110 HR 3000 IH: Josephine Butler United States Health Service
U.S. House of Representatives
2007-07-11
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of
contents
(a)This Act may be cited as the Josephine Butler United States Health Service
Act
.
(b)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 for Health Services.
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.
2.The Congress makes the following
findings:
(1)The health of the
Nation’s people is a foundation of their well-being.
(2)High quality
health care is a right of all people.
(3)Many of the
Nation’s people are unable fully to exercise this right because of the
inability of the present health care delivery system to make high quality
health care available to all individuals regardless of race, sex, age, national
origin, income, marital status, sexual orientation, religion, political belief,
place of residence, 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.
3.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.
4.For the purposes of this Act, unless the
context implies otherwise:
(1)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)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 careThe 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)The term National Health Board means the
National Health Board of the Service.
(5)The
term Service means the United States Health Service established in
section 101.
(6)
(A)The term health care services means the
services described in paragraphs (1) through (5) of section 213(a).
(B)The term supplemental services means the
services described in paragraphs (1), (2), and (3) of section 213(b).
(7)The
term user means an individual who is eligible under section 211 to
receive health care services from the Service under this Act.
<enum>I</enum><header>Establishment and
Operation of the United States Health Service</header>
<section id="H66F708D0EE4E42078CC0CA6402070D4"><enum>101.</enum><header>Establishment of
the Service</header>
<subsection id="HFFC728840E0E48A5931BD12000EA575E"><enum>(a)</enum><header>In
general</header><text>There is established, as an independent establishment of
the executive branch of the United States, the United States Health
Service.</text>
</subsection><subsection id="H3524237444394879862C69A6E69CDEA"><enum>(b)</enum><header>Authority</header>
<paragraph id="H3C6EF963409449619EC9CD6ED78B42B7"><enum>(1)</enum><header>National Health
Board</header><text>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.</text>
</paragraph><paragraph id="H942337482FE7479FAAC163F98F89C763"><enum>(2)</enum><header>Eminent domain
authority</header><text>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.</text>
</paragraph></subsection><subsection id="HBA512A62E45D45B2B0B184A03595A14B"><enum>(c)</enum><header>Administration</header><text>The
Board shall implement administrative measures as necessary to assure the
equitable distribution and allocation of health care resources and
services.</text>
</subsection><subsection id="H12849FF35FBF4370AF00ECC2AF594B25"><enum>(d)</enum><header>Accountability
and control</header><text>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.</text>
</subsection></section><section id="H053792FB5D9749D2AF5B1E3DBB5D41DD"><enum>102.</enum><header>Appointment of
the National Health Board</header><text display-inline="no-display-inline">The
President shall, no later than 30 days after the date of the enactment of this
Act, appoint 21 individuals—</text>
<paragraph id="H7D3C2B40D60C4DA88D8DF023717FEB7"><enum>(1)</enum><text>who are 18 years of
age or older;</text>
</paragraph><paragraph id="HC77C5BC26B034C82B7AEB42B6DF4E6A6"><enum>(2)</enum><text>who are concerned
about the health care problems of the Nation;</text>
</paragraph><paragraph id="H7D71728A61964836ADF02DB438F87599"><enum>(3)</enum><text>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</text>
</paragraph><paragraph id="H4408FFA231614055A2105BEC2474B564"><enum>(4)</enum><text>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.</text>
</paragraph></section><section id="H02B0E93D10D4431BB4C488E25BADE391"><enum>103.</enum><header>Powers and
duties of the National Health Board</header><text display-inline="no-display-inline">The National Health Board shall—</text>
<paragraph id="HD38874D2374B4AF6A329C340A3E881F"><enum>(1)</enum><text>establish the
boundaries of health care delivery regions, in accordance with section
107;</text>
</paragraph><paragraph id="HDB7BA9F7EE8D4C1E800480A1B73A400"><enum>(2)</enum><text>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;</text>
</paragraph><paragraph id="H81012734BE37472685644CE7CABE6B6C"><enum>(3)</enum><text>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</text>
</paragraph><paragraph id="H35DC910266324FD9989760405C1D4BC0"><enum>(4)</enum><text>provide for the
recording of minutes of each of its meetings, and shall make such records
available to the public for inspection and copying.</text>
</paragraph></section><section id="H3A06E8EBD9894BA0BD69EEB6EBD6D912"><enum>104.</enum><header>Representation
in local and regional authorities</header><text display-inline="no-display-inline">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.</text>
</section><section id="H8863D0A30474475583E7DA1C001D18D4"><enum>105.</enum><header>Public
accountability and financial disclosure</header>
<subsection id="H1B6ADB3BF0924EFE9BEE43B81EED633"><enum>(a)</enum><header>Prohibition of
conflicts of interest</header>
<paragraph id="H56096354A7A34B1BA81597FD39294B1C"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph id="H5EDADE1E96F14FB8B4FC9322AC0092D1"><enum>(2)</enum><header>Exception</header><text>Paragraph
(1) shall not apply to employment as a health worker by the Service as
specified in this Act.</text>
</paragraph></subsection><subsection id="HAD75733617C74431BB46C24EA9F34DA"><enum>(b)</enum><header>Disclosure</header><text>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.</text>
</subsection></section><section id="HEE495FB0E6974142A5D619D32014CE12"><enum>106.</enum><header>Inspector
General for Health Services</header><text display-inline="no-display-inline">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.</text>
</section><section id="HD6431022383C4617A834102BAE013F1E"><enum>107.</enum><header>Establishment
of health care delivery regions</header>
<subsection id="H42692AD824564D398B46256045CD2377"><enum>(a)</enum><header>Establishment of
health care delivery regions</header><text>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.</text>
</subsection><subsection id="HF7C3B95743DC4608A0CCFF919D14077B"><enum>(b)</enum><header>Requirements for
delivery regions</header><text>Each health care delivery region shall meet the
following requirements:</text>
<paragraph id="H63176B48D1E04820B5B0DE1B2EEFC245"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph id="H95465C39122D48D09FE4C4CF7900D1"><enum>(2)</enum><text>The
region shall have a population of not less than 500,000 and of not more than
3,000,000 individuals, except that—</text>
<subparagraph id="H1C82C534A30F446D9F078BA584EC42B5"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph id="H6B4326C40CD54B1C8C2DB390E426F312"><enum>(B)</enum><text>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.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">A region
under subparagraph (B) may be a sparsely populated frontier area which consists
