
                proposed to be modified, and
                    (B) of the date, time, and location of the public 
                hearing on such modification, as required in paragraph 
                (2), and
            (2) a public hearing at which individuals can speak or 
        present written statements relating to the modification of such 
        boundaries.

           Part C--General Provisions Regarding Health Boards

                              definitions

    Sec. 121. As used in this part, the term ``full member'' means, 
with respect to a health board, a member of such board other than an 
associate member described in section 122(a)(4).

                      membership of health boards

    Sec. 122. (a) Each health board shall be composed of--
            (1) members elected or appointed and approved in accordance 
        with this part B;
            (2) one member--
                    (A) in the case of a community board, appointed by 
                the occupational safety and health action council 
                established under section 412 for such community, and
                    (B) in the case of a regional board, appointed by 
                the occupational safety and health action council 
                established under section 413 for such region;
            (3) such voting user members as the members of the board 
        described in paragraphs (1) and (2) may determine from time to 
        time (in consultation with elements of the population from 
        which the members are being selected) to be necessary in order 
        to ensure that (1) the user members of the board approximate 
        the population within its area by race, sex, income level, and 
        language and (2) segments of the population having special 
        health needs (such as the physically and mentally handicapped 
        and the aged) are appropriately represented; and
            (4) such nonvoting associate members as the members of such 
        board may determine from time to time to be necessary to 
        provide appropriate representation of appropriate units of 
        State, territorial, and local government and of segments of the 
        population having special health needs; and in the case of the 
        Interim National Health Board and National Health Board, to 
        carry out the purposes of this Act.
    (b)(1) Except as provided in paragraph (2), no individual may serve 
as a full member of a health board in a community, district, or region, 
or of the National Health Board, for more than four consecutive years, 
exclusive of any time that might be served as a member by election or 
appointment (A) before the effective date of health services, (B) for a 
2-year term under section 118(b)(3)(A), 118(c)(2)(A), or 118(d)(2)(A), 
or (C) by appointment under subsection (d) to fill a vacancy.
    (2) Full members of a health board shall serve until their 
successors are certified in accordance with this Act.
    (c)(1)(A) Within 60 days of the date of the presentation to the 
appropriate regional board of a petition, signed by at least 15 percent 
of the number of registered users residing in a community or of 
eligible area health workers, requesting the recall of a user member or 
elected worker member, respectively, of a board elected and approved in 
accordance with this title, such regional board shall conduct an 
election on the recall of such member.
    (B) The provisions of section 114 (except for subsection (a) 
thereof) and procedures established thereunder regarding elections of 
user and worker members shall apply with respect to recall elections 
conducted under this paragraph, except that for the purposes of this 
paragraph, any reference in such section to an interim regional board 
or to the Interim National Health Board shall be considered as a 
reference to a regional board or to the National Health Board, 
respectively.
    (2) A member of a district or regional board or an interim regional 
board appointed in accordance with this title may be recalled from 
office by the affirmative vote of two-thirds of the members of the 
health board which appointed such member.
    (3) A member of the Interim National Health Board or National 
Health Board may be removed from office by the President for 
inefficiency, neglect of duty, malfeasance in office, or, in the case 
of the National Health Board, upon recommendation by the affirmative 
vote of two-thirds of the members of the regional board which nominated 
such member.
    (d)(1) A vacancy caused by the death, resignation, or removal of a 
member (hereinafter in this subsection referred to as a ``vacating 
member'') of a health board, elected or appointed in accordance with 
this title, before the expiration of the term for which such vacating 
member was elected or appointed, shall be filled not later than 60 days 
after the date of such vacancy--
            (A) in the case of a member of a community board, by 
        election of an eligible individual, in accordance with section 
        114 (except for subsection (a) thereof);
            (B) in the case of a member of a district or regional 
        board, an interim regional board, or the National Health Board, 
        by appointment or election and, in the case of the National 
        Health Board, Presidential approval of an eligible individual 
        by the health board or workers which appointed or elected such 
        vacating member; and
            (C) in the case of a member of the Interim National Health 
        Board, by appointment by the President.
    (2) Any individual appointed to fill a vacancy under this 
subsection shall serve only for the unexpired term of office of the 
vacating member.
    (3) For the purposes of this subsection, the term ``eligible 
individual'' means, with respect to filling the place of a vacating 
member, an individual who is eligible, under the applicable provisions 
of this Act, to serve on a health board in the capacity in which the 
vacating member was elected or appointed.

                 meetings and records of health boards

    Sec. 123. (a)(1) Each full member of a health board shall have one 
vote in meetings of such board.
    (2) A majority of the full members of each health board shall 
constitute a quorum for the transaction of the business of such board, 
and such board shall act upon the vote of a majority of the full 
members present and voting.
    (b)(1) Except as otherwise provided in this Act, the full members 
of each health board shall, at the first meeting following the 
certification of such board, elect a chairperson and vice chairperson 
from among the full members of such board.
    (2) The chairperson of each health board shall be responsible for 
convening meetings of such board and for such other duties as such 
board may assign. Upon the written request of two full members of such 
board, the chairperson shall convene a meeting of such board.
    (3) The vice chairperson shall perform the duties of the 
chairperson in the event that the chairperson is unable to perform such 
functions.
    (c)(1) Each health board shall provide for the recording of the 
minutes of each of its meetings and each of the meetings of its 
committees and advisory groups, and shall make such records available 
to the public for inspection and copying.
    (2) Meetings of each health board and each committee and advisory 
group thereof (except meetings that concern an individual user or 
health worker, and such individual requests that the meeting be closed) 
shall be open to the public and shall be held at such times and in such 
places as the board determines to be convenient to attendance by the 
public.
    (3) Each health board shall establish a principal office within the 
area it serves.
    (d) Each health board shall disseminate within the area it serves 
full information regarding its activities, including the furnishing of 
health care and supplemental services.
    (e)(1) Each health board may establish such rules, consistent with 
this Act, as it finds necessary for the effective and expeditious 
transaction of its duties and functions.
    (2) Each health board may establish such committees and advisory 
groups, and appoint to them such individuals (including health 
workers), as it deems necessary to carry out its duties and functions.
    (f)(1) A full member of the Interim National Health Board or 
National Health Board may receive compensation at a rate not to exceed 
the daily equivalent of the annual rate of basic pay in effect for 
grade GS-18 of the General Schedule for each day (including traveltime) 
during which the member is engaged in the actual performance of such 
member's duties plus reimbursement for travel, subsistence, and other 
necessary expenses incurred in the performance of such member's duties.
    (2) A full member of a health board, other than the Interim 
National Health Board of the National Health Board, may receive such 
amounts per diem when engaged in the actual performance of such 
member's duties, or such annual salary, plus reimbursement for travel, 
subsistence, and other necessary expenses incurred in the performance 
of such member's duties, as the appropriate National Health Board may 
establish.

   procedures for establishment of national guidelines and standards

    Sec. 124. (a) In addition to guidelines and standards otherwise 
required to be established by this Act, the National Health Board shall 
establish such guidelines and standards as will facilitate the 
implementation of the objectives of this Act and as will encourage 
innovation and experimentation in the implementation of these 
objectives.
    (b) The National Health Board shall submit, at least 90 days before 
the date of establishment of a guideline or standard under this Act, 
each such guideline or standard to regional boards for their review and 
comments.
    (c) The National Health Board and the regional boards shall 
establish programs that provide orientation, education, and technical 
assistance to members of area health boards in the use and application 
of guidelines and standards established by the National Health Board.

                assistance to area health board members

    Sec. 125. Each regional board shall provide orientation, education, 
and technical assistance to members of district and community boards in 
its region, and the appropriate National Health Board shall provide 
such support to members of regional boards, to insure that such members 
are prepared to perform their duties as members of such boards with 
maximum effectiveness.

      TITLE II--DELIVERY OF HEALTH CARE AND SUPPLEMENTAL SERVICES

            Part A--Patients' Rights in Health Care Delivery

                          basic health rights

    Sec. 201. The Service, in its delivery of health care services to 
users, shall ensure that every such individual is given the following 
basic health rights:
            (1) The right to receive high quality health care and 
        supplemental services without charge and without discrimination 
        on account of race, sex, age, religion, language, income, 
        marital status, sexual orientation, dress, or previous health 
        status.
            (2) The right to humane, respectful, dignified, and 
        comforting health care, and to the reduction of pain and 
        distressful symptoms.
            (3) The right to have health care services delivered in a 
        convenient and timely manner.
            (4) The right to choose the health workers who shall be 
        responsible for, and the health facilities in which to receive, 
        the individual's health care services.
            (5) The right of access to all information, including the 
        individual's health records and the medical dictionary produced 
        under section 433(b), which promotes an understanding of 
        health, except when a review committee (the majority of whose 
        members are users) established by the area health board 
        maintaining the information has determined that the provision 
        of the specific information would be harmful to the individual.
            (6) The right to have all health care information, reports, 
        and educational materials translated into the individual's 
        primary language.
            (7) The right to receive, prior to the delivery of any 
        health care service, a careful, prompt, and intelligible-- 
                    (A) explanation of the indications, diagnoses, 
                benefits, side-effects, and risks involved in the 
                delivery of such service, and a description of 
                alternatives to such service (including no treatment);
                    (B) answer to any question relating to such health 
                care service; and
                    (C) explanation of one's health rights described in 
                this part, and
        the right to have such health care service delivered only with 
        the individual's prior, voluntary, written consent.
            (8) The right to refuse the initial or continuing delivery 
        of any health care service whenever such refusal does not 
        directly endanger the public health or, in accordance with 
        State law, of the individual if the individual is dangerous to 
        himself or herself.
            (9) The right to have all individually identifiable 
        information and documents treated confidentially and not 
        disclosed (except for statistical purposes and for the control 
        of communicable diseases, drug abuse, and child abuse) without 
        the individual's prior, voluntary, and written consent.
            (10) The right of access at all times to individuals or 
        groups for counseling, health information, and assistance on 
        health matters.
            (11) The right to be accompanied and visited at any time by 
        a friend, relative, or independent advocate of the individual's 
        choosing, and the right to have routine services, such as 
        feeding, bathing, dressing, and bedding changes, performed by a 
        friend or relative, if the individual so chooses.
            (12) The right, in the event of terminal illness, to die 
        with a maximum degree of dignity, to be provided all necessary 
        symptom relief, to be provided (and for the individual's family 
        to be provided) counseling and comfort, and to be allowed (if 
        desired) to die at home.
            (13) The right of access to a complaint and grievance 
        system and to legal assistance to enforce these rights.

          right to paid leave to receive health care services

    Sec. 202. (a) The Fair Labor Standards Act of 1938 is amended by 
inserting after section 7 (29 U.S.C. 207) the following new section:

                  ``minimum health leave compensation

    ``Sec. 7A. Each employee of any employer who in any workweek is 
engaged in commerce or in the production of goods for commerce, or is 
employed in an enterprise engaged in commerce or in the production of 
goods for commerce, shall be entitled to receive from the employer, for 
each 35 hours he is employed by the employer (not counting more than 35 
hours in any workweek), compensation for one hour of employment at the 
regular rate at which the employee is employed (as that term is used in 
section 7 of this Act) for an hour (1) during the period of 52 weeks 
beginning with the workweek with which the entitlement is earned, and 
(2) during which the employee is unable to work because of the need for 
the employee (or a dependent of that employee) to receive necessary 
health care services.''.
    (b) The Fair Labor Standards Act of 1938 is further amended-- 
            (1) by striking out ``sections 6 and 7'' in section 3(o) 
        and inserting in lieu thereof ``sections 6, 7, and 7A'';
            (2)(A) by striking out ``and 7'' in section 13(a) before 
        paragraph (1) and inserting in lieu thereof ``, 7, and 7A'';
            (B) by striking out ``sections 6 and 7'' in section 
        13(a)(3) and inserting in lieu thereof ``sections 6, 7, and 
        7A'';
            (C) by inserting ``7A,'' in subsections (d) and (f) of 
        section 13 after ``7,'' each place it appears;
            (3) by striking out ``6 and 7'' in section 14(d) and 
        inserting in lieu thereof ``6, 7, and 7A'';
            (4) by striking out ``section 6 or section 7'' in section 
        15(a) and inserting in lieu thereof ``section 6, 7, or 7A'';
            (5)(A) by striking out ``section 6 or section 7'' in 
        section 16(b) and inserting in lieu thereof ``section 6, 7, or 
        7A'';
            (B) by striking out ``or their unpaid overtime 
        compensation'' in section 16(b) and inserting in lieu thereof 
        ``their unpaid overtime compensation, or their unpaid health 
        leave compensation'';
            (C) by inserting ``or of unpaid health leave compensation'' 
        in section 16(b) after ``amount of unpaid overtime 
        compensation'';
            (D) by striking out ``section 6 or 7'' in the first 
        sentence of section 16(c) and inserting in lieu thereof 
        ``section 6, 7, or 7A'';
            (E) by striking out ``unpaid overtime compensation'' in the 
        first sentence of section 16(c) and inserting in lieu thereof 
        ``, unpaid overtime compensation, or unpaid health leave 
        compensation'';
            (F) by striking out ``or overtime compensation'' in the 
        second sentence of section 16(c) and inserting in lieu thereof 
        ``, overtime compensation, or health leave compensation'';
            (G) by striking out ``or unpaid overtime compensation under 
        sections 6 and 7'' in the third sentence of section 16(c) and 
        inserting in lieu thereof ``, unpaid overtime compensation, or 
        unpaid health leave compensation under sections 6, 7, and 7A'';
            (6)(A) by inserting ``or minimum health leave compensation 
        higher than the minimum health leave compensation established 
        under this Act'' in the first sentence of section 18(a) before 
        ``, and no provision''; and
            (B) by inserting ``, or justify any employer in reducing 
        health leave compensation provided by him which is in excess of 
        the applicable minimum health leave compensation under this 
        Act'' before the period at the end of the second sentence of 
        section 18(a).

 Part B--Eligibility for, Nature of, and Scope of Services Provided by 
                              the Service

                        eligibility for services

    Sec. 211. (a) All individuals while within the United States are 
eligible to receive health care and supplemental services under this 
Act.
    (b) For purposes of this section, the term ``United States'' 
includes Indian reservations, the District of Columbia, the 
Commonwealth of Puerto Rico, the Virgin Islands, Guam, Samoa, and the 
Northern Mariana Islands.

