[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3000 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 3000

  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

                            October 1, 1999

 Ms. Lee (for herself, Mrs. Christensen, and Mr. Jackson of Illinois) 
 introduced the following bill; which was referred to the Committee on 
   Commerce, and in addition to the Committees on Education and the 
    Workforce, and Ways and Means, 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,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Josephine Butler 
United States Health Service Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

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

                    Subtitle 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.
             Subtitle 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.
         Subtitle 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.
Sec. 126. Public accountability and financial disclosure by health 
                            board members.
Sec. 127. Inspector General for Health Services.
      TITLE II--DELIVERY OF HEALTH CARE AND SUPPLEMENTAL SERVICES

          Subtitle A--Patients' Rights in Health Care Delivery

Sec. 201. Basic health rights.
Sec. 202. Right to paid leave to receive health care services.
Subtitle 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.
Subtitle 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 
                            childbearing.
                     TITLE III--HEALTH LABOR FORCE

              Subtitle 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.
                Subtitle B--Education of Health Workers

Sec. 311. Health team schools.
Sec. 312. Service requirement.
Sec. 313. Payment for certain educational loans.
   Subtitle 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

      Subtitle A--Advocacy, Grievance Procedures, and Trusteeships

Sec. 401. Advocacy and legal services program.
Sec. 402. Grievance procedures and trusteeships.
          Subtitle 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.
     Subtitle C--Health and Health Care Delivery Research, Quality 
                      Assurance, and Health Equity

Sec. 421. Principles and guidelines for research.
Sec. 422. Establishment of institutes.
 Subtitle 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

                    Subtitle A--Health Service Taxes

Sec. 501. Individual and corporate income taxes.
Sec. 502. Other changes in the Internal Revenue Code of 1986.
Sec. 503. Existing employer-employee health benefit plans.
Sec. 504. Workers compensation programs.
                 Subtitle 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.
              Subtitle C--Preparation of Plans and Budgets

Sec. 521. Determination of fund availability.
Sec. 522. Preparation of area plans and budgets.
            Subtitle 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.
                     Subtitle 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.

SEC. 2. FINDINGS.

    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, employment 
        status, or previous health status.
            (4) The present health care system has failed to provide 
        financial coverage for health care services for more than forty 
        million Americans, and the percent lacking such coverage grows 
        each year.
            (5) The present health care system has failed to provide 
        for sufficient effective preventive measures that would address 
        the deterioration in occupational, environmental, and social 
        conditions affecting the health of the people of this Nation.
            (6) Unnecessary and excessive profits and administrative 
        expenses have inflated the cost of health care.
            (7) The growth of for-profit medical care and for-profit 
        managed care is making it difficult for health care personnel 
        to provide, and users to receive, the full range of health 
        services they believe to be necessary, appropriate, and 
        desirable.
            (8) 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.
            (9) The present health care system has failed to make full 
        and efficient use of allied health workers.
            (10) 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.

SEC. 3. PURPOSES.

    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, employment 
        status, 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.

SEC. 4. DEFINITIONS.

    For the purposes of this Act, unless the context implies otherwise:
            (1) Service.--The term ``Service'' means the United States 
        Health Service established in section 101.
            (2) National health board-related terms.--
                    (A) National health board.--The term ``National 
                Health Board'' means the National Health Board of the 
                Service.
                    (B) Interim national health board.--The term 
                ``Interim National Health Board'' means the Interim 
                National Health Board, appointed under section 102, of 
                the Service.
                    (C) Appropriate national health board.--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.
            (3) Health board-related terms.--
                    (A) Health board.--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) Area health board.--The term ``area health 
                board'' means a regional health board, a district 
                health board, or a community health board established 
                under this Act.
            (4) Area-related terms.--
                    (A) Community.--The term ``community'' means a 
                health care delivery community established under title 
                I.
                    (B) District.--The term ``district'' means a health 
                care delivery district established under title I.
                    (C) Region.--The term ``region'' means a health 
                care delivery region established under title I.
                    (D) Area.--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.
            (5) Local board-related terms.--
                    (A) Interim regional board.--The term ``interim 
                regional board'' means an interim regional health board 
                established in accordance with section 112.
                    (B) Regional board.--The term ``regional board'' 
                means a regional health board established in accordance 
                with title I.
                    (C) District board.--The term ``district board'' 
                means a district health board established in accordance 
                with title I.
                    (D) Community board.--The term ``community board'' 
                means a community health board established in 
                accordance with title I.
            (6) Regional and district boards.--
                    (A) Respective regional board.--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) Respective district board.--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.
            (7) User-related terms.--
                    (A) User.--The term ``user'' means an individual 
                who is eligible under section 211 to receive health 
                care services from the Service under this Act.
                    (B) Registered user.--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) Eligible user.--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) User member.--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) Indirect provider of health care.--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, 
                                medical equipment, 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, medical equipment, 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.
            (8) Worker-related terms.--
                    (A) Health worker.--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) Authorized health worker.--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) Eligible area health worker.--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) Worker member.--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.
            (9) Facility-related terms.--
                    (A) Health care facility.--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) Area health care facility.--The term ``area 
                health care facility'' means, with respect to an area 
                health board, a health care facility established by the 
                area health board.
            (10) Service-related terms.--
                    (A) Health care services.--The term ``health care 
                services'' means the services described in paragraphs 
                (1) through (5) of section 213(a).
                    (B) Supplemental services.--The term ``supplemental 
                services'' means the services described in paragraphs 
                (1), (2), and (3) of section 213(b).
            (11) Number of residents.--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.
            (12) Effective date of health services.--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

                    Subtitle A--Initial Organization

SEC. 101. ESTABLISHMENT OF THE SERVICE.

    (a) In General.--There is established, as an independent 
establishment of the executive branch of the United States, the United 
States Health Service.
    (b) Authority.--
            (1) National health board.--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) Eminent domain authority.--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.