of a very large or multi-state geographic area.</continuation-text></paragraph><paragraph id="H592C18AE3F834402B65C5C1F24BD9417"><enum>(3)</enum><text>The boundaries of
each region shall take into account—</text>
<subparagraph id="H06880506666340148598E7F72916F81F"><enum>(A)</enum><text>any economic or
geographic barrier to the receipt of health care and supplemental services in
nonmetropolitan areas, and</text>
</subparagraph><subparagraph id="H030BC555085C4176A21D777908805990"><enum>(B)</enum><text>the differences in
needs between nonmetropolitan and metropolitan areas in the planning,
development, and delivery of health care and supplemental services.</text>
</subparagraph></paragraph></subsection><subsection id="H29D4466B3CEC44EDB4CBF7CF054DCAF1"><enum>(c)</enum><header>Modification of
boundaries</header><text>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.</text>
</subsection><subsection id="H52E63920C949467A984D5E3D64BDA8D7"><enum>(d)</enum><header>Process</header><text>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—</text>
<paragraph id="H9930CB62BAD842D4A35B631206D6A500"><enum>(1)</enum><text>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</text>
</paragraph><paragraph id="HE8F7C0D1EE7C43B7BCD64894ABFFAB71"><enum>(2)</enum><text>a
public hearing at which individuals can speak or present written statements
relating to the establishment of such boundaries.</text>
</paragraph></subsection></section><enum>II</enum><header>Delivery of Health
Care and Supplemental Services</header>
<subtitle id="HCCC7EF9A10C04D259C34EB5FFE2599F9"><enum>A</enum><header>Patients’ Rights
in Health Care Delivery</header>
<section id="H8BB37541AF9D430081F7564E5471232D"><enum>201.</enum><header>Basic health
rights</header><text display-inline="no-display-inline">The Service, in its
delivery of health care services to users, shall ensure that every such
individual is given the following basic health rights:</text>
<paragraph id="HEE4FC07695A545A18431007CF7F256B8"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph id="HB3C427FE0F264808BF38F614B9EE3E7D"><enum>(2)</enum><text>The right to
humane, respectful, dignified, and comforting health care, and to the reduction
of pain and distressful symptoms.</text>
</paragraph><paragraph id="HA2E081128606417ABB3068FD61DA9E00"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph id="HF3CB7E2518A7416AA6877DF80024DDBE"><enum>(4)</enum><text>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.</text>
</paragraph><paragraph id="HFBAFF414E44A41F2B0AC4CBD4B58DDD5"><enum>(5)</enum><text>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.</text>
</paragraph><paragraph id="H930EC6607D76438DAFC2FBC75E520048"><enum>(6)</enum><text>The right to have
all health care information, reports, and educational materials translated into
the individual’s primary language.</text>
</paragraph><paragraph id="HEA2EFE069E8845C7AFF54DB3A5154DAA"><enum>(7)</enum><text>The right to
receive, prior to the delivery of any health care service, a careful, prompt,
and intelligible—</text>
<subparagraph id="HB21A68C98B12425DA6C69C4C42823957"><enum>(A)</enum><text>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);</text>
</subparagraph><subparagraph id="H484A602AE1B74894B029B8C926AB53AE"><enum>(B)</enum><text>answer to any
question relating to such health care service; and</text>
</subparagraph><subparagraph id="HA06577ED3E4140FF9B966E503FDB9AB"><enum>(C)</enum><text>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.</text>
</subparagraph></paragraph><paragraph id="HE4AA2D742B614DE89BDE2644FE688EB"><enum>(8)</enum><text>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.</text>
</paragraph><paragraph id="H2A2B0BD585564FEBA1CBE1500016C1E5"><enum>(9)</enum><text>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.</text>
</paragraph><paragraph id="HD411FAA2E8C04B919B00CC00865B3DBB"><enum>(10)</enum><text>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—</text>
<subparagraph id="HD9C48EDB230B44D7928BDC612C734436"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph id="HC1BDC62915AA4BB8B485AF005EE5DDB"><enum>(B)</enum><text>provide counseling
and assistance to users in filing complaints; and</text>
</subparagraph><subparagraph id="H1CDDA685FEE346D6A75D38AB8C79939B"><enum>(C)</enum><text>investigate
instances of poor quality services or improper treatment of users and bring
such instances to the attention of the applicable authority.</text>
</subparagraph></paragraph><paragraph id="H601E491502EA4692BB656DDE97A4F336"><enum>(11)</enum><text>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.</text>
</paragraph><paragraph id="HF4E0D2007CC14F1D9DF4EF671D2732C8"><enum>(12)</enum><text>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.</text>
</paragraph><paragraph id="H6C522716ABC0410B8B4066165CC0007F"><enum>(13)</enum><text>The right of
access to a complaint and grievance system and to legal assistance to enforce
these rights.</text>
</paragraph></section><section id="H49A1D02F17BD4310ACDC4003753EBD91"><enum>202.</enum><header>Right to paid
leave to receive health care services</header>
<subsection id="H82FB4ABD267F454593D946AB75FFBAA"><enum>(a)</enum><header>Amendment to fair
labor standards Act</header><text>The Fair Labor Standards Act of 1938 is
amended by inserting after section 7 (<external-xref legal-doc="usc" parsable-cite="usc/29/207">29 U.S.C. 207</external-xref>) the following new
section:</text>
<quoted-block id="H682520BE754F47C183455BFA9522B96E" style="traditional">
<section id="HF7065B98BDE44B1C909822D8F22266BA"><enum>7A.</enum><header>Minimum health leave compensation</header><text>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—</text>
<paragraph id="HCD280303787E4D058E89AE2AE61A07F"><enum>(1)</enum><text>during the period
of 52 weeks beginning with the workweek with which the entitlement is earned,
and</text>
</paragraph><paragraph id="HB8B920A662D049069503CDF4EB26CAA0"><enum>(2)</enum><text>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.</text>
</paragraph></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HC0A014563A194722965B60AF3300B5A2"><enum>(b)</enum><header>Conforming
amendments</header><text>The Fair Labor Standards Act of 1938 is further
amended—</text>
<paragraph id="HBB13C7FAB1E04610A2D7A31255E2AFC9"><enum>(1)</enum><text>in section 3(o),
by striking <quote>sections 6 and 7</quote> and inserting <quote>sections 6, 7,
and 7A</quote>;</text>
</paragraph><paragraph id="H3F9BCA06800E4BDE99E219B0211EFD01"><enum>(2)</enum><text>in section
13—</text>
<subparagraph id="H27C5199DD9EF4B4D87D3D8801F9912F8"><enum>(A)</enum><text display-inline="yes-display-inline">in subsection (a) before paragraph (1), by
striking <quote>and 7</quote> and inserting <quote>, 7, and 7A</quote>;</text>
</subparagraph><subparagraph id="H8777C23FB555411C89C6B4C3F1322B7"><enum>(B)</enum><text display-inline="yes-display-inline">in subsection (a)(3), by striking
<quote>sections 6 and 7</quote> and inserting <quote>sections 6, 7, and
7A</quote>; and</text>
</subparagraph><subparagraph id="H901EB263BFA64486B94CA74029A2A8AC"><enum>(C)</enum><text display-inline="yes-display-inline">in subsections (d) and (f), by inserting
<quote>7A,</quote> after <quote>7,</quote> each place it appears;</text>
</subparagraph></paragraph><paragraph id="H747C5C526A98412598A7B39888F2392D"><enum>(3)</enum><text>in section 14(d),
by striking <quote>6 and 7</quote> and inserting <quote>6, 7, and
7A</quote>;</text>
</paragraph><paragraph id="HEEA4F579E03648C893F46BA3AF614F4F"><enum>(4)</enum><text>in section 15(a),