                        entitlement to services

    Sec. 212. (a) Except as provided in subsection (b), the Service 
shall, on and after the effective date of health services, provide 
users with all health care services and supplemental services described 
in section 213 which the Service determines, in accordance with this 
title, to be necessary or appropriate for the promotion and enhancement 
of health, for the prevention of disease, and for the diagnosis and 
treatment of, and rehabilitation following, injury, disability, or 
disease.
    (b) Services provided under this Act shall not include personal 
comfort or cosmetic services unless the area health board providing the 
services determines that the services are required for health-related 
reasons.

           provision of health care and supplemental services

    Sec. 213. (a) The Service shall provide in the United States the 
following health care services in or through facilities established by 
the Service--
            (1) the promotion of health and well-being through health 
        education programs to be carried out in facilities of the 
        Service as well as in workplaces, schools, and elsewhere 
        utilizing all appropriate media, and by assisting other 
        Government agencies in taking appropriate actions to promote 
        health and well-being;
            (2) the prevention of illness, injury, and death through 
        education and advocacy addressed to the social, occupational, 
        and environmental causes of ill-health; through the provision 
        of appropriate preventive services including social, medical, 
        occupational, and environmental health services, on both an 
        emergency and sustained basis; through screening and other 
        early detection programs to identify and ameliorate the primary 
        causes of ill-health; and, where appropriate, through actions 
        taken on an emergency basis to halt environmental threats to 
        life and health;
            (3) the diagnosis and treatment of illness and injury, 
        including emergency medical services, comprehensive outpatient 
        and inpatient health care services, occupational health 
        services, mental health services, dental care, long-term care, 
        and home health services;
            (4) the rehabilitation of the sick and disabled, including 
        physical, psychological, occupational, and other specialized 
        therapies; and
            (5) the provision of drugs, therapeutic devices, 
        appliances, equipment, and other medical supplies (including 
        eyeglasses, other visual aids, dental aids, hearing aids, and 
        prosthetic devices) certified effective in the National 
        Pharmacy and Medical Supply Formulary (published under section 
        432(a)) and furnished or prescribed by authorized health 
        workers.
The Service may not provide such health care services in a region, 
district, or community other than under the auspices of a regional, 
district, or community board established in accordance with this Act.
    (b) The Service shall provide the following services supplemental 
to the delivery of health care services in or through health care 
facilities established by the Service--
            (1) ambulance and other transportation services to insure 
        ready and timely access to necessary health care;
            (2) child care services for individuals who, during the 
        time they receive outpatient health care services from the 
        Service or are working in a health care facility of the 
        Service, are responsible for a child's care; and
            (3) homemaking and home health services--
                    (A) to enable the provision of inpatient health 
                services at a health care facility of the Service to an 
                individual who has the sole responsibility for the care 
                (i) of a child under 15 years of age, or (ii) of a 
                physically or mentally handicapped individual who 
                requires the care of another individual, and
                    (B) for the bedfast or severely handicapped 
                individual, when provision of such services eliminates 
                the need for the individual to receive inpatient 
                services; and
            (4) such counseling and social service assistance as will 
        avoid the unnecessary provision of health care services.
    (c) The Service shall conduct the functions, especially those 
related to environmental health and the prevention of illness, 
currently performed by the departments of health of the States and 
localities, to the extent consistent with Federal, State, and local 
law, and shall cooperate with State and local governments in its 
conduct of such functions.
    (d) The Service shall provide, at rates established by the National 
Health Board, for reimbursement of the cost of emergency health care 
services furnished in facilities not operated by the Service or by 
health workers not employed by the Service, when an injury or acute 
illness requires immediate medical attention under circumstances making 
it medically impractical for the ill or injured individual to receive 
care in a Service facility or by an employee of the Service.

  Part C--Health Care Facilities and Delivery of Health Care Services

establishment of health care facilities and distribution of delivery of 
                     health care and other services

    Sec. 221. (a)(1) Each community board shall, not later than the 
effective date of health services and to the maximum extent feasible, 
establish and maintain in its community such health care facilities as 
are necessary for the efficient and effective delivery to individuals 
residing in its community of comprehensive primary health care services 
(defined in paragraph (2)), specialized health care services (defined 
in paragraph (3)), special services (defined in paragraph (4)) and 
community-oriented health measures (defined in paragraph (5)). Such 
health care facilities shall be established and maintained in a manner 
that, as soon as possible and to the greatest extent feasible, provides 
services through a single comprehensive health center.
    (2) As used in paragraph (1), the term ``comprehensive primary 
health care services'' means those basic outpatient health care 
services typically needed for the promotion of health and the 
prevention and treatment of common illnesses and includes the following 
health care services--
            (A) general primary medical and dental care, including 
        diagnosis and treatment, routine physical examinations, 
        laboratory, and radiologic services, and home visits by health 
        workers, as appropriate;
            (B) preventive health services, including immunizations, 
        nutrition counseling and consultation, and periodic screening 
        and assessment services;
            (C) children's health services, including assessment of 
        growth and development, education and counseling on 
        childrearing and child development, and school and day-care 
        center health services;
            (D) obstetrical and gynecological services, including 
        family planning and contraceptive services, pregnancy (prenatal 
        and postnatal) and abortion counseling and services;
            (E) comprehensive geriatric services;
            (F) vision and hearing examinations and provision of 
        eyeglasses and other visual aids and hearing aids;
            (G) 24-hour emergency medical services;
            (H) provision of pharmaceuticals and therapeutic devices, 
        and medical appliances and equipment;
            (I) mental health services, including psychological and 
        psychiatric counseling;
            (J) home health services; and
            (K) occupational safety and health services, including 
        screening, diagnosis, treatment, and education.
    (3) As used in paragraph (1), the term ``specialized health care 
services'' means those health care services of a specialized nature 
(whether delivered in an inpatient or outpatient setting) which, 
applying guidelines established by the National Health Board and by the 
respective regional board, may be provided most effectively and 
efficently in a community setting.
    (4) As used in paragraph (1), the term ``special services'' means 
supportive services and the facilities (including nursing homes and 
multiservice centers) in which such services are provided for 
individuals who are physically or mentally handicapped, mentally ill, 
infirm, or chronically ill, so as to promote the integration and 
functioning of such individuals within the community.
    (5) As used in paragraph (1), the term ``community-oriented health 
measures'' includes efforts to focus organized community activities 
upon the promotion of health and the prevention of illness and injury, 
support for self-help and mutual aid groups offering health promotion 
and rehabilitative support programs; surveillance of potential threats 
to community health, and prompt action to protect against such threats, 
and includes outreach efforts to ensure that all residents are aware of 
and able to utilize the health services of the Service, as needed.
    (b) Each district board shall, not later than the effective date of 
health services, establish and maintain in its district--
            (1) a general hospital for the efficient and effective 
        delivery of health care services to individuals residing in the 
        district requiring inpatient diagnosis, treatment, care, and 
        rehabilitation for injury or illness; and
            (2) such other health care facilities as are necessary, 
        using guidelines established by the National Health Board and 
        by the respective regional board, to promote the efficient and 
        effective delivery of health care services within its district.
In addition, each district board shall provide such health care 
services of a specialized nature (whether delivered in an inpatient or 
outpatient setting) as, taking into account guidelines established by 
the National Health Board and its respective regional board, may be 
provided most effectively and efficiently at the district level.
    (c) Each regional board shall, not later than the effective date of 
health services, establish and maintain in its region--
            (1) a regional medical facility for the efficient and 
        effective delivery of highly specialized health care services, 
        using guidelines established by the National Health Board, to 
        individuals residing in the region requiring highly specialized 
        treatment, care, and rehabilitation for injury or illness;
            (2) health care and supplemental services for individuals 
        whose health care needs otherwise cannot be met by community or 
        district boards because of occupational or other factors, 
        including individuals residing within the region on a temporary 
        or seasonal basis (including migratory agricultural workers) 
        and individuals confined to prisons and other correctional 
        institutions; and
            (3) such other health care facilities as are necessary to 
        promote the efficient and effective delivery of health care 
        services within its region.
    (d) Each area health board, taking into account guidelines 
established by the National Health Board, shall provide the following 
through its health care facilities established pursuant to this 
section:
            (1) Health promotion through education on personal health 
        matters, nutrition, the avoidance of illness, and the effective 
        use of health care services with particular emphasis on the 
        appropriate and safe use (discouraging the overuse) of drugs 
        and medical techniques.
            (2) Maintenance and appropriate transmission and 
        transferral of personal health records for each user of the 
        services of the board consistent with section 201(9).
            (3) Referral services, including referrals, where 
        appropriate, to health care facilities established by other 
        boards.
            (4) Supplemental services (described in section 213(b)), as 
        appropriate.
            (5) Assistance to individuals who, because of language or 
        cultural differences or educational or other handicaps, are 
        unable fully to utilize the services available from and 
        delivered by the board.
            (6) Information (A) on the rights ensured under this Act, 
        (B) on the guidelines and standards established by the 
        appropriate National Health Board, and (C) on how the area 
        health board is implementing such rights and applying such 
        guidelines and standards.
            (7) Information on the grievance mechanisms established 
        pursuant to part A of title IV and on legal services available 
        to pursue grievances against the board.
            (8) Environmental health inspection and monitoring 
        services, including investigations relating to the prevention 
        of communicable diseases, in cooperation with State and local 
        authorities in the board's area.
            (9) Research and data-gathering on the leading causes of 
        ill-health in the board's area and on health care delivery, in 
        accordance with section 421.
            (10) In the case of each inpatient health care facility, 
        discharge planning and followup services (A) to identify 
        patients who will need continuing care after discharge from the 
        facility and (B) to plan, with the patient and the patient's 
        family, arrangements and referrals to meet such postdischarge 
        needs.
    (e)(1) Each area health board shall, in establishing health care 
facilities under this section, hire health workers (including 
administrative personnel) in sufficient numbers and with appropriate 
qualifications to ensure that such facilities provide the health care 
and other services described in this section.
    (2) In its establishment of health care facilities under this 
section, each area health board shall purchase or lease such premises 
as it deems necessary and suitable, utilizing, where appropriate, 
existing health facilities, including health centers and clinics, 
hospitals, nursing homes, and medical laboratories.
    (3) In its establishment of health care facilities under this 
section, each area health board shall seek to minimize fragmentation 
and duplication in delivery of health care and other services so as to 
promote the effective and efficient delivery of such services.
    (4) Each regional board, taking into account guidelines established 
by the National Health Board, shall provide for affiliation and 
coordination of the operation and staff of the health care facilities 
in its region with the operation and staff of other appropriate health 
care facilities established within the region such board serves and 
within adjacent regions.
    (f) The National Health Board shall establish guidelines for 
distribution and coordination of the delivery of health care and other 
services described in this section and shall, before the effective date 
of health services, plan and facilitate the transition to the new 
distribution of health care facilities and health workers to be 
effected on and after that date.
    (g) In the case that a community or district board fails, on the 
effective date of health services, to substantially and materially 
provide health care and supplemental services in accordance with this 
section, its respective regional board shall take such steps as it 
deems necessary, consistent with the provisions of section 402 
(relating to grievance proceedings), to provide health care and 
supplemental services to users in the community or district affected. 
Such steps may include, in addition to appointment of a trustee or 
trustee committee under section 402(d)(3)(D)--
            (1) requiring that the community or district board in an 
        adjacent community or district provide such services to users 
        residing in the community or district affected, or
            (2) providing reimbursement for the provision of specified 
        health care services in accordance with procedures and 
        schedules in effect under title XVIII of the Social Security 
        Act immediately before the effective date of health services 
        (except that only users in the affected community or district 
        shall be considered as entitled to receive such specified 
        services under such title).
Paragraph (2) shall not apply on and after three years after the 
effective date of health services.

           operation and inspection of health care facilities

    Sec. 222. (a)(1) Each health board, with respect to each health 
care facility it has established, shall establish policies and 
organizational plans consistent with this section and with parts A and 
C of title III (relating to the health labor force) for the operation 
of such facility and shall establish procedures to ensure that the 
facility is operated in accordance with such policies and plans.
    (2) In establishing, implementing, and modifying such policies and 
plans, each health board shall seek the fullest possible participation 
of health workers who are employed in, and users who receive health 
care services from, health care facilities affected by such policies 
and plans.
    (3) If a health board that has established more than one health 
care facility determines that it cannot itself effectively manage the 
operation of all such facilities or if a facility serves principally a 
population with special health needs which is not appropriately 
represented on the health board, the health board may provide for the 
establishment of a health care facility board or boards, composed of 
users and health workers (or representatives of users or workers of a 
facility or facilities) in an appropriate number and in a proportion 
approximating that on the health board, to assume the duties of the 
health board with respect to the operation of the facility or 
facilities involved.
    (b) Such policies and plans shall provide for--
            (1) the management of each facility by the workers in such 
        facilities through mechanisms which provide full participation 
        of health workers of all job categories and skill levels 
        employed in such facility;
            (2) the elimination of dominance by health professionals 
        and the encouragement of cooperation and mutual respect among 
        all health workers; and
            (3) regular accountability of the health workers to the 
        health board which established the facility for the efficient 
        and effective operation of the facility.
    (c)(1) On and after 3 years after the effective date of health 
services, a health board may not permit a health care facility it has 
established to be used for the private delivery of inpatient or 
outpatient health care services.
    (2) No individual employed by a health board may engage in the 
private delivery of health care services.
    (3) For the purposes of this subsection, the term ``private 
delivery of health care services'' means the delivery of health care 
services for which an individual, group, or organization receives 
remuneration from any source other than the Health Service Trust Fund 
established in section 511.
    (d) Each health board shall ensure that any health care facility 
that it operates which provides health care services on an outpatient 
basis is open during hours that will permit all users to make use of 
such services.
    (e)(1) Each health board shall ensure that any health care facility 
that it operates which provides (or is designed to provide) substantial 
health care services on an inpatient basis to individuals over a 
continuous period of 30 days or longer--
            (A)(i) provides comfortable living quarters for inpatients 
        that are clean and adequately heated, cooled, and ventilated;
            (ii) provides adequate staff for its inpatients;
            (iii) provides nutritional food for its inpatients;
            (iv) provides inpatients with opportunities for creative 
        activity and recreation;
            (v) establishes and maintains a review committee in 
        accordance with paragraph (2); and
            (vi) informs an inpatient of all decisions involving the 
        inpatient's health and well-being and permits the inpatient 
        (and the review committee upon the inpatient's request) to 
        participate fully in such decisions;
            (B) and does not--
                    (i) censor or harass communication between an 
                inpatient and others by telephone, letter, or in 
                person;
                    (ii) confiscate personal property of an inpatient, 
                unless possession of such property would interfere with 
                the provision of health care;
                    (iii) deny an inpatient the social and sexual life 
                of such individual's preference;
                    (iv) require that an inpatient work;
                    (v) pay an inpatient less than minimum wage for 
                work performed while receiving health care services;
                    (vi) physically restrain an inpatient involuntarily 
                for a period exceeding 72 hours without the facility's 
                review committee (described in paragraph (2)) 
                determining, within 72 hours of its initiation and not 
                less often than every 2 weeks during which such 
                restraint is continued, that such restraint is required 
                for the physical safety of the inpatient or of others; 
                or
                    (vii) take punitive or discriminatory action 
                (including transfer between or within facilities, 
                changes in physical comforts and diets, changes in 
                opportunities for social interaction and communication, 
                or restriction of full participation in recreational 
                and creative activities) without the prior approval, 
                and renewed approval not less often than every week 
                thereafter, of the facility's review committee 
                (described in paragraph (2)).
    (2)(A) Each health board shall provide that at least once each year 
the inpatients at that time of each health care facility it operates 
which provides (or is designed to provide) health care services on an 
inpatient basis to individuals over a continuous period of 30 days or 
longer shall elect, from among themselves and any representatives of 
user associations which have a demonstrated interest in the care of 
such inpatients, a review committee (hereinafter in this paragraph 
referred to as the ``committee'') of not less than 3 members.
    (B) Any member of the committee may be recalled by a vote of two-
thirds of the number of inpatients in the facility.
    (C) In any election or recall under this paragraph any inpatient 
who is not able to vote for any reason shall be permitted to appoint 
another individual to vote as proxy.
    (f) In order to assure that quality care is provided in health care 
facilities of the Service--
            (1) each area health board shall conduct regular 
        inspections of health care facilities it has established,
            (2) each regional board shall conduct regular inspections 
        of district and community health care facilities established in 
        its region, and
            (3) the National Health Board shall conduct regular 
        inspections of area and national health care facilities,
and the results of such inspections of a facility shall be reported to 
the appropriate area health board and users of the facility and shall 
be made available to the public.

