[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1033 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 1033
To amend the Social Security Act to provide grants and flexibility
through demonstration projects for States to provide universal,
comprehensive, cost-effective systems of health care coverage, with
simplified
administration.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 14, 2001
Mr. Tierney (for himself, Mr. Bonior, Mr. Capuano, Ms. Carson of
Indiana, Mr. Conyers, Mr. DeFazio, Mr. Hilliard, Mr. McDermott, Mr.
Nadler, Ms. Norton, Mr. Olver, Ms. Rivers, Mr. Sanders, Mr. Weiner, Mr.
Stark, Mr. Fattah, Mr. McGovern, Ms. Lee, Ms. Schakowsky, Ms. Waters,
Mr. Baldacci, Mr. Kucinich, Mr. Gutierrez, Mrs. Meek of Florida, Mr.
Kildee, Ms. Millender-McDonald, Mr. George Miller of California, Mrs.
Christensen, Mr. Hinchey, Mr. Lantos, Mrs. Jones of Ohio, Mr. Filner,
Mr. Lewis of Georgia, Mr. Evans, Mr. Hastings of Florida, Ms. Jackson-
Lee of Texas, Mr. Brady of Pennsylvania, Mr. Payne, Ms. Baldwin, Mr.
Markey, Mr. Thompson of Mississippi, Mr. Owens, and Mr. Davis of
Illinois) introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Social Security Act to provide grants and flexibility
through demonstration projects for States to provide universal,
comprehensive, cost-effective systems of health care coverage, with
simplified administration.
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 ``States' Right To
Innovate in Health Care Act of 2001''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings and purposes.
Sec. 3. Amendment to Social Security Act.
``TITLE XXII--STATE COMPREHENSIVE HEALTH CARE AND COST CONTAINMENT
DEMONSTRATION PROJECTS
``Sec. 2201. Planning grants.
``Sec. 2202. Demonstration grants.
``Sec. 2203. State plan requirements.
``Sec. 2204. Interstate arrangements.
``Sec. 2205. Definitions.''.
SEC. 2. FINDINGS AND PURPOSES.
(a) Findings.--Congress finds the following:
(1) In 1998, annual health care expenditures in the United
States totaled $1.15 trillion, or $4,094 per person.
(2) In 1998, health care expenditures represented 13.5
percent of the gross domestic product (GDP) in the United
States and grew at the rate of 5.6 percent while the gross
domestic product grew only at the rate of 4.9 percent.
(3) Businesses, and consumers, would save approximately
$562.8 billion over 7 years if health care expenditures were
increasing at the same rate as GDP growth.
(4) Because many individuals do not have health insurance
coverage, they may incur health care costs which they do not
fully reimburse, resulting in cost-shifting to others.
(5) As a consequence of the piecemeal health care system in
the United States, administrative overhead costs approximately
$1,000 per person annually while other Western industrialized
nations with universal health care systems spend approximately
$200 per person annually for administrative overhead.
(b) Purpose.--It is the purpose of this Act to encourage States--
(1) to develop plans for universal, comprehensive, cost-
effective systems of health care with simplified administration
to individuals residing in such States; and
(2) to implement such plans by offering transitional grants
and by removing Federal statutory and administrative barriers
that may inhibit or discourage efforts by States to provide
such health care while maintaining Federal payments for health
care under Federal health care programs.
SEC. 3. AMENDMENT TO SOCIAL SECURITY ACT.
The Social Security Act (42 U.S.C. 301 et seq.) is amended by
adding at the end the following new title:
``TITLE XXII--STATE COMPREHENSIVE HEALTH CARE AND COST CONTAINMENT
DEMONSTRATION PROJECTS
``SEC. 2201. PLANNING GRANTS.
``(a) Application.--A State may apply to the Secretary for a State
planning grant under this section to develop a State plan to offer
universal comprehensive health care, with simplified administration,
and to improve the cost-effectiveness of the health care delivery
system.