SEC. 102. APPOINTMENT OF INTERIM NATIONAL HEALTH BOARD.

    (a) In General.--The President shall, no later than 30 days after 
the date of the 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 approximate the 
        percentage of rural and frontier populations; 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) Designation of Chairperson and Vice Chairperson.--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.

SEC. 103. POWERS AND DUTIES OF THE INTERIM NATIONAL HEALTH BOARD.

    (a) Term.--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) Duties.--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) Application of Requirements.--The Interim National Health Board 
shall operate in a manner consistent with the provisions of subtitle C.
    (d) Initial Report.--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.

SEC. 104. AUTHORIZATION.

    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.

             Subtitle B--Organization of Area Health Boards

SEC. 111. ESTABLISHMENT OF HEALTH CARE DELIVERY REGIONS.

    (a) Establishment of Health Care Delivery Regions.--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) Requirements for Delivery Regions.--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.
        A region under subparagraph (B) may be a sparsely populated 
        frontier area which consists of a very large or multi-state 
        geographic area.
            (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) Process.--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) Modification of Boundaries.--The boundaries of regions shall be 
modified in accordance with section 119.

SEC. 112. APPOINTMENT OF INTERIM REGIONAL HEALTH BOARDS.

    (a) Appointment of Interim Regional Boards.--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) Composition.--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) Designation of Chairperson and Vice Chairperson.--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) Vacancies.--A vacancy in the membership of an interim regional 
board shall be filled in the same manner as the original appointment.
    (e) Term.--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) Duties.--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) Operational Requirements.--Each interim regional board shall 
operate in a manner in accordance with subtitle C of this title.

SEC. 113. ESTABLISHMENT OF HEALTH CARE DELIVERY DISTRICTS AND HEALTH 
              CARE DELIVERY COMMUNITIES.

    (a) In General.--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) Division Into Districts.--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) Division of Districts Into Communities.--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) Process.--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) Process for Modification of Boundaries.--The boundaries of 
districts and communities shall be modified in accordance with section 
119.

SEC. 114. ELECTION OF COMMUNITY HEALTH BOARDS.

    (a) In General.--
            (1) User members.--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) Worker members.--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) Number.--
            (1) User members.--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) Worker members.--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) Nomination and Election Procedures.--
            (1) In general.--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) Nomination process.--
                    (A) User members.--Such procedures for election of 
                user members shall provide, except as otherwise 
                provided in this subtitle, 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) Worker members.--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) Certification.--
            (1) In general.--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.
            (2) Initial meeting.--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.

SEC. 115. APPOINTMENT OF DISTRICT HEALTH BOARDS.

    (a) Initial Appointment.--
            (1) User members.--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) Worker members.--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) Worker members.--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) Notice of appointment.--The user and worker members of 
        each such community board shall promptly notify their 
        respective interim regional board of appointments under this 
        subsection.
    (b) Certification.--
            (1) In general.--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) Initial meeting.--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.

SEC. 116. APPOINTMENT OF REGIONAL HEALTH BOARDS.

    (a) In General.--
            (1) User members.--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) Appointment of worker member.--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) Election of worker member.--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) Notice.--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) Certification.--
            (1) In general.--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) Initial meeting.--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.

SEC. 117. APPOINTMENT OF THE NATIONAL HEALTH BOARD.

    (a) Assignment of Regions.--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) Appointment of Members.--
            (1) User member.--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) Worker member.--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) Notice and review.--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) Certification.--
            (1) In general.--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) Initial meeting.--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.

SEC. 118. SUBSEQUENT ELECTION AND APPOINTMENT OF MEMBERS OF HEALTH 
              BOARDS.

    (a) Terms.--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) Elections.--
            (1) User members.--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) Worker members.--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) Process.--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) Communities.--
            (1) Assignment.--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) Appointment.--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) Certification.--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) Initial meeting.--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) Districts.--
            (1) Assignment.--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) Appointment.--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) Certification.--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) Initial meeting.--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) National Health Board.--
            (1) Appointments.--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) Certification.--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) Initial meeting.--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.

SEC. 119. MODIFICATION OF THE BOUNDARIES OF HEALTH CARE DELIVERY AREAS.

    (a) In General.--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) Process.--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) Review of Appropriateness.--
            (1) In general.--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 (or 10 percent, in the case of a region 
                where more than one-third of the geographic area 
                includes frontier communities, of the residents 
                residing in the frontier portion of the region) 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) Process.--Any review conducted under paragraph (1) 
        shall comply with the procedures of subsection (d) (relating to 
        open hearings and public participation).
            (3) Standards for modification.--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) Process.--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.

         Subtitle C--General Provisions Regarding Health Boards

SEC. 121. DEFINITIONS.

    As used in this subtitle, 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).

SEC. 122. MEMBERSHIP OF HEALTH BOARDS.

    (a) Composition.--Each health board shall be composed of--
            (1) members elected or appointed and approved in accordance 
        with this subtitle 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 (A) the user members of the board approximate 
        the population within its area by race, sex, income level, and 
        language and (B) 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) Term Limits.--
            (1) In general.--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) Exception.--Full members of a health board shall serve 
        until their successors are certified in accordance with this 
        Act.
    (c) .--
            (1) Recall elections.--
                    (A) In general.--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) Process.--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) Vote required.--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) Removal of national health board member.--A member of 
        the Interim National Health Board or National Health Board may 
        be removed from office by the President for 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) Vacancies.--
            (1) In general.--A vacancy caused by the death, 
        resignation, or removal of a member (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) Term of vacancy appointment.--Any individual appointed 
        to fill a vacancy under this subsection shall serve only for 
        the unexpired term of office of the vacating member.
            (3) Eligible individual defined.--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.

SEC. 123. MEETINGS AND RECORDS OF HEALTH BOARDS.