provisions of health services relating to reproduction and childbearing

    Sec. 223. (a)(1) Area health boards, as appropriate, shall provide 
the following services:
            (A) Complete information on contraception and provision of 
        birth control materials or medication of the individual's 
        choosing.
            (B) Complete and effective evaluation and treatment of 
        venereal diseases and diseases of the reproductive organs.
            (C) Complete information and counseling with respect to 
        pregnancy, childbearing, and possible outcomes involving 
        genetically induced anomalies.
    (2) Area health boards, as appropriate, shall provide the following 
services:
            (A) Complete and effective pregnancy testing.
            (B) Prenatal services, including physical examination, 
        counseling, and instruction of expectant parents in nutrition, 
        childrearing, and children's health care services.
            (C) Safe, comfortable, and convenient abortion services.
            (D) Counseling by women in conjunction with the provision 
        of all gynecologic, female contraceptive, and abortion services 
        and counseling by men for male fertility-related services.
    (3) The services described in paragraphs (1) and (2) shall be 
delivered without coercion or harassment, with complete 
confidentiality, and without prior approval of individuals other than 
the individual receiving the services.
    (4) An individual shall be permitted to be accompanied by a person 
of the individual's choice during the provision of the services 
described in paragraphs (1) and (2) to the extent this would not 
significantly increase the medical risk to the individual.
    (b) No area health board may perform upon an individual a treatment 
or procedure (other than a treatment or procedure required to preserve 
the life of the individual) which could reasonably be expected to 
affect the individual's capacity to reproduce children, unless (1) the 
individual has given voluntary written consent to the treatment or 
procedure after being given complete information on the effect of the 
treatment or procedure on the individual's reproductive capacity, and 
on possible alternative treatments and procedures, at least 30 days 
before beginning the treatment or procedure, and (2) the individual 
has, after such 30-day waiting period, again given written consent to 
the performance of the treatment or procedure, except that in the case 
of a woman who has given initial written consent to a sterilization she 
may be sterilized in less than 30 days following such consent (but in 
no case in less than 72 hours) if (A) she had given initial written 
consent at least 30 days before her anticipated delivery date, she 
delivers before the anticipated date, and the sterilization is 
performed at the time of delivery, or (B) she undergoes emergency 
abdominal surgery within the 30-day waiting period and the 
sterilization is concurrent with the abdominal surgery.
    (c) An area health board shall insure that, before a mastectomy or 
other breast cancer treatment is performed on a woman, the woman shall 
be provided with complete information on the complete range of medical 
options available for treatment of her condition and the risks and side 
effects of each option and an opportunity to consult individuals of her 
choice, and shall have given voluntary written consent to such 
procedure.
    (d) An area health board shall provide that a woman giving birth to 
an infant shall have the right to choose from a complete range of 
childbirth options including--
            (1) giving birth at home, in a birth center (if available), 
        or in a hospital;
            (2) the presence during childbirth of a person or persons 
        of her choosing;
            (3) the position for labor and delivery which she chooses;
            (4) caring for her infant at her bedside;
            (5) feeding her infant according to the method and schedule 
        of her choice; and
            (6) selecting the birth attendant of her own choice.
She shall be provided with information on the benefits, risks, and side 
effects of each option and an opportunity to consult individuals and 
groups of her choosing for information and assistance on these options.

                     TITLE III--HEALTH LABOR FORCE

                Part A--Job Categories and Certification

                          effect of state law

    Sec. 301. Notwithstanding any law of a State or political 
subdivision to the contrary, the Service, acting in accordance with the 
provisions of this Act, shall be the sole judge of the qualifications 
of its employees.

                    qualifications of health workers

    Sec. 302. (a) Each area health board shall, taking into account 
guidelines established by the National Health Board, establish 
procedures which will ensure that, except in emergency situations, any 
work which is classified under a job category established under this 
part is performed by a health worker who at the time of such work was 
(1) certified (in accordance with this part) as competent to perform 
the work under such job category, and (2) authorized to perform such 
work by the area health board which employs such worker.
    (b) Each area health board that employs health workers who perform 
work classified under a job category established under this part shall 
provide for the periodic review and assessment of the competency of 
such workers to perform the work within such job category, and shall 
provide opportunities for health workers to be assessed and certified 
with respect to skills required for advancement to other job 
categories.
    (c) In order to assure that health workers provide high quality 
health care services in the Service--
            (1) each regional board shall provide for periodic review 
        and assessment of the performance of health workers employed by 
        district and community boards in its region, and
            (2) the National Health Board shall provide for periodic 
        review and assessment of the performance of health workers 
        employed by regional boards and the National Health Board,
and the results of such examinations of health workers shall be 
reported to the appropriate area health board and the users residing in 
the areas in which the health workers are employed and shall be made 
available to the public.

      establishment of job categories and certification standards

    Sec. 303. (a)(1) The National Health Board shall establish such 
guidelines for the classification, certification, and employment of 
health workers by job category as it determines to be necessary (A) to 
ensure that health workers who perform work for the Service which 
requires specialized skills have demonstrated that they possess such 
skills, (B) to expand the roles of health workers to enable them to 
participate in health care delivery to the maximum extent consistent 
with their skills, and (C) to provide for affiliation of health workers 
with health care facilities at the community, district, and regional 
levels. These guidelines shall permit alternative approaches to 
healing, and practitioners skilled in such approaches, when these 
approaches have not been demonstrated to be injurious to health.
    (2) In establishing guidelines under paragraph (1), the National 
Health Board shall provide for (A) sufficient flexibility to permit 
regional health boards to utilize health workers most effectively to 
meet the health needs of the region, and (B) sufficient uniformity to 
permit mobility of health workers among the regions.
    (3) In establishing guidelines under paragraph (1)(C), and as 
appropriate to the job responsibilities of the respective health 
workers, the National Health Board shall require that each health 
worker employed by a community board must work part of the time in a 
health care facility operated by the respective district or regional 
board, and that each health worker (including the faculty of health 
team schools) employed by a district or regional board must work part 
of the time in a health care facility operated by a community board 
within the district or region.
    (4) The National Health Board shall periodically evaluate the job 
categories and certification practices established by area health 
boards under this section and shall make such modifications to its 
guidelines as it determines will promote the delivery of quality health 
care services.
    (5) The National Health Board shall assist regional boards in 
applying the guidelines established under this subsection.
    (b)(1) For each job category (other than a job category determined 
by the National Health Board to involve highly specialized skills 
requiring advanced specialty training), each regional health board 
shall, taking into account the guidelines established under subsection 
(a), establish certification standards which shall specify--
            (A) the functions performed by a healthworker employed in 
        such job category;
            (B) the skills required in the course of properly 
        performing work under such job category;
            (C) the initial and continuing training, experience, and 
        performance which must be undertaken or demonstrated by a 
        health worker to achieve and maintain competency to perform the 
        work within such job category; and
            (D) the curriculum which a health worker must follow in 
        studies in a health team school (established under part B) to 
        demonstrate sufficient competence to satisfy the specification 
        of subparagraph (C) for such job category.
Each area health board within the region shall apply such standards to 
all health workers employed by it. In applying such standards, such 
boards shall recognize health worker training, experience, and 
performance undertaken or demonstrated before the establishment of 
health team schools under part B, subject to such periodic review and 
assessment and to such continuing training, experience, or performance 
as may be required under this part.
    (2) For each job category established and determined by the 
National Health Board to involve highly specialized skills requiring 
advanced specialty training, the National Health Board shall make the 
specifications described in subparagraphs (A) through (D) of paragraph 
(1), and area health boards shall apply such certification standards to 
all health workers employed by them in such job categories.
    (3) A health board which establishes standards for a job category 
under this subsection shall periodically review such standards and 
shall supplement, modify, or eliminate such standards as it determines 
will facilitate the delivery of quality health care services under this 
Act.

                  Part B--Education of Health Workers

                          health team schools

    Sec. 311. (a)(1) Except as provided in paragraph (2), each regional 
board, in consultation with the community and district boards in its 
region, shall establish a health team school (hereinafter in this part 
referred to as a ``school'') in accordance with this section to provide 
programs of initial and continuing basic education in health care 
delivery for health workers in all job categories, and to provide 
initial continuing advanced education in health care specialties and 
health science specialty fields. Each school shall be established and 
functioning not later than 4 years after the effective date of health 
services unless the National Health Board approves a plan, submitted by 
the regional board, for the establishment of a school within a 
reasonable time after such deadline.
    (2) If a regional board determines, after consultation with the 
community and district boards in its region, that conducting particular 
educational programs within a school in its region would be inefficient 
or otherwise inappropriate, it may collaborate with one or more 
regional boards for adjacent regions conducting joint educational 
programs. In the case of the establishment of such a joint program, all 
further references in this part to a region or a regional board with 
respect to a school offering a joint program shall refer to the regions 
included within, and the regional boards offering, the joint program.
    (3) Schools shall be funded exclusively by the Service, shall not 
charge nor accept tuition or fees for enrollment, and shall provide 
each student with an adequate allowance for living expenses, 
educational supplies, and any child care expenses.
    (4) The National Health Board shall assist regional boards in the 
establishment and maintenance of schools.
    (b) Schools shall be operated and maintained in accordance with the 
following principles:
            (1) The activities of each school shall be designed to meet 
        the health needs of the region, districts, and communities 
        which it serves.
            (2) The number of students enrolled in each educational 
        program in a school shall be based on the regional, district, 
        and community boards' assessments of the needs for health 
        workers within such region, districts, and communities.
            (3) Schools shall integrate the education of health workers 
        in the different job categories (established under part A) so 
        as to permit health workers to be educated and certified for 
        successively higher levels of health care work.
            (4) Each school's admissions policies, curriculum policies, 
        faculty hiring procedures, and governance plan shall be 
        established and implemented by the regional board in accordance 
        with subsections (c) through (f), respectively, and with the 
        fullest possible participation of the community and district 
        boards, health workers, staff, and students in its region.
            (5) A school may not use individuals who are from low-
        income populations or minority groups, or who are women or 
        confined in mental or penal institutions, as subjects for 
        training or demonstration in numbers that are disproportionate 
        to their numbers in the population of the region, and may not 
        use any individuals as subjects for training or demonstration 
        in a manner beyond that required for the immediate purpose of 
        the training or demonstration.
The National Board shall establish, not later than one year after the 
effective date of health services, guidelines for the application of 
these principles and for the phased integration of health worker 
education programs, including medical, dental, osteopathic, and nursing 
school programs, in existence on the date of enactment of this Act into 
the schools established under this section.
    (c) Each regional board shall establish and implement admissions 
policies for education programs in its school. Such policies shall--
            (1) emphasize previous health-related work experience, as 
        evaluated by health workers (including peers), by individuals 
        who have received health care services from the applicant, and 
        by faculty members;
            (2) minimize the use of criteria of academic performance 
        other than such criteria as have been shown to be significantly 
        related to future work performance;
            (3) give preference to segments of the population of the 
        region under-represented among health workers;
            (4) to the extent consistent with paragraph (3), provide 
        for admission of individuals so that the student body 
        approximates the population of the region by race, sex, family 
        income, and language; and
            (5) require that the applicant agree, if accepted into the 
        school, to perform health care services in accordance with 
        section 312.
    (d) Each regional board shall establish and implement curriculum 
policies for educational programs in its school. Such policies shall--
            (1) give priority in study and field work to the leading 
        causes of illness and death in the region, including 
        environmental, biological, and social determinants of mortality 
        and morbidity;
            (2) give special consideration to studying the social, as 
        well as biological, causation and prevention of illness and 
        disease, and to the differing health care needs of populations 
        facing special health risks and having special cultures and 
        lifestyles within the region;
            (3) provide that all students shall take a common, initial 
        sequence of courses and that students preparing for more 
        advanced types of health work shall take studies that are 
        progressively more specialized and differentiated;
            (4) emphasize work-study experience in all types of health 
        care facilities in the region, including community and 
        workplace facilities, facilities for the aged, mentally ill, 
        and mentally retarded, health care facilities in prisons and 
        other correctional institutions, alcohol and drug 
        rehabilitation facilities, environmental health facilities, and 
        all other health care facilities of the Service in communities 
        and districts in the region;
            (5) emphasize the appropriate and safe use, and discourage 
        the overuse, of drugs and medical techniques; and
            (6) facilitate the development by all health workers of 
        skills in decisionmaking and assessment of patient needs in 
        cooperation with other health workers and with patients.
    (e) Each regional board shall establish and implement faculty 
hiring procedures for its school. Such procedures shall, to the maximum 
extent feasible, create a faculty which approximates the population of 
the region by race, sex, and language.
    (f) Each regional board shall establish and implement a governance 
plan for the management of its school. Such plan shall give significant 
decisionmaking powers to staff and students of the school.

                          service requirement

    Sec. 312. (a)(1) No individual may be enrolled by a regional board 
in a school unless the individual agrees to perform health care 
services as an employee of the Service in the job category for which 
training is being provided (A) for a period of time equal to the period 
of such enrollement in the school but not less than 2 years, (B) 
beginning not later than 1 year after the date of the individual's 
graduation from the school, and (C) for an area health board with the 
highest priority ranking under subsection (c) that agrees to employ the 
individual.
    (2) An individual's obligation to perform service under an 
agreement described in paragraph (1) shall be deferred only for a 
period during which the individual is physically or mentally incapable 
of performing such service.
    (3) No health board may employ an individual who has made an 
agreement described in paragraph (1), other than in accordance with 
subsection (c), until the individual has completed the period of 
obligated service in accordance with this section.
    (4) Except as provided in paragraph (5), if an individual breaches 
an agreement under paragraph (1) by failing (for any reason) either to 
begin such individual's service obligation or to complete such service 
obligation, the Service shall be entitled to recover from the 
individual an amount determined in accordance with the formula

      

                                                                                                                
                                                                        s                                       
                                                   A=    <3-ln (>   1- --- <3-ln )>                             
                                                                        t                                       

in which ``A'' is the amount the Service is entitled to recover; ``'' 
is an amount determined by the National Health Board to be the costs to 
the Service of the education program and allowance received by the 
individual and the interest on such costs which would be payable if at 
the time the costs were undertaken they were loans bearing interest at 
the maximum legal prevailing rate, as determined by the Treasurer of 
the United States; ``t'' is the total number of months in the 
individual's period of obligated service; and ``s'' is the number of 
months of such period served by the individual. Any amount of damages 
which the Service is entitled to recover under this paragraph shall, 
within the 1-year period beginning on the date of the breach of the 
agreement, be paid to the Service.
    (5)(A) Any obligation of an individual under this subsection for 
service or payment of damages shall be canceled upon the death of the 
individual.
    (B) The National Health Board shall provide for the waiver or 
suspension of any obligation of service or payment by an individual 
under this part whenever compliance by the individual is impossible or 
would involve extreme hardship to the individual and if enforcement of 
such obligation with respect to any individual would be unconscionable.
    (C) Any obligation of an individual under this part for payment of 
damages may be released by a discharge in bankruptcy under title 11 of 
the United States code only if such discharge is granted after the 
expiration of the 5-year period beginning on the first date that 
payment of such damages is required.
    (b) Each area health board shall periodically assess the ratio of 
the number of health workers employed by the board in each job category 
(established under part A) to the number of residents in the area.
    (c)(1) With respect to an individual obligated to perform service 
under this section as a result of completion of an educational program 
for a job category in a school, the priority ranking (referred to in 
subsection (a)(1)(C)) of area health boards for hiring the individual 
is as follows:
            (A) The regional board for the region, or a district or 
        community board for a district or community in the region, in 
        which the program was completed, if the region, district, or 
        community is a health worker shortage area (as defined in 
        paragraph (2)) with respect to the job category for which the 
        individual received training.
            (B) A regional, district, or community board (other than 
        one described in subparagraph (A)) for a region, district, or 
        community which is a health worker shortage area with respect 
        to the job category for which the individual received training.
            (C) Any other area health board.
    (2) For the purposes of paragraph (1), the term ``health worker 
shortage area'' means, with respect to a job category for which an 
individual has received training in a school, a region, district, or 
community which--
            (A) has a ratio of the number of health workers in the job 
        category employed by the regional, district or community board, 
        respectively, to the number of residents in the region, 
        district, or community (whichever is applicable) which is less 
        than two-thirds of the ratio of the total number of health 
        workers in the job category employed by all the regional, 
        district, or community boards, respectively, in the Nation to 
        the number of residents in the Nation, and
            (B) has plans and a budget which provide for the hiring of 
        an individual in the job category.
    (3) The National Health board shall establish a program to match 
the locational preferences of graduates of schools with the needs and 
preferences of regional, district, and community boards.

