[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3080 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 3080
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 10, 2001
Ms. Lee introduced the following bill; which was referred to the
Committee on Energy and 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
Sec. 101. Establishment of the Service.
Sec. 102. Appointment of the National Health Board.
Sec. 103. Powers and duties of the National Health Board.
Sec. 104. Representation in local and regional authorities.
Sec. 105. Public accountability and financial disclosure.
Sec. 106. Inspector General.
Sec. 107. Establishment of health care delivery regions.
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.
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. Workplace health facilities.
Sec. 414. Employee rights relating to occupational safety and health.
Sec. 415. 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 regional budgets.
Subtitle D--Allocation and Distribution of Funds
Sec. 531. National budget.
Sec. 532. Special operating expense fund.
Sec. 533. Distribution of funds.
Sec. 534. 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 as follows:
(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.
(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 overcome present disparities in health and access to
health care resources, especially for currently underserved
innercity and rural populations, minority groups, prisoners,
and occupational groups, by redistributing health care
resources to underserved populations, and by enhancing public
health and preventive health services.
(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) 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.
(2) Health worker.--The term ``health worker'' includes--
(A) any employee of the Service; and
(B) 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.
(3) Indirect provider of health care.--The term ``indirect
provider of health care'' means an individual who--
(A) receives (either directly or through his or her
spouse) more than \1/10\ 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;
(B) holds a fiduciary position with, or has a
fiduciary interest in, any entity described in clause
(ii) or (iv) of subparagraph (A); or
(C) is engaged in issuing any policy or contract of
individual or group health insurance or hospital or
medical service benefits.
(4) National health board.--The term ``National Health
Board'' means the National Health Board of the Service.
(5) Service.--The term ``Service'' means the United States
Health Service established in section 101.
(6) 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).
(7) User.--The term ``user'' means an individual who is
eligible under section 211 to receive health care services from
the Service under this Act.
TITLE I--ESTABLISHMENT AND OPERATION OF THE UNITED STATES HEALTH
SERVICE
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 National Health Board and, in
accordance with this Act and guidelines established by such
Board, by local and regional authorities affiliated with the
Board.
(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.
(c) Administration.--The Board shall implement administrative
measures as necessary to assure the equitable distribution and
allocation of health care resources and services.
(d) Accountability and Control.--The Board shall establish
mechanisms to assure accountable, representative and democratic
governance of the Service and of health care facilities by health care
users and workers, with limits on conflicts of interest as described in
this Act.
SEC. 102. APPOINTMENT OF THE NATIONAL HEALTH BOARD.
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 National Health Board of the Service.
SEC. 103. POWERS AND DUTIES OF THE NATIONAL HEALTH BOARD.
The National Health Board shall--
(1) establish the boundaries of health care delivery
regions, in accordance with section 107;
(2) establish procedures for creating local and regional
authorities within each health care delivery region, to oversee
and administer the delivery of health services, pursuant to
section 104, and other provisions of this Act in their
respective regions and local areas;
(3) 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; and
(4) provide for the recording of minutes of each of its
meetings, and shall make such records available to the public
for inspection and copying.
SEC. 104. REPRESENTATION IN LOCAL AND REGIONAL AUTHORITIES.
The governing bodies of the local and regional authorities created
pursuant to section 103(b) shall consist of representatives of users
resident in their local area or region and representatives of health
workers employed by the Service in their local area or region.
Representatives of such users shall comprise the majority of such
representatives and representatives of such health workers shall
comprise a minority.
SEC. 105. PUBLIC ACCOUNTABILITY AND FINANCIAL DISCLOSURE.
(a) Prohibition of Conflicts of Interest.--
(1) In general.--Individuals with direct or indirect
conflicts of interest shall not serve on health boards or
authorities. 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 or authorities shall
fully disclose any such potential conflicts of interest, and if elected
or appointed shall sever any affiliations that could result in a
conflict.
