[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4325 Introduced in House (IH)]







108th CONGRESS
  2d Session
                                H. R. 4325

 To guarantee for all Americans quality, affordable, and comprehensive 
                       health insurance coverage.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 11, 2004

 Ms. Baldwin (for herself, Mr. Tierney, Mr. McDermott, Ms. Schakowsky, 
 Mr. Grijalva, Mr. Conyers, Ms. Lee, Ms. Jackson-Lee of Texas, and Mr. 
    Obey) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   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 guarantee for all Americans quality, affordable, and comprehensive 
                       health insurance coverage.

    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 ``Health Security 
for All Americans Act''.
    (b) Table of Contents.--The table of contents of the Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
 TITLE I--HEALTH SECURITY FOR ALL AMERICANS--EXPANSION PHASE (PHASE I)

Sec. 101. Expansion phase (phase I) voluntary State universal health 
                            insurance coverage plans.
            ``TITLE XXII--HEALTH SECURITY FOR ALL AMERICANS

               ``Part A--Expansion Phase (Phase I) Plans

        ``Sec. 2201. Purpose; voluntary State plans.
        ``Sec. 2202. Plan requirements.
        ``Sec. 2203. Coverage requirements for expansion phase (phase 
                            I) plans.
        ``Sec. 2204. Allotments.
        ``Sec. 2205. Administration.
        ``Sec. 2206. Definitions.''.
TITLE II--HEALTH SECURITY FOR ALL AMERICANS--UNIVERSAL PHASE (PHASE II)

Sec. 201. Universal phase (phase II) State universal health insurance 
                            coverage plans.
               ``Part B--Universal Phase (Phase II) Plans

        ``Sec. 2211. Purpose; mandatory State plans.
        ``Sec. 2212. Plan requirements.
        ``Sec. 2213. Coverage requirements for universal phase (phase 
                            II) plans.
        ``Sec. 2214. Requirements for employers regarding the provision 
                            of benefits.
        ``Sec. 2215. Allotments.
        ``Sec. 2216. Administration; definitions.
Sec. 202. Consumer protections.
                     ``Part C--Consumer Protections

        ``Sec. 2221. Home care standards.
        ``Sec. 2222. Consumer protection in the event of termination or 
                            suspension of services.
        ``Sec. 2223. Consumer protection through disclosure of 
                            information.
        ``Sec. 2224. Consumer protection through notice of changes in 
                            health care delivery.
                     TITLE III--PATIENT PROTECTIONS

Sec. 301. Incorporation of certain protections.
 TITLE IV--HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS

Sec. 401. Health Care Quality, Patient Safety, and Workforce Standards 
                            Institute.
Sec. 402. Health Care Quality, Patient Safety, and Workforce Standards 
                            Advisory Committee.
                  TITLE V--IMPROVING MEDICARE BENEFITS

Sec. 501. Full mental health and substance abuse treatment benefits 
                            parity.
                TITLE VI--LONG-TERM AND HOME HEALTH CARE

Sec. 601. Studies and demonstration projects to identify model 
                            programs.
                        TITLE VII--MISCELLANEOUS

Sec. 701. Nonapplication of ERISA.
Sec. 702. Sense of Congress regarding offsets.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The health of the American people is the foundation of 
        American strength, productivity, and wealth.
            (2) The guarantee of health care coverage and access to 
        quality medical care to all Americans is a fundamental right 
        and is essential to the general welfare.
            (3) 43,600,000 Americans, more than 8,500,000 of whom are 
        children, have no health insurance.
            (4) Health insurance coverage is unstable; less than \1/2\ 
        of all adults have been in their current health plan for 3 
        years.
            (5) The average American will hold at least 7 jobs during 
        their life, risking lack of health coverage every time they 
        change or are between jobs.
            (6) Annual health care expenditures in the United States 
        total $1.55 trillion.
            (7) In the United States, personal health care spending 
        grows 2.5 percent faster than the gross domestic product.
            (8) Although the United States spends considerably more in 
        health care per person than any other nation, it ranks only 
        fifteenth among countries worldwide on an overall index 
        designed to measure a range of health goals according to the 
        World Health Organization.
            (9) One of 4 adults, about 40,000,000 people, say they have 
        gone without needed medical care because they couldn't afford 
        it.
            (10) Nearly 31,000,000 Americans face collection agencies 
        annually because they owe money for medical bills.
            (11) The average American worker is paying twice as much 
        for family coverage than 10 years ago.
            (12) Because many individuals do not have health insurance 
        coverage, they may incur health care costs which they do not 
        fully reimburse, resulting in cost-shifting to others.
            (13) As a consequence of the piecemeal health care system 
        in the United States, administrative overhead costs 
        approximately $1,059 per person annually, while other Western 
        industrialized nations with universal health care systems spend 
        approximately $200 per person annually for administrative 
        overhead.
            (14) The United States should adopt national goals of 
        universal, affordable, comprehensive health insurance coverage 
        and should provide generous matching grants to the States to 
        achieve those goals within 5 years of the date of enactment of 
        this Act.

 TITLE I--HEALTH SECURITY FOR ALL AMERICANS--EXPANSION PHASE (PHASE I)

SEC. 101. EXPANSION PHASE (PHASE I) VOLUNTARY STATE UNIVERSAL HEALTH 
              INSURANCE COVERAGE PLANS.

    The Social Security Act (42 U.S.C. 301 et seq.) is amended by 
adding at the end the following:

            ``TITLE XXII--HEALTH SECURITY FOR ALL AMERICANS

               ``PART A--EXPANSION PHASE (PHASE I) PLANS

``SEC. 2201. PURPOSE; VOLUNTARY STATE PLANS.

    ``(a) Purpose.--The purpose of this part is to provide funds to 
participating States to enable those States to ensure universal health 
insurance coverage by establishing State administered systems targeted 
to State residents with a family income that does not exceed 300 
percent of the poverty line.
    ``(b) Expansion Phase (Phase I) Plan Required.--A State is not 
eligible for a payment under section 2205(a) unless the State has 
submitted to the Secretary a plan that--
            ``(1) sets forth how the State intends to use the funds 
        provided under this part to ensure universal, affordable, and 
        comprehensive health insurance coverage to eligible residents 
        of the State consistent with the provisions of this part; and
            ``(2) has been approved under section 2202(d).

``SEC. 2202. PLAN REQUIREMENTS.