by striking <quote>section 6 or section 7</quote> and inserting <quote>section
6, 7, or 7A</quote>;</text>
</paragraph><paragraph id="H9DD58F3AE78245F3AAA3CFF5611F5B35"><enum>(5)</enum><text>in section
16—</text>
<subparagraph id="H7D729B69F96843D6A0AE00D99BC5E1A6"><enum>(A)</enum><text display-inline="yes-display-inline">in subsection (b), by striking
<quote>section 6 or section 7</quote> and inserting <quote>section 6, 7, or
7A</quote>;</text>
</subparagraph><subparagraph id="HB7991283ABC3447A9B2C6212631E5F51"><enum>(B)</enum><text display-inline="yes-display-inline">in subsection (b), by striking <quote>or
their unpaid overtime compensation</quote> and inserting <quote>their unpaid
overtime compensation, or their unpaid health leave
compensation</quote>;</text>
</subparagraph><subparagraph id="HE373CF86929249658662C718DCA60058"><enum>(C)</enum><text display-inline="yes-display-inline">in subsection (b), by inserting <quote>or
of unpaid health leave compensation</quote> after <quote>amount of unpaid
overtime compensation</quote>;</text>
</subparagraph><subparagraph id="H3B7A5E3FECFA45C684AD7BDA445C1B76"><enum>(D)</enum><text display-inline="yes-display-inline">in the first sentence of subsection (c), by
striking <quote>section 6 or 7</quote> and inserting <quote>section 6, 7, or
7A</quote>;</text>
</subparagraph><subparagraph id="H6C87212DA48A42A9ACCB32259364E652"><enum>(E)</enum><text display-inline="yes-display-inline">in the first sentence of subsection (c), by
striking <quote>unpaid overtime compensation</quote> and inserting <quote>,
unpaid overtime compensation, or unpaid health leave
compensation</quote>;</text>
</subparagraph><subparagraph id="H231665765AC440D995BB623F9458D00"><enum>(F)</enum><text display-inline="yes-display-inline">in the second sentence of subsection (c),
by striking <quote>or overtime compensation</quote> and inserting <quote>,
overtime compensation, or health leave compensation</quote>; and</text>
</subparagraph><subparagraph id="H2E395AEC25CA44CF8F4F2E00C9E38700"><enum>(G)</enum><text display-inline="yes-display-inline">in the third sentence of subsection (c), by
striking <quote>or unpaid overtime compensation under sections 6 and 7</quote>
and inserting <quote>, unpaid overtime compensation, or unpaid health leave
compensation under sections 6, 7, and 7A</quote>; and</text>
</subparagraph></paragraph><paragraph id="H52A5D281E2884F2390B94DABCE1E6EB8"><enum>(6)</enum><text>in section
18(a)—</text>
<subparagraph id="HF28E705153284216826BD948505935E8"><enum>(A)</enum><text display-inline="yes-display-inline">in the first sentence, by inserting
<quote>or minimum health leave compensation higher than the minimum health
leave compensation established under this Act</quote> before <quote>, and no
provision</quote>; and</text>
</subparagraph><subparagraph id="H07D7014F22D14FF89968A903AFC6CBB"><enum>(B)</enum><text display-inline="yes-display-inline">the second sentence, by inserting before
the period at the end the following: <quote>, 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</quote>.</text>
</subparagraph></paragraph></subsection></section></subtitle><subtitle id="H4EFB457E897F406D00D2355097159000"><enum>B</enum><header>Eligibility for,
Nature of, and Scope of Services Provided by the Service</header>
<section id="HCD4D716826B34420B92119DB833FE46E"><enum>211.</enum><header>Eligibility for
Services</header>
<subsection id="H9D3EAFA2F77E49589DB447BD922E325D"><enum>(a)</enum><header>In
general</header><text>All individuals while within the United States are
eligible to receive health care and supplemental services under this
Act.</text>
</subsection><subsection id="H4CB1B0DB784A4F199C2DFDD5CCF2A2F7"><enum>(b)</enum><header>United States
defined</header><text>For purposes of this section, the term <term>United
States</term> includes Indian reservations, the District of Columbia, the
Commonwealth of Puerto Rico, the Virgin Islands, Guam, Samoa, and the Northern
Mariana Islands.</text>
</subsection></section><section id="HD11CB73E8FBC40FAA9FF8800F5BAC75"><enum>212.</enum><header>Entitlement to
services</header>
<subsection id="H90A1AF4570D446F89019D94E8BA249C1"><enum>(a)</enum><header>In
general</header><text>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.</text>
</subsection><subsection id="H6EF0C867EEC54FA5B15274D12E720077"><enum>(b)</enum><header>Exclusion</header><text>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.</text>
</subsection></section><section id="HE19FB41F26DD49B8BA730127E258E87D"><enum>213.</enum><header>Provision of
health care and supplemental services</header>
<subsection id="HD2C1721621474B96A2D52B6EB1BC93BA"><enum>(a)</enum><header>In
general</header><text>The Service shall provide in the United States the
following health care services in or through facilities established by the
Service—</text>
<paragraph id="H0219B677AB894FCA9E07326D123C5967"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph id="H7C12B07E712948448BA226C517A9915D"><enum>(2)</enum><text>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;</text>
</paragraph><paragraph id="H745E7B844E1347A88C8F9898F637001F"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph id="H235B667E339E4414AFAAE0C3698E59E0"><enum>(4)</enum><text>the rehabilitation
of the sick and disabled, including physical, psychological, occupational, and
other specialized therapies; and</text>
</paragraph><paragraph id="HD578F816FF0A48F7B94D3F5D04D634A6"><enum>(5)</enum><text>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.</text>
</paragraph></subsection><subsection id="H93DAE6E29C8440CE80A40600A9344781"><enum>(b)</enum><header>Supplemental
Services</header><text>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—</text>
<paragraph id="H7E85B78CC9D74BFBB58203CF80B27CD"><enum>(1)</enum><text>ambulance and other
transportation services to insure ready and timely access to necessary health
care;</text>
</paragraph><paragraph id="HB63DDD34383444BC96879F27CBC600A7"><enum>(2)</enum><text>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;</text>
</paragraph><paragraph id="H328BCB568F4647BE83F029592EF5D40"><enum>(3)</enum><text>homemaking and home
health services—</text>
<subparagraph id="H5999E96B98D14291B65D1E30AA4049AA"><enum>(A)</enum><text>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</text>
<clause id="HE37AF21769804BC7A170BC93FA68DD00"><enum>(i)</enum><text>of a
child under 15 years of age, or</text>
</clause><clause id="HEA415178E8584D529F2E7CD4A92BD428"><enum>(ii)</enum><text>of
a physically or mentally handicapped individual who requires the care of
another individual, and</text>
</clause></subparagraph><subparagraph id="H521DF56117254C5F9BEFF68005EF044"><enum>(B)</enum><text>for the bedfast or
severely handicapped individual; and</text>
</subparagraph></paragraph><paragraph id="HB1529974392143E485C405BCEB22416"><enum>(4)</enum><text>such counseling and
social service assistance as will avoid the unnecessary provision of health
care services.</text>
</paragraph></subsection><subsection id="H31952DE505C941D4A17313596DCC813C"><enum>(c)</enum><header>Local public
Health Services</header><text>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.</text>
</subsection><subsection id="H2B1D9DB0584E4027887474D66FD9CF21"><enum>(d)</enum><header>Emergency health
care Services</header><text>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.</text>
</subsection></section></subtitle><subtitle id="H23266EE6A9614A47995BAF375471B949"><enum>C</enum><header>Health Care