    (a) Full Member Rights.--
            (1) Voting.--Each full member of a health board shall have 
        one vote in meetings of such board.
            (2) Quorum.--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) Chairperson.--
            (1) Election.--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) Responsibilities.--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) Vice chairperson.--The vice chairperson shall perform 
        the duties of the chairperson in the event that the chairperson 
        is unable to perform such functions.
    (c) Records.--
            (1) In general.--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) Access.--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) Office.--Each health board shall establish a principal 
        office within the area it serves.
    (d) Dissemination of Information.--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) Rules.--
            (1) In general.--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) Committees.--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) Compensation.--
            (1) National board.--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) Other health boards.--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.

SEC. 124. PROCEDURES FOR ESTABLISHMENT OF NATIONAL GUIDELINES AND 
              STANDARDS.

    (a) In General.--In addition to guidelines and standards otherwise 
required to be established by this Act, the National Health Board shall 
establish by regulation (after notice and opportunity for public 
comment) 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) Review.--The National Health Board shall submit, at least 90 
days before the date of publishing a proposed guideline or standard 
under this Act, each such guideline or standard to regional boards for 
their review and comments.
    (c) Technical Assistance.--The National Health Board and the 
regional boards shall establish programs that provide orientation, 
education, and technical assistance (including support staff) to 
members of area health boards in the use and application of guidelines 
and standards established by the National Health Board.

SEC. 125. ASSISTANCE TO AREA HEALTH BOARD MEMBERS.

    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.

SEC. 126. PUBLIC ACCOUNTABILITY AND FINANCIAL DISCLOSURE BY HEALTH 
              BOARD MEMBERS.

    (a) Prohibition of Conflicts of Interest.--
            (1) In general.--Individuals with direct or indirect 
        conflicts of interest shall not serve on health boards at any 
        level. Subject to paragraph (2), such conflicts may consist of 
        ownership of, employment in, or other financial affiliation 
        with any industry in a position to profit or otherwise benefit 
        from the activities of the health board.
            (2) Exception.--Paragraph (1) shall not apply to employment 
        as a health worker by the Service as specified in this Act.
    (b) Disclosure.--Candidates for health boards at any level shall 
fully disclose any such potential conflicts of interest, and if elected 
shall sever any affiliations that could result in a conflict. The 
severing of such ties shall be documented and reported to the National 
Health Board, which shall be accountable for monitoring and enforcing 
the provisions of this section.

SEC. 127. INSPECTOR GENERAL FOR HEALTH SERVICES.

    Within the United States Health Service there shall be an Office of 
the Inspector General, to be headed by an Inspector General for Health 
Services, that shall have authority to ensure the effective operation 
of the health boards pursuant to this Act and to investigate and pursue 
any grievances against such boards. The Inspector General shall have 
the same authority as an Inspector General has under the Inspector 
General Act of 1978.

      TITLE II--DELIVERY OF HEALTH CARE AND SUPPLEMENTAL SERVICES

          Subtitle A--Patients' Rights in Health Care Delivery

SEC. 201. BASIC HEALTH RIGHTS.

    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 from any facility within the Service 
        capable of providing such 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 all medically necessary or 
        appropriate health services delivered in a convenient and 
        timely manner. Any decision to deny or postpone such necessary 
        or appropriate care shall be made only on the basis of 
        temporary and reasonable limitations in the availability of 
        service personnel and physical facilities. Users shall have the 
        opportunity for timely and effective appeal of any decision to 
        deny or postpone care.
            (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.
            (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 all 
                medically necessary or appropriate 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 subtitle, 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, the health 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, including access to user advocates who shall--
                    (A) assist users in choosing the most appropriate 
                sites from which to receive health services and the 
                most appropriate health workers from whom to receive 
                such services;
                    (B) provide counseling and assistance to users in 
                filing complaints; and
                    (C) investigate instances of poor quality services 
                or improper treatment of users and bring such instances 
                to the attention of the applicable authority.
            (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.

SEC. 202. RIGHT TO PAID LEAVE TO RECEIVE HEALTH CARE SERVICES.

    (a) Amendment to Fair Labor Standards Act.--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) Conforming Amendments.--The Fair Labor Standards Act of 1938 is 
further amended-- 
            (1) by striking ``sections 6 and 7'' in section 3(o) and 
        inserting ``sections 6, 7, and 7A'';
            (2)(A) by striking ``and 7'' in section 13(a) before 
        paragraph (1) and inserting ``, 7, and 7A'';
            (B) by striking ``sections 6 and 7'' in section 13(a)(3) 
        and inserting ``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 ``6 and 7'' in section 14(d) and inserting 
        ``6, 7, and 7A'';
            (4) by striking ``section 6 or section 7'' in section 15(a) 
        and inserting ``section 6, 7, or 7A'';
            (5)(A) by striking ``section 6 or section 7'' in section 
        16(b) and inserting ``section 6, 7, or 7A'';
            (B) by striking ``or their unpaid overtime compensation'' 
        in section 16(b) and inserting ``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 ``section 6 or 7'' in the first sentence of 
        section 16(c) and inserting ``section 6, 7, or 7A'';
            (E) by striking ``unpaid overtime compensation'' in the 
        first sentence of section 16(c) and inserting ``, unpaid 
        overtime compensation, or unpaid health leave compensation'';
            (F) by striking ``or overtime compensation'' in the second 
        sentence of section 16(c) and inserting ``, overtime 
        compensation, or health leave compensation'';
            (G) by striking ``or unpaid overtime compensation under 
        sections 6 and 7'' in the third sentence of section 16(c) and 
        inserting ``, 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).

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

SEC. 211. ELIGIBILITY FOR SERVICES.

    (a) In General.--All individuals while within the United States are 
eligible to receive health care and supplemental services under this 
Act.
    (b) United States Defined.--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.

SEC. 212. ENTITLEMENT TO SERVICES.

    (a) In General.--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) Exclusion.--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.