                 payment for certain educational loans

    Sec. 313. (a) In the case of any individual who has incurred any 
educational loan before the fourth year after the effective date of 
health services and for the individual's costs for an educational 
program in health care delivery, health care specialties, or health 
science specialty fields, the National Health Board shall make 
payments, in accordance with subsection (b), for and on behalf of that 
individual, on the principal of and interest on any such loan which is 
outstanding on the date the individual begins to work for the Service.
    (b) The payments described in subsection (a) shall be made by the 
National Health Board as follows:
            (1) Upon completion by the individual for whom the payments 
        are to be made of the first year of employment with the 
        Service, the National Health Board shall pay 30 percent of the 
        principal of, and the interest on, each loan described in 
        subsection (a) which is outstanding on the date he began such 
        employment.
            (2) Upon completion by that individual of the second year 
        of such employment, the National Health Board shall pay another 
        30 percent of the principal of, and the interest on, each such 
        loan.
            (3) Upon completion by that individual of a third year of 
        such employment, the National Health Board shall pay another 25 
        percent of the principal of, and the interest on, each such 
        loan.
            (4) Upon completion by that individual of a fourth year of 
        such employment, the National Health Board shall pay the 
        remaining 15 percent of the principal of, and all remaining 
        interest on, each such loan.
No payment may be made under this subsection with respect to a loan 
unless the person on whose behalf the payment is to be made has 
submitted to the National Health Board a certified copy of the 
agreement under which such loan was made.
    (c) Notwithstanding the requirement of completion of employment 
specified in subsection (b), the National Health Board shall on or 
before the due date thereof, pay any loan or loan installment which may 
fall due within the period of employment for which the borrower may 
receive payments under this section, upon the declaration of such 
borrower, at such times and in such manner as the National Health Board 
may prescribe (and supported by such other evidence as the National 
Health Board may reasonably require), that the borrower is then 
employed as described in subsection (b) and that the borrower will 
continue to be so engaged for the period required (in the absence of 
this subsection) to entitle the borrower to have made the payments 
provided by this section for such period, except that not more than 85 
percent of the principal of any such loan shall be paid pursuant to 
this subsection.

  Part C--Employment and Labor-Management Relations Within the Service

          employment, transfer, promotion, and receipt of fees

    Sec. 321. (a) Health boards shall, in accordance with this Act and 
taking into account guidelines and standards established by the 
appropriate National Health Board, employ, classify, and fix the 
salaries and benefits of all employees of the Service employed in the 
Service's facilities.
    (b) The appropriate National Health Board, in establishing 
guidelines and standards under this part, shall, to the extent feasible 
and consistent with the provisions of this part, provide for--
            (1) employment and promotion in the Service in the same 
        manner as is provided for employment and promotion under the 
        Federal civil service system;
            (2) meaningful opportunities for career advancement;
            (3) encouragement of health workers to use up to 10 percent 
        of their work time for continuing education under part B 
        without loss of pay or other job rights; and
            (4) full protection of employees' rights by providing an 
        opportunity for a fair hearing on adverse actions with 
        representation of their own choosing.
    (c) Health boards, in hiring employees to fill vacancies in newly 
created positions, shall give preference to individuals who were 
employed as health workers, or self-employed while delivering health 
services, before the date of enactment of this Act. The National Health 
Board shall ensure, through such steps as it deems necessary, that all 
such individuals desiring to be employed within the Service shall find 
appropriate employment in the Service.
    (d) Employees of the Service shall be eligible for promotion or 
transfer to any position in the Service for which they are qualified. 
Each regional board shall establish and maintain a job placement 
service to assist health workers in its region in identifying suitable 
employment opportunities and in transferring between jobs with 
different area health boards in the region. The authority given by this 
subsection shall be used to provide a maximum degree of career 
opportunities for employees and to ensure continued improvement of 
health care services.
    (e) A community or district board may not hire an individual to 
fill a job vacancy that is classified under part A in a job category 
if--
            (1) the community or district board, respectively, has a 
        ratio of the number of health workers in the job category 
        employed by such board to the number of residents in the 
        community or district (whichever is applicable) which is 
        greater than four-thirds of the ratio of the total number of 
        health workers in the job category employed by all the 
        community or district boards, respectively, in its region to 
        the number of residents in such region; and
            (2) there is a community or district within its region 
        which is a health worker shortage area (as defined in section 
        312(c)(2)) with respect to the job category.
    (f) An employee of the Service may not receive any fee or 
perquisite on account of duties performed by virtue of such employment, 
except from a health board established under this Act.

          applicability of laws relating to federal employees

    Sec. 322. (a) Chapter 75 of title 5, United States Code (relating 
to adverse actions against employees), apply to employees of the 
Service (other than employees serving on the personal staff of members 
of health boards) except to the extent provided-- 
            (1) in a collective-bargaining agreement negotiated on 
        behalf of and applicable to them; or
            (2) in procedures established by the Service and approved 
        by the Office of Personnel Management.
    (b) Employees of the Service are covered by subchapter I of chapter 
81 of title 5, United States Code (relating to compensation for work 
injuries).
    (c)(1) Chapter 83 of title 5, United States Code (relating to civil 
service retirement), applies to employees of the Service except to the 
extent provided in a collective-bargaining agreement negotiated on 
behalf of and applicable to them.
    (2) The Service shall withhold from pay and shall pay into the 
Civil Service Retirement and Disability Fund the amounts specified in 
chapter 83 of title 5, United States Code, as required under paragraph 
(1). The Service, upon request of the Office of Personnel Management, 
but not less frequently than annually, shall pay to the Office the 
costs reasonably related to the administration of Fund activities for 
employees of the Service.
    (d) Sick and annual leave and compensatory time of employees of the 
Service, whether accrued prior to or after the commencement of 
operations of the Service, shall be obligations of the Service.
    (e)(1) Compensation, benefits, and other terms and conditions of 
employment in effect on the effective date of health services for 
employees of the Federal Government performing functions that are 
provided under this Act by the Service, shall apply to all employees of 
the Service performing similar functions until changed by the Service 
in accordance with this Act. Subject to the provisions of this Act, the 
provisions of subchapter I of chapter 85 and chapter 87 of title 5, 
United States Code (relating to unemployment compensation and life 
insurance), apply to employees of the Service unless varied, added to, 
or substituted for in accordance with paragraph (2).
    (2) No variation, addition, or substitution with respect to fringe 
benefits shall result in a program of fringe benefits which on the 
whole is less favorable to employees of the Service than fringe 
benefits in effect for employees of the Federal Government on the 
effective date of health services. No variation, addition, or 
substitution with respect to fringe benefits of employees for whom 
there is a collective-bargaining representative shall be made except by 
agreement between such representative and the Service.

        applicability of federal labor-management relations laws

    Sec. 323. (a)(1) The provisions of the National Labor Relations Act 
(42 U.S.C. 141 et seq.) shall apply to the Service and its employees to 
the extent, not inconsistent with subsection (b), to which such 
provisions apply to employers (as defined in section 2(2) of such Act), 
except that-- 
            (A) the phrase ``or any individual employed as a 
        supervisor'' in section 2(3) of such Act shall not apply 
        (thereby making such Act apply, for these purposes, to such 
        individuals);
            (B) section 9(b)(1) of such Act (providing for separate 
        treatment for professional and nonprofessional employees) shall 
        not apply;
            (C) sections 206 through 210 of such Act (relating to 
        national emergencies) shall, for purposes of this Act, have the 
        phrases ``the President of the United States'' and ``the 
        President'', wherever they appear, replaced by the phrase ``the 
        National Health Board (or a committee thereof to which it has 
        delegated such authority)'' and the phrase ``national health or 
        safety'' replaced by the phrase ``health or safety of the 
        residents of any region''; and
            (D) section 213 (providing for intervention in a strike or 
        lockout by the Director of the Federal Mediation and 
        Conciliation Service) shall not apply.
    (2) Paragraphs (3) and (4) of section 7311 of title 5, United 
States Code (prohibiting participation in a strike or an organization 
asserting the right to strike), shall not apply to employees of the 
Service.
    (b)(1) Collective-bargaining agreements between area health boards 
and duly recognized bargaining representatives of employees of the 
Service may include procedures for resolution by the parties of 
grievances and adverse actions arising under the agreement, including 
procedures culminating in binding third-party arbitration.
    (2) Area health boards and duly recognized bargaining 
representatives of employees of the Service may by mutual agreement 
adopt procedures for the resolution by the parties (A) of grievances 
and adverse actions arising under collective-bargaining agreements, and 
(B) of disputes or impasses arising in the negotiation of such 
agreements.
    (c) Section 3(e) of the Labor-Management Reporting and Disclosure 
Act of 1959 (42 U.S.C. 402(e)) is amended by inserting ``the United 
States Health Service and'' after ``and includes''.

          defense of certain malpractice and negligence suits

    Sec. 324. (a) The remedy against the United States provided by 
sections 1346(b) and 2672 of title 28, United States Code, or by 
alternative benefits provided by the United States where the 
availability of such benefits precludes a remedy under section 1346(b) 
of such title, for damage for personal injury, including death, 
resulting from the performance of medical, surgical, dental, or related 
functions, including the conduct of clinical studies or investigations, 
by any employee of the Service while acting within the scope of the 
employee's employment, shall be exclusive of any other civil action or 
proceeding by reason of the same subject matter against the employee 
(or the employee's estate) whose act or omission gave rise to the 
claim.
    (b) The Attorney General shall defend any civil action or 
proceeding brought in any court against any person referred to in 
subsection (a) (or the person's estate) for any such damage or injury. 
Any such person against whom such civil action or proceeding is brought 
shall deliver within such time after date of service or knowledge of 
service as determined by the Attorney General, all process served upon 
the person or an attested true copy thereof to the person's immediate 
superior or to whomever was designated by the appropriate National 
Health Board to receive such papers and such person shall promptly 
furnish copies of the pleading and process therein to the United States 
attorney for the district embracing the place wherein the proceeding is 
brought, to the Attorney General, and to the appropriate National 
Health Board.
    (c)(1) Upon a certification by the Attorney General that the 
defendant was acting in the scope of employment at the time of the 
incident out of which the suit arose, any such civil action or 
proceeding commenced in a State court shall be removed without bond at 
any time before trial by the Attorney General to the district court of 
the United States of the district and division embracing the place 
wherein it is pending and the proceeding deemed a tort action brought 
against the United States under the provision of title 28, United 
States Code, and all references thereto.
    (2) If a United States district court determines on a hearing on a 
motion to remand held before a trial on the merits that the case so 
removed is one in which a remedy by suit within the meaning of 
subsection (a) is not available against the United States, the case 
shall be remanded to the State court.
    (3) Where a remedy by suit within the meaning of subsection (a) is 
not available because of the availability of a remedy through 
proceedings for compensation or other benefits from the United States 
as provided by any other law, the case shall be dismissed, but in the 
event the running of any limitation of time for commencing, or filing 
an application or claim in, such proceedings for compensation or other 
benefits shall be deemed to have been suspended during the pendency of 
the civil action or proceeding under this section.
    (d) The Attorney General may compromise or settle any claim 
asserted in such civil action or proceeding in the manner provided in 
section 2677 of title 28, United States Code, and with the same effect.
    (e) For purposes of this section, the provisions of section 2680(h) 
of title 28, United States Code, shall not apply to assault or battery 
arising out of negligence in the performance of medical, surgical, 
dental, or related functions, including the conduct of clinical studies 
or investigations.
    (f) The appropriate National Health Board may, to the extent it 
deems appropriate, hold harmless or provide liability insurance for any 
employee of the Service for damage for personal injury, including 
death, negligently caused by such employee while acting within the 
scope of employment and as a result of the performance of medical, 
surgical, dental, or related functions, including the conduct of 
clinical studies or investigations, if the employee is assigned to a 
foreign country or detailed to a State or political subdivision thereof 
or to a nonprofit institution, and if the circumstances are such as are 
likely to preclude the remedies of third persons against the United 
States described in section 2679(b) of title 28, United States Code, 
for such damage or injury.