Facilities and Delivery of Health Care Services</header>
<section id="H2DD4FE3403D446CEA2BA6916A611D5B0"><enum>221.</enum><header>Establishment
of health care facilities and distribution of delivery of health care and other
services</header>
<subsection id="HD35CDB58A13A4D0EA5D0B0D5AFF43203"><enum>(a)</enum><header>Health Service
areas</header><text>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.</text>
</subsection><subsection id="H3FC387725DB04D78B5453487F98FBE0"><enum>(b)</enum><header>Health care
facilities</header>
<paragraph id="H09F8D38FB32846CC9F7D941EC2BCC800"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph id="HBFF79A72AB044343B3E7F6B600C49308"><enum>(2)</enum><header>Comprehensive
primary health care services defined</header><text>As used in paragraph (1),
the term <term>comprehensive primary health care services</term> 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—</text>
<subparagraph id="H76707AD5863B4B8DB2FA35B3B76C26EC"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph id="H35DB788C820B4DC090DB56B717DD759B"><enum>(B)</enum><text>preventive health
services, including at least immunizations, nutrition counseling and
consultation, and periodic screening and assessment services;</text>
</subparagraph><subparagraph id="H9172B1D97C21476A97FA5B6C9697FF"><enum>(C)</enum><text>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;</text>
</subparagraph><subparagraph id="HA4EBEFE6FF5241C085F3D01FAD16DD10"><enum>(D)</enum><text>obstetrical and
gynecological services, including family planning and contraceptive services,
pregnancy (prenatal and postnatal) and abortion counseling and services;</text>
</subparagraph><subparagraph id="HCE2C3265EB104ED5B063BD4FB908E3B8"><enum>(E)</enum><text>comprehensive
geriatric services;</text>
</subparagraph><subparagraph id="H060D942787184F3CB6B88D66B9D8DF1C"><enum>(F)</enum><text>vision and hearing
examinations and provision of eyeglasses and other visual aids and hearing
aids;</text>
</subparagraph><subparagraph id="HA7648555ABB34C988BAC533FD83FB0CB"><enum>(G)</enum><text>24-hour emergency
medical services;</text>
</subparagraph><subparagraph id="H386164F9CE8940519C776B105C1165C5"><enum>(H)</enum><text>provision of
pharmaceuticals and therapeutic devices, and medical appliances and
equipment;</text>
</subparagraph><subparagraph id="H7545279D074A479DA5744B895FDACEED"><enum>(I)</enum><text>mental health
services, including psychological and psychiatric counseling;</text>
</subparagraph><subparagraph id="H7008CA67D48E459EB7C47CD4DCD20088"><enum>(J)</enum><text>home health
services; and</text>
</subparagraph><subparagraph id="H54C91AC367174C26A062FF077E6DD31D"><enum>(K)</enum><text>occupational
safety and health services, including screening, diagnosis, treatment, and
education.</text>
</subparagraph></paragraph><paragraph id="H0225035F4AAD4EC1AD5D5CB7143F00C0"><enum>(3)</enum><header>Specialized
health care services defined</header><text>As used in paragraph (1), the term
<term>specialized health care services</term> 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.</text>
</paragraph><paragraph id="H78AB8A9719EF4ACBA96B445D9C286CA6"><enum>(4)</enum><header>Special services
defined</header><text>As used in paragraph (1), the term <term>special
services</term> 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.</text>
</paragraph><paragraph id="H54FA89C212C34D08B6905D415F219819"><enum>(5)</enum><header>Community-oriented
health measures defined</header><text>As used in paragraph (1), the term
<term>community-oriented health measures</term> 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.</text>
</paragraph></subsection><subsection id="H3B235729C20342E683CE4DD94504A89E"><enum>(c)</enum><header>Allocation of
hospitals</header><text>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—</text>
<paragraph id="HF7C36F2C1A4F49368C86CAE4D69F9CA6"><enum>(1)</enum><text>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</text>
</paragraph><paragraph id="H083B8812E6FC4FACAC1E98C8A630FD1E"><enum>(2)</enum><text>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.</text>
</paragraph><continuation-text continuation-text-level="subsection">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.</continuation-text></subsection><subsection id="HBAD243FBC3AF4809B055BFF167C24490"><enum>(d)</enum><header>Specialized
services</header><text>The Board shall, not later than the effective date of
health services, establish and maintain—</text>
<paragraph id="H8BA492DEA5FC4B11B4DD097DE366E3C"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph id="H9F6F891EF92A4DF0979C87786984DD5D"><enum>(2)</enum><text>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</text>
</paragraph><paragraph id="HD9AD3ACC3D834D8DA26D09D5EF2D4E3B"><enum>(3)</enum><text>such other health
care facilities as are necessary to promote the efficient and effective
delivery of health care services.</text>
</paragraph></subsection><subsection id="HD6D77942765249EBA2A7CA8224C9376"><enum>(e)</enum><header>Health
services</header><text>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:</text>
<paragraph id="H60602628EF514C2194174489A2F5995E"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph id="H4F0B048FFE6C42FF86BCC744E480F234"><enum>(2)</enum><text>Maintenance and
appropriate transmission and transferal of personal health records for each
user of the services consistent with section 201(9).</text>
</paragraph><paragraph id="H6AEDEE7B874340309C3572271EF7A107"><enum>(3)</enum><text>Referral services,
including referrals, where appropriate, to other health care facilities.</text>
</paragraph><paragraph id="H245FD3E59EBC472AA488A736D6C64300"><enum>(4)</enum><text>Supplemental
services (described in section 213(b)), as appropriate.</text>
</paragraph><paragraph id="H7329ED3397014227A607702E20CEA24F"><enum>(5)</enum><text>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.</text>
</paragraph><paragraph id="HD9158DEE78B2464ABB15EF0939C8DDAD"><enum>(6)</enum><text>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.</text>
</paragraph><paragraph id="H859C0D73D5E0407796E305D4D7034E45"><enum>(7)</enum><text>Information on the
grievance mechanisms established pursuant to subtitle A of title IV and on
legal services available to pursue grievances against the Board.</text>
</paragraph><paragraph id="H4E44CBD91577409791CBC928772317D4"><enum>(8)</enum><text>Environmental
health inspection and monitoring services, including investigations relating to
the prevention of communicable diseases, in cooperation with State and local
authorities.</text>
</paragraph><paragraph id="HE394FB4CA7E543B3AAD5C4A9652840A5"><enum>(9)</enum><text>Research and data
gathering on the leading causes of ill health and injury and on health care
delivery, in accordance with section 421.</text>
</paragraph><paragraph id="HB2073CD22841465EAAB7D08A24FAB7"><enum>(10)</enum><text>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.</text>
</paragraph></subsection><subsection id="H30B04412570E45D8952F2B745FD47E41"><enum>(f)</enum><header>Authorities</header>
<paragraph id="H38ADBF425E564A92B4B14016B5F49392"><enum>(1)</enum><header>Effective
delivery</header><text>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.</text>
</paragraph><paragraph id="H8D60031C4D194535008D4664D0E5D2AA"><enum>(2)</enum><header>Coordination</header><text>The
Board shall provide mechanisms to coordinate care across political and
geographic boundaries as necessary.</text>