SEC. 213. PROVISION OF HEALTH CARE AND SUPPLEMENTAL SERVICES.

    (a) In General.--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) Supplemental Services.--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; and
            (4) such counseling and social service assistance as will 
        avoid the unnecessary provision of health care services.
    (c) Local Public Health Services.--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) Emergency Health Care Services.--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.

Subtitle 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.

    (a) Community Facilities.--
            (1) In general.--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) Comprehensive primary health care services defined.--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 at least 
                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) Specialized health care services defined.--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 efficiently in a community setting.
            (4) Special services defined.--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) Community-oriented health measures defined.--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) District Responsibilities.--Each district board shall 
periodically determine the necessity to establish and maintain in its 
district inpatient and other specialized health care facilities. Where 
found appropriate, it shall 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) Regional Responsibilities.--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) Area Health Board Responsibilities.--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 transferal 
        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 subtitle 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 and injury 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) Authorities.--
            (1) Employment of workers.--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. The regional board shall be 
        consulted in the hiring of all senior administrative and 
        clinical personnel.
            (2) Facilities.--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. The regional board 
        shall be consulted in the purchase or leasing of such 
        facilities.
            (3) Effective delivery.--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) Coordination.--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.
            (5) Assistance to community and district health boards.--
        Each regional board shall assist the community and district 
        health boards in its region in establishing and operating 
        services. This shall include providing for the education of 
        health workers under section 311, assistance in hiring all 
        health workers for the region, and assistance in purchasing or 
        leasing of such premises as it deems necessary and suitable, in 
        consultation with the appropriate community and district health 
        boards in its region.
            (6) Assuring availability and accessibility of services.--
        Each regional board shall, taking into account guidelines 
established by the National Health Board, take whatever additional 
steps are necessary to ensure that all of the health services required 
under this title are available and accessible in a timely manner to 
adults, infants, children, and individuals with disabilities in its 
region. Toward that end, it shall--
                    (A) ensure that users within its region have access 
                to a sufficient number of each category of health 
                worker, including primary care providers, specialists, 
                and other health care professionals, in a manner so 
                that, to the maximum extent possible, such providers 
                are geographically accessible to all residences and 
                workplaces within the region and are culturally and 
                linguistically appropriate;
                    (B) ensure that services are available in a manner 
                which ensures continuity of care, availability within 
                reasonable hours of operation, and include emergency 
                and urgent care services which shall be accessible at 
                all times within the service area;
                    (C) ensure that any process established to 
                coordinate care shall ensure ongoing direct access to 
                relevant specialists and shall not impose an undue 
                burden on users with chronic health conditions;
                    (D) ensure that appropriate steps are taken to 
                eliminate any transportation or other barriers to the 
                timely receipt of services;
                    (E) ensure that a user who has a severe, complex, 
                or chronic condition shall have access to the most 
                appropriate health care coordinator (as defined in 
                paragraph (7)(A)); and
                    (F) ensure that priorities in the use of services 
                and facilities shall be set by the appropriate health 
                care professionals using criteria of medical necessity 
                and that any limitations or delay in access to services 
                shall be based only on limits of available service 
                personnel and physical facilities.
            (7) Definitions.--For purposes of this subsection:
                    (A) Health care coordinator.--The ``health care 
                coordinator'' means a health worker who performs case 
                management (as defined in subparagraph (B)) functions 
                in consultation with the health care team, the patient, 
                family, and community.
                    (B) Case management.--The term ``case management'' 
                means a coordinated set of activities conducted for the 
                management of an individual user's serious, 
                complicated, protracted or chronic health conditions in 
                order to ensure cost-effective and benefit-maximizing 
                treatment.
    (f) Guidelines.--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) Use of Evidence-Based Clinical Decision Criteria.--
            (1) In general.--The National Health Board shall authorize 
        the National Institute of Evaluative Clinical Research 
        described in section 422 to establish evidence-based clinical 
        decision criteria, where feasible, that shall apply throughout 
        the Nation.
            (2) Clinical decision criteria defined.--For purposes of 
        this section, the term ``clinical decision criteria'' means the 
        recorded (written or otherwise) screening procedures, decision 
        abstracts, clinical protocols, and practice guidelines used as 
        an important basis to determine the necessity and 
        appropriateness of health care services, in combination with 
        the facts of particular cases, the judgment of health care 
        professionals, and the preferences of users. Such criteria 
        shall be clearly documented and available to all health workers 
        and shall include a mechanism for periodically updating such 
        criteria.
    (h) Notice of Determinations.--Each health board shall provide 
users with timely notice of any determination to provide, deny, or 
delay provision of a service, and information about the relevant 
clinical decision criteria upon which such determination is based, if 
any. Such notification shall include information concerning the 
appropriate procedure to appeal such decision.
    (i) Accountability.--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.

SEC. 222. OPERATION AND INSPECTION OF HEALTH CARE FACILITIES.

    (a) Establishment of Policies.--
            (1) In general.--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) Input.--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) Health facility boards.--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) General Policy.--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) Private Delivery.--
            (1) Restrictions.--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) Employment restrictions.--No individual employed by a 
        health board may engage in the private delivery of health care 
        services.
            (3) Private delivery of health care services defined.--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) Hours of Operation.--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) Inpatient Services.--
            (1) Adequate care.--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) Inpatient representatives.--
                    (A) Election.--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 (in this paragraph referred to as the ``committee'') of not 
less than 3 members.
                    (B) Recall.--Any member of the committee may be 
                recalled by a vote of two-thirds of the number of 
                inpatients in the facility.
                    (C) Voting.--In the case of 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) Inspections.--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.

SEC. 223. PROVISION OF HEALTH SERVICES RELATING TO REPRODUCTION AND 
              CHILDBEARING.