    ``(a) In General.--Every expansion phase (phase I) plan shall 
include provisions for the following:
            ``(1) Information on the level of health insurance 
        coverage.--
                    ``(A) The level of health insurance coverage within 
                the State as determined under subsection (b).
                    ``(B) The base coverage gap for the year involved 
                as determined under subsection (b)(4).
                    ``(C) State efforts to provide or obtain health 
                insurance coverage for uncovered residents of the 
                State, including the steps the State is taking to 
                identify and enroll all uncovered residents of the 
                State who are eligible to participate in public or 
                private health insurance programs.
            ``(2) Details of, and timelines for, expansion phase (phase 
        i) plan.--
                    ``(A) Use of funds; coordination.--The activities 
                that the State intends to carry out using funds 
                received under this part, including how the State will 
                coordinate efforts under this part with existing State 
                efforts to increase the health insurance coverage of 
                individuals.
                    ``(B) Timelines.--Consistent with subsection (c), 
                the manner in which the State will reduce the base 
                coverage gap for the year involved, including a 
                timetable with specified targets for reducing the base 
                coverage gap by--
                            ``(i) 50 percent within 2 years after the 
                        date of approval of the expansion phase (phase 
                        I) plan; and
                            ``(ii) 100 percent within 4 years after 
                        such date.
            ``(3) Maintenance of effort.--The manner in which the State 
        will ensure that--
                    ``(A) employers within the State will continue to 
                provide not less than the level of financial support 
                toward the health insurance premiums required for 
                coverage of their employees as such employers provided 
                as of the date of enactment of this title; and
                    ``(B) the State will continue to provide not less 
                than the level of State expenditures incurred for 
                State-funded health programs as of such date.
        For purposes of this paragraph, any population or service that 
        was covered under the medicaid program under title XIX under a 
        waiver under section 1115 or section 1902(r)(2) shall be 
        treated as if such State expenditures had been based on the 
        enhanced FMAP formula used under the State children's health 
        insurance program under title XXI.
            ``(4) State outreach programs; access.--The manner in 
        which, and a timetable for when, the State will--
                    ``(A) institute outreach programs; and
                    ``(B) ensure that all eligible residents of the 
                State have access to the health insurance coverage 
                provided under this part.
            ``(5) Assurance of coverage of essential services.--An 
        assurance that the State program established under this part 
        will comply with the requirements of section 1867 (commonly 
        referred to as the `Emergency Medical Treatment and Active 
        Labor Act').
            ``(6) Representation on boards and commissions.--The manner 
        in which the State will ensure that all Boards and Commissions 
        that the State establishes to administer the plan will include, 
        among others, representatives of providers, consumers, 
        employers, and health worker unions.
            ``(7) Disclosure of information to the public.--The manner 
        in which the State will ensure that, with respect to entities 
        and individuals that provide services for which reimbursement 
        is provided under this part--
                    ``(A) financial arrangements between insurers and 
                providers and between providers and medical equipment 
                suppliers are disclosed to the public; and
                    ``(B) ownership interests and health care worker 
                qualifications and credentials are disclosed to the 
                public.
            ``(8) Consumer protections.--The manner in which the State 
        will ensure compliance with sections 2221, 2222, 2223, and 
        2224.
            ``(9) Public review.--The manner in which the State will 
        provide for the public review of institutional changes in 
        services provided, markets and regions covered, withdrawal or 
        movement of services, closures or downsizing, and other actions 
        that affect the provision of health insurance under the plan.
            ``(10) Services in rural and underserved areas; cultural 
        competency.--The manner in which the State will ensure--
                    ``(A) coverage in rural and underserved areas; and
                    ``(B) that the needs of culturally diverse 
                populations are met.
            ``(11) Mechanisms to minimize adverse risk selection.--The 
        manner in which the State will encourage mechanisms to minimize 
        adverse risk selection that provide choice of health plans and 
        control costs.
            ``(12) Limitation on administrative expenditures.--The 
        manner in which the State will ensure that all qualified plans 
        in the State expend at least 90 percent (or, during the first 2 
        years of the plan, 85 percent) of total income received from 
premiums on the provision of covered health care benefits (excluding 
all costs for marketing, advertising, health plan administration, 
profits, or capital accumulation) to individuals.
            ``(13) Self-employed and multiemployed.--The manner in 
        which the State will address self-employed individuals and 
        multiwage earner families.
            ``(14) Requirement to maintain medicaid benefits.--The 
        manner in which the State will ensure that individuals who are 
        eligible for medical assistance under title XIX and who receive 
        benefits under the expansion phase (phase I) plan shall receive 
        any items or services that are not available under the 
        expansion phase (phase I) plan but that are available under the 
        State medicaid program under title XIX through `wraparound 
        coverage' under such program.
            ``(15) Cost containment; risk selection.--What cost 
        containment strategies the State will employ and how the State 
        will reduce adverse risk selection.
            ``(16) Other matters.--Any other matter determined 
        appropriate by the Secretary.
    ``(b) Current Level of Coverage.--
            ``(1) In general.--The Secretary shall develop a 
        standardized survey approach that provides timely and up-to-
        date data to determine the percentage of the population of each 
        State that is currently covered by a health insurance plan or 
        program that provides coverage that meets the requirements of 
        section 2203(a).
            ``(2) Biannual survey.--The Secretary shall provide for the 
        conduct of the survey developed under paragraph (1) not less 
        than biannually to make coverage determinations for purposes of 
        paragraph (1).
            ``(3) Use of alternative system.--The Secretary shall 
        permit a State to utilize an alternative population-based 
        monitoring system to make determinations with respect to 
        coverage in the State for purposes of paragraph (1) if the 
        Secretary determines that such system meets or exceeds the 
        methodological standards utilized in the survey developed under 
        paragraph (1).
            ``(4) Base coverage gap.--For purposes of subsection 
        (a)(1)(A), the base coverage gap for a State shall be equal to 
        100 percent of the eligible individuals and families in the 
        State for the year involved, less the current level of coverage 
        for those individuals and families for such year as determined 
        under paragraph (1) or (3).
    ``(c) Reducing the Level of Uninsured Individuals.--
            ``(1) In general.--To be eligible to receive funds under 
        this part, a State shall agree to administer an expansion phase 
        (phase I) plan with a goal of providing health insurance 
        coverage for 100 percent of the eligible residents of the State 
        by not later than 4 years after the date of approval of the 
        State's expansion phase (phase I) plan.
            ``(2) Permissible activities.--A State may use amounts 
        provided under this part for any activities consistent with 
        this part that are appropriate to enroll individuals in health 
        plans and health programs to meet the targets contained in the 
        State plan under subsection (a)(2)(B), including through the 
        use of direct payments to health plans or, in the case of a 
        single State plan, directly to providers of services.
    ``(d) Process for Submission, Approval, and Amendment of Expansion 
Phase (Phase I) Plan.--The provisions of section 2106 apply to an 
expansion phase (phase I) plan under this part in the same manner as 
they apply to a State plan under title XXI, except that no expansion 
phase (phase I) plan may be effective earlier than January 1, 2004, and 
all expansion phase (phase I) plans must be submitted for approval by 
not later than December 31, 2005.