               TITLE IV--OTHER FUNCTIONS OF HEALTH BOARDS

        Part A--Advocacy, Grievance Procedures, and Trusteeships

                  advocacy and legal services program

    Sec. 401. (a) Each area health board shall establish a program of 
health advocacy to ensure the full realization of the patient rights 
enumerated in part A of title II. Such a program shall include--
            (1) the employment of individuals having basic legal 
        knowledge and skills as health advocates;
            (2) the presence of health advocates (A) in inpatient 
        health care facilities at all times, and (B) in other health 
        care facilities during the provision of health care services;
            (3) provision for health advocates to (A) inform, on an 
        ongoing basis, users and health workers of such patient rights 
        and (B) report to the area health board any infraction of such 
        rights which is not promptly corrected;
            (4) provision for regular meetings between health workers 
        and health advocates, users, and any user representatives to 
        discuss ways of ensuring the fulfillment of such rights through 
        affirmative action of such workers and the area health board; 
        and
            (5) appropriate action by the area health board to ensure 
        that infractions of such rights are promptly and sufficiently 
        corrected.
    (b)(1) The National Health Board shall establish a health rights 
legal services program and shall provide such program with sufficient 
legal and administrative personnel, funding, and facilities (A) to 
ensure that users and health workers receive, free of charge, high 
quality legal services (including representation in grievance 
proceedings commenced under section 402) for legal problems related to 
health rights and health care services, and (B) to improve, through 
litigation and other activities, the health care system and expand the 
rights of users and health workers.
    (2) The health rights legal services program shall provide 
directly, by contract with the Legal Services Corporation, or by 
contract with members of the private bar, for--
            (A) establishment of a legal services office in each region 
        to provide representation (other than representation provided 
        under subparagraph (B)) of users, health workers, and voluntary 
        associations having a demonstrated interest in health care in 
        proceedings and hearings under section 402; and
            (B) establishment of legal services offices in such 
        communities and districts as are determined, in accordance with 
        guidelines established by the National Health Board, to have 
        inadequate legal services to provide the legal services 
        described in paragraph (1)(A).
    (3) The National Health Board may carry out the functions described 
in paragraph (1)(B) directly, by contract, or otherwise.

                 grievance procedures and trusteeships

    Sec. 402. (a)(1) Each regional and interim regional board shall 
provide, in accordance with this section, that any user, health worker, 
or any user association having a demonstrated interest in health care 
may commence a grievance proceeding before such board (or a person or 
committee designated by such board) with respect to an alleged 
violation of this Act by a district or community board within its 
region. Each regional and interim regional board may commence a 
grievance proceeding before itself (or a person or committee designated 
by such board) with respect to an alleged violation of this Act by a 
district or community board within its region.
    (2) The appropriate National Health Board shall provide, in 
accordance with this section, that any user, health worker, or any user 
association having a demonstrated interest in health care may commence 
a grievance proceeding before such Board (or a person or committee 
designated by such Board) with respect to an alleged violation of this 
Act by a regional or interim regional board. The appropriate National 
Health Board may commence a grievance proceeding before itself (or a 
person or committee designated by such Board) with respect to an 
alleged violation of this Act by a regional or interim regional board.
    (b)(1) The appropriate National Health Board shall provide, subject 
to paragraphs (3) and (4), for its review (or a review by a person or 
committee designated by the Board), by appeal to the Board by any party 
to a proceeding described in subsection (a)(1) or on its own 
initiative, of an adverse decision by a regional or interim regional 
board in the proceeding.
    (2) On and after the date a suit with respect to an adverse 
determination in a grievance proceeding or review proceeding is filed 
under subsection (e), no review proceeding respecting such proceeding 
may be commenced by appeal to the Board under paragraph (1), and any 
such review proceeding which was commenced by appeal to the Board under 
such paragraph before the date of filing of such suit and is pending on 
such date shall promptly be discontinued.
    (3) No review of an adverse administrative decision may be made by 
appeal or by initiative under this subsection unless the appeal is 
filed or notice of the initiative is published (as the case may be) not 
later than 15 days after the publication of the decision.
    (c)(1) Whenever a grievance proceeding is commenced under 
subsection (a), the entity before which the proceeding is held shall 
investigate the grievance.
    (2) An entity before which a proceeding or review proceeding is 
commenced under subsection (a) or (b)--
            (A) shall conduct a full and open public hearing on the 
        grievance as part of such proceeding--
                    (i) if the grievance is supported by a petition 
                signed by a minimal number of residents (as defined in 
                paragraph (4)); or
                    (ii) before the entity (or the body which 
                designated it) may set aside an election or transfer 
                any functions of a health board under subsection (d); 
                and
            (B) may conduct such a hearing if the entity determines 
        that such hearing is in the public interest.
    (3) The entity that conducts a hearing under paragraph (2) shall 
provide for timely notice to, and opportunity to be heard by, any party 
with a direct interest in the grievance for which the hearing is 
conducted.
    (4) As used in paragraph (1), the term ``minimal number of 
residents'' means, with respect to a grievance which concerns a health 
board which is--
            (A) a community board, 100 individuals,
            (B) a district board, 300 individuals, and
            (C) a regional or interim regional board, 1,000 
        individuals,
who are 18 years of age or older and who reside in the area served by 
the board.
    (d)(1) With respect to a grievance proceeding begun under 
subsection (a) relating to the conduct of an election of a community 
board, if the entity before which such proceeding is commenced under 
such subsection, or is reviewed under subsection (b), determines that 
the election (A) was not conducted substantially in compliance with 
this Act or (B) has revealed the systematic failure of the user members 
of such community board to approximate the population of the community 
by race, sex, language, and income level, the entity shall set aside 
the election and, unless such determination is reviewed under 
subsection (b), the entity shall require that another election for 
members of the community board be conducted, in accordance with this 
Act, not later than 60 days after the date of such determination. If 
such election is conducted because of a determination under clause (B), 
the election shall be conducted (and subsequent elections may be 
conducted) in such a manner, including the use of geographic or other 
subdivisions for electoral purposes, as will facilitate the 
representation of significant elements of the population of a community 
by race, sex, language, and income level.
    (2) With respect to a grievance proceeding begun under subsection 
(a) relating to a grievance other than the conduct of an election of a 
community board, if the entity before which such proceeding is 
commenced under such subsection, or is reviewed under subsection (b), 
determines that the grievance represents--
            (A) a failure by a health board to comply substantially and 
        materially with this Act, the entity shall require that a new 
        election or appointment, in accordance with this Act, of 
        members of the health board be conducted or made within 60 days 
        of the date of such determination; or
            (B) a failure by a health board to comply, but not 
        substantially and materially, with this Act, the entity may 
        require that a new election or appointment, in accordance with 
        this Act, of members of the health board be conducted or made 
        if such failure is not corrected within a reasonable period of 
        time (specified by the entity) of the date of such 
        determination.
    (3)(A) If an entity determines under paragraph (1) or (2) that a 
community or district board has failed to comply with this Act, the 
entity shall transfer to the regional (or interim regional) board for 
such community or district such functions of the community or district 
board as it determines necessary to carry out this Act until a new 
election or appointment is conducted or made.
    (B) If an entity determines under paragraph (2) that a regional or 
interim regional board has failed to comply with this Act, the entity 
shall transfer to the appropriate National Health Board such functions 
of the regional or interim regional board as it determines necessary to 
carry out this Act until a new regional or interim regional board is 
appointed.
    (C) If a health board is transferred the functions of another 
health board under this paragraph, until a new election or appointment 
of the other health board has been certified, (i) the health board 
shall have the powers of the other health board to conduct such 
functions, (ii) the health board may appoint a trustee (or trustee 
committee) to have such powers and carry out such functions, and (iii) 
any expenses that are certified by the health board (or by the trustee 
or trustee committee appointed by it) as having been incurred by it in 
discharging the functions transferred to it under this paragraph shall 
be paid from funds allocated to the other health board.
    (e) Any party to a grievance proceeding or review proceeding 
commenced under this section may bring suit in the United States 
district court for the judicial district in which such proceeding, or 
review proceeding, was brought, for the review of an adverse 
determination in such proceeding or review proceeding. Such court shall 
affirm such determination unless it finds that such determination is 
not supported by substantial evidence or is arbitrary and capricious.

            Part B--Occupational Safety and Health Programs

                 functions of the national health board

    Sec. 411. (a) On and after the effective date of health services, 
the National Health Board shall oversee occupational safety and health 
programs conducted at the regional level, and shall participate in the 
establishment and administration of occupational safety and health 
standards under the Occupational Safety and Health Act of 1970.
    (b) In its participation in the establishment and administration of 
occupational safety and health standards under the Occupational Safety 
and Health Act of 1970, the National Health Board shall seek the advice 
and comments of regional occupational safety and health action councils 
established under section 413.
    (c)(1) To provide for participation of the National Health Board in 
the establishment and administration of occupational safety and health 
standards, the Occupational Safety and Health Act of 1970 (29 U.S.C. 
651 et seq.) is amended--
            (A) by adding at the end of section 3 the following new 
        paragraph:
            ``(15) The term `National Health Board' means the National 
        Health Board of the United States Health Services.'';
            (B) by striking out ``Secretary of Health and Human 
        Services'' each place it appears (other than in section 22(b)) 
        and inserting in lieu thereof ``National Health Board'';
            (C) by inserting ``shall request the National Health Board 
        and'' in the first sentence of section 6(b)(1) before ``may 
        request'';
            (D) by inserting ``the Board and'' in the second sentence 
        of section 6(b)(1) after ``The Secretary shall provide'';
            (E) by striking out ``An'' in the third sentence of section 
        6(b)(1) and inserting in lieu thereof ``The Board and an'';
            (F) by striking out ``its'' each place it appears in the 
        third sentence of section 6(b)(1) and inserting in lieu thereof 
        ``their'';
            (G) by inserting ``after consultation with the National 
        Health Board and'' in the fourth sentence of section 6(b)(6)(A) 
        after ``may be granted only'';
            (H) by inserting ``after consultation with the National 
        Health Board and'' in the third sentence of section 6(d) before 
        ``after opportunity for'';
            (I) by striking out ``The Secretary'' and all that follows 
        through ``shall each'' in section 8(g)(2) and inserting in lieu 
        thereof ``The Secretary shall'';
            (J) by striking out ``their'' in section 8(g)(2) and 
        inserting in lieu thereof ``his'';
            (K) by inserting ``after consultation with the National 
        Health Board and'' in section 16 before ``after notice and 
        opportunity'';
            (L) by inserting ``(after consultation with the National 
        Health Board)'' in section 18(c) after ``in his judgment'';
            (M) by inserting ``and the National Health Board'' in 
        section 19(d) after ``Secretary'' each place it appears; and
            (N) by striking out the first sentence of paragraph (5) of 
        section 20(a).
    (2) The amendments made by paragraph (1) shall take effect on the 
effective date of health services.
    (f) The National Health Board shall establish guidelines--
            (1) for its participation in the establishment and 
        administration of occupational safety and health standards 
        under the Occupational Safety and Health Act of 1970;
            (2) for the election of community occupational safety and 
        health action councils under section 412;
            (3) for the establishment of regional occupational safety 
        and health programs under section 413;
            (4) for the establishment and operation of workplace health 
        facilities under section 414; and
            (5) for the provision of assistance by regional and 
        community boards to regional and community occupational safety 
        and health councils, respectively, and to workplace safety and 
        health committees established under section 415.

          community occupational safety and health activities

    Sec. 412. (a)(1) Each community board shall cooperate with the 
appropriate regional board in the establishment and implementation of 
an occupational safety and health program for its region.
    (2) Each community board shall provide for the organization and 
operation (including staff and support) in its community of a community 
occupational safety and health action council (hereinafter in this part 
referred to as a ``COSHAC'') in accordance with this section.
    (b) The members of a COSHAC shall be elected by individuals 
employed in the community as follows:
            (1) Employees of each workplace in the community which has 
        500 or more employees shall be entitled to elect one member for 
        each 500 such employees in such workplace.
            (2) Employees of workplaces in the community which have 
        fewer than 500 employees shall be entitled to vote in 
        community-wide elections for a number of members equal to (A) 
        the total number of employees in such workplaces divided by 
        500, (B) rounded (if necessary) to the next highest whole 
        number.
The elections of COSHAC members shall be conducted by the community 
board for such COSHAC under guidelines established by the National 
Board.
    (c) Each COSHAC shall--
            (1) appoint one individual to serve, at its pleasure, as a 
        member of the community board for such COSHAC;
            (2) appoint one individual to serve, at its pleasure, as a 
        member of the regional occupational safety and health action 
        council for its region;
            (3) advise the community board on, and oversee, 
        occupational safety and health programs in the community;
            (4) promote and assist in the establishment of workplace 
        occupational safety and health committees in workplaces in the 
        community, and advise and facilitate such committees' actions 
        relating to safety and health hazards in workplaces in the 
        community; and
            (5) assist employees in determining methods of, and 
        requirements for, inspections of workplaces in the community 
        for safety and health hazards.

            regional occupational safety and health programs

    Sec. 413. (a)(1) Each regional board shall establish an 
occupational health and safety program for its region in accordance 
with this subsection and under guidelines established by the National 
Health Board.
    (2) A regional occupational health and safety program shall, to the 
maximum extent feasible, use the facilities and resources of community 
boards in the region and shall include--
            (A) training programs to enhance the ability of employees 
        in the region to monitor safety and health conditions in their 
        workplaces and to assist safety and health inspectors in the 
        conduct of workplace inspections;
            (B) facilitating communication among workers employed in 
        similar industries in the region and the Nation with respect to 
        occupational health and safety hazards they face in common;
            (C) baseline and periodic biologic screening of employees 
        in the region;
            (D) development and maintenance of environmental monitoring 
        programs to identify and isolate hazardous workplaces and work 
        areas in the region;
            (E) the analysis of employment-related injuries and 
        illnesses occurring in the region; and
            (F) staff and support for the operation of the regional 
        occupational safety and health action council (hereinafter in 
        this part referred to as the ``ROSHAC'') established in the 
        region under this section.
    (b) Each ROSHAC shall--
            (1) appoint one individual to serve, at its pleasure, as a 
        member of the regional board for such ROSHAC;
            (2) advise the regional board on, and oversee, occupational 
        safety and health programs in the region; and
            (3) advise the National Health Board on the establishment 
        and administration of occupational safety and health standards 
        under the Occupational Safety and Health Act of 1970.

                      workplace health facilities

    Sec. 414. (a) The employer in each workplace shall establish and 
maintain a health facility in or near the workplace to provide 
occupational and emergency health care services to individuals employed 
in the workplace in accordance with this section and guidelines and 
standards for such facilities established by the National Health Board.
    (b) Each workplace health facility established pursuant to 
subsection (a) shall, taking into account guidelines established by the 
National Health Board--
            (1) be organized in a manner so as to provide an 
        appropriate number of appropriately skilled health workers to 
        meet occupational and emergency health care needs of employees 
        in the workplace; and
            (2) be operated by the community board for the community in 
        which the workplace is predominantly located, or, where such 
        board deems appropriate, by the employer, with the cost in 
        either case borne by the employer in each workplace.

       employee rights relating to occupational safety and health

    Sec. 415. (a)(1) Employees in each workplace having 25 or more 
employees shall have the right to establish workplace occupational 
safety and health committees (hereinafter in this subsection referred 
to as ``committees'') with members of their choosing.
    (2) Members of committees (composed of the greater of 3 members or 
one member for each 100 employees in the workplace) shall, without any 
loss of pay or other job rights--
            (A) be permitted to spend eight hours of each month 
        inspecting their workplace and conducting such other functions 
        relating to occupational safety and health as are determined by 
        the employees in the workplace; and
            (B) be permitted to accompany any safety and health 
        inspectors during inspections of the workplace.
    (b) Employees in each workplace shall have the right, without any 
loss of pay or other job rights--
            (1) to monitor safety and health conditions in their 
        workplace whenever they reasonably deem it necessary and with 
        whatever reasonable scientific instruments and expert 
        assistance they choose; and
            (2) to remove themselves from the site of any hazard to 
        their safety or health until an authorized inspector has 
        certified that the hazard has been eliminated.
    (c) Employers shall adopt all feasible engineering measures that 
will minimize occupational safety and health hazards in the workplace. 
Where such measures are not adequate to protect employees from such 
hazards, employers shall furnish their employees with, or reimburse 
their employees for the reasonable cost of, equipment and clothing 
needed to protect an employee from any residual occupational safety and 
health hazards in the workplace.
    (d) Employees or their duly chosen representatives shall have the 
right to inspect all medical records maintained by their employers on 
the condition of their health, and shall have the right to be assisted 
during such inspections by persons of their choosing.
    (e) Employers shall provide their employees with copies of all 
reports, studies, and data concerning conditions affecting the health 
and safety of employees within their workplaces, with annual reports on 
the morbidity and mortality experience of present and former employees, 
and with timely notification of the presence within the workplace of 
any materials, agents, or conditions which may have a deleterious 
effect on the safety and health of their employees, along with relevant 
information on hazards and precautions, symptoms, remedies, and 
antidotes.
    (f) Employees shall have the right to seek, through collective 
bargaining, occupational safety and health standards, including 
standards relating to physical and mental stress and speed of work, 
more restrictive than such standards established under the Occupational 
Safety and Health Act of 1970.

                              definitions

    Sec. 416. (a) For purposes of this part, the term ``workplace'' 
means the regular location where work is performed by one or more 
employees of an employer.
    (b) For the purposes of sections 414 and 415, the terms 
``employer'' and ``employee'' have the same meanings those terms have 
in section 3 of the Occupational Safety and Health Act of 1970 (42 
U.S.C. 653).