    (a) Provision of Services.--
            (1) Family planning.--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) Pregnancy.--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 for women in conjunction with the 
                provision of all gynecologic, female contraceptive, and 
                abortion services and counseling for men on male 
                fertility-related services.
            (3) Voluntary.--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) Accompaniment.--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) Voluntary Consent.--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)--
                    (A) if 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;
                    (B) if she undergoes emergency abdominal surgery 
                within the 30-day waiting period and the sterilization 
                is concurrent with the abdominal surgery; or
                    (C) in the case of an elective sterilization 
                procedure, such as tubal ligation or vasectomy, that is 
                scheduled and performed separately from the act of 
                childbirth, where prior informed consent is provided 
                and the procedure is performed at the next subsequent 
                or any later medical visit after informed consent is 
                obtained.
    (c) Breast Cancer Treatment.--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) Birthing Options.--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

              Subtitle A--Job Categories and Certification

SEC. 301. EFFECT OF STATE LAW.

    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.

SEC. 302. QUALIFICATIONS OF HEALTH WORKERS.

    (a) Certification of Competence.--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 subtitle is performed by a health worker who at 
the time of such work was--
            (1) certified (in accordance with this subtitle) 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) Periodic Assessments.--Each area health board that employs 
health workers who perform work classified under a job category 
established under this subtitle 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) Other Periodic Reviews.--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.

SEC. 303. ESTABLISHMENT OF JOB CATEGORIES AND CERTIFICATION STANDARDS.

    (a) In General.--
            (1) Classification.--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) Considerations.--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) Local employment.--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) Periodic evaluation.--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) National board assistance.--The National Health Board 
        shall assist regional boards in applying the guidelines 
        established under this subsection.
    (b) Certification Standards.--
            (1) Establishment.--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 subtitle 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 subtitle B, subject to such periodic review and 
        assessment and to such continuing training, experience, or 
        performance as may be required under this subtitle.
            (2) Specifications.--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) Periodic review.--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.
            (4) Quality protection.--
                    (A) Prohibition of downgrades of levels.--No 
                individual health facility administrator is authorized 
                to downgrade the level of skill, license or 
                certification required to perform duties delineated by 
                the Board.
                    (B) Review.--
                            (i) Review of staffing changes.--Upon 
                        enactment of this Act, the Board shall convene 
                        a national level task force to review the 
                        impact on the safety and health of patients and 
                        workers of downgrading and deskilling of health 
                        care job categories by replacing licensed with 
                        unlicensed workers during the 1990s, 
                        particularly in the nursing area, and to 
                        recommend remedies as appropriate.
                            (ii) Whistleblower protection.--Health care 
                        workers who report compromises in the quality 
                        of care shall not be subjected to 
                        recriminations.
                    (C) Workforce staffing levels.--The Board may 
                establish health workforce staffing levels, or delegate 
                that power to regional or district health boards, as it 
                determines will promote the delivery of quality health 
                care services.

                Subtitle B--Education of Health Workers

SEC. 311. HEALTH TEAM SCHOOLS.

    (a) Establishment.--
            (1) In general.--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 subtitle 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) Substitution of collaboration.--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 subtitle 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) Use of funds.--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) National board assistance.--The National Health Board 
        shall assist regional boards in the establishment and 
        maintenance of schools.
    (b) Operational Principles.--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 subtitle 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 or without their explicit 
        consent.
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) Admissions Policies.--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) Curriculum Policies.--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 user needs in 
        cooperation with other health workers and with users.
    (e) Faculty Hiring Procedures.--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) Governance Plans.--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.

SEC. 312. SERVICE REQUIREMENT.

    (a) Service Requirement.--
            (1) In general.--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 enrollment 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) Deferral.--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) Completion of service required.--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) Penalty for breach of agreement.--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) Cancellation.--
                    (A) Upon death.--Any obligation of an individual 
                under this subsection for service or payment of damages 
                shall be canceled upon the death of the individual.
                    (B) Extreme hardship exception.--The National 
                Health Board shall provide for the waiver or suspension 
                of any obligation of service or payment by an 
                individual under this subtitle 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) Limitation on discharge in bankruptcy.--Any 
                obligation of an individual under this subtitle 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) Periodic Reassessment of Worker Ratios.--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 subtitle 
A) to the number of residents in the area.
    (c) Priority Ranking.--
            (1) In general.--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) Health worker shortage area defined.--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) Worker matches.--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.

SEC. 313. PAYMENT FOR CERTAIN EDUCATIONAL LOANS.

    (a) Loan Payment Program.--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) Making of Payment.--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) Payment During Employment.--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.

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

SEC. 321. EMPLOYMENT, TRANSFER, PROMOTION, AND RECEIPT OF FEES.

    (a) Service Employees.--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) Policies.--The appropriate National Health Board, in 
establishing guidelines and standards under this subtitle, shall, to 
the extent feasible and consistent with the provisions of this 
subtitle, 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 subtitle 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) Hiring Preferences.--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) Promotion and Transfer.--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) Vacancies.--A community or district board may not hire an 
individual to fill a job vacancy that is classified under subtitle 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) No Undue Financial Incentives.--No health worker should benefit 
financially from the provision or denial of services to individual 
patients, beyond their regular remuneration.
    (g) Sole Employer.--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.
    (h) Grandfather Clause.--The National Board shall support 
alternative procedures to assure that health care professionals meet 
required standards, particularly those currently practicing in health 
professional shortage areas in inner cities and in rural communities.
    (i) Transitional Employment.--Up to 1 percent of the budget of the 
United States Health Service for each of its first 2 years may be 
expended for the retraining and hiring of sales, administrative, 
clerical, and service employees displaced as a result of this Act, 
including those in the health insurance industry.

SEC. 322. APPLICABILITY OF LAWS RELATING TO FEDERAL EMPLOYEES.

    (a) In General.--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) Coverage Under Workers Compensation.--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) Civil Service.--
            (1) Application of civil service retirement.--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) Withholding.--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) Accrual of Sick and Annual Leave.--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) Application of Conditions.--
            (1) Terms of employment.--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) Limitation on variation.--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.