``SEC. 2203. COVERAGE REQUIREMENTS FOR EXPANSION PHASE (PHASE I) PLANS.

    ``(a) Required Scope of Health Insurance Coverage.--Health 
insurance coverage provided under this part shall consist of at least 
the benefits provided under the Federal Employees Health Benefits 
Program standard Blue Cross/Blue Shield preferred provider option 
service benefit plan, described in and offered under section 8903(1) of 
part 5, United States Code, plus mental health and substance abuse 
treatment benefits parity for all individuals, and benefits for early 
and periodic screening and diagnosis services (EPSDT) under section 
1905(a)(4)(B) for all individuals under 21 years of age.
    ``(b) Limitations on Premiums and Cost-Sharing.--
            ``(1) Description; general conditions.--An expansion phase 
        (phase I) plan shall include a description, consistent with 
        this subsection, of the amount (if any) of premiums, cost-
        sharing, or other similar charges imposed. Any such charges 
        shall be imposed pursuant to a public schedule.
            ``(2) Limitations on premiums and cost-sharing.--
                    ``(A) Individuals and families with income below 
                150 percent of poverty line.--In the case of an 
                individual or family whose income is at or below 150 
                percent of the poverty line--
                            ``(i) the State plan may not impose a 
                        premium; and
                            ``(ii) the total annual aggregate amount of 
                        cost-sharing imposed by a State with respect to 
                        all individuals in a family may not exceed 0.5 
                        percent of the family's income for the year 
                        involved.
                    ``(B) Individuals and families with income between 
                150 and 300 percent of poverty line.--In the case of an 
                individual or family whose income exceeds 150 percent 
                but does not exceed 300 percent of the poverty line--
                            ``(i) the State plan may not impose a 
                        premium that exceeds an amount that is equal 
                        to--
                                    ``(I) 20 percent of the average 
                                cost of providing benefits to an 
                                individual (or a family) under this 
                                part in the year involved; or
                                    ``(II) 3 percent of the family's 
                                income for the year involved; and
                            ``(ii) the total annual aggregate amount of 
                        premiums and cost-sharing (combined) imposed by 
                        a State with respect to all individuals in a 
                        family may not exceed 5 percent of the family's 
                        income for the year involved.
                    ``(C) Individuals and families with income above 
                300 percent of poverty line.--In the case of an 
                individual or family whose income exceeds 300 percent 
                of the poverty line--
                            ``(i) the State plan may not impose a 
                        premium that exceeds 20 percent of the average 
                        cost of providing benefits to an individual (or 
                        a family of the size involved) under this part 
                        in the year involved; and
                            ``(ii) the total annual aggregate amount of 
                        premiums and cost-sharing (combined) imposed by 
                        a State with respect to all individuals in a 
                        family may not exceed 7 percent of the family's 
                        income for the year involved.
                    ``(D) Self-employed individuals.--The State shall 
                establish rules for self-employed individuals based on 
                individual and family income.
            ``(3) Collection.--The State shall establish procedures for 
        collecting any premiums, cost-sharing, or other similar charges 
        imposed under this part. Such procedures shall provide for 
        annual reconciliations and adjustments.
    ``(c) Application of Certain Requirements.--
            ``(1) Restriction on application of preexisting condition 
        exclusions.--The expansion phase (phase I) plan shall not 
        permit the imposition of any preexisting condition exclusion 
        for covered benefits under the plan.
            ``(2) Choice of plans.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), the expansion phase (phase I) plan 
                shall offer eligible individuals and families a choice 
                of qualified plans from which to receive benefits under 
                this part. At least 1 plan shall be a preferred 
                provider option plan.
                    ``(B) Waiver.--The Secretary--
                            ``(i) may waive the requirement under 
                        subparagraph (A) if determined appropriate; and
                            ``(ii) shall waive such requirement in the 
                        case of a State that establishes a single State 
                        plan.

``SEC. 2204. ALLOTMENTS.

    ``(a) State Allotments.--
            ``(1) In general.--With respect to a fiscal year, the 
        Secretary shall allot to each State with an expansion phase 
        (phase I) plan approved under this part the amount determined 
        under paragraph (2) for such State for such fiscal year.
            ``(2) Determination of cost of coverage.--The amount 
        determined under this paragraph is the amount equal to--
                    ``(A) the product of--
                            ``(i) the Federal participation rate for 
                        the State as determined under subsection (b) 
                        or, if applicable, the enhanced Federal 
                        participation rate for the State, as determined 
                        under subsection (c);
                            ``(ii) the estimated cost for the minimum 
                        benefits package required to comply under 
                        section 2203, not to exceed the sum of--
                                    ``(I) the total annual Government 
                                and employee contributions required for 
                                individual or self and family health 
                                benefits coverage under the Federal 
                                Employees Health Benefits Program 
                                standard Blue Cross/Blue Shield 
                                preferred provider option service 
                                benefit plan, described in and offered 
                                under section 8903(1) of title 5, 
                                United States Code (adjusted for age 
                                and other factors, as the Secretary 
                                determines appropriate); and
                                    ``(II) the estimated average cost-
                                sharing expense for an individual or 
                                family; and
                            ``(iii) the estimated number of residents 
                        to be enrolled in the expansion phase (phase I) 
                        plan; less
                    ``(B) the sum of--
                            ``(i) the individual or family health 
                        insurance contribution and cost-sharing 
                        payments to be made in accordance with section 
                        2203(b); and
                            ``(ii) any applicable employer contribution 
                        to such payments.
    ``(b) Federal Participation Rate.--For purposes of subsection 
(a)(2)(A)(i), the Federal participation rate for a State shall be equal 
to the enhanced FMAP determined for the State under section 2105(b).
    ``(c) Enhanced Federal Participation Rate.--
            ``(1) In general.--For purposes of subsection (a)(2)(A)(i), 
        the enhanced Federal participation rate for a State shall be 
        equal to the Federal participation rate for such State under 
        subsection (b), as adjusted by the Secretary based on the 
        decrease in the base coverage gap in the State.
            ``(2) Amount of adjustment and application.--
                    ``(A) Amount of adjustment.--The Federal 
                participation rate under subsection (b) with respect to 
                a State shall be increased by--
                            ``(i) 1 percentage point if the base 
                        coverage gap of the State has decreased by at 
                        least 50 percent within 2 years after the date 
                        of approval of the expansion phase (phase I) 
                        plan, as determined by the Secretary; and
                            ``(ii) 3 percentage points if the base 
                        coverage gap of the State has decreased by 100 
                        percent within 4 years after the date of 
                        approval of the expansion phase (phase I) plan, 
                        as determined by the Secretary.
                    ``(B) Application.--The increase described in--
                            ``(i) subparagraph (A)(i) shall only apply 
                        to a State for the period beginning with the 
                        month of the determination under such 
                        subparagraph and ending with the month 
                        preceding the month of the determination under 
                        subparagraph (A)(ii) (if any), but in no event 
                        for more than 24 months; and
                            ``(ii) subparagraph (A)(ii) shall apply to 
                        a State for any year (or portion thereof) 
                        beginning with the month of the determination 
                        under such subparagraph.
            ``(3) Full coverage.--For purposes of this part, a State 
        shall be deemed to have decreased its base coverage gap by 100 
        percent if the Secretary determines that--
                    ``(A) 98 percent of all eligible residents of the 
                State are provided health insurance coverage under the 
                expansion phase (phase I) plan; and
                    ``(B) the remaining 2 percent of such residents are 
                served by alternative health care delivery systems as 
                demonstrated by the State.
    ``(d) Grants to Indian Tribes, Native Hawaiian Organizations, and 
Alaska Native Organizations.--
            ``(1) In general.--Out of funds appropriated under 
        subsection (e), the Secretary shall reserve an amount, not to 
        exceed 1 percent of the total allotments determined under 
        subsection (a) for a fiscal year, to make grants to Indian 
        tribes, Native Hawaiian organizations, and Alaska Native 
        organizations for development and implementation of universal 
        health insurance coverage plans for members of such tribes and 
        organizations.
            ``(2) Plan.--To be eligible to receive a grant under 
        paragraph (1), an Indian tribe, Native Hawaiian organization, 
        or Alaska Native organization shall submit a universal health 
        insurance coverage plan to the Secretary at such time, in such 
        manner, and containing such information, as the Secretary may 
        require.
            ``(3) Regulations.--The Secretary shall issue regulations 
        specifying the requirements of this part that apply to Indian 
        tribes, Native Hawaiian organizations, and Alaska Native 
        organizations receiving grants under paragraph (1).
    ``(e) Appropriation.--
            ``(1) In general.--Out of any funds in the Treasury not 
        otherwise appropriated, there is appropriated to carry out this 
        title such sums as may be necessary for fiscal year 2004 and 
        each fiscal year thereafter.
            ``(2) Budget authority.--Paragraph (1) constitutes budget 
        authority in advance of appropriations Acts and represents the 
        obligation of the Federal Government to provide States, Indian 
        tribes, Native Hawaiian organizations, and Alaska Native 
        organizations with the allotments determined under this section 
        and the grants for administrative and outreach activities under 
        section 2205.