``(b) Contents.--The Secretary may not approve such a State
planning grant for a State unless the application for the grant
includes or provides for the following:
``(1) Budget.--A budget and a budget justification.
``(2) Planning process.--A description of how under the
grant the State shall--
``(A) identify options to provide a universal,
comprehensive, and cost-effective system of health
care, with simplified administration, that is
affordable and accessible to all eligible beneficiaries
in the State; and
``(B) conduct an analysis that compares projected
overall health expenditures over a 7-year period under
the proposed system with the projected overall health
expenditures that would otherwise occur during such
period.
``(3) Opportunity for public participation.--Assurances
that the State will include a process for public contribution
and participation in the planning process.
``(c) Number of States; Period of Grant.--The Secretary may not
award State planning grants under this section to more than 10 States.
A State planning grant under this section shall be effective for a
period of up to 30 months. In awarding State planning grants under this
section the Secretary shall give preference to States from a variety of
geographic areas in the United States.
``(d) Amount.--The amount of a State planning grant under this
section to a State may not exceed $3,750,000.
``(e) Technical Assistance.--The Secretary shall provide States
with technical assistance in applying for and implementing State
planning grants under this section. At the request of the Secretary,
other Departments and Offices of the Federal Government shall provide
States with such technical assistance.
``SEC. 2202. DEMONSTRATION GRANTS.
``(a) Application.--A State that has developed a State plan may
apply to the Secretary for approval of a demonstration grant under this
section to achieve a cost-effective delivery system of universal,
comprehensive health care with simplified administration. The Secretary
shall notify the chief executive officer of all States of the
availability of demonstration grants under this section.
``(b) Approval.--The Secretary shall approve the applications of
not more than 5 States under this section. In approving grants under
this section the Secretary shall give preference to States from a
variety of geographic areas in the United States. If the Secretary
determines that a State no longer meets the conditions for approval of
the grant, the Secretary shall notify the State of such determination
and provide the State with an opportunity to correct deficiencies in a
timely manner. If the Secretary further determines that a State has not
corrected such deficiencies in a timely manner, the Secretary shall
terminate the grant (including waivers authorized under the grant).
``(c) Period.--A demonstration grant approved under this section
shall be effective for 7 years from the date of final approval of the
demonstration grant application under subsection (b).
``(d) State Plan Required.--The Secretary may not approve a
demonstration grant under this section unless the State has a State
plan to carry out the grant consistent with the requirements of section
2203.
``(e) Funding.--
``(1) Transitional grant amount.--The amount awarded under
this section to a State with a demonstration grant approved
under this section may not exceed an aggregate amount of
$10,000,000 plus $3 multiplied by the number of eligible State
residents of the State, to assist the State in the transition
of the health care delivery and financing infrastructure. Such
amount shall be made available to a State during the period of
transition, as provided in the State plan. The number of
eligible State residents of a State shall be determined based
on the best available Census Bureau data as of the July 1
before the date the grant under this section is approved.
``(2) Maintenance of federal funds under waivers.--Pursuant
to the waivers under subsection (f), the Federal Government
shall pay to a State amounts for health care under Federal
health care programs that would otherwise have been payable by
the Federal Government but for the State's universal,
comprehensive health care system under this section.
``(f) Waiver of ERISA Preemption and Waivers To Pool Funds.--As
part of a demonstration grant under this section and subject to the
benefit maintenance requirements applicable under section 2203(b), a
State may request (and the Secretary may grant) the following waivers
of requirements and provisions to the extent necessary to carry out the
State plan under section 2203:
``(1) ERISA.--Waiving application of section 514 of the
Employee Retirement Income Security Act of 1974.