            Part C--Health and Health Care Delivery Research

                 principles and guidelines for research

    Sec. 421. (a) On and after the effective date of health services, 
the Service shall conduct a program of research concerning health and 
health care delivery. On and after 2 years after such date, such 
research program shall conform to the following principles:
            (1) The research shall, to the maximum extent possible, be 
        performed under the direction of, and in association with, 
        community, district, and regional boards.
            (2) No research shall be conducted within, or using the 
        resources of, an area health facility until it has been 
        reviewed and approved by the area health board responsible for 
        such facility.
            (3) Priority shall be given in health research to the 
        prevention and correction of the leading causes of illness and 
        death, particularly environmental, occupational, nutritional, 
        social, and economic causes.
            (4) Priority shall be given in health care delivery 
        research to improvement of the effectiveness and efficiency of 
        ambulatory and primary health care delivery, including research 
        on alternative systems of health care delivery and alternative 
        conceptions of health and health care.
            (5) No experimentation to evaluate new preventive, 
        diagnostic, or therapeutic methods or agents shall be 
        undertaken upon human subjects until all animal research which 
        may effectively contribute to evaluating such methods or agents 
        has been undertaken.
            (6) No research shall be conducted on a human subject 
        without the subject's informed written consent.
            (7) No research shall be conducted on a human subject while 
        the subject is involuntarily confined to an institution.
            (8) Each health board, in planning and conducting research 
        under the program, shall cooperate with appropriate officials 
        conducting related research in the Department of Health and 
        Human Services, the Environmental Protection Agency, other 
        Federal Government agencies, and agencies and departments of 
        State, territorial, and local governments.
            (9) The results of research shall be disseminated to the 
        public and to area health boards in a manner that will most 
        readily permit the use of such results to improve the health of 
        users and the delivery of health care services.
    (b) The National Health Board shall establish guidelines for the 
conduct of research in conformance with the principles described in 
subsection (a).

                      establishment of institutes

    Sec. 422. On the effective date of health services, the National 
Institutes of Health (established under title IV of the Public Health 
Service Act) are transferred to the National Health Board. In addition, 
the National Health Board shall establish the following institutes:
    (1) A National Institute of Epidemiology, which shall--
            (A) gather and analyze disease-related statistics collected 
        by the Service;
            (B) plan, conduct, support, and assist in epidemiologic 
        research conducted by the Service;
            (C) conduct and support research on epidemiologic 
        methodology and experimental epidemiology;
            (D) establish and maintain an early warning system for the 
        detection of new diseases and epidemics; and
            (E) assist in the formulation of policies to eliminate or 
        reduce the causes of illness and injury and to prevent and 
        curtail epidemics of these conditions.
    (2) A National Institute of Evaluative Clinical Research, which 
shall--
            (A) gather and analyze all evidence collected by the 
        Service dealing with the effectiveness of preventive, 
        diagnostic, and therapeutic measures and the occurrence of 
        iatrogenic illnesses;
            (B) analyze evidence on newly-discovered or proposed 
        preventive, diagnostic, and therapeutic methods and agents;
            (C) plan and conduct clinical trials, in conformance with 
        the limitations of part A of title II; and
            (D) assist the National Health Board, in cooperation with 
        other bodies, including the National Institute of Pharmacy and 
        Medical Supply, in developing guidelines and standards for the 
        introduction of new methods of prevention, diagnosis, and 
        treatment.
    (3) A National Institute of Health Care Services, which shall--
            (A) analyze data and statistics on the health care 
        resources and needs of the Nation and on the quality of present 
        services;
            (B) conduct comparative studies of health care services in 
        the various regions of the Nation, and make recommendations for 
        the improvement of health care services in areas with inferior 
        quality of health care services;
            (C) plan and conduct research on alternative methods of 
        health care delivery, on the functions, tasks, performance and 
        work relationships of various kinds and categories of health 
        workers, on patterns of organization of health care, and on the 
        effectiveness and benefits of health care in relation to costs; 
        and
            (D) assist the National Health Board in formulating 
        national policies to improve the quality of health care 
        services.
    (4) A National Institute of Pharmacy and Medical Supply, which 
shall--
            (A) recommend to the National Health Board standards 
        regarding the quality, distribution, and price of all drugs, 
        therapeutic devices, appliances and equipment to be used by the 
        Service;
            (B) certify drugs, therapeutic devices, appliances, and 
        equipment for use in the health facilities of the Service, and 
        for furnishing to users of such health facilities;
            (C) assist the National Health Board in issuing a National 
        Pharmacy and Medical Supply Formulary; and
            (D) conduct a comprehensive program of pharmaceutical and 
        medical supply research and utilization education using, to the 
        maximum extent possible, regional facilities operated in 
        association with the respective regional health boards.
    (5) A National Institute of Sociology of Health and Health Care, 
which shall--
            (A) conduct ongoing analyses of the basic epistemological 
        assumptions of health and health care;
            (B) assess critically the effects of scientific medicine 
        and of divisions in institutional and technical skills in 
        health care;
            (C) evaluate the effects of health care measures and 
        policies upon population groups and subgroups in the Nation;
            (D) identify and analyze the social, occupational, and 
        environmental factors in modern society affecting health and 
        well-being;
            (E) analyze alternative, holistic approaches to the human 
        body, health, and causality of ill health and the lack of 
        social and psychological well-being; and
            (F) assist the National Health Board in formulating 
        national policies relating to the promotion of health and the 
        provision of health care.

   Part D--Health Planning, Distribution of Drugs and Other Medical 
                 Supplies, and Miscellaneous Functions

                     health planning and budgeting

    Sec. 431. (a) Each area health board shall, under guidelines 
established by the National Health Board, collect data on the supply of 
and demand for health workers in facilities under its supervision, and 
on the delivery of health care and supplemental services in health care 
facilities under its supervision, shall evaluate such data in relation 
to the health care needs of their respective area, and shall transmit 
such data and evaluation--
            (1) to its respective regional board, in the case of a 
        district or community board, and
            (2) to the National Health Board, in the case of a regional 
        board,
and shall make available such data and evaluations to residents of its 
area.
    (b) Each regional board shall coordinate the planning and 
administration of the delivery of health care services, health worker 
education, and health research in its region, and shall facilitate the 
planning and administration of such programs by district and community 
boards in its region.
    (c) The National Health Board shall formulate a 1-year and 5-year 
national health plan and budget, taking into account the area plans and 
budgets prepared in accordance with section 522, to provide guidance 
and direction to area health boards.

            distribution of drugs and other medical supplies

    Sec. 432. (a)(1) The National Health Board, after consultation with 
the regional boards, shall, not later than the effective date of health 
services, publish and disseminate to area health boards a National 
Pharmacy and Medical Supply Formulary (hereinafter in this section 
referred to as the ``Formulary'').
    (2) The Formulary shall contain a listing of drugs, therapeutic 
devices, appliances, equipment, and other medical supplies (including 
eyeglasses, other visual aids, hearing aids, and prosthetic devices) 
(hereinafter in this section referred to as ``drugs and other medical 
supplies''). For each item on such listing the Formulary shall contain 
(A) the standards of quality for the production of such item, (B) the 
medical conditions for which the item is certified as effective for 
purposes of the provision of health care services under this Act, and 
(C) such other information on such item as the National Health Board 
determines to be appropriate for the effective and efficient delivery 
of health care services under this Act.
    (3) The National Health Board shall, at regular intervals, update 
the contents of the Formulary and publish a price list for items listed 
in the Formulary, which prices shall reflect the actual costs of 
manufacture.
    (b)(1) Each regional board shall establish a program, in accordance 
with this subsection and under guidelines established by the National 
Health Board, for the purchase and distribution of drugs and other 
medical supplies for use in health care facilities established by such 
board or by a community or district board within its region.
    (2) Such program shall provide for the purchase of each drug or 
other medical supply item only (A) following competitive bidding on 
such item or (B) based on the price listed for such item in the price 
list published under subsection (a)(3).
    (3) Such program shall provide for the distribution of drugs (and 
their dispensing by community and district boards in its region) under 
their generic names.
    (4) For purposes of paragraph (3), the term ``generic names'' means 
the established names, as defined in section 502(e)(2) of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 352(e)(2)).
    (c) The National Health Board is authorized to establish and 
operate drug and medical supply manufacturing facilities, if it 
determines that such operation will result in reduced expenditures by 
the Service.

          miscellaneous functions of the national health board

    Sec. 433. (a) The appropriate National Health Board shall publish, 
not later than December 31 of each year, a report presenting and 
evaluating operations of the Service during the fiscal year ending in 
such year and surveying the future health needs of the Nation and plans 
the Board has for the Service to meet such needs.
    (b) The National Health Board shall, not later than the effective 
date of health services, prepare and disseminate to area health boards, 
for use by users, a comprehensive dictionary of terms used in health 
care records and services maintained or provided by the Service. Such 
dictionary shall explain terms related to symptoms, signs, diagnoses, 
etiologic agents and conditions, diagnostic procedures, and the 
treatment and prevention of, and rehabilitation following, illnesses, 
and shall include extensive citations of lay and professional sources 
which a user might consult for additional information on such terms.

                   TITLE V--FINANCING OF THE SERVICE

                      Part A--Health Service Taxes

                 individual and corporate income taxes

    Sec. 501. (a)(1) Subchapter A of chapter 1 of the Internal Revenue 
Code of 1954 (relating to normal taxes and surtaxes) is amended by 
adding at the end thereof the following new part:

                    ``PART VII--HEALTH SERVICE TAXES

                              ``Sec. 59. Tax imposed.

``SEC. 59. TAX IMPOSED.

    ``(a) Individuals, Estates, and Trusts.--In addition to other 
taxes, there is hereby imposed for each taxable year on the taxable 
income of every individual and of every estate and trust taxable under 
section 1(d), a tax in an amount equal to 10 percent of the total 
amount of the normal tax and surtax imposed by section 11 for such 
taxable year.''.
    ``(b) Corporation.--In addition to the other taxes, there is hereby 
imposed for each taxable year on the taxable income of every 
corporation, a tax in an amount equal to 90 percent of the total amount 
of the normal tax and surtax imposed by section 11 for such taxable 
year.''.
    (2) The table of parts of such subchapter A is amended by adding 
after the item relating to part VI the following new item:

                              ``Part VII. Health service taxes.''.
    (b) Subsection (a) of section 3402 of the Internal Revenue Code of 
1954 (relating to income tax collected at source) is amended by 
inserting after the third sentence thereof the following sentence: 
``With respect to wages paid on and after the effective date of health 
services under the Health Service Act (as established in section 601 of 
such Act), the Secretary shall prescribe new tables which shall be the 
same as the tables prescribed under the previous sentence, except that 
such tables shall be modified to the extent necessary to reflect the 
amendment made to subchapter A of chapter 1 by section 501(a)(1) of the 
Health Service Act.''.
    (c) The amendments made in this section shall apply to taxable 
years beginning on or after the effective date of health services.

           other changes in the internal revenue code of 1954

    Sec. 502. (a) Denial of Exclusion From Gross Income for Amounts 
Paid by Third Parties for Medical Care.--Section 105 of the Internal 
Revenue Code of 1954 (relating to amounts received under accident and 
health plans) is amended by striking out subsection (b).
    (b) Denial of Exclusion From Gross Income of Certain Contributions 
by the Employer to Health Plans.--Section 106 of such Code (relating to 
contributions by employer to accident and health plans) is amended to 
read as follows:

``SEC. 106. CONTRIBUTIONS BY EMPLOYERS TO ACCIDENT AND HEALTH PLANS.

    ``Gross income does not include contributions by the employer to 
accident or health plans for compensation (through insurance or 
otherwise) to his employees for personal injuries or sickness to the 
extent that such contributions do not provide for health care and 
supplemental services available to such employees under the Health 
Service Act.''
    (c) Denial of Deduction of Health Care Expenses as Trade or 
Business Expenses.--Section 162 of such Code (relating to trade or 
business expenses) is amended by redesignating subsection (h) as 
subsection (i) and by adding after subsection (g) the following new 
subsection:
    ``(h) Payments for Health Care.--No deduction shall be allowed 
under subsection (a) for any amount paid for health care services 
(other than any amount of tax imposed by section 59 and paid by the 
employer on behalf of his employees) which an individual was eligible 
to receive under title II of the Health Service Act.''.
    (d) Denial of Deduction for Contributions to Certain Medical and 
Hospital Facilities.--(1) Paragraph (2) of section 170(c) of such Code 
(relating to charitable, etc., contributions and gifts) is amended by 
inserting ``(other than an organization described in subsection 
(b)(1)(A)(iii))'' after ``(2) A corporation, trust, or community chest, 
fund, or foundation''.
    (2) Subsection (e) of section 501 of such Code (relating to 
cooperative hospital service organizations) is amended by striking out 
the last sentence.
    (e) Denial of Deduction for Medical, Dental, Etc., Expenses.--(1) 
Section 213 of such Code (relating to medical, dental, etc., expenses) 
is repealed.
    (2) The table of sections of part VII of subchapter B of chapter 1 
of subtitle A of such Code is amended by striking out the item relating 
to section 213.
    (f) Hospital Insurance Tax.--(1) Subsection (b) of section 1401 of 
such Code (relating to rate of tax on self-employment income) is 
repealed.
    (2)(A) Subsection (b) of section 3101 of such Code (relating to 
rate of tax on employees under the Federal Insurance Contributions Act) 
is repealed.
    (B) Section 3201 of such Code (relating to rate of tax imposed on 
employees under the Railroad Retirement Tax Act) is amended by striking 
out ``(a) plus the rate imposed by section 3101(b)''.
    (C) Subsection (a) of section 3211 of such Code (relating to rate 
of tax on employee representatives under the Railroad Retirement Tax 
Act) is amended by striking out ``3101(a), 3101(b)'' and inserting in 
lieu thereof ``3101(a)''.
    (D) Subsection (e) of section 6051 of such Code (relating to 
railroad employees) is repealed.
    (g) The amendments made by this section shall apply to taxable 
years beginning on or after the effective date of health services.

            existing employer-employee health benefit plans

    Sec. 503. No contractual or other nonstatutory obligation of any 
employer to pay for or provide any health care and supplemental service 
to his present and former employees and their dependents and survivors, 
or to any of such persons, shall apply on and after the effective date 
of health services to the extent such individuals are eligible to 
receive such health care and supplemental services under this Act.

                     workers compensation programs

    Sec. 504. No workers compensation program, whether established 
pursuant to Federal or State law or private initiative, shall pay for 
or provide any health care and supplemental services on and after the 
effective date of health services, to the extent such health care and 
supplemental services are available under this Act.