</paragraph><paragraph id="H199DC045E5DA454CAD8582E8E2BB19FB"><enum>(3)</enum><header>Assuring
availability and accessibility of services</header><text>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—</text>
<subparagraph id="H6A6A1719CD634BEF9311621785A12208"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph id="HD2EC8AE8AC2241969FB62DB83711CEE"><enum>(B)</enum><text>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;</text>
</subparagraph><subparagraph id="HE179B0F84CCD444EA5CF5379943DC692"><enum>(C)</enum><text>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;</text>
</subparagraph><subparagraph id="H4A74207C931844C7AD1BC58F93181D62"><enum>(D)</enum><text>ensure that
appropriate steps are taken to eliminate any transportation or other barriers
to the timely receipt of services;</text>
</subparagraph><subparagraph id="H03C2F809371642119F487D76F6FB8809"><enum>(E)</enum><text>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</text>
</subparagraph><subparagraph id="H07628296CBD544ED99E1400037AEDDF"><enum>(F)</enum><text>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.</text>
</subparagraph></paragraph><paragraph id="H6C46A221DF5F4B2EB5795760E4CBC37D"><enum>(4)</enum><header>Definitions</header><text>For
purposes of this subsection:</text>
<subparagraph id="H9EEE6A6B0BBB4CE682F6F2DA680237"><enum>(A)</enum><header>Health care
coordinator</header><text>The <term>health care coordinator</term> 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.</text>
</subparagraph><subparagraph id="HE01C34F79E994AE196AB6BA961B90033"><enum>(B)</enum><header>Case
management</header><text>The term <term>case management</term> 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.</text>
</subparagraph></paragraph></subsection><subsection id="H9047E6408EE54F15AA067FF2BD02F139"><enum>(g)</enum><header>Guidelines</header><text>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.</text>
</subsection><subsection id="H8A4B7407CD204BFBAF847B4201608B39"><enum>(h)</enum><header>Use of
evidence-based clinical decision criteria</header>
<paragraph id="HD58245233C5845F986C8A736A9C66277"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph id="H664DEB4D589043D800A3EF680070AB18"><enum>(2)</enum><header>Clinical
decision criteria defined</header><text>For purposes of this section, the term
<term>clinical decision criteria</term> 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.</text>
</paragraph></subsection><subsection id="H1D785CF9889043C284685D75AE327808"><enum>(i)</enum><header>Notice of
determinations</header><text>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.</text>
</subsection><subsection id="H9706EEC631B04AF7003DD49125D8F071"><enum>(j)</enum><header>Accountability</header><text>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—</text>
<paragraph id="HFDFFB6800E5D48EFAF5CDEA43479485E"><enum>(1)</enum><text>requiring the
provision of services; and</text>
</paragraph><paragraph id="HE33BD6CC7F2D48C18920B3E76261B9C0"><enum>(2)</enum><text>providing
reimbursement for the provision of specified health care services in accordance
with procedures and schedules in effect under title XVIII of the
<act-name parsable-cite="SSA">Social Security Act</act-name> immediately before
the effective date of health services.</text>
</paragraph></subsection></section><section id="H26E399F3BA824E59A9C99F1F74C200ED"><enum>222.</enum><header>Operation and
inspection of health care facilities</header>
<subsection id="HC43A9BAF1E2F46359171C94DECD21765"><enum>(a)</enum><header>Establishment of
policies</header>
<paragraph id="HA2B0B5DD18EF4C508B7CACFC7FAC675F"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph id="H9F711D3768174362A16F01B67DD4633C"><enum>(2)</enum><header>Health worker
and user control</header><text>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.</text>
</paragraph></subsection><subsection id="HC768F2A3B18041EBACCB53C6E224CC7D"><enum>(b)</enum><header>Employment
restrictions</header>
<paragraph id="H72BB905BDE86452EAC334DAF4D559B6D"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph id="H07A7BB4A6ABB46BAAF90F51158B4F9BC"><enum>(2)</enum><header>Private delivery
of health care services defined</header><text>For the purposes of this
subsection, the term <term>private delivery of health care services</term>
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.</text>
</paragraph></subsection><subsection id="H988C84A1BBE04B00B597473F78C001DF"><enum>(c)</enum><header>Operations of
health care facilities</header>
<paragraph id="H6586BD1E94424F7F86FC9572E9E420C1"><enum>(1)</enum><header>Hours of
operation</header><text>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.</text>
</paragraph><paragraph id="HEE69655AF72B46AFA453B807E561EB18"><enum>(2)</enum><header>Effective
delivery</header><text>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.</text>
</paragraph></subsection></section><section id="HA000CCB2D63146338000F1B5CE2FF70"><enum>223.</enum><header>Provision of
health services relating to reproduction and childbearing</header>
<subsection id="H4F0FB85E82C241DDB3507EDC40D7C157"><enum>(a)</enum><header>Provision of
services</header>
<paragraph id="HA0A4B2D67CDC449BA2C2E7699989BB57"><enum>(1)</enum><header>In
general</header><text>The following services shall be provided:</text>
<subparagraph id="HED4D14B53AF1479FBD168FB6D9D0CB40"><enum>(A)</enum><header>Family
planning</header>
<clause id="H2B2B1FF5B9AD402482F2628EA4034BEC"><enum>(i)</enum><text>Complete
information on contraception and provision of birth control materials or
medication of the individual’s choosing.</text>
</clause><clause id="H1C91E8B0E3DA4F898CDF31BEF8887089"><enum>(ii)</enum><text>Complete and
effective evaluation and treatment of sexually transmitted diseases and
diseases of the reproductive organs.</text>
</clause><clause id="HE1540CA60D8C4A50B2887089491E5191"><enum>(iii)</enum><text>Complete
information and counseling with respect to pregnancy, childbearing, and
possible outcomes involving genetically induced anomalies.</text>
</clause></subparagraph><subparagraph id="HB8CB03B924AA4B8C8BDACBEB8435D743"><enum>(B)</enum><header>Pregnancy</header>
<clause id="H0B0B9604680140E1983D1300D39D4104"><enum>(i)</enum><text>Complete and
effective pregnancy testing.</text>
</clause><clause id="H14D9765A952B461BA47E6CE2AB5F7BAB"><enum>(ii)</enum><text>Prenatal
services, including physical examination, counseling, and instruction of
expectant parents in nutrition, childrearing, and children’s health care
services.</text>
</clause><clause id="HF62FB460DFA94ED9B200E7C1E95099C5"><enum>(iii)</enum><text>Safe,
comfortable, and convenient abortion services.</text>
</clause><clause id="H204B2D6D72DC40E6893C391C12979352"><enum>(iv)</enum><text>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.</text>
</clause></subparagraph></paragraph><paragraph id="HDE95353F3F1E4D859F339390E8CB4BA"><enum>(2)</enum><header>Voluntary</header><text>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.</text>
</paragraph><paragraph id="HD2E6676EC4CD41EDB5907615AC7EFBEF"><enum>(3)</enum><header>Accompaniment</header><text>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.</text>
</paragraph></subsection><subsection id="H10F4401E492E4235A4142CFC509181EF"><enum>(b)</enum><header>Voluntary
consent</header><text>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—</text>
<paragraph id="H501AD4F749E745BDAA436B499358CA57"><enum>(1)</enum><text>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</text>