SEC. 106. INSPECTOR GENERAL FOR HEALTH SERVICES.
Within the United States Health Service there shall be an Office of
the Inspector General for Health Services, to be headed by an Inspector
General for Health Services, that shall have authority to ensure the
effective operation of the services pursuant to this Act and to
investigate and pursue any grievances against the National Health Board
or its local authorities. The Inspector General shall have the same
authority as an Inspector General has under the Inspector General Act
of 1978.
SEC. 107. 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 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 3,000,000; and
(B) the population of a region may be less than
500,000 if the 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) Modification of Boundaries.--The National Health Board shall
review the boundaries of regions no later than 2 years after each
decennial national census, or upon receipt of and at such other times
as it deems necessary, and may modify the boundary of any region in
which there has been a substantial shift of population justifying such
modification or if such modification would better carry out the
purposes of this Act, and if such modification is approved in a
referendum of residents in an area whose regional identification would
be changed by making such modification.
(d) Process.--At least 60 days prior to the establishment of the
boundaries of any region, or modification of the boundaries, the
National Health Board shall collaborate with its regional authorities
to 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.
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) in section 3(o), by striking ``sections 6 and 7'' and
inserting ``sections 6, 7, and 7A'';
(2) in section 13--
(A) by striking ``and 7'' in subsection (a) before
paragraph (1) and inserting ``, 7, and 7A'';
(B) by striking ``sections 6 and 7'' in subsection
(a)(3) and inserting ``sections 6, 7, and 7A''; and
(C) by inserting ``7A,'' in subsections (d) and (f)
after ``7,'' each place it appears;
(3) in section 14(d), by striking ``6 and 7'' and inserting
``6, 7, and 7A'';
(4) in section 15(a), by striking ``section 6 or section
7'' and inserting ``section 6, 7, or 7A'';
(5) in section 16--
(A) by striking ``section 6 or section 7'' in
subsection (b) and inserting ``section 6, 7, or 7A'';
(B) by striking ``or their unpaid overtime
compensation'' in subsection (b) and inserting ``their
unpaid overtime compensation, or their unpaid health
leave compensation'';
(C) by inserting ``or of unpaid health leave
compensation'' in subsection (b) after ``amount of
unpaid overtime compensation'';
(D) by striking ``section 6 or 7'' in the first
sentence of subsection (c) and inserting ``section 6,
7, or 7A'';
(E) by striking ``unpaid overtime compensation'' in
the first sentence of subsection (c) and inserting ``,
unpaid overtime compensation, or unpaid health leave
compensation'';
(F) by striking ``or overtime compensation'' in the
second sentence of subsection (c) and inserting ``,
overtime compensation, or health leave compensation'';
and
(G) by striking ``or unpaid overtime compensation
under sections 6 and 7'' in the third sentence of
subsection (c) and inserting ``, unpaid overtime
compensation, or unpaid health leave compensation under
sections 6, 7, and 7A''; and
(6) in section 18--
(A) by inserting ``or minimum health leave
compensation higher than the minimum health leave
compensation established under this Act'' in the first
sentence of subsection (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 subsection (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 National Health Board
or its designee 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, vision 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.
(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;
(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 maintain 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) Health Service Areas.--The National Health Board, in
consultation with local authorities and residents of the local
communities affected, shall establish such health care facilities as
are necessary to provide all necessary comprehensive primary and
specialized health care services, including distributing such health
care resources in a manner as to overcome present shortages and ensure
equitable access for every resident to needed health care resources. In
establishing such facilities, the National Health Board shall rely
primarily on existing political boundaries for the purposes of
allocating health services, including cities, counties, perinatal
services regions, States, and Federal Medicare regions, and shall
determine the need to establish additional or supplementary regional
health service areas that may cross existing boundaries.