                   Part B--Health Service Trust Fund

               establishment of health service trust fund

    Sec. 511. (a) There is hereby created on the books of the Treasury 
of the United States a trust fund to be known as the Health Service 
Trust Fund (hereinafter in this title referred to as the ``Trust 
Fund''). The Trust Fund shall consist of such gifts and bequests as may 
be made to the Service and such amounts as may be deposited in, or 
appropriated to, such fund as provided in this part.
    (b) There is hereby appropriated to the Trust Fund for each fiscal 
year beginning in the fiscal year in which the effective date of health 
services (as defined in title VI) falls, and for each fiscal year 
thereafter, out of any moneys in the Treasury not otherwise 
appropriated, an amount equal to 100 percent of expected net receipts 
from the taxes imposed by sections 59 and 3111(b) of the Internal 
Revenue Code of 1954 (as estimated by the Secretary of the Treasury). 
The amount appropriated by the preceding sentence shall be transferred 
from time to time from the general fund in the Treasury to the Trust 
Fund in such smaller amounts to be determined on the basis of estimates 
by the Secretary of the Treasury of the receipts specified in the 
preceding sentence; and proper adjustments shall be made in the amounts 
subsequently transferred to the extent prior estimates were in excess 
of or were less than the receipts specified in such sentence.

           transfer of funds to the health service trust fund

    Sec. 512. (a) On the effective date of health services, there are 
transferred to the Trust Fund all of the assets and liabilities of the 
Federal Hospital Insurance Trust Fund and the Federal Supplementary 
Medical Insurance Trust Fund.
    (b) In addition to the sums appropriated by section 511(b), there 
is appropriated to the Trust Fund for each fiscal year, out of any 
moneys in the Treasury not otherwise appropriated, a governmental 
contribution equal to 40 percent of the sums appropriated by section 
511(b) for such fiscal year. There shall be deposited in the Trust Fund 
all recoveries of overpayments, and all receipts under loans or other 
agreements entered into, under this Act.

              administration of health service trust fund

    Sec. 513. (a) With respect to the Trust Fund, there is hereby 
created a body to be known as the Board of Trustees of the Trust Fund 
(hereinafter in this section referred to as the ``Board of Trustees'') 
composed of the Secretary of the Treasury, the Secretary of Health and 
Human Services, and the Chairperson of the National Health Board, all 
ex officio. The Secretary of the Treasury shall be the Managing Trustee 
of the Board of Trustees (hereinafter in this section referred to as 
the ``Managing Trustee''). The Chairperson of the National Health Board 
shall serve as the Secretary of the Board of Trustees. The Board of 
Trustees shall meet not less frequently than once each calendar year. 
It shall be the duty of the Board of Trustees to--
            (1) hold the Trust Fund;
            (2) report to the Congress not later than the first day of 
        April of each year on the operation and status of the Trust 
        Fund during the preceding fiscal year and on its expected 
        operation and status during the current fiscal year and the 
        next 2 fiscal years;
            (3) report immediately to the Congress whenever the Board 
        is of the opinion that the amount of the Trust Fund is unduly 
        small; and
            (4) review the general policies followed in managing the 
        Trust Fund, and recommend changes in such policies, including 
        necessary changes in the provisions of law which govern the way 
        in which the Trust Fund is to be managed.
The report provided for in paragraph (2) shall include a statement of 
the assets of, and the disbursements made from, the Trust Fund during 
the preceding fiscal year, an estimate of the expected income to, and 
disbursements to be made from, the Trust Fund during the current fiscal 
year and each of the next 2 fiscal years, and a statement of the 
actuarial status of the Trust Fund. Such report shall be printed as a 
House document of the session of the Congress to which the report is 
made.
    (b) It shall be the duty of the Managing Trustee to invest such 
portion of the Trust Fund as is not, in his judgment, required to meet 
current withdrawals. Such investments may be made only in interest-
bearing obligations of the United States or in obligations guaranteed 
as to both principal and interest by the United States. For such 
purpose such obligations may be acquired (1) on original issue at the 
issue price, or (2) by purchase of outstanding obligations at the 
market price. The purposes for which obligations of the United States 
may be issued under the Second Liberty Bond Act, as amended, are hereby 
extended to authorize the issuance at par of public-debt obligations 
for purchase by the Trust Fund.
    (c) Any obligations acquired by the Trust Fund (except public-debt 
obligations issued exclusively to the Trust Fund) may be sold by the 
Managing Trustee at the market price, and such public-debt obligations 
may be redeemed at par plus accrued interest.
    (d) The interest on, and the proceeds from the sale or redemption 
of, any obligations held in the Trust Fund shall be credited to and 
form a part of the Trust Fund.
    (e) The Managing Trustee shall pay from time to time from the Trust 
Fund such amounts as the National Health Board certifies are necessary 
to carry out this Act.

                Part C--Preparation of Plans and Budgets

                   determination of fund availability

    Sec. 521. (a)(1) The National Health Board shall, not later than 
January 1 of each year, initially fix the maximum amount of funds which 
may (except as provided in subsection (c)) be obligated during the 
fiscal year beginning on October 1 of such year for expenditure from 
the Trust Fund.
    (2) Such amount shall not exceed for a fiscal year the lesser of--
            (A) 140 percent of the expected net receipts during the 
        fiscal year (as estimated by the Secretary of the Treasury) 
        from the taxes imposed by sections 59 and 3111(b) of the 
        Internal Revenue Code of 1954;
            (B) the amount of the aggregate obligations that the 
        National Health Board determines were (or will be) incurred by 
        the Service from the Trust Fund during the previous fiscal 
        year, adjusted to reflect changes in the cost of living, in the 
        number of users, and in the capacity of the Service to provide 
        services under this Act, as such changes are reflected in the 
        plans and budgets prepared and submitted by area health boards 
        under this part; or
            (C) the amount fixed under subsection (b).
    (3) The National Health Board may at any time refix such amount to 
reflect changes (A) of one percent or more in the expected net tax 
receipts (described in paragraph (2)(A)), or (B) of five percent or 
more in the cost of living, number of users, or the capacity of the 
Service to provide services under this Act. The National Health Board 
shall promptly report to Congress any increase made in such amount and 
the reasons therefor.
    (b) The National Health Board shall fix in a fiscal year an amount, 
which the maximum amount described in subsection (a)(1) may not exceed 
in the fiscal year, which is less than the amount described in 
subsection (a)(2)(A) if the Board determines that--
            (1) restriction of the amount to be made available for 
        obligation will not materially impair the adequacy or quality 
        of health care and supplemental services provided to users, or
            (2) improvement in the organization, delivery, or 
        utilization of such services has lessened their aggregate cost 
        (or increase in such cost).
    (c) The National Health Board may obligate for expenditure from the 
Trust Fund, in addition to the maximum amount which may be obligated in 
a fiscal year under subsection (a), such funds as are necessary to 
provide health care and supplemental services needed because of an 
epidemic, disaster, or other occurrence which was not, and could not 
have been, reasonably planned for by the Board and for which the 
contingency fund provided in section 534(b)(6) is insufficient. The 
National Health Board shall promptly report to Congress any obligation 
made pursuant to this subsection and the reasons therefor.
    (d) In addition to the maximum amounts which may be obligated 
pursuant to subsection (a), the National Health Board may allocate 
funds borrowed in accordance with section 541 for such purposes as it 
deems necessary and appropriate.

                 preparation of area plans and budgets

    Sec. 522. (a) Each community board shall, not later than January 1 
of each year, submit to its respective district board a plan and budget 
for the fiscal year beginning on October 1 of such year. In preparing 
such plan and budget, each community board shall consult with users and 
health workers in the community to assure effective and coordinated 
planning for the efficient use of resources in its community.
    (b) Each district board shall, not later than February 1 of each 
year, submit to its respective regional board a plan and budget for the 
fiscal year beginning on October 1 of such year. In preparing such plan 
and budget, each district board shall consult with the users, health 
workers, and community boards in its district to assure effective and 
coordinated planning for the efficient use of resources in its 
district.
    (c) Each regional board shall, not later than March 1 of each year, 
submit to the National Health Board a plan and budget for the fiscal 
year beginning on October 1 of such year. In preparing such plan and 
budget, each regional board shall consult with the users, health 
workers, and district boards in its region to assure effective and 
coordinated planning for the efficient use of resources in its region.
    (d) In preparing the budgets required by this section, each area 
health board shall specify its operating, prevention, capital, and 
research expenses anticipated for the fiscal year covered by the budget 
and for the 5-year period beginning with such fiscal year.

              Part D--Allocation and Distribution of Funds

                            national budget

    Sec. 531. (a) The National Health Board shall prepare, taking into 
consideration the budgets submitted under section 522(c), and, as soon 
after April 1 of each year as is practicable, shall transmit to the 
regional boards a national health budget for the fiscal year beginning 
on October 1 of such year. Such budget shall divide the total funds 
available for obligation in such year, as determined under section 521, 
into--
            (1) funds for ordinary operating expenses, which shall be 
        further divided into funds for use by the National Health 
        Board, and funds to be allocated (in accordance with subsection 
        (b)) to the regional boards for use by the regional boards and 
        the district and community boards within their regions;
            (2) funds for preventive health measures, which shall be 
        further divided into funds for use by the National Health Board 
        and funds to be allocated (in accordance with subsection (b)) 
        to the regional boards for use by the regional boards and the 
        district and community boards within their regions;
            (3) funds for capital expenses, which shall be further 
        divided into funds for use by the National Health Board and 
        funds to be allocated (in accordance with subsection (c)) to 
        the regional boards for use by the regional boards and district 
        and community boards within their regions;
            (4) funds for research expenses, which shall be further 
        divided into funds for the conduct of research under the 
        supervision of the National Health Board and funds to be 
        allocated (in accordance with subsection (b)) to the regional 
        boards for the conduct of research under the supervision of the 
        regional, district, and community boards; and
            (5) funds for special operating expenses, as described in 
        section 534.
    (b) Funds for ordinary operating expenses, for preventive health 
measures, and for research expenses which are allocated to the regional 
boards under subsection (a) shall be divided among the regions in the 
proportion which the number of residents in each region bears to the 
total population of the Nation.
    (c) Funds for capital expenses which are allocated to the regional 
boards under subsection (a) shall be allocated, to the extent 
consistent with the efficient and equitable use of resources, to the 
regional boards in accordance with the budgets for capital expenses 
submitted by such boards to the National Health Board under section 
522(c), except that during the first 10 fiscal years following the 
effective date of health services, priority shall be given to regions 
lacking adequate health care facilities on such effective date.
    (d) A budget submitted to the regional boards under subsection (a) 
shall be adopted upon the approval of such budget by a majority of such 
regional boards.

                            regional budgets

    Sec. 532. (a) Each regional board shall prepare, taking into 
consideration the budgets submitted under section 522 (b), and, as soon 
as may be practicable after the adoption under section 531 of the 
national health budget for any fiscal year, shall transmit a regional 
budget, covering operating, prevention, capital, and research expenses 
for such fiscal year, to each district board in its region. Such 
regional budget shall be adopted upon the approval of such budget by a 
majority of such district boards.
    (b) Funds for capital expenses shall be allocated, to the extent 
consistent with the efficient and equitable use of resources, to the 
district boards in a region in accordance with the budgets for capital 
expenses submitted by such boards to the regional board under section 
522(b), except that during the first 10 fiscal years following the 
effective date of health services, priority shall be given to districts 
lacking adequate health care facilities on such effective date.
    (c) Funds to be allocated to district boards for ordinary operating 
expenses, preventive health measures, and research expenses shall be 
allocated to each district board in the same proportion as the number 
of residents in such district bears to the number of residents in the 
respective region.

                            district budgets

    Sec. 533. (a) Each district board shall prepare, taking into 
consideration the budgets submitted under section 522 (a), and, as soon 
as may be practicable after the adoption under section 532 of the 
regional health budget for any fiscal year for the respective region, 
shall transmit a district budget, covering operating, prevention, 
capital, and research expenses for such fiscal year, to each community 
board in its district. Such district budget shall be adopted upon the 
approval of such budget by a majority of such community boards.
    (b) Funds for capital expenses shall be allocated, to the extent 
consistent with the efficient and equitable use of resources, to the 
community boards in a district in accordance with the budgets for 
capital expenses submitted by such boards to the district board under 
section 522(a), except that during the first 10 fiscal years following 
the effective date of health services, priority shall be given to 
communities lacking adequate health care facilities on such effective 
date.
    (c) Funds to be allocated to community boards for ordinary 
operating expenses, preventive health measures, and research expenses 
shall be allocated to each community board in the same proportion as 
the number of residents in such community bears to the number of 
residents in the respective district.

                     special operating expense fund

    Sec. 534. (a) A fund for special operating expenses shall be 
incorporated into each budget prepared by the National Health Board. 
For the purposes of this title, the term ``special operating expenses'' 
means operating expenses associated with--
            (1) the care and treatment of users 65 years of age or 
        older;
            (2) the care and treatment of persons confined to full-time 
        residential care institutions, including nursing homes and 
        facilities for the treatment of mental illness;
            (3) the special health care needs of low-income users;
            (4) the special health care needs of residents of rural 
        areas;
            (5) special health care needs arising from environmental or 
        occupational health conditions;
            (6) special health care needs arising from unexpected 
        occurrences, including epidemics and natural disasters; and
            (7) the conduct of environmental health inspection and 
        monitoring services.
    (b) The special operating expense fund shall be allocated as 
follows:
            (1) Funds for the additional operating expenses associated 
        with the care and treatment of users 65 years of age or older 
        shall be allocated to district and community boards and shall 
        consist of uniform basic capitation amounts multiplied by the 
        number of residents 65 years of age or older in the respective 
        districts and communities. The basic capitation amounts for 
        districts and for communities shall be determined by the 
        National Health Board, based upon studies of the additional 
        operating expenses associated with the care and treatment of 
        such residents in such districts and communities.
            (2) Funds for the additional operating expenses associated 
        with the care and treatment of persons confined to full-time 
        residential care institutions shall be allocated to the 
        district and community boards responsible for such institutions 
        and shall consist of a uniform basic capitation amount for each 
        kind of institution, multiplied by the number of residents in 
        such institutions in the respective districts and communities. 
        The basic capitation amounts shall be determined by the 
        National Health Board, based upon studies of the additional 
        operating expenses associated with the care and treatment of 
        such persons and the maintenance of such institutions.
            (3) Funds shall be allocated to community boards for the 
        additional operating expenses associated with the special 
        health care needs of low-income persons. Such payments shall be 
        allocated to community boards in proportion to the number of 
        residents in their communities having incomes below the poverty 
        level (as defined by the Secretary of Commerce). The total 
        funds allocated for this purpose shall be no less than 2 
        percent of the ordinary operating expense funds allocated in 
        accordance with section 531(a).
            (4) Funds for the additional operating expenses associated 
        with the special health care needs of residents of rural areas 
        shall be allocated to district and community boards serving 
        areas of low population density and shall consist of basic 
        capitation amounts multiplied by the number of residents in the 
        respective districts and communities. The basic capitation 
        amounts shall be determined by the National Health Board based 
        upon studies of the additional operating expenses associated 
        with the provision of health care in areas of low population 
        density.
            (5) Funds for the additional operating expenses associated 
        with special regional health care needs arising from 
        environmental and occupational health problems shall be 
        allocated to regional boards by the National Health Board in 
        accordance with its determination of such special needs. The 
        total funds allocated for this purpose shall be no greater than 
        one-half of 1 percent of the ordinary operating expense funds 
        allocated in accordance with section 531(a).
            (6) Funds for the additional operating expenses associated 
        with special health care needs arising from unexpected 
        occurrences shall be retained by the National Health Board in a 
        contingency fund and shall be allocated by the National Health 
        Board in accordance with its determination of such needs. The 
        total funds retained for this purpose in any one fiscal year 
        shall be no greater than one-half of 1 percent of the ordinary 
        operating expense funds allocated in such year in accordance 
        with section 531(a).
            (7) Funds for the additional operating expenses associated 
        with the conduct of environmental health inspection and 
        monitoring services shall be allocated by the National Health 
        Board to the area health boards providing such services.