</paragraph><paragraph id="H4EA7ACC799FF47AC8657B621B5BDA33"><enum>(2)</enum><text>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)—</text>
<subparagraph id="HE0A13A2C633A4F40B279E93822EA9069"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph id="H6890EE3C0BDA4CAFBE67BFE22E583CDA"><enum>(B)</enum><text>if she undergoes
emergency abdominal surgery within the 30-day waiting period and the
sterilization is concurrent with the abdominal surgery; or</text>
</subparagraph><subparagraph id="H4096CDF9168F4B66BF25960100CE8BA9"><enum>(C)</enum><text>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.</text>
</subparagraph></paragraph></subsection><subsection id="HFCE2B5F6A4C04431887300476E11D4A4"><enum>(c)</enum><header>Breast cancer
treatment</header><text>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.</text>
</subsection><subsection id="H59EADF86AECE4690A83D11C742710890"><enum>(d)</enum><header>Birthing
options</header><text>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—</text>
<paragraph id="HDF51AF7F660548308B006C70403FF5CE"><enum>(1)</enum><text>giving birth at
home, in a birth center (if available), or in a hospital;</text>
</paragraph><paragraph id="H31498A8512FF467FA7E7D83B0698278C"><enum>(2)</enum><text>the presence
during childbirth of a person or persons of her choosing;</text>
</paragraph><paragraph id="H482D908ED6A24956823B61DC5008099"><enum>(3)</enum><text>the position for
labor and delivery which she chooses;</text>
</paragraph><paragraph id="HB9ACAFA289174F62877634361328EC92"><enum>(4)</enum><text>caring for her
infant at her bedside;</text>
</paragraph><paragraph id="HE8CFD94E8F98407CB3E76B46B656A347"><enum>(5)</enum><text>feeding her infant
according to the method and schedule of her choice; and</text>
</paragraph><paragraph id="HE3CD6B08E58642F7AF25B69C8A8E0B8"><enum>(6)</enum><text>selecting the birth
attendant of her own choice.</text>
</paragraph><continuation-text continuation-text-level="subsection">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.</continuation-text></subsection></section></subtitle><enum>III</enum><header>Health Labor
Force</header>
<subtitle id="H4658DE7431E540BDAFA29D1FD600A5A"><enum>A</enum><header>Job
Categories and Certification</header>
<section id="H77FDCBFF6192480CA23BB78131FAD377"><enum>301.</enum><header>Effect of State
law</header><text display-inline="no-display-inline">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.</text>
</section><section id="H457CF59C8C3D452395E81D2855096D94"><enum>302.</enum><header>Qualifications
of health workers</header>
<subsection id="H3DC7A6F77BB64151B6969C6DBA9F2000"><enum>(a)</enum><header>Certification of
competence</header><text>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—</text>
<paragraph id="H86856B90ED4A4B6AAB3438B3D4DA205"><enum>(1)</enum><text>certified (in
accordance with this subtitle) as competent to perform the work under such job
category, and</text>
</paragraph><paragraph id="HF435B9AA21B14740AE41CC555189ADC2"><enum>(2)</enum><text>authorized to
perform such work by the employer of such worker.</text>
</paragraph></subsection><subsection id="H5E98056A5A2B419FA0A124F12E6CC744"><enum>(b)</enum><header>Periodic
assessments</header><text>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.</text>
</subsection></section><section id="HDAD3889CD9E843A400D23B66CB033B1F"><enum>303.</enum><header>Establishment
of job categories and certification standards</header>
<subsection id="HA406227F294C45FA823663BA17CDCE56"><enum>(a)</enum><header>In
general</header>
<paragraph id="HBB35D5F62F134270006EBBC1875E41CB"><enum>(1)</enum><header>Classification</header><text>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—</text>
<subparagraph id="H250C504C49D747EEA3420763B989293F"><enum>(A)</enum><text>to ensure that
health workers who perform work for the Service which requires specialized
skills have demonstrated that they possess such skills,</text>
</subparagraph><subparagraph id="HDC565785096E401CBC2646C5BAA7799B"><enum>(B)</enum><text>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</text>
</subparagraph><subparagraph id="HAA78E3CCA54E46DA806805FC4063F336"><enum>(C)</enum><text>to provide for
affiliation of health workers with health care facilities at the community,
district, and regional levels.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">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.</continuation-text></paragraph><paragraph id="H225E5170158945E8AC9F540933A380C"><enum>(2)</enum><header>Considerations</header><text>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.</text>
</paragraph></subsection><subsection id="H0D36F75380FF43EE000731ED032F7B44"><enum>(b)</enum><header>Certification
standards</header>
<paragraph id="H831A238CA4F341D7957B5163DEA0446C"><enum>(1)</enum><header>Establishment</header><text>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—</text>
<subparagraph id="H373A3C073EB34E2B842BC63755F84073"><enum>(A)</enum><text>the functions
performed by a health worker employed in such job category;</text>
</subparagraph><subparagraph id="H7EFE0C6A79A04EF692000900F3AF4D9F"><enum>(B)</enum><text>the skills
required in the course of properly performing work under such job
category;</text>
</subparagraph><subparagraph id="HD5B12671D3A14682ACF25E55C9FE9D71"><enum>(C)</enum><text>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</text>
</subparagraph><subparagraph id="H9F2E8FB715E343DF93FEAEFF00D987FC"><enum>(D)</enum><text>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.</text>
</subparagraph></paragraph><paragraph id="H4809E30E335E4F03A525A446AB29194"><enum>(2)</enum><header>Specifications</header><text>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).</text>
</paragraph><paragraph id="H4A6FFE92E81940D6BF00747C3E4F648D"><enum>(3)</enum><header>Periodic
review</header><text>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.</text>
</paragraph><paragraph id="H16AD063A1F7243EAA8D5E69200C978FE"><enum>(4)</enum><header>Quality
protection</header>
<subparagraph id="H49D8E3441FF64CB59B97D87B26C6003D"><enum>(A)</enum><header>Prohibition of
downgrades of levels</header><text>No individual health facility administrator
is authorized to downgrade the level of skill, license or certification
required to perform duties delineated by the Board.</text>
</subparagraph><subparagraph id="H3D727F989A0644B8A3B9896058B28F04"><enum>(B)</enum><header>Review</header>
<clause id="H5AD186FAEFD348E69D8034F06CA72CFD"><enum>(i)</enum><header>Review of
staffing changes</header><text>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.</text>
</clause><clause id="HA402E1D74C004E048CCB232B6D234758"><enum>(ii)</enum><header>Whistleblower
protection</header><text>Health care workers who report compromises in the
quality of care shall not be subjected to recriminations.</text>
</clause></subparagraph><subparagraph id="HA7B2D97A96DC461A86378567EF5503E2"><enum>(C)</enum><header>Workforce
staffing levels</header><text>The Board may establish health workforce staffing
levels as it determines will promote the delivery of quality health care
services.</text>
</subparagraph></paragraph></subsection></section></subtitle><subtitle id="HFBB4557002124B0697070148DC7FBD45"><enum>B</enum><header>Education of
Health Workers</header>
<section id="H297C27BE15A84198A5CD07E2E4864F5D"><enum>311.</enum><header>Health team
schools</header>