``SEC. 2205. ADMINISTRATION.

    ``(a) Payments.--
            ``(1) In general.--
                    ``(A) Quarterly.--Subject to subparagraph (B) and 
                subsection (b), the Secretary shall make quarterly 
                payments to each State with an expansion phase (phase 
                I) plan approved under this part, from its allotment 
                under section 2204.
                    ``(B) Funding for administration and outreach.--
                            ``(i) Authority to make grants.--In 
                        addition to the allotments determined under 
                        section 2204, the Secretary may make grants to 
                        States, Indian tribes, Native Hawaiian 
                        organizations, and Alaska Native organizations 
                        for expenditures for administrative and 
                        outreach activities.
                            ``(ii) Amounts.--
                                    ``(I) In general.--A grant awarded 
                                under this subparagraph shall not 
                                exceed the applicable percentage (as 
                                determined under subclause (II)) of the 
                                total amount allotted to the State, 
                                Indian tribe, Native Hawaiian 
                                organization, or Alaska Native 
                                organization under section 2204.
                                    ``(II) Applicable percentage.--For 
                                purposes of subclause (I), the 
                                applicable percentage is--
                                            ``(aa) 10 percent for 2005 
                                        through 2009; and
                                            ``(bb) 3 percent for 2010 
                                        and each year thereafter.
            ``(2) Advance payment; retrospective adjustment.--The 
        Secretary may make payments under this part for each quarter on 
        the basis of advance estimates by the State and such other 
        investigation as the Secretary may find necessary, and may 
        reduce or increase the payments as necessary to adjust for any 
        overpayment or underpayment for prior quarters.
            ``(3) Flexibility in submittal of claims.--Nothing in this 
        subsection shall be construed as preventing a State from 
        claiming as expenditures in the quarter expenditures that were 
        incurred in a previous quarter.
    ``(b) Authority for Blended Rate for Health Security, Medicaid, and 
SCHIP Funds.--The Secretary shall establish procedures for blending the 
payments that a State is entitled to receive under this title, title 
XIX, and title XXI into 1 payment rate if--
            ``(1) the State requests such a blended payment; and
            ``(2) the Secretary finds that the State meets maintenance 
        of effort requirements established by the Secretary.
    ``(c) Limitations on Federal Payments Based on Cost Containment.--
            ``(1) Determination of baseline.--Each year (beginning with 
        2004), the Secretary shall establish a baseline projection for 
        the national rate of growth in private health insurance 
        premiums for such year.
            ``(2) Requirement.--Beginning with fiscal year 2005 and 
        each fiscal year thereafter, any payment made to a State under 
        section 2204 shall not exceed the amount paid to the State 
        under such section for the preceding fiscal year, adjusted for 
        changes in enrollment and a premium inflation adjustment that 
        is 0.5 percent below the baseline projection determined under 
        paragraph (1) for the year, unless the State adopts (and the 
        Secretary approves) cost containment strategy that will reduce 
        the rate of growth of spending.
    ``(d) Other Limitations on Use of Funds.--
            ``(1) In general.--A State participating under part A, and, 
        effective January 1, 2008, all States under part B, shall 
        ensure that any payments received by the State under section 
        2205 or 2116(a) are not used by any individual or entity, 
        including providers or health plans that contract to provide 
        services herein, to finance directly or indirectly, or to 
        otherwise facilitate expenditures to influence health care 
        workers of such individual or entity with respect to issues 
        related to unionization.
            ``(2) Construction.--Nothing in this subsection shall be 
        construed to limit expenditures made for the purpose of good 
        faith collective bargaining or pursuant to the terms of a bona 
        fide collective bargaining agreement.
    ``(e) Waiver of Federal Requirements.--A State may request (and the 
Secretary may grant) a waiver of any provision of Federal law that the 
State determines is necessary in order to carry out an approved 
expansion phase (phase I) plan under this part.
    ``(f) Report.--Not later than January 1, 2005, and each January 1 
thereafter, the Secretary, in consultation with the General Accounting 
Office and the Congressional Budget Office, shall prepare and submit to 
the appropriate committees of Congress a report on the number of States 
receiving payments under this part for the year for which the report is 
being prepared as well as the level of insurance coverage attained by 
each such State.

``SEC. 2206. DEFINITIONS.