``(2) Medicare.--Waiving provisions necessary to permit the
State--
``(A) to use funds otherwise paid under title XVIII
for beneficiaries residing in the State; and
``(B) to permit the State to enter into an
arrangement with the Secretary under which eligible
State residents who are not otherwise enrolled for
benefits under parts A and B of such title are enrolled
for such benefits under such title and the State
provides for such actuarially appropriate reimbursement
to the Secretary with respect to coverage of such
benefits for such residents as is necessary to assure
that the Trust Funds under such title are not adversely
affected by virtue of such waiver, such reimbursement
subject to--
``(i) an independent audit, to be reviewed
by the Comptroller General of the United
States, assuring that such reimbursement does
not adversely affect in any way the Trust Funds
for medicare eligible beneficiaries, and
``(ii) in the case that the audit
determines that additional reimbursement to the
Secretary is required, such additional
reimbursement, with appropriate adjustments for
interest attributable to the late
reimbursement.
``(3) Medicaid.--Waiving provisions necessary to permit the
State to use funds otherwise paid to the State under title XIX.
``(4) SCHIP.--Waiving provisions necessary to permit the
State to use funds otherwise paid to the State under title XXI.
``(5) FEHBP.--Waiving provisions necessary to permit the
State to use funds otherwise paid under chapter 89 of title 5,
United States Code, or allowing the Office of Personnel
Management to purchase health care coverage for Federal
employees and retirees in the State under the State plan.
``(6) Use of other funds.--Waiving provisions necessary to
permit the State to use funds otherwise provided under other
Federal programs for the provision of health care coverage or
services, identified by the State.
``(7) Other laws.--Waiving of other provisions of Federal
law identified by the State under section 2203(e)(3) only if
the Secretary determines such a waiver to be appropriate after
consultation with the head of the Federal agency or department
concerned.
The Secretary may grant a waiver under this subsection only if the
State provides the Secretary with satisfactory assurances that
necessary safeguards have been taken to protect the health and welfare
of individuals provided services under the waiver and that financial
accountability is maintained for any funds expended under the waiver.
The Secretary may grant a waiver under paragraph (1) only with the
concurrence of the Secretary of Labor.
``(g) Reenrollment of Eligible State Residents Who Move From a
Participating State.--In the case of an eligible State resident who is
covered under a State plan under section 2203, who (but for such
coverage) is eligible to be enrolled in a program described in
subsection (f) (including the medicare and medicaid programs), and who
is not enrolled in such a program because of such coverage, if the
resident leaves the State to reside in a State that does not have such
a State plan in effect, the resident shall be permitted,
notwithstanding any other provision of law, to enroll immediately in
such a program if the resident is still otherwise eligible to be so
enrolled. In the case of such enrollment in the medicare program, the
resident shall be treated for purposes of section 1882(s)(2) (relating
to availability of medigap policies without underwriting) as if the
resident had turned 65 years of age on the date the resident enrolls in
the medicare program.
``(h) Duties of the Secretary.--
``(1) Guidance and information.--The Secretary shall--
``(A) provide guidance to State health care
authorities regarding applications for grants under
this title and exchange information with, and otherwise
assist, such authorities upon the request of the
authorities;
``(B) set application procedures;
``(C) review and approve applications for
demonstration grants under this section, including
providing for appropriate waivers described in
subsection (f);
``(D) provide appropriate levels of funding for
such approved applications consistent with such
section;
``(E) conduct such evaluation, monitoring,
compliance, and other review functions as may be
appropriate;
``(F) develop guidelines, standards, and formats
for States to follow in evaluating, reporting, and
collecting data in order to enable the Commission to
monitor State plan administration and compliance, and
to evaluate and compare the effectiveness of State
plans; and
``(G) implement any other requirements or
activities necessary and appropriate under this title.
``(2) Annual report.--The Secretary shall submit to the
President and the Congress an annual report. Such report shall
be submitted not later than March 30 of each year and shall
include information concerning States that receive grants under
this title and the effectiveness of any health care programs
assisted by such grants during the previous year.