SEC. 323. APPLICABILITY OF FEDERAL LABOR-MANAGEMENT RELATIONS LAWS.

    (a) Application of NLRA.--
            (1) In general.--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) Strikes permitted.--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) Neutrality in Union Matters.--The National Health Board shall 
adopt as a matter of general policy that governing boards at each level 
of the Service, and employers acting as agents of these boards, agree 
to determine employee preference on the subject of labor union 
representation, and to determine which one if union representation is 
preferred, by a card check procedure conducted by a neutral third party 
in lieu of a formal election.
    (c) Collective Bargaining.--
            (1) In general.--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) Alternative procedures.--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.
    (d) Conforming Amendment.--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''.

SEC. 324. DEFENSE OF CERTAIN MALPRACTICE AND NEGLIGENCE SUITS.

    (a) Exclusive Remedy.--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) Defense.--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) Procedure.--
            (1) Removal from state courts.--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) Motions to remand.--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) Effect of alternative remedies.--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) Settlement.--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) Limitation.--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) Liability Insurance.--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

      Subtitle A--Advocacy, Grievance Procedures, and Trusteeships

SEC. 401. ADVOCACY AND LEGAL SERVICES PROGRAM.

    (a) Establishment of Program.--Each area health board shall 
establish a program of health advocacy to ensure the full realization 
of the patient rights enumerated in subtitle 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) Health Rights Legal Services.--
            (1) Establishment of program.--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) Services.--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 sections 324 and 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) Use of contracts.--The National Health Board may carry 
        out the functions described in paragraph (1)(B) directly, by 
        contract, or otherwise.

SEC. 402. GRIEVANCE PROCEDURES AND TRUSTEESHIPS.

    (a) Grievance Proceedings.--
            (1) Before regional boards.--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) Before national board.--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) Review.--
            (1) By national board.--The appropriate National Health 
        Board shall provide, subject to paragraphs (2) and (3), 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) Limitation once suit commenced.--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) Time limit.--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) Investigation.--
            (1) In general.--Whenever a grievance proceeding is 
        commenced under subsection (a), the entity before which the 
        proceeding is held shall investigate the grievance.
            (2) Hearing.--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) Notice.--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) Minimal number of residents defined.--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) Actions Upon Grievances.--
            (1) Election grievances.--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 
        subparagraph (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) Other grievances.--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) Transfer of functions.--
                    (A) To regional boards.--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) To national board.--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) Transitional authority.--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) Right To Sue.--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.

          Subtitle B--Occupational Safety and Health Programs

SEC. 411. FUNCTIONS OF THE NATIONAL HEALTH BOARD.

    (a) Oversight Authority.--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) Seeking Advice.--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) Conforming Amendments.--
            (1) In general.--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 ``Secretary of Health and Human 
                Services'' each place it appears (other than in section 
                22(b)) and inserting ``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 ``An'' in the third sentence of 
                section 6(b)(1) and inserting ``The Board and an'';
                    (F) by striking ``its'' each place it appears in 
                the third sentence of section 6(b)(1) and inserting 
                ``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 ``The Secretary'' and all that 
                follows through ``shall each'' in section 8(g)(2) and 
                inserting ``The Secretary shall'';
                    (J) by striking ``their'' in section 8(g)(2) and 
                inserting ``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 the first sentence of paragraph (5) 
                of section 20(a).
            (2) Effective date.--The amendments made by paragraph (1) 
        shall take effect on the effective date of health services.
    (f) Guidelines.--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.

SEC. 412. COMMUNITY OCCUPATIONAL SAFETY AND HEALTH ACTIVITIES.

    (a) Description of Activities.--
            (1) Cooperation with regional board.--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) Establishment of community occupational safety and 
        health action council (coshac).--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 subtitle 
        referred to as a ``COSHAC'') in accordance with this section.
    (b) Members of COSHAC.--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) Duties of COSHAC.--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.

SEC. 413. REGIONAL OCCUPATIONAL SAFETY AND HEALTH PROGRAMS.

    (a) Regional Programs.--
            (1) Establishment.--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) Use of community facilities.--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 subtitle referred to as the 
                ``ROSHAC'') established in the region under this 
                section.
    (b) Duties of Regional Occupational Safety and Health Action 
Councils (ROSHACs).--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.

SEC. 414. WORKPLACE HEALTH FACILITIES.

    (a) Establishment.--Each Community Health Board shall establish 
worksite health facilities, distributed to make available 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. Such 
facilities shall be maintained by each employer where the facility is 
located, or by the group of employers covered by a facility if the 
Community Health Board determines that a shared site is optimal.
    (b) Application of Guidelines.--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.

SEC. 415. EMPLOYEE RIGHTS RELATING TO OCCUPATIONAL SAFETY AND HEALTH.

    (a) Workplace Committees.--
            (1) Establishment.--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) Membership.--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) Safety-Related Rights.--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) Safe Workplaces.--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) Right To Inspect Medical Records.--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) Copies of Reports.--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) Right To Negotiate Standards.--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.

SEC. 416. DEFINITIONS.

    (a) Workplace.--For purposes of this subtitle, the term 
``workplace'' means the regular location where work is performed by one 
or more employees of an employer.
    (b) Employer; Employee.--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).

     Subtitle C--Health and Health Care Delivery Research, Quality 
                      Assurance, and Health Equity

SEC. 421. PRINCIPLES AND GUIDELINES FOR RESEARCH.