(b) Health Care Facilities.--
(1) In general.--The National Health Board and its local
authorities shall, not later than the effective date of health
services and to the maximum extent feasible, establish and
maintain such health care facilities as are necessary for the
efficient and effective delivery to individuals 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 in each community 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, 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) Allocation of Hospitals.--The National Health Board, in
consultation with its local authorities, shall periodically determine
the necessity to establish and maintain inpatient and other specialized
health care facilities in particular locations. Where found
appropriate, it shall establish and maintain--
(1) general hospitals for the efficient and effective
delivery of health care services to individuals 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 to
promote the efficient and effective delivery of health care
services.
In addition, the Board shall distribute and provide such health care
services of a specialized nature (whether delivered in an inpatient or
outpatient setting) as may be provided most effectively and
efficiently.
(c) Specialized Services.--The Board shall, not later than the
effective date of health services, establish and maintain--
(1) specialized medical facilities for the efficient and
effective delivery of highly specialized health care services,
using guidelines it shall establish, to individuals requiring
highly specialized treatment, care, and rehabilitation for
injury or illness;
(2) health care and supplemental services for individuals
whose health care are related to occupational or other factors,
including individuals residing within a 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.
(d) Health Services.--States and the National Health Board, through
its local and regional authorities, shall provide the following through
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
consistent with section 201(9).
(3) Referral services, including referrals, where
appropriate, to other health care facilities.
(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 Board,
and (C) on how the 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.
(9) Research and data gathering on the leading causes of
ill health and injury 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) Effective delivery.--In its establishment of health
care facilities, the National 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.
(2) Coordination.--The Board shall provide mechanisms to
coordinate care across political and geographic boundaries as
necessary.
(3) Assuring availability and accessibility of services.--
The Board shall 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 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;
(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 (4)(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.
(4) 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.--The National Health Board, and its
local and regional authorities, 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 the Health Service fails on
the effective date of health services, to substantially and materially
provide health care and supplemental services in accordance with this
section, redress and alternative sources of care shall be authorized by
an independent authority accountable to Congress and State
legislatures. Such redress may include--
(1) requiring the provision of services; and
(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.
SEC. 222. OPERATION AND INSPECTION OF HEALTH CARE FACILITIES.
(a) Establishment of Policies.--
(1) In general.--Each health care facility shall be subject
to 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) Health worker and user control.--The National Health
Board and its regional and local authorities shall establish
policies and mechanisms for control of health care facilities
by health care workers who are employed in, and users who
receive services from, the respective facility, and shall
promulgate rules preventing a financial conflict of interest by
decisionmaking bodies.
(b) Employment Restrictions.--
(1) In general.--No individual entitled to make decisions
regarding establishment, allocation, or operation of a health
facility may engage in the private delivery of health care
services.
(2) 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.
(c) Operations of Health Care Facilities.--
(1) Hours of operation.--Any health care facility which
provides health care services on an outpatient basis shall be
open during hours that will permit all users to make use of
such services.
(2) Effective delivery.--In its establishment of health
care facilities under this section, the 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.
SEC. 223. PROVISION OF HEALTH SERVICES RELATING TO REPRODUCTION AND
CHILDBEARING.
(a) Provision of Services.--
(1) In general.--The following services shall be provided:
(A) Family planning.--
(i) Complete information on contraception
and provision of birth control materials or
medication of the individual's choosing.
(ii) Complete and effective evaluation and
treatment of sexually transmitted diseases and
diseases of the reproductive organs.
(iii) Complete information and counseling
with respect to pregnancy, childbearing, and
possible outcomes involving genetically induced
anomalies.
(B) Pregnancy.--
(i) Complete and effective pregnancy
testing.
(ii) Prenatal services, including physical
examination, counseling, and instruction of
expectant parents in nutrition, childrearing,
and children's health care services.
(iii) Safe, comfortable, and convenient
abortion services.
(iv) 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.
(2) Voluntary.--The services described in paragraph (1)
shall be delivered without coercion or harassment, with
complete confidentiality, and without prior approval of
individuals other than the individual receiving the services.