``(3) Approval process.--The provisions of section 2106(c)
shall apply to State plans and the Secretary under this title
in the same manner as they apply to State plans and the
Secretary under such section.
``SEC. 2203. STATE PLAN REQUIREMENTS.
``(a) Coverage.--
``(1) In general.--A State plan shall provide a process and
a timeline for achieving coverage of all eligible State
residents statewide, without regard to employment status,
income, health status or preexisting condition, or location of
residency within the State.
``(2) Outreach mechanisms.--A State plan shall describe the
outreach mechanisms to be used to assure coverage of all
eligible individuals, including measures to assure coverage of
individuals in hard-to-reach populations and to assure benefits
are provided to eligible individuals located in underserved
areas.
``(b) Benefits.--
``(1) Basic benefits.--A State plan shall provide for
health benefits that--
``(A) are at least actuarially equivalent to the
standard Blue Cross/Blue Shield preferred provider
option service benefit plan, described in and offered
under section 8903(1) of title 5, United States Code;
and
``(B) include benefits for at least the following
items and services:
``(i) Inpatient and outpatient hospital
services, including emergency services
available 24 hours a day.
``(ii) Long term, acute, and chronic care
services, including skilled nursing facility
services, intermediate care facility services
home health services, home and community-based
long-term care services, hospice care, and
services in intermediate care facilities for
individuals diagnosed with mental retardation.
``(iii) Professional services of health
care practitioners authorized to provide health
care services under State law.
``(iv) Community-based primary health care
services, including rural health clinic
services and Federally-qualified health center
services.
``(v) Laboratory, x-ray services, and
diagnostic tests.
``(vi) Preventive care, including prenatal,
well-baby, and well-child care, appropriate
immunizations, pap smears, screening
mammography, colorectal cancer screening,
physical examinations, and family planning.
``(vii) Prescription drugs and biologicals,
including insulin and medical foods.
``(viii) Mental health services.
``(ix) Substance abuse treatment services.
``(x) Vision services, including routine
eye examinations, eyeglasses, and contact
lenses.
``(xi) Hearing services, including hearing
aids.
``(xii) Dental services, including routine
check ups.
``(xiii) Durable medical equipment,
including home dialysis supplies and equipment.
``(xiv) Emergency ambulance services.
``(xv) Prosthetics.
``(xvi) Outpatient therapy, including
physical therapy, occupational therapy, and
speech language pathology services and related
services.
``(2) Assurance that benefits are not reduced for
individuals covered under federal programs.--Insofar as the
State under the plan incorporates funding provided by Federal
programs described in section 2202(f), the State plan may not
provide for a reduction in benefits (including coverage,
access, availability, duration, and beneficiary rights, and, if
applicable, vaccine benefits under section 1928) otherwise
provided for under such programs or an increase in cost-sharing
and premiums otherwise provided for under such programs.
``(3) Continuation of benefits for certain aliens.--Nothing
in this title shall be construed as affecting the access of
aliens described in section 2204(1)(D) to health care services
provided under law for such aliens as of the date of the
enactment of this title.
``(c) Quality Assurance.--
``(1) In general.--A State plan shall provide, and
describe, mechanisms to be used to assure, monitor, and
maintain the quality of items and services furnished under the
plan.
``(2) Health outcomes.--A State plan shall describe the
plan's projected effect on health outcomes in the State,
including estimates of health benefits, decreased morbidity and
mortality, and improved productivity resulting from reduction
in the number of individuals without health benefits.
``(d) Programs for Medical Education.--A State plan shall describe
health professions training and graduate medical education activities
applicable under the plan, and shall provide, under the State plan, for
payment from Federal, State, and local governments for such training
and education activities in the amounts that would otherwise be payable
by such governments but for the State's universal, comprehensive health
care system under the State plan.