    (a) Conduct.--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) The National Health Board shall encourage and support 
        the conduct of clinical trials that may improve the health of 
        the public. Any clinical trial conducted with the intention of 
        evaluating new preventive, diagnostic, or therapeutic methods 
        or agents shall be conducted only in accordance with 
        established ethical procedures that protect subjects from undue 
        harm. If benefit becomes apparent, by scientific consensus, 
        before the scheduled conclusion of any clinical trial, such 
        trial shall nevertheless be terminated, and the benefit made 
        available to trial participants and the public at large.
            (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 Federal Government 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) Guidelines.--The National Health Board shall establish 
guidelines for the conduct of research in conformance with the 
principles described in subsection (a).

SEC. 422. ESTABLISHMENT OF INSTITUTES.

    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) National institute of epidemiology.--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) National institute of evaluative clinical research.--A 
        National Institute of Evaluative Clinical Research, which 
        shall--
                    (A) create a uniform electronic data base for 
                research on quality improvement in clinical care and 
                the organization and delivery of services, and for 
                research on outcomes of care;
                    (B) assess and analyze evidence on newly-discovered 
                or proposed preventive, diagnostic, and therapeutic 
                methods and agents, including new technologies, and 
                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 their introduction;
                    (C) analyze evidence on newly-discovered or 
                proposed preventive, diagnostic, and therapeutic 
                methods and agents;
                    (D) plan and conduct clinical trials, in 
                conformance with the limitations of subtitle A of title 
                II;
                    (E) 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;
                    (F)(i) regularly assess and recommend measures to 
                improve the health status of the population, which 
                methods shall include analysis of the national health 
                data base, regular surveys of the population regarding 
                their experience and evaluation of their health and 
                health services, and such other methods as designated 
                by the Institute;
                    (ii) identify the most effective methods of 
                prevention, diagnosis and treatment, as determined by 
                the most recent evidence, and assist the National 
                Health Board, in cooperation with other bodies, in 
                establishing guidelines to improve clinical practice, 
                including clinical decision criteria per section 
                221(f);
                    (iii): regularly monitor and report to the National 
                Health Board for further action the extent of 
                inappropriate care, including underservice and 
                overservice, and its consequences;
                    (iv) develop additional methods of quality 
                improvement for implementation by the National Health 
                Board and other entities, including systematic review 
                of patterns of practice that compromise the quality of 
                care and recommendations to redress such practices, 
                education for health care workers to improve the 
                quality of care, and guidelines for the optimal 
                organization of health services and the use of tertiary 
                care facilities;
                    (G) administer the periodic convening of the U.S. 
                Preventive Health Services Task Force, which shall 
                recommend to the National Board a schedule for 
                preventive health services based on age and sex, which 
                schedule shall reflect the most recent medical 
                evidence; and
                    (H) provide education for users on clinical 
                effectiveness guidelines and the most effective 
                preventive, diagnostic, and treatment practices.
            (3) National institute of health care services.--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) National institute of pharmacy and medical supply.--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) National institute of sociology of health and health 
        care.--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, economic, 
                occupational, distributional, 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.

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

SEC. 431. HEALTH PLANNING AND BUDGETING.

    (a) In General.--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) Coordination.--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) Plans.--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.

SEC. 432. DISTRIBUTION OF DRUGS AND OTHER MEDICAL SUPPLIES.

    (a) National Formulary.--
            (1) Publication.--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 (in this section referred to as the ``Formulary'').
            (2) Contents.--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) (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) Updating.--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) Drug Purchase Programs.--
            (1) In general.--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) Pricing.--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) Generic distribution.--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) Generic names defined.--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) Authority To Manufacture.--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.

SEC. 433. MISCELLANEOUS FUNCTIONS OF THE NATIONAL HEALTH BOARD.

    Sec. 433. (a) Annual Report.--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) Dissemination.--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, information about health and health 
services deemed essential to ensure users' active and informed 
participation in the health care system, including information that is 
culturally appropriate for each area's principal cultural and ethnic 
groupings, 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

                    Subtitle A--Health Service Taxes

SEC. 501. INDIVIDUAL AND CORPORATE INCOME TAXES.

    (a) Health Service Taxes.--
            (1) In general.--Subchapter A of chapter 1 of the Internal 
        Revenue Code of 1986 (relating to normal taxes and surtaxes) is 
        amended by adding at the end the following new part:

                   ``PART VIII--HEALTH SERVICE TAXES

                              ``Sec. 59B. Tax imposed.

``SEC. 59B. 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 tax 
imposed by section 1 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) Clerical amendment.--The table of parts of such 
        subchapter A is amended by adding after the item relating to 
        part VII the following new item:


                              ``Part VIII. Health service taxes.''.
    (c) Effective Date.--The amendments made in this section shall 
apply to taxable years beginning on or after the effective date of 
health services.

SEC. 502. OTHER CHANGES IN THE INTERNAL REVENUE CODE OF 1986.

    (a) Denial of Exclusion From Gross Income for Amounts Paid by Third 
Parties for Medical Care.--Section 105 of the Internal Revenue Code of 
1986 (relating to amounts received under accident and health plans) is 
amended by striking subsection (b).
    (b) Denial of Exclusion From Gross Income of Certain Contributions 
by the Employer to Health Plans.--Subsection (a) of section 106 of such 
Code (relating to contributions by employer to accident and health 
plans) is amended to read as follows:
    ``(a) General Rule.--Except as otherwise provided in this section, 
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 Josephine Butler United States 
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 (p) as 
subsection (q) and by adding after subsection (o) the following new 
subsection:
    ``(p) 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 59B and paid by the 
employer on behalf of his employees) which an individual was eligible 
to receive under title II of the Josephine Butler United States 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 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 such Code is amended by striking 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.
                    (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(a) of such Code (relating to rate 
                of tax imposed on employees under the Railroad 
                Retirement Tax Act) is amended by striking 
                ``subsections (a) and (b)'' and inserting ``subsection 
                (a)''.
                    (C) Section 3211(a)(1) of such Code (relating to 
                rate of tax on employee representatives under the 
                Railroad Retirement Tax Act) is amended by striking 
                ``subsections (a) and (b)'' and inserting ``subsection 
                (a)''.
                    (D) Subsection (e) of section 6051 of such Code 
                (relating to railroad employees) is repealed.
    (g) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning on or after the effective date of 
health services.