(3) 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 paragraph (1) to the
extent this would not significantly increase the medical risk
to the individual.
(b) Voluntary Consent.--No health care provider 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.--The National 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.--The National 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.--The National Health Board shall
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 employer of such
worker.
(b) Periodic Assessments.--There shall be periodic review and
assessment of the competency of such workers to perform the work within
their job category, and opportunities for health workers to be assessed
and certified with respect to skills required for advancement to other
job categories.
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 utilization of 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.
(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), the National Health Board shall, taking into account
the guidelines established under subsection (a), establish
certification standards which shall specify--
(A) the functions performed by a health worker
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.
(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).
(3) Periodic review.--Standards for a job category under
this subsection shall be periodically reviewed to supplement,
modify, or eliminate such standards as 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 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), the
Board shall establish a procedure for converting existing
educational facilities for health services workers to create
health team schools (each 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. Such schools
shall be established and functioning not later than 4 years
after the effective date of health services.
(2) 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.
(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 population.
(2) The number of students enrolled in each educational
program in a school shall be based on the needs for health
workers within a given area, defined by geographic and
political boundaries.
(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 in accordance with subsections (c)
through (f), respectively, and with the fullest possible
participation of the community 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 Health 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.--Admissions policies for education
programs in schools 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 underrepresented 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.--The National Health Board, in
consultation with its local and regional authorities, shall establish
and implement curriculum policies for educational programs in schools.
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.--Faculty hiring procedures in
schools shall, to the maximum extent feasible, create a faculty which
approximates the population of the region by race, sex, and language.
(f) Governance Plans.--Governance plans for the management of a
school 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 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 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 individual who has
made an agreement described in paragraph (1) may be employed
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
A=C (1-s / (t)) in which--
(A) ``A'' is the amount the Service is entitled to
recover;
(B) ``C'' 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;
(C) ``t'' is the total number of months in the
individual's period of obligated service; and
(D) ``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.--The National 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) in an area to the number of residents in the area.
(c) 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 regions.
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.--The National Health Board shall employ,
classify, and fix the salaries and benefits of all employees of the
Service employed in the Service's facilities.
(b) Policies.--The 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.--The National Health Board, in hiring for
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. A job placement service in each region shall
assist health workers in its region in identifying suitable employment
opportunities and in transferring between jobs. 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) No Undue Financial Incentives.--No health worker should benefit
financially from the provision or denial of services to individual
patients, beyond their regular remuneration.
(f) 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 the Service.
(g) Grandfather Clause.--The National Health 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.
(h) 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
the National Health Board 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.--The National Health Board 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 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.--The National 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 National 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 National Health
Board; and
(5) appropriate action by the National 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.
(a) Grievance Proceedings.--
(1) In general.--The 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 the
Board (or a person or committee designated by such Board) with
respect to an alleged violation of this Act. The 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.
(2) Grievances against national health board.--Grievances
against the National Health Board may be presented to and
adjudicated by the Inspector General for Health Services or the
Inspector's General local designees. Grievants shall also have
access to review in the courts.
(b) Review.--
(1) By national health board.--The 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
(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 30
days after the publication of the decision.
(c) Investigation.--Whenever a grievance proceeding is commenced
under subsection (a), the entity before which the proceeding is held
shall investigate the grievance.