    ``In this title:
            ``(1) Cost-sharing.--The term `cost-sharing' has the 
        meaning given such term under the Federal Employees Health 
        Benefits Program standard Blue Cross/Blue Shield preferred 
        provider option service benefit plan described in and offered 
        under section 8903(1) of part 5, United States Code, and 
        includes deductibles, copayments, coinsurance, as such terms 
        are defined for purposes of such plan.
            ``(2) Eligible residents of a state.--
                    ``(A) In general.--The term `eligible residents of 
                a State' means an individual or family who--
                            ``(i) is (or consists of) a resident of the 
                        State involved;
                            ``(ii) except as provided in subparagraph 
                        (B), has a family income that does not exceed 
                        300 percent of the poverty line;
                            ``(iii) is (or consists of) a citizen of 
                        the United States, a legal resident alien, or 
                        an individual otherwise residing in the United 
                        States under the authority of Federal law; and
                            ``(iv) in the case of an individual, is not 
                        eligible for benefits under the medicare 
                        program under title XVIII or for medical 
                        assistance under the medicaid program under 
                        title XIX (other than under the application of 
                        section 1902(a)(10)(A)(ii)(XIV)).
                    ``(B) Option to provide coverage for individuals 
                and families with higher income.--If approved by the 
                Secretary, a State may increase the percentage 
                described in subparagraph (A)(ii), or eliminate all 
                income eligibility criteria in order to provide 
                coverage under this part to more individuals and 
                families.
            ``(3) Expansion phase (phase i) plan.--The term `expansion 
        phase (phase I) plan' means the State universal health 
        insurance coverage plan submitted under section 2201(b).
            ``(4) Health care services.--The term `health care 
        services' includes medical, surgical, mental health, and 
        substance abuse services, whether provided on an inpatient or 
        outpatient basis.
            ``(5) Health care worker.--The term `health care worker' 
        means an individual employed by an employer that provides--
                    ``(A) health care services; or
                    ``(B) necessary related services, including 
                administrative, food service, janitorial, or 
                maintenance service to an entity that provides such 
                health care services.
            ``(6) Health plan.--The term `health plan' includes health 
        insurance coverage, as defined in section 2791(b)(1) of the 
        Public Health Service Act (42 U.S.C. 300gg-91(b)(1)) and group 
        health plans, as defined in section 2791(a) of such Act (42 
        U.S.C. 300gg91(b)(1)).
            ``(7) Mental health and substance abuse treatment benefits 
        parity.--
                    ``(A) In general.--The term `mental health and 
                substance abuse treatment benefits parity' means, with 
                respect to health coverage, that the coverage does not 
                impose treatment limitations or financial requirements 
                on the coverage of mental health benefits if similar 
                requirements are not imposed on coverage of medical and 
                surgical benefits in comparable settings (including 
                inpatient and outpatient settings).
                    ``(B) Treatment limitations.--The term `treatment 
                limitations' means limits on the frequency of 
                treatment, number of visits, or other limits on the 
scope and duration of treatment, as covered by a group health plan (or 
health insurance coverage offered in connection with such a plan). Such 
term does not include limits on benefits or coverage based solely on 
medical necessity.
                    ``(C) Financial requirements.--The term `financial 
                requirements' means copayments, deductibles, out-of-
                network charges, out-of-pocket contributions or fees, 
                annual limits, and lifetime aggregate limits imposed on 
                covered individuals.
            ``(8) Poverty line.--The term `poverty line' has the 
        meaning given such term in section 673(2) of the Community 
        Services Block Grant Act (42 U.S.C. 9902(2)), including any 
        revision required by such section.
            ``(9) Premium.--The term `premium' includes any enrollment 
        fees and other similar charges.
            ``(10) Qualified plan.--The term `qualified plan' means a 
        health plan that satisfies the coverage requirements described 
        under section 2203 and participates in an expansion phase 
        (phase I) plan.''.

TITLE II--HEALTH SECURITY FOR ALL AMERICANS--UNIVERSAL PHASE (PHASE II)

SEC. 201. UNIVERSAL PHASE (PHASE II) STATE UNIVERSAL HEALTH INSURANCE 
              COVERAGE PLANS.

    Title XXII of the Social Security Act, as added by section 101, is 
amended by adding at the end the following:

               ``PART B--UNIVERSAL PHASE (PHASE II) PLANS

``SEC. 2211. PURPOSE; MANDATORY STATE PLANS.

    ``(a) Purpose.--The purposes of this part are to--
            ``(1) require States to establish and implement State-
        administered systems to ensure universal health insurance 
        coverage; and
            ``(2) provide funds to States for the establishment and 
        implementation of such systems.
    ``(b) Universal Phase (Phase II) Plan Required.--
            ``(1) In general.--Except as provided in paragraph (2), not 
        later than January 1, 2007, a State shall submit to the 
        Secretary a plan that sets forth how the State intends to use 
        the funds provided under this part to ensure universal, 
        affordable, and comprehensive health insurance coverage to 
        eligible residents of the State consistent with the provisions 
        of this part.
            ``(2) States with phase i plans.--
                    ``(A) In general.--Not later than January 1, 2007, 
                a State with a phase I State plan shall submit an 
                addendum to such plan that provides assurances to the 
                Secretary that such plan conforms to the requirements 
                of this part.
                    ``(B) Conversion to universal phase (phase ii) 
                plan.--If an addendum to an expansion phase (phase I) 
                plan is approved by the Secretary--
                            ``(i) the plan shall be automatically 
                        converted to a universal phase (phase II) plan; 
                        and
                            ``(ii) section 2214 and any provision of 
                        part A that is inconsistent with this part 
                        shall not apply to the plan.
            ``(3) Failure to submit plan or addendum.--If a State fails 
        to submit a plan as required in paragraph (1) (or an addendum 
        as required in paragraph (2)), or fails to have such plan or 
        addendum approved by the Secretary, such State shall be in 
        violation of this part; and any residents of such a State may 
        bring a cause of action against the State in Federal district 
        court to require the State to comply with the provisions of 
        this part.

``SEC. 2212. PLAN REQUIREMENTS.