<subsection id="H297DECAF5D464FC887985287C813ACC"><enum>(a)</enum><header>Establishment</header>
<paragraph id="H292E15775BE04FE681C73076C4C86B49"><enum>(1)</enum><header>In
general</header><text>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 <quote>school</quote>) 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.</text>
</paragraph><paragraph id="H6EB1E62625B1414484C33F948468DBC7"><enum>(2)</enum><header>Use of
funds</header><text>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.</text>
</paragraph></subsection><subsection id="H4BD13E2BB31B4C4CA6625235B133638B"><enum>(b)</enum><header>Operational
principles</header><text>Schools shall be operated and maintained in accordance
with the following principles:</text>
<paragraph id="H9E6A39428475414AABEE7DE5A61B03B5"><enum>(1)</enum><text>The activities of
each school shall be designed to meet the health needs of the
population.</text>
</paragraph><paragraph id="H1923E062967443DCB5251300B8111911"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph id="H1AF64099004845F084D56FD049DFFE57"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph id="HA3A5E785B54A4EEAA8D0FE703DA306DB"><enum>(4)</enum><text>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.</text>
</paragraph><paragraph id="H59FA071DA4B0470FBC8D00C8505F0072"><enum>(5)</enum><text>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.</text>
</paragraph><continuation-text continuation-text-level="subsection">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.</continuation-text></subsection><subsection id="HA8CA0ABC737842FE81B162C7D2C4753C"><enum>(c)</enum><header>Admissions
policies</header><text>Admissions policies for education programs in schools
shall—</text>
<paragraph id="HF468FE24E55F495DAD611D5D817C4600"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph id="H673C1A9A079B4F6ABC5B3C40DA22D69E"><enum>(2)</enum><text>minimize the use
of criteria of academic performance other than such criteria as have been shown
to be significantly related to future work performance;</text>
</paragraph><paragraph id="H93322F69B7D9447900545E54D00C27E"><enum>(3)</enum><text>give preference to
segments of the population of the region underrepresented among health
workers;</text>
</paragraph><paragraph id="H9ECD5B6709AF4AC2BADFA89607F7ECCD"><enum>(4)</enum><text>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</text>
</paragraph><paragraph id="HDAFDEE3774554582B398169D60A1D775"><enum>(5)</enum><text>require that the
applicant agree, if accepted into the school, to perform health care services
in accordance with section 312.</text>
</paragraph></subsection><subsection id="HF778A70C3B4F4D358812C6506BDBF2D0"><enum>(d)</enum><header>Curriculum
policies</header><text>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—</text>
<paragraph id="HAFBD94E2875A4E9EA3722E9343D4264"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph id="HDF93A6B3EA4445AFA39165657233A603"><enum>(2)</enum><text>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;</text>
</paragraph><paragraph id="H954D752B4D994454BFB77ED11ED65212"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph id="HD8A19A1FAC714CACB63CB8FE92006657"><enum>(4)</enum><text>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;</text>
</paragraph><paragraph id="H43FCDCB4138E4589B03BC954D3DE14F2"><enum>(5)</enum><text>emphasize the
appropriate and safe use, and discourage the overuse, of drugs and medical
techniques; and</text>
</paragraph><paragraph id="H94DCD454CEB542FEA6028B99EEE02030"><enum>(6)</enum><text>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.</text>
</paragraph></subsection><subsection id="HD834F9384EE44EDA96B7DDCFB976921"><enum>(e)</enum><header>Faculty hiring
procedures</header><text>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.</text>
</subsection><subsection id="HD60062EC1BD24216B1F32C42C00856E"><enum>(f)</enum><header>Governance
plans</header><text>Governance plans for the management of a school shall give
significant decisionmaking powers to staff and students of the school.</text>
</subsection></section><section id="HB7F71862A5EF4882A71C4923BE7C33A2"><enum>312.</enum><header>Service
requirement</header>
<subsection id="HB52CF4B019634609BCB004FC93C71284"><enum>(a)</enum><header>Service
requirement</header>
<paragraph id="H5F3BF999AB3D4542BB447183C678BA39"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph id="H7FCB4CA83E8A4E398B89A24CA818C407"><enum>(A)</enum><text>for a period of
time equal to the period of such enrollment in the school but not less than 2
years;</text>
</subparagraph><subparagraph id="HD1F3624E359541A4862D53517E93D3A1"><enum>(B)</enum><text>beginning not
later than 1 year after the date of the individual’s graduation from the
school; and</text>
</subparagraph><subparagraph id="H59E29082E3D04F708CC639DFB5B45B57"><enum>(C)</enum><text>for an area with
the highest priority ranking under subsection (c) that agrees to employ the
individual.</text>
</subparagraph></paragraph><paragraph id="H26E313D8E84247FE8166947E8DB87412"><enum>(2)</enum><header>Deferral</header><text>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.</text>
</paragraph><paragraph id="HEE0D80FEB92E401FA18901D73EAC19F5"><enum>(3)</enum><header>Completion of
service required</header><text>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.</text>
</paragraph><paragraph id="HE306620331264A28B9332DC913B34C4E"><enum>(4)</enum><header>Penalty for
breach of agreement</header><text>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—</text>
<subparagraph id="H396474649D0040E5871D76C4000047C5"><enum>(A)</enum><text><quote>A</quote>
is the amount the Service is entitled to recover;</text>
</subparagraph><subparagraph id="H02436A752F3043E6A2BECC98614D0015"><enum>(B)</enum><text><quote>C</quote>
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;</text>
</subparagraph><subparagraph id="H94BF6A4199C349DEA4BA994CCD32D75"><enum>(C)</enum><text><quote>t</quote> is
the total number of months in the individual’s period of obligated service;
and</text>
</subparagraph><subparagraph id="H1153BDB3758C4175A2AF5CECEDBE77D"><enum>(D)</enum><text><quote>s</quote> 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.</text>
</subparagraph></paragraph><paragraph id="HCBD67C3EDD104262B717BE32A900E780"><enum>(5)</enum><header>Cancellation</header>
<subparagraph id="H58893D1786ED414AA404DB6FAE76444F"><enum>(A)</enum><header>Upon
death</header><text>Any obligation of an individual under this subsection for
service or payment of damages shall be canceled upon the death of the
individual.</text>
</subparagraph><subparagraph id="HA8AA0A232A394E408DE444008DFA907E"><enum>(B)</enum><header>Extreme hardship
exception</header><text>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.</text>
</subparagraph><subparagraph id="HECE668C8B26042DA8E15E865C637672"><enum>(C)</enum><header>Limitation on
discharge in bankruptcy</header><text>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.</text>
</subparagraph></paragraph></subsection><subsection id="H668F351B6B50493F007FCE771736CF1F"><enum>(b)</enum><header>Periodic
reassessment of worker ratios</header><text>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.</text>
</subsection><subsection id="H2363D89F70CD4A1F8DE8E1BE7090CAA9"><enum>(c)</enum><header>Worker
matches</header><text>The National Health Board shall establish a program to
match the locational preferences of graduates of schools with the needs and
preferences of regions.</text>