                         distribution of funds

    Sec. 535. (a) Funds allocated under the national health budget 
shall be distributed by the National Health Board from the Trust Fund. 
No health board may request or receive funds from any other source.
    (b) All payments shall be made to area health boards, and shall be 
expended by such boards, in accordance with the budgets adopted under 
sections 531 through 533. If the budget for any area health board for a 
fiscal year is not adopted before the beginning of the fiscal year, 
until such budget is adopted such area health board shall continue to 
receive ordinary operating expense funds, prevention expense funds, and 
research expense funds at the rate at which it was receiving such funds 
during the preceding fiscal year, and it shall receive special 
operating expense funds in accordance with section 534.
    (c) Each area health board shall maintain separate accounts for-- 
            (1) funds for operating expenses, including ordinary 
        operating expenses and special operating expenses;
            (2) funds for preventive health measures;
            (3) funds for capital expenses; and
            (4) funds for research expenses.
Funds in a capital expense account shall be expended only for capital 
expenses. Funds in a research expense account shall be expended only 
for operations, equipment, and facilities for health and health care 
delivery research conducted in accordance with part C of title IV. 
Separate accounts shall not be required for funds for ordinary 
operating expenses and for special operating expenses.
    (d) Area health boards shall be paid at such time or times as the 
National Health Board finds appropriate.
    (e) Before and during any fiscal year, supplementary funds may be 
allocated to any area health board if the National Health Board finds 
that such funds are required by events occurring or information 
acquired after the initial allocations to such health board were made.
    (f) Area health boards may retain funds received from the National 
Health Board for 2 years following the receipt of such funds. Any funds 
which are unexpended after such time shall be returned to the National 
Health Board for deposit in the Trust Fund.

                 annual statement, records, and audits

    Sec. 536. (a) Each area health board shall prepare annually and 
transmit to the National Health Board a statement which shall 
accurately show the financial operations of such board and the 
facilities supervised by it for the year for which such statement is 
prepared.
    (b) Each area health board shall keep such records as the National 
Health Board determines to be necessary for the purposes of this Act, 
including for the facilitation of audits.
    (c) The National Health Board and the Comptroller General of the 
United States, or their duly authorized representatives, shall, for the 
purpose of audits, have access to any books, documents, papers, and 
records which in their opinion are related or pertinent to the 
operation of the Service.

                       Part E--General Provisions

                        issuance of obligations

    Sec. 541. (a) The National Health Board is authorized to borrow 
money and to issue and sell such obligations as it determines necessary 
to carry out the purposes of this Act, but only in such amounts as may 
be specified from time to time in appropriation Acts. The aggregate 
amount of any such obligations outstanding at any one time shall not 
exceed $10,000,000,000.
    (b) The National Health Board may pledge the assets of the Trust 
Fund and pledge and use its revenues and receipts for the payment of 
the principal of or interest on such obligations, for the purchase or 
redemption thereof, and for other purposes incidental thereto. The 
National Health Board is authorized to enter into binding covenants 
with the holders of such obligations, and with the trustee, if any, 
under any agreement entered into in connection with the issuance 
thereof with respect to the establishment of reserve, sinking, and 
other funds, stipulations concerning the issuance of obligations or the 
execution of leases or lease purchases relating to properties of the 
Service and such other matters as the National Health Board deems 
necessary or desirable to enhance the marketability of such 
obligations.
    (c) Obligations issued by the Service under this section-- 
            (1) shall be in such forms and denominations;
            (2) shall be sold at such times and in such amounts;
            (3) shall mature at such time or times;
            (4) shall be sold at such prices;
            (5) shall bear such rates of interest;
            (6) may be redeemable before maturity in such manner, at 
        such times, and at such redemption premiums;
            (7) may be entitled to such relative priorities of claim on 
        the assets of the Service with respect to principal and 
        interest payments; and
            (8) shall be subject to other terms and conditions, as the 
        National Health Board determines.
    (d) Obligations issued by the Service under this section shall-- 
            (1) be negotiable or nonnegotiable and bearer or registered 
        instruments, as specified therein and in any indenture or 
        covenant relating thereto;
            (2) contain a recital that they are issued under this 
        section, and such recital shall be conclusive evidence of the 
        regularity of the issuance and sale of such obligations and of 
        their validity;
            (3) be lawful investments and may be accepted as security 
        for all fiduciary, trust, and public funds, the investment or 
        deposit of which shall be under the authority or control of any 
        officer or agency of the Government of the United States, and 
        the Secretary of the Treasury or any other officer or agency 
        having authority over or control of any such fiduciary, trust, 
        or public funds, may at any time sell any of the obligations of 
        the Service acquired under this section;
            (4) be exempt both as to principal and interest from all 
        taxation now or hereafter imposed by any State or local taxing 
        authority except estate, inheritance, and gift taxes; and
            (5) not be obligations of, nor shall payment of the 
        principal thereof or interest thereon be guaranteed by, the 
        Government of the United States, except as provided in 
        subsection (g).
    (e) At least 15 days before selling any issue of obligations, the 
National Health Board shall advise the Secretary of the Treasury of the 
amount, proposed date of sale, maturities, terms and conditions, and 
expected maximum rates of interest of the proposed issue in appropriate 
detail and shall consult with him or his designee thereon. The 
Secretary may elect to purchase such obligations under such terms, 
including rates of interest, as he and the National Health Board may 
agree, but at a rate of yield no less than the prevailing yield on 
outstanding marketable Treasury securities of comparable maturity, as 
determined by the Secretary. If the Secretary does not purchase such 
obligations, the National Health Board may proceed to issue and sell 
them to a party or parties other than the Secretary upon notice to the 
Secretary and upon consultation as to the date of issuance, maximum 
rates of interest, and other terms and conditions.
    (f) Subject to the conditions of subsection (e), the National 
Health Board may require the Secretary of the Treasury to purchase 
obligations of the Service in such amounts as will not cause the 
holding by the Secretary of the Treasury resulting from such required 
purchases to exceed $2,000,000,000 at any one time. This subsection 
shall not be construed as limiting the authority of the Secretary to 
purchase obligations of the Service in excess of such amount.
    (g) Notwithstanding subsection (d)(5), obligations issued by the 
Service shall be obligations of the Government of the United States, 
and payment of principal and interest thereon shall be fully guaranteed 
by the Government of the United States, such guaranty being expressed 
on the face thereof, if and to the extent that--
            (1) the National Health Board requests the Secretary of the 
        Treasury to pledge the full faith and credit of the Government 
        of the United States for the payment of principal and interest 
        thereon; and
            (2) the Secretary, in his discretion, determines that it 
        would be in the public interest to do so.
    (h) For the purpose of any purchase of the obligations of the 
Service, the Secretary of the Treasury is authorized to use as a public 
debt transaction the proceeds from the sale of any securities issued 
under the Second Liberty Bond Act, as now or hereafter in force, and 
the purposes for which securities may be issued under the Second 
Liberty Bond Act, as now or hereafter in force, are extended to include 
any purchases of the obligations of the Service under this part. The 
Secretary of the Treasury may, at any time, sell any of the obligations 
of the Service acquired by him under this chapter. All redemptions, 
purchases, and sales by the Secretary of the obligations of the Service 
shall be treated as public debt transactions of the United States.

                              definitions

    Sec. 542. For purposes of this title:
            (1) The term ``operating expenses'' means the cost of 
        providing, planning, operating, and maintaining services, 
        facilities, programs, and boards (other than those associated 
        with research) established or furnished under this Act, and of 
        capital buildings and equipment (other than those associated 
        with research) costing less than $100,000, except for funds 
        associated with the conduct of preventive health measures and 
        research.
            (2) The term ``capital expenses'' means expenses which 
        under generally accepted accounting principles are not properly 
        chargeable as expenses of operation and maintenance, which 
        exceed $100,000, and which are not associated primarily with 
        the conduct of research.

                   TITLE VI--MISCELLANEOUS PROVISIONS

                   effective date of health services

    Sec. 601. The effective date of health services under this Act is 
January 1 of the fourth calendar year after the year in which this Act 
is enacted.

                          repeal of provisions

    Sec. 602. (a) Effective on the effective date of health services, 
the following provisions of law are repealed:
    (1) The Public Health Service Act, except for--
            (A) title I (relating to short title and definitions), 
        parts F and G of title III (relating to licensing and 
        quarantine authority), and title XIV (relating to safety of 
        public water systems); and
            (B) titles VII and VIII, which shall remain effective, 
        during the period beginning on such effective date and ending 
        on the date occurring 4 years after such effective date, with 
        respect to the provision of assistance to educational 
        institutions, and students thereof, in areas which have not 
        established health team schools under part A of title III of 
        this Act.
    (2) Titles V, XVIII, and XIX of the Social Security Act (relating 
to the maternal and child health and crippled children's services, 
Medicare, and Medicaid); part B of title XI of such Act (relating to 
professional standards review); sections 226, 1121 through 1124, and 
1126 of such Act (relating to entitlement to hospital insurance 
benefits, uniform health reporting systems, limitation on Federal 
participation for capital expenditures, program for determining 
qualification for certain health care personnel, disclosure of 
ownership and related information, and disclosure of certain 
convictions); and so much of title XX of such Act (relating to grants 
to States for services) as provides for payments to States for health 
care and supplemental services.
    (3) Chapter 89 of title 5, United States Code (relating to health 
insurance for Federal employees).
    (4) Chapters 17, 73, and 81 and section 1506 of title 38, United 
States Code (relating to medical benefits and programs relating to 
veterans).
    (5) Sections 1079 through 1083 and section 1086 of title 10, United 
States Code (relating to the civilian health and medical program of the 
uniformed services).
    (6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, 
Treatment, and Rehabilitation Act of 1970; the Comprehensive Alcohol 
Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act 
Amendments of 1974; and section 4 of the Comprehensive Drug Abuse 
Prevention and Control Act of 1970 (relating to medical treatment of 
narcotic addiction).
    (7) Public Law 83-568 (42 U.S.C. 2001-2004b) (relating to hospital 
and other health facilities for Indians) and Public Law 85-151 (42 
U.S.C. 2005-2005f) (relating to community hospitals for Indians).
    (8) The District of Columbia Medical Facilities Construction Act of 
1968 and the District of Columbia Medical and Dental Manpower Act of 
1970.
    (9) Sections 232 and 242 and title XI of the National Housing Act 
(relating to mortgage insurance for nursing homes, hospitals, and group 
practice facilities).
    (10) The Mental Retardation Facilities and Community Mental Health 
Centers Construction Act of 1963.
    (11) The Family Planning Services and Population Research Act of 
1970.
    (12) The National Arthritis Act of 1974 and the National Diabetes 
Mellitus Research and Education Act.
    (13) Titles I and II and section 301 of the Lead-Based Paint 
Poisoning Prevention Act (42 U.S.C. 4801, 4811, 4821) (relating to 
grant programs for lead-based paint poisoning prevention).
    (14) The Act of March 2, 1897 (21 U.S.C. 41-50) (relating to tea 
importation).
    (15) Subsection (e) of section 20 and section 22 of the 
Occupational Safety and Health Act of 1970 (relating to the National 
Institute for Occupational Safety and Health).
    (b)(1) Not later than three years after the date of enactment of 
this Act, the President shall prepare, in consultation with the 
appropriate National Health Board, and transmit to Congress legislation 
(A) to repeal or amend such provisions of law as are inconsistent with 
the purposes of this Act or the provision of health care and 
supplemental services by the Service under this Act, and (B) to make 
such conforming and technical amendments in provisions of law as may be 
necessary to properly effect the repeal of provisions described in 
subsection (a) and the repeal or amendment of provisions described in 
clause (A) of this paragraph.
    (2) Such legislation shall include the transfers of such authority 
of the Secretary of Health and Human Services under the provisions of--
            (A) the Controlled Substances Act;
            (B) chapter 175 of title 28, United States Code (relating 
        to civil commitment and rehabilitation of narcotics addicts);
            (C) chapter 314 of title 18, United States Code (relating 
        to sentencing of narcotic addicts to commitment for treatment);
            (D) the Narcotic Addict Rehabilitation Act of 1966;
            (E) the Drug Abuse Office and Treatment Act of 1972;
            (F) the Occupational Safety and Health Act of 1970;
            (G) the Lead-Based Paint Poisoning Prevention Act;
            (H) the Federal Cigarette Labeling and Advertising Act;
            (I) the Federal Food, Drug, and Cosmetic Act;
            (J) the Fair Packaging and Labeling Act;
            (K) the Act of March 4, 1923 (21 U.S.C. 61-64) (relating to 
        filled milk);
            (L) the Act of February 15, 1927 (21 U.S.C. 141-149) 
        (relating to milk importation);
            (M) the Federal Caustic Poison Act;
            (N) the Federal Coal Mine Health and Safety Act of 1969 
        (other than title IV thereof); and
            (O) the Solid Waste Disposal Act,
to the Service as the President determines, after consultation with the 
National Health Board, to be appropriate.
    (c)(1) The National Health Board shall, immediately upon its 
initial appointment, and in consultation with the Secretary of Health 
and Human Services, review the programs conducted under the specified 
provisions of the Public Health Service Act and the other Acts 
described in section 602(a) and shall determine how the Service shall 
carry out the purposes of such programs.
    (2) Not later than one year after the effective date of health 
services, the National Health Board shall report to the President and 
to the Congress on how the Service is carrying out the purposes of the 
programs authorized to be conducted under provisions of law which are 
repealed by subsection (a) (other than paragraph (1)(B) thereof).
    (3) Not later than 5 years after the effective date of health 
services, the National Health Board shall report to the President and 
to the Congress on how the Service is carrying out the purposes of 
programs described in subsection (a)(1)(B).
    (d) Not later than 2 years after the effective date of health 
services, the National Health Board shall transmit to Congress a 
proposed codification of all the provisions of law which contain 
functions that are transferred or relate to the Service.

                         transition provisions

    Sec. 603. (a) Amounts appropriated to carry out the purposes of any 
provisions of law repealed by this Act and available on the effective 
date of such repeal shall be transferred on such date to the Health 
Service Trust Fund (established under section 511 of this Act).
    (b) The President is authorized to transfer so much of the 
positions, personnel, assets, liabilities, contracts, property, and 
records employed, held, used, arising from, available to or made 
available in connection with the functions or programs repealed by this 
Act to the Service as may be agreed upon by the President and the 
National Health Board.
    (c) In the case where the authority for the establishment of any 
office or agency, or all the functions of such office or agency, are 
repealed under section 602, such office or agency shall lapse.
    (d) The amendments made by section 602--
            (1) shall not apply with respect to any contract entered 
        into before the effective date of such amendments, and
            (2) shall not affect (A) any right or obligation arising 
        out of any matter occurring before the effective date of such 
        amendments, or (B) any administrative or judicial proceeding 
        (whether or not initiated before that date) for the 
        adjudication or enforcement of any such right or obligation.

                 amendment to budget and accounting act

    Sec. 604. (a) Section 201 of the Budget and Accounting Act, 1921 
(31 U.S.C. 11) is amended by inserting after subsection (j) the 
following new subsection:
    ``(k) The Budget transmitted pursuant to subsection (a) shall set 
forth the items enumerated in paragraphs (4) through (9) and (12) of 
subsection (a) with respect to expenditures from and appropriations to 
the Health Service Trust Fund (established under section 511 of the 
Health Service Act) separately from such items with respect to 
expenditures and appropriations relating to other operations of the 
Government.''.
    (b) The amendment made by subsection (a) shall apply with respect 
to fiscal years beginning more than 1 year after the date of enactment 
of this Act.

                              separability

    Sec. 605. If any provision of this Act, or the application of such 
provision to any person or circumstance, shall be held invalid, the 
remainder of this Act, or the application of such provision to persons 
or circumstances other than those as to which it is held invalid, shall 
not be affected thereby.
                                 <all>