``(e) Financing.--
``(1) Budget.--A State plan shall incorporate a budget
which contains--
``(A) detailed projections of health care
expenditures presently and under the proposed system,
including an identification and calculation of the
amount of funding to be provided by the Federal, State,
and local governments under the plan and an assurance
that the amount of expenditures made by the State and
local governments will not be reduced as a result of
the implementation of the plan; and
``(B) a description (and an estimate of costs) of
transitional activities to be undertaken in
implementing the proposed system.
``(2) Cost containment.--A State plan shall describe the
means to be used to contain costs under the plan, including
when and how the plan will increase efficiencies.
``(3) Federal expenditure limit.--A State plan shall
contain assurances that aggregate Federal expenditures on
health care (including Federal expenditures under titles 5, 10,
and 38 of the United States Code, and under this Act) under the
plan will not exceed aggregate Federal expenditures that would
have been incurred in the absence of such plan.
``(f) Implementation.--
``(1) In general.--A State plan shall describe the method
(including a timetable and period of transition) for
implementing the plan.
``(2) Coordination.--A State plan shall identify all
Federal, State, and local programs that provide health care
services in the State and describe how such programs would be
incorporated in, or coordinated with, the health coverage
system under the plan.
``(3) Federal waivers required.--A State plan shall
identify any waivers of Federal law required to implement the
plan, including the use of any pooled Federal funds and other
waivers described in section 2202(f).
``(4) Approval of state legislature.--A State plan shall
provide that State approvals and commitments (including
approval of the State legislature) necessary for the
implementation of the plan will be obtained by not later than 1
year after the date of the Secretary's approval of the plan.
Any approval of a grant is conditioned upon the timely
completion of such approvals and commitments.
``(g) Evaluation.--A State plan shall provide for a process for its
evaluation, and shall comply with any evaluation reporting or data
collection requirements imposed by the Secretary.
``(h) Construction.--Nothing in this title shall be construed as
preempting State laws that provide greater protections or benefits than
the protections or benefits required under this title.
``SEC. 2204. INTERSTATE ARRANGEMENTS.
``(a) In General.--One or more contiguous States in a geographic
region may file a joint application for planning and demonstration
grants under this title.
``(B) Congressional Approval.--Congress hereby authorizes and
approves States entering into Interstate Compacts in order to conduct
joint health care programs under such a grant.
``(c) References to State.--In the case of a joint application
described in subsection (a), any reference in this title to a State is
deemed to refer to all of the States, and the approval of a grant with
respect to such a joint application shall be counted as 1 State for
purposes of applying sections 2201(c) and 2202(b).
``SEC. 2205. DEFINITIONS.
``As used in this title:
``(1) Eligible state resident.--The term `eligible State
resident' means any resident of the United States who is a
citizen or national of the United States, or lawful resident
alien, and who resides in any particular State. Such term may
include, at the option of a State, the following:
``(A) State employees and dependents of such
employees.
``(B) Employees, and dependents of such employees,
working in a work site of a business located in the
State.
``(C) One or more classes of nonimmigrants (as
defined in section 101(a)(15) of the Immigration and
Nationality Act) specified in the State plan.
``(D) Aliens unlawfully present in the United
States.
``(2) Lawful resident alien.--The term `lawful resident
alien' means an alien lawfully admitted for permanent residence
and any other alien lawfully residing permanently in the United
States under color of law, including an alien granted asylum or
with lawful temporary resident status under section 210, 210A,
or 245A of the Immigration and Nationality Act.
``(3) Secretary.--The term `Secretary' means the Secretary
of Health and Human Services.
``(4) State.--Subject to section 2204(c), the term `State'
means a State, the District of Columbia, the Commonwealth of
Puerto Rico, the United States Virgin Islands, Guam, American
Samoa, and the Commonwealth of the Northern Mariana Islands.
``(5) State plan.--The term `State plan' means a
comprehensive health care plan of a State participating in a
State Care demonstration project under this title that meets
the requirements of section 2203.''.
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