(d) 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) 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) in section 3, by adding at the end 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) in the first sentence of section 6(b)(1), by
inserting ``shall request the National Health Board
and'' before ``may request'';
(D) in the second sentence of section 6(b)(1), by
inserting ``the Board and'' after ``The Secretary shall
provide'';
(E) in the third sentence of section 6(b)(1), by
striking ``An'' and inserting ``The Board and an'';
(F) in the third sentence of section 6(b)(1), by
striking ``its'' each place it appears and inserting
``their'';
(G) in the fourth sentence of section 6(b)(6)(A),
by inserting ``after consultation with the National
Health Board and'' after ``may be granted only'';
(H) in the third sentence of section 6(d), by
inserting ``after consultation with the National Health
Board and'' before ``after opportunity for'';
(I) in section 8(g)(2), by striking ``The
Secretary'' and all that follows through ``shall each''
and inserting ``The Secretary shall'';
(J) in section 8(g)(2), by striking ``their'' and
inserting ``his'';
(K) in section 16, by inserting ``after
consultation with the National Health Board and''
before ``after notice and opportunity'';
(L) in section 18(c), by inserting ``(after
consultation with the National Health Board)'' after
``in his judgment'';
(M) in section 19(d), by inserting ``and the
National Health Board'' after ``Secretary'' each place
it appears; and
(N) in section 20(a), by striking the first
sentence of paragraph (5).
(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; and
(2) for the establishment and operation of workplace health
facilities under section 413.
SEC. 412. COMMUNITY OCCUPATIONAL SAFETY AND HEALTH ACTIVITIES.
The Occupational Safety and Health Administration, under the
direction of the National Health Board, shall develop and provide staff
support for local and regional occupational safety and health programs,
to include community-based occupational safety and health councils that
represent community workers and residents. Such programs shall--
(1) 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
(2) assist employees in determining methods of, and
requirements for, inspections of workplaces in the community
for safety and health hazards.
(A) implement 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) facilitate 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) conduct baseline and periodic biologic
screening of employees in the region;
(D) develop and maintain environmental monitoring
programs to identify and isolate hazardous workplaces
and work areas in the region;
(E) analyze employment-related injuries and
illnesses occurring in the region
SEC. 413. WORKPLACE HEALTH FACILITIES.
(a) Establishment.--The Occupational Safety and Health
Administration, under the direction of the National Health Board, shall
develop a program to 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 may be maintained by each
employer where the facility is located, or by the group of employers
covered by a facility.
(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 for the community in which
the workplace is predominantly located, or, where the National
Health Board or its local authority deems appropriate, by the
employer, with the cost in either case borne by the employer in
each workplace.
SEC. 414. 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 (each in this
subsection referred to as a ``committee'') 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. 415. 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 413 and 414,
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,
agencies representative of the population.
(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 National Health Board, or a
designated local authority 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) The planning and conduct of research under the program,
shall take place in cooperation 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 National Health Board 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.
(a) In General.--On the effective date of health services, the
agencies of the Department of Health and Human Services that conduct
research on health and health care are transferred to the National
Health Board. These include the Agency for Healthcare Research and
Quality, the Agency for Toxic Substances and Disease Registry, the
Centers for Disease Control and Prevention, the National Institutes of
Health (established under title IV of the Public Health Service Act),
and the Substance Abuse and Mental Health Services Administration. 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.
(F) provide technical assistance and support to
regional and local jurisdictions related to measures to
prevent and curtail outbreaks of illness and injury.
(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 Health 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 regional facilities to the
maximum extent possible
(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, cultural,
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.
(b) Coordination of Effort.--The National Health Board will
establish mechanisms for internal coordination of research among the
five Institutes, and will also coordinate effort with agencies under
the Department of Health and Human Services, including the Food and
Drug Administration and the Health Resources and Services
Administration.
Subtitle D--Health Planning, Distribution of Drugs and Other Medical
Supplies, and Miscellaneous Functions
SEC. 431. HEALTH PLANNING AND BUDGETING.
(a) In General.--The National Health Board shall develop and
implement guidelines to 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 as necessary for implementation, and shall make
available such data and evaluations to residents of their respective
area.
(b) Coordination.--The National Health Board shall coordinate the
planning and administration of the delivery of health care services,
health worker education, and health research within regions, and shall
facilitate the planning and administration of such programs.
(c) Plans.--The National Health Board shall formulate a 1-year and
5-year national health plan and budget, taking into account the
regional budgets prepared in accordance with section 522.