    ``(a) In General.--A universal phase (phase II) plan shall include 
a description, consistent with the requirements of this part, of the 
following:
            ``(1) Details of the universal phase (phase ii) plan.--The 
        activities that the State intends to carry out using funds 
        received under this part to ensure that all eligible residents 
        of the State have access to the coverage provided under this 
        part, including how the State will coordinate efforts under the 
        program under this part with existing State efforts to increase 
        to 100 percent the health insurance coverage of eligible 
        residents of the State by January 1, 2009.
            ``(2) Requirements for employers.--The manner in which the 
        State will ensure that employers within the State will comply 
        with the requirements of section 2214.
            ``(3) Part a provisions.--The following provisions apply to 
        a universal phase (phase II) plan under this part in the same 
        manner as such provisions apply to an expansion phase (phase I) 
        plan under part A:
                    ``(A) State outreach programs; access.--Section 
                2202(a)(4).
                    ``(B) Assurance of coverage of essential 
                services.--Section 2202(a)(5).
                    ``(C) Representation on boards and commissions.--
                Section 2202(a)(6).
                    ``(D) Disclosure of information to the public.--
                Section 2202(a)(7).
                    ``(E) Consumer protections and workforce 
                standards.--Section 2202(a)(8).
                    ``(F) Public review.--Section 2202(a)(9).
                    ``(G) Services in rural and underserved areas; 
                cultural competency.--Section 2202(a)(10).
                    ``(H) Purchasing pools.--Section 2202(a)(11).
                    ``(I) Limitation on administrative expenditures.--
                Section 2202(a)(12).
                    ``(J) Self-employed and multiemployed.--Section 
                2202(a)(13).
                    ``(K) Medicaid wraparound coverage.--Section 
                2202(a)(14).
            ``(4) Other matters.--Any other matter determined 
        appropriate by the Secretary.
    ``(b) Permissible Activities.--A State may use amounts provided 
under this part for any activities consistent with this part that are 
appropriate to enroll individuals in health plans to ensure that all 
eligible residents of the State are provided coverage under this part, 
including through the use of direct payments to health plans or 
providers of services.
    ``(c) Cost Containment; Competitive Bidding.--Notwithstanding 
subsection (b), State purchasing pools shall solicit bids from health 
plans at least annually.
    ``(d) Process for Submission, Approval, and Amendment of Universal 
Phase (Phase II) Plan.--Section 2106 applies to a universal phase 
(phase II) plan under this part in the same manner as such section 
applies to a State plan under title XXI, except that no universal phase 
(phase II) plan may be effective earlier than January 1, 2008, and all 
such plans must be submitted for approval by not later than January 1, 
2007.

``SEC. 2213. COVERAGE REQUIREMENTS FOR UNIVERSAL PHASE (PHASE II) 
              PLANS.

    ``(a) Required Scope of Health Insurance Coverage.--Section 2203(a) 
applies to a universal phase (phase II) plan under this part.
    ``(b) Universal Coverage.--All States shall ensure that by January 
1, 2009, 100 percent of eligible residents of the State have health 
insurance coverage that meets the requirements of section 2203(a).
    ``(c) Limitations on Premiums and Cost-Sharing.--Section 2203(b) 
applies to a universal phase (phase II) plan under this part.
    ``(d) Application of Certain Requirements.--Section 2203(c) applies 
to a universal phase (phase II) plan under this part.

``SEC. 2214. REQUIREMENTS FOR EMPLOYERS REGARDING THE PROVISION OF 
              BENEFITS.

    ``(a) Requirements.--Subject to subsection (c)(2)(B), an employer 
in a State shall comply with the following requirements:
            ``(1) Employers with less than 500 employees.--
                    ``(A) In general.--An employer with less than 500 
                employees shall enroll each employee in a State-
                designated purchasing pool.
                    ``(B) Contributions.--
                            ``(i) In general.--Notwithstanding 
                        subparagraph (A) and subject to clause (ii), 
                        the employer shall make a contribution on 
                        behalf of each employee for health insurance 
                        coverage that is equal to at least 80 percent 
                        of the total premiums for such coverage for 
                        employees and their families if the employee 
                        elects dependent coverage.
                            ``(ii) Limitation.--An employer shall not 
                        be liable under subparagraph (B) for more than 
                        10 percent of each employee's annual wages.
            ``(2) Employers with at least 500 employees.--
                    ``(A) In general.--An employer with at least 500 
                employees, a majority of whose wages fall below an 
                amount equal to 300 percent of the poverty line 
                applicable to a family of the size involved, shall 
                comply with the requirements applicable to an employer 
                under paragraph (1).
                    ``(B) Other employers.--
                            ``(i) In general.--An employer with at 
                        least 500 employees that is not described in 
                        subparagraph (A) shall, at the option of the 
                        employer, either--
                                    ``(I) comply with the requirements 
                                applicable to an employer under 
                                paragraph (1); or
                                    ``(II) provide health insurance 
                                coverage to all employees and their 
                                families (if the employee elects 
                                dependent coverage) that meets the 
                                requirements of section 2213 and the 
                                employer contribution required under 
                                paragraph (1)(B).
                            ``(ii) Additional employer contribution.--
                        An employer that elects to comply with clause 
                        (i)(I) shall contribute an additional 1 percent 
                        of payroll into the State-designated purchasing 
                        pool in which it participates.
            ``(3) Rule of construction.--Nothing in this title shall be 
        construed as prohibiting a labor organization from collectively 
        bargaining for an employer contribution that is greater than 
        the contribution that is required under paragraph (1)(B) or, as 
        applicable, for health insurance benefits that are greater than 
        the coverage required under paragraph section 2203(a).
            ``(4) Part-time employees.--An employer shall be 
        responsible for meeting the requirements under this subsection 
        for all employees of the employer.
            ``(5) Multiemployer families.--In the case of a family with 
        more than 1 employer, the employers of individuals within the 
        family shall apportion their contributions in accordance with 
        rules established by the State.
    ``(b) Nonapplicability.--This section shall not apply--
            ``(1) to any State that establishes a single payor system; 
        or
            ``(2) to any State that established a universal phase 
        (phase II) plan through an approved addendum to an expansion 
        phase (phase I) plan.
    ``(c) Private Cause of Action.--
            ``(1) Liability.--An employer that fails to comply with the 
        requirements of subsection (a) or otherwise takes adverse 
        action against an employee for the purpose of interfering with 
        the attainment of any right to which the employee may be 
        entitled to under this title, shall be liable to the employee 
        affected.
            ``(2) Amount.--The amount of the liability described in 
        paragraph (1) shall be an amount equal to--
                    ``(A) the contributions that otherwise would have 
                been made by the employer on behalf of the employee 
                under this section;
                    ``(B) an additional amount as liquidated damages; 
                and
                    ``(C) consequential damages for reasonably 
                foreseeable injuries resulting from such action.
            ``(3) Jurisdiction; equitable relief.--
                    ``(A) Jurisdiction.--An action under this 
                subsection may be maintained against any employer in 
                any Federal or State court of competent jurisdiction by 
                any 1 or more employees.
                    ``(B) Equitable relief.--In addition to the damages 
                described in paragraph (2), a court may enjoin any act 
                or practice that violates this title.
            ``(4) Attorney's fees.--If a plaintiff or plaintiffs 
        prevail in an action brought under this subsection, the court 
        shall, in addition to any judgment awarded to the plaintiff or 
        plaintiffs, award the reasonable attorney's fees and costs 
        associated with the bringing of the action.