SEC. 503. EXISTING EMPLOYER-EMPLOYEE HEALTH BENEFIT PLANS.

    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.

SEC. 504. WORKERS COMPENSATION PROGRAMS.

    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.

                 Subtitle B--Health Service Trust Fund

SEC. 511. ESTABLISHMENT OF HEALTH SERVICE TRUST FUND.

    (a) Establishment.--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 (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 subtitle.
    (b) Appropriation.--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 59B and 3111(b) of the 
Internal Revenue Code of 1986 (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.

SEC. 512. TRANSFER OF FUNDS TO THE HEALTH SERVICE TRUST FUND.

    (a) Of Medicare Trust Funds.--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) Additional Amounts.--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.

SEC. 513. ADMINISTRATION OF HEALTH SERVICE TRUST FUND.

    (a) Board of Trustees.--With respect to the Trust Fund, there is 
hereby created a body to be known as the Board of Trustees of the Trust 
Fund (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 (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) Investment.--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) Issuance of Obligations.--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) Payment of Interest.--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) Payments.--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.

              Subtitle C--Preparation of Plans and Budgets

SEC. 521. DETERMINATION OF FUND AVAILABILITY.

    (a) Maximum Funds.--
            (1) Fixing.--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) Limitation.--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 1986;
                    (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 subtitle; or
                    (C) the amount fixed under subsection (b).
            (3) Refixing.--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) Lesser Amount.--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) Obligation.--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) Obligation of Borrowed Amounts.--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.

SEC. 522. PREPARATION OF AREA PLANS AND BUDGETS.

    (a) Community Boards.--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) District Boards.--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) Regional Boards.--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) Budget Breakdowns.--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.

            Subtitle D--Allocation and Distribution of Funds

SEC. 531. NATIONAL BUDGET.

    (a) Preparation.--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, and which 
        measures shall include primary prevention to improve the 
        conditions under which people live that affect health status;
            (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) Ordinary Operating Expenses.--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) Capital Expenses.--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) Adoption.--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.

SEC. 532. REGIONAL BUDGETS.

    (a) Preparation.--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) Capital Expenses.--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) District Allocations.--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.

SEC. 533. DISTRICT BUDGETS.

    (a) Preparation.--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) Capital Expenses.--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) Allocation for Community Boards.--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.

SEC. 534. SPECIAL OPERATING EXPENSE FUND.

    (a) In General.--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 communities of color 
        that experience disparities in health status compared to white 
        populations;
            (5) the special health care needs of residents of rural or 
        frontier areas, or non-contiguous states and territories;
            (6) special health care needs arising from environmental or 
        occupational health conditions;
            (7) special health care needs arising from unexpected 
        occurrences, including epidemics and natural disasters; and
            (8) the conduct of environmental health inspection and 
        monitoring services.
    (b) Allocation.--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 shall be allocated to community boards for the 
        additional operating expenses associated with the special 
        health care needs of communities of color to the extent that 
        they experience disparities in health status compared to white 
        populations. The basic capitation amounts shall be determined 
        by the National Health Board, based upon studies of the 
        additional operating expenses associated with providing the 
        necessary or appropriate health services for communities of 
        color, and the additional expenses associated with eliminating 
        such disparities in health status.
            (5) Funds for the additional operating expenses associated 
        with the special health care needs of residents of rural or 
        frontier areas, or non-contiguous states and territories, 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 or 
        extreme geographic access barriers, or both.
            (6) 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).
            (7) 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).
            (8) 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.

SEC. 535. DISTRIBUTION OF FUNDS.

    (a) In General.--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) Payments and Expenditures.--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) Accounts.--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 subtitle C of title IV. 
Separate accounts shall not be required for funds for ordinary 
operating expenses and for special operating expenses.
    (d) Payment Frequency.--Area health boards shall be paid at such 
time or times as the National Health Board finds appropriate.
    (e) Allocation of Supplementary Payments.--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) Use of Funds.--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.

SEC. 536. ANNUAL STATEMENT, RECORDS, AND AUDITS.

    (a) Annual Statement.--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) Record Keeping.--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) Audits.--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.

                     Subtitle E--General Provisions

SEC. 541. ISSUANCE OF OBLIGATIONS.

    (a) Borrowing Authority.--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) Pledging of Assets.--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) Form of Obligations.--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) Character of Obligations.--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) Consultation With Treasury.--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) Purchase of Obligations.--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) Full Faith and Credit.--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) Public Debt Transaction.--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 subtitle. 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.

SEC. 542. DEFINITIONS.

    For purposes of this title:
            (1) Operating expenses.--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) Capital expenses.--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

SEC. 601. EFFECTIVE DATE OF HEALTH SERVICES.

    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.

SEC. 602. REPEAL OF PROVISIONS.

    (a) In General.--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 subtitle 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) Preparation of Additional List.--
            (1) In general.--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 subparagraph (A) of this 
                paragraph.
            (2) Transfer authority.--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) Review of Programs.--
            (1) In general.--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) Initial report.--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) Later report.--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) Codification Proposal.--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.

SEC. 603. TRANSITION PROVISIONS.

    (a) Transfer of Appropriations.--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) Transfer of Personnel, Assets, Etc.--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) Lapses of Offices.--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) Application of Amendments.--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.

SEC. 604. AMENDMENT TO BUDGET AND ACCOUNTING ACT.

    (a) Health Service Budget.--Section 1105 of title 31, United States 
Code, is amended by adding at the end the following new subsection:
    ``(h) 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 
Josephine Butler United States Health Service Act) separately from such 
items with respect to expenditures and appropriations relating to other 
operations of the Government.''.
    (b) Effective Date.--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.

SEC. 605. SEPARABILITY.

    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>