SEC. 432. DISTRIBUTION OF DRUGS AND OTHER MEDICAL SUPPLIES.
(a) National Formulary.--
(1) Publication.--The National Health Board, shall, not
later than the effective date of health services, publish and
disseminate 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.--The National Health Board shall establish
a program, in accordance with this subsection for the purchase
and distribution of drugs and other medical supplies for use in
health care facilities.
(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 and dispensing of drugs 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.
(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, 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.''.
(b) 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.
(2) Subsection (b) of section 3101 of such Code (relating
to rate of tax on employees under the Federal Insurance
Contributions Act) is repealed.
(3) Section 3201(a) of such Code (relating to rate of tax
imposed on employees under the Railroad Retirement Tax Act) is
amended by striking ``the sum of the rates of tax in effect
under subsections (a) and (b) of section 3101'' and inserting
``the rate of tax in effect under section 3101(a)''.
(4) 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)'' the
first place it appears and inserting ``subsection (a)''.
(5) 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. (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 532(b)(7) 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 REGIONAL BUDGETS.
(a) Population Need.--In preparing its annual budget the National
Health Board, in coordination with its local and regional authorities,
shall determine the projected per capita health expenditures for each
region, based on the evaluation of health care needs described in this
Act.
(b) Budget Breakdowns.--In preparing its annual budget the National
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 for each such
region.
Subtitle D--Allocation and Distribution of Funds
SEC. 531. NATIONAL BUDGET.
(a) Preparation.--The National Health Board shall prepare, taking
into consideration the budgets prepared under section 522, as soon
after April 1 of each year as is practicable, 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 funds for--
(1) ordinary operating expenses;
(2) preventive health measures, and which measures shall
include primary prevention to improve the conditions under
which people live that affect health status;
(3) capital expenses;
(4) research expenses; and
(5) special operating expenses, as described in section
532.
(b) Ordinary Operating Expenses.--Funds for ordinary operating
expenses, for preventive health measures, and for research expenses
shall be divided among regions in the proportion which the number of
residents in each region bears to the total population of the Nation,
adjusted for population need as defined in this Act.
(c) Capital Expenses.--Funds for capital expenses shall be
allocated, to the extent consistent with the efficient and equitable
use of resources, 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.
SEC. 532. 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 noncontiguous 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 and shall consist of uniform basic capitation
amounts multiplied by the number of residents 65 years of age or older
in the respective areas. The basic capitation amounts for areas 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 areas.
(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 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 areas. 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 areas for the additional
operating expenses associated with the special health care
needs of low-income persons. Such payments shall be allocated
in proportion to the number of residents in these areas 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 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 noncontiguous States and territories, shall
be allocated to communities serving areas of low population
density and shall consist of basic capitation amounts
multiplied by the number of residents in the respective areas.
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 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 \1/2\ 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 \1/2\ 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 for providing such services.
SEC. 533. 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.
Participating providers may not request or receive funds from any other
source.
(b) Payments and Expenditures.--All payments shall be expended in
accordance with the budget adopted under section 531. If the budget for
any fiscal year is not adopted before the beginning of the fiscal year,
until such budget is adopted the National Health Service 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 532.
(c) Accounts.--The National 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.--Service providers under this Act 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 Service
provider if the National Health Board finds that such funds are
required by events occurring or information acquired after the initial
allocations were made.
(f) Use of Funds.--Service providers 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. 534. ANNUAL STATEMENT, RECORDS, AND AUDITS.
(a) Annual Statement.--Each Service provider shall prepare annually
and transmit to the National Health Board a statement which shall
accurately show its financial operations and for the year for which
such statement is prepared.
(b) Recordkeeping.--Each Service provider shall keep such records
as determined 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, XIX, and XXI of the Social Security
Act (relating to the maternal and child health and crippled
children's services, Medicare, Medicaid, and State children's
health insurance program); 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 subsection
(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.
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