``SEC. 2215. ALLOTMENTS.

    ``(a) State Allotments.--Subsections (a) and (b) of section 2204 
apply to a universal phase (phase II) plan under this part in the same 
manner as such subsections apply to an expansion phase (phase I) plan 
under part A.
    ``(b) Special Rule for Expansion Phase (Phase I) Plans.--A State 
that operated an expansion phase (phase I) plan and converted such plan 
to a universal phase (phase II) plan pursuant to section 2211(b)(2)(B) 
shall continue to be eligible for the enhanced Federal participation 
rate determined under section 2204(c).
    ``(c) Grants to Indian Tribes, Native Hawaiian Organizations, and 
Alaska Native Organizations.--Section 2204(d) applies to a universal 
phase (phase II) plan under this part.
    ``(d) Appropriation.--
            ``(1) In general.--Out of any funds in the Treasury not 
        otherwise appropriated, there is appropriated to carry out this 
        title such sums as may be necessary for fiscal year 2008 and 
        each fiscal year thereafter.
            ``(2) Budget authority.--Paragraph (1) constitutes budget 
        authority in advance of appropriations Acts and represents the 
        obligation of the Federal Government to provide States, Indian 
        tribes, Native Hawaiian organizations, and Alaska Native 
        organizations with the allotments determined under this section 
        and the grants for administrative and outreach activities under 
        section 2205(a)(1)(B) (as applied to this part under section 
        2216(a)).

``SEC. 2216. ADMINISTRATION; DEFINITIONS.

    ``(a) Administration.--The provisions of section 2205 (other than 
subsection (c) of such section) apply to a universal phase (phase II) 
plan under this part in the same manner as such provisions apply to an 
expansion phase (phase I) plan under part A.
    ``(b) Definitions.--
            ``(1) Application of section 2206.--The definitions set 
        forth in section 2206 apply to a universal phase (phase II) 
        plan under this part in the same manner as such provisions 
        apply to an expansion phase (phase I) plan under part A except 
        that for purposes of this part, the definition of `eligible 
        residents of a State' set forth in section 2206(2) shall be 
        applied without regard to subparagraphs (A)(ii) and (B).
            ``(2) Universal phase (phase ii) plan.--In this title, the 
        term `universal phase (phase II) plan' means the State 
        universal health insurance coverage plan submitted under 
        section 2211(b).''.

SEC. 202. CONSUMER PROTECTIONS.

    Title XXII of the Social Security Act, as amended by section 201, 
is amended by adding at the end the following:

                     ``PART C--CONSUMER PROTECTIONS

``SEC. 2221. HOME CARE STANDARDS.

    ``In order to ensure that home care services are provided in a 
consumer-directed manner, a State participating under part A, and, 
effective January 1, 2008, all States under part B, shall satisfy the 
Secretary that any health plan that provides home care services under 
this title creates, or contracts with, a viable entity other than the 
consumer or individual provider to provide effective billing, payments 
for services, tax withholding, unemployment insurance, and workers 
compensation coverage, and to serve as the statutory employer of the 
home care provider. Recipients of such services shall retain the right 
to independently select, hire, terminate, and direct the work of the 
home care provider.

``SEC. 2222. CONSUMER PROTECTION IN THE EVENT OF TERMINATION OR 
              SUSPENSION OF SERVICES.

    ``A State participating under part A, and, effective January 1, 
2008, all States under part B, shall satisfy the Secretary that any 
health plan providing services under this title shall ensure that 
enrollees will receive continued health services in the event that the 
plan's health care services are terminated or suspended, including as 
the result of the plan filing for bankruptcy relief under title 11, 
United States Code, or the failure of the plan to provide payments to 
providers, lockouts, work stoppages, or other labor management 
problems.

``SEC. 2223. CONSUMER PROTECTION THROUGH DISCLOSURE OF INFORMATION.

    ``(a) In General.--A State participating under part A, and, 
effective January 1, 2008, all States under part B, shall satisfy the 
Secretary that any health care provider that provides services to 
individuals under this title shall provide to the State information 
regarding the identity, employment location, and qualifications of 
health care workers providing services under--
            ``(1) the licensure of the provider; or
            ``(2) a contract between the provider and a health plan or 
        the State.
    ``(b) Availability to Public.--A health care provider shall make 
the information described in subsection (a) available to the public.

``SEC. 2224. CONSUMER PROTECTION THROUGH NOTICE OF CHANGES IN HEALTH 
              CARE DELIVERY.

    ``A State participating under part A, and, effective January 1, 
2008, all States under part B, shall describe how the State will 
provide, at a minimum, the following protections:
            ``(1) Adequate advance notice to the public, the affected 
        health care workers, and labor organizations representing such 
        workers, of a pending--
                    ``(A) facility or operating unit closure;
                    ``(B) sale, merger, or consolidation of a facility 
                or operating unit;
                    ``(C) transfer of work from 1 facility or entity to 
                another facility or entity; or
                    ``(D) reduction of services.
            ``(2) A right of first refusal for similar vacant positions 
        with--
                    ``(A) the resulting entity, in the case of a health 
                care worker whose position was eliminated following a 
                merger of the worker's original employer with a new 
                entity; or
                    ``(B) the contractor, in the case of a health care 
                worker whose position was eliminated following the 
                contracting out of the work the worker formerly 
                performed.''.

                     TITLE III--PATIENT PROTECTIONS

SEC. 301. INCORPORATION OF CERTAIN PROTECTIONS.

    (a) Incorporation.--The provisions of the following bills are 
hereby enacted into law:
            (1) S. 1052 of the 107th Congress, as passed by the Senate 
        on June 29, 2001.
            (2) H.R. 2340 of the 107th Congress, as introduced on June 
        27, 2001.
    (b) Publication.--In publishing this Act in slip form and in the 
United States Statutes at Large pursuant to section 112, of title 1, 
United States Code, the Archivist of the United States shall include 
after the date of approval at the end appendixes setting forth the 
texts of the bills referred to in subsection (a) of this section.

 TITLE IV--HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS

SEC. 401. HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS 
              INSTITUTE.

    (a) Establishment.--
            (1) Institute.--There is established within the Agency for 
        Healthcare Research and Quality, an institute to be known as 
        the Health Care Quality, Patient Safety, and Workforce 
        Standards Institute (in this section referred to as the 
        ``Institute'').
            (2) Director.--The Secretary of Health and Human Services 
        shall appoint a director of the Institute. The director shall 
        administer the Institute and carry out the duties of the 
        director under this section subject to the authority, 
        direction, and control of the Secretary.
    (b) Mission.--The mission of the Institute is to--
            (1) demonstrate how patient safety issues and workplace 
        conditions are linked to quality patient care and the reduction 
        of the incidence of medical errors; and
            (2) reduce the incidence of medical errors and improve 
        patient safety and quality of care.
    (c) Duties.--In carrying out the mission of the Institute, the 
director of the Institute shall--
            (1) work closely with the director of the Agency for 
        Healthcare Research and Quality to ensure that issues related 
        to workplace conditions are reflected in the activities 
        conducted by such agency in order to reduce the incidence of 
        medical errors and improve patient safety and quality of care, 
        including--
                    (A) the establishment of national goals;
                    (B) the development and implementation of a 
                research agenda;
                    (C) the development and promotion of best 
                practices;
                    (D) the development of performance and staffing 
                standards in consultation with the Health Care 
                Financing Administration and other Federal agencies, as 
                appropriate; and
                    (E) the development and dissemination of 
                information, educational and training materials, and 
                other criteria as it relates to the delivery of quality 
                care;
            (2) provide recommendations to the Secretary of Health and 
        Human Services and other Federal agencies with responsibility 
        for health care quality and the development of standards that 
        impact on the delivery of quality patient care on standards 
        related to workplace conditions and patient safety;
            (3) support the activities of the Health Care Financing 
        Administration related to the development of new or revised 
        conditions of participation under the medicare and medicaid 
        programs and subsequent rulemaking on issues related to 
        workplace conditions, medical errors, and patient safety and 
        quality of care; and
            (4) conduct other activities determined appropriate by the 
        director of the Institute.
    (d) Workplace Conditions.--For purposes of this section, the term 
``workplace conditions'' shall include issues related to--
            (1) health care worker staffing;
            (2) hours of work;
            (3) confidentiality and whistleblower protections;
            (4) employee participation in decisionmaking roles that 
        contribute to improved quality of care and the reduction of the 
        incidence of medical errors;
            (5) workforce training; and
            (6) the impact of health care delivery restructuring on 
        communities and health care workers.
    (e) Definition of Health Care Worker.--
            (1) In general.--In this section, the term ``health care 
        worker'' means an individual employed by an employer that 
        provides--
                    (A) health care services; or
                    (B) necessary related services, including 
                administrative, food service, janitorial, or 
                maintenance service to an entity that provides such 
                health care services.
            (2) Health care services.--In paragraph (1), the term 
        ``health care services'' includes medical, surgical, mental 
        health, and substance abuse services, whether provided on an 
        in-patient or outpatient basis.
    (f) Authorization of Appropriations.--There are authorized to be 
appropriated to the Institute such sums as may be necessary to carry 
out the purposes of this section.

SEC. 402. HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS 
              ADVISORY COMMITTEE.

    (a) Establishment of Committee.--There is established a Health Care 
Quality, Patient Safety, and Workforce Standards Committee (in this 
section referred to as the ``Committee'').
    (b) Functions of Committee.--
            (1) Advice to institute.--The Committee shall provide 
        advice to the Director of the Health Care Quality, Patient 
        Safety, and Workforce Standards Institute established under 
        section 401 on issues related to the duties of the Director.
            (2) Initial report.--Not later than December 31, 2004, the 
        Committee shall submit an initial report to the Secretary that 
        contains--
                    (A) recommendations regarding minimal workforce 
                standards that are critical for improved health care 
                quality and patient safety; and
                    (B) recommendations regarding additional ways to 
                reduce the incidence of medical errors and to improve 
                patient safety and quality of care.
            (3) Final report.--Not later than December 31, 2005, the 
        Committee shall submit a final report to the Secretary of 
        Health and Human Services regarding the recommendations 
        contained in the initial report required under paragraph (2), 
        including any modifications of such recommendations.
    (c) Structure and Membership of the Committee.--
            (1) Structure.--The Committee shall be composed of the 
        Director of the Health Care Quality, Patient Safety, and 
        Workforce Standards Institute established under section 401 and 
        15 additional members who shall be appointed by the Secretary 
        of Health and Human Services.
            (2) Membership.--
                    (A) In general.--The members of the Committee shall 
                be chosen on the basis of their integrity, 
                impartiality, and good judgment, and shall be 
                individuals who are, by reason of their education, 
                experience, and attainments, exceptionally qualified to 
                perform the duties of members of the Committee.
                    (B) Specific members.--In making appointments under 
                paragraph (1), the Secretary of Health and Human 
                Services shall ensure that the following groups are 
                represented:
                            (i) Health care providers and health care 
                        workers, including labor unions representing 
                        health care workers.
                            (ii) Consumer organizations.
                            (iii) Health care institutions.
                            (iv) Health education organizations.
    (d) Chairman.--The Director of the Health Care Quality, Patient 
Safety, and Workforce Standards Institute established under section 401 
shall chair the Committee.

                  TITLE V--IMPROVING MEDICARE BENEFITS

SEC. 501. FULL MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT BENEFITS 
              PARITY.

    Notwithstanding any provision of title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.), beginning January 1, 2004, each 
individual who is entitled to benefits under part A or enrolled under 
part B of the medicare program, including an individual enrolled in a 
Medicare+Choice plan offered by a Medicare+Choice organization under 
part C of such program, shall be provided full mental health and 
substance abuse treatment parity under the medicare program established 
under such title of such Act consistent with title XXII of the Social 
Security Act (as added by this Act).

                TITLE VI--LONG-TERM AND HOME HEALTH CARE

SEC. 601. STUDIES AND DEMONSTRATION PROJECTS TO IDENTIFY MODEL 
              PROGRAMS.

    The Secretary of Health and Human Services shall--
            (1) conduct studies and demonstration projects, through 
        grant, contract, or interagency agreement, that are designed to 
        identify model programs for the provision of long-term and home 
        health care services;
            (2) report regularly to Congress on the results of such 
        studies and demonstration projects; and
            (3) include in such report any recommendations for 
        legislation to expand or continue such studies and projects.

                        TITLE VII--MISCELLANEOUS

SEC. 701. NONAPPLICATION OF ERISA.

    The provisions of section 514 of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1144) shall not apply with respect to 
health benefits provided under a group health plan (as defined in 
section 733(a) of that Act (29 U.S.C. 1191b(a))) qualified to offer 
such benefits under an expansion phase (phase I) plan under title XXII 
of the Social Security Act (as added by this Act) or under a universal 
phase (phase II) plan under such title.

SEC. 702. SENSE OF CONGRESS REGARDING OFFSETS.

    It is the sense of Congress that any sums necessary for the 
implementation of this Act, and the amendments made by this Act, should 
be offset by--
            (1) general revenues available as a result of an on-budget 
        surplus for a fiscal year;
            (2) direct savings in health care expenditures resulting 
        from the implementation of this Act; and
            (3) reductions in unnecessary Federal tax benefits 
        available only to individuals and large corporations that are 
        in the maximum tax brackets.
                                 <all>