</subsection></section><section id="HE430220AF2194749B101796986C83559"><enum>313.</enum><header>Payment for
certain educational loans</header>
<subsection id="H216DCDE71FB3478BA97C68CB002BC1FA"><enum>(a)</enum><header>Loan payment
program</header><text>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.</text>
</subsection><subsection id="HDCB1A8F4B9DE44D19EA5CD21435456D5"><enum>(b)</enum><header>Making of
payment</header><text>The payments described in subsection (a) shall be made by
the National Health Board as follows:</text>
<paragraph id="HDF1B8B903F264B738D392667D17CBC31"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph id="H6A237FBFEAB3403AB65EE86C7BD6CD4E"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph id="HD97416B279DF44CE813031968369541E"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph id="H82C443B09DB341E4BBF4279C8F242E2B"><enum>(4)</enum><text>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.</text>
</paragraph><continuation-text continuation-text-level="subsection">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.</continuation-text></subsection><subsection id="HA634EAAFD0F74519B0F130E7F71FF970"><enum>(c)</enum><header>Payment during
employment</header><text>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.</text>
</subsection></section></subtitle><subtitle id="H25BE29FFD129408496CDDE92ADB35C9D"><enum>C</enum><header>Employment and
Labor-Management Relations within the Service</header>
<section id="H77267FCADA24449FB136001FC9B0E237"><enum>321.</enum><header>Employment,
transfer, promotion, and receipt of fees</header>
<subsection id="HB764E44DEC654DBB808233573629A9A7"><enum>(a)</enum><header>Service
employees</header><text>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.</text>
</subsection><subsection id="H5C2514C810F746C081B8C9CDA39B6EC1"><enum>(b)</enum><header>Policies</header><text>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—</text>
<paragraph id="H14EACE98CEAF48BD9251DC955592FC79"><enum>(1)</enum><text>employment and
promotion in the Service in the same manner as is provided for employment and
promotion under the Federal civil service system;</text>
</paragraph><paragraph id="H355D52BF739A416796ACD6BD77C1C2B9"><enum>(2)</enum><text>meaningful
opportunities for career advancement;</text>
</paragraph><paragraph id="H2E59F56513D14EEE85B05EF151797AF"><enum>(3)</enum><text>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</text>
</paragraph><paragraph id="HBD2807DDFB6A4A81AE009F26A9333FE"><enum>(4)</enum><text>full protection of
employees’ rights by providing an opportunity for a fair hearing on adverse
actions with representation of their own choosing.</text>
</paragraph></subsection><subsection id="HD62915E0DD944D8CAA6294A4D0A74680"><enum>(c)</enum><header>Hiring
preferences</header><text>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.</text>
</subsection><subsection id="H69D92AE830DF4845A97C74FAAECA3330"><enum>(d)</enum><header>Promotion and
transfer</header><text>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.</text>
</subsection><subsection id="H8C46DCA7CB444789B6D2CAC2D1C42974"><enum>(e)</enum><header>No undue
financial incentives</header><text>No health worker should benefit financially
from the provision or denial of services to individual patients, beyond their
regular remuneration.</text>
</subsection><subsection id="H966F504523CE455EBE962E5909A687BE"><enum>(f)</enum><header>Sole
employer</header><text>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.</text>
</subsection><subsection id="H8370DF8123A4451CB6FC205622D777CC"><enum>(g)</enum><header>Grandfather
clause</header><text>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.</text>
</subsection><subsection id="H19D92E84570F4C4BA4BEB4E27900804B"><enum>(h)</enum><header>Transitional
employment</header><text>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.</text>
</subsection></section><section id="H8A83AB80323842ACA4C565EECBE0238"><enum>322.</enum><header>Applicability of
laws relating to Federal employees</header>
<subsection id="HBF136611A47C4A49806EE5298864F115"><enum>(a)</enum><header>In
general</header><text><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/75">Chapter 75</external-xref> 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—</text>
<paragraph id="HD22F73192585479B8ED68F149FF1E315"><enum>(1)</enum><text>in a collective
bargaining agreement negotiated on behalf of and applicable to them; or</text>
</paragraph><paragraph id="H24B99377F71248EEA900D1FCD99D8543"><enum>(2)</enum><text>in procedures
established by the Service and approved by the Office of Personnel
Management.</text>
</paragraph></subsection><subsection id="H90B674BD96314B9999FF75343DDB5FFD"><enum>(b)</enum><header>Coverage under
workers compensation</header><text>Employees of the Service are covered by
subchapter I of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/81">chapter 81</external-xref> of title 5, United States Code (relating to
compensation for work injuries).</text>
</subsection><subsection id="HD35CD9213B0440859EE246C4D1111CB0"><enum>(c)</enum><header>Civil
Service</header>
<paragraph id="H0BD75563249D4B19A5752D3B863D7957"><enum>(1)</enum><header>Application of
civil Service retirement</header><text><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/83">Chapter 83</external-xref> 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.</text>
</paragraph><paragraph id="H7F8772555E5448698596DAD102AB3510"><enum>(2)</enum><header>Withholding</header><text>The
Service shall withhold from pay and shall pay into the Civil Service Retirement
and Disability Fund the amounts specified in <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/83">chapter 83</external-xref> 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.</text>
</paragraph></subsection><subsection id="H90070DAFABCC44E29B39444D3B3476F8"><enum>(d)</enum><header>Accrual of sick
and annual leave</header><text>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.</text>
</subsection><subsection id="H8A49472B01C34164B2EECFA7BF1FD8"><enum>(e)</enum><header>Application of
conditions</header>
<paragraph id="H41CE5FF6F24C4D8285FF403700F440DE"><enum>(1)</enum><header>Terms of
employment</header><text>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
<external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/87">chapter 87</external-xref> 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).</text>
</paragraph><paragraph id="H635A6C7529814BBD9BA75C1841C934CB"><enum>(2)</enum><header>Limitation on
variation</header><text>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.</text>
</paragraph></subsection></section><section id="HE64BB01992A540DAB728D1DE0225F229"><enum>323.</enum><header>Applicability
of Federal labor-management relations laws</header>
<subsection id="H4C67C12634DE43169B088EEE32D51174"><enum>(a)</enum><header>Application of
NLRA</header>
<paragraph id="H4CA3FC9C446746DDBD57ED2441CACEA2"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph id="HEAE72DDDD8E447C1BEE00A5E8234686"><enum>(A)</enum><text>the phrase
<quote>or any individual employed as a supervisor</quote> in section 2(3) of
such Act shall not apply (thereby making such Act apply, for these purposes, to
such individuals);</text>
</subparagraph><subparagraph id="HE39906CB687C41C4B08D6C941D546105"><enum>(B)</enum><text>section 9(b)(1) of
such Act (providing for separate treatment for professional and nonprofessional
employees) shall not apply;</text>
</subparagraph><subparagraph id="HCFA8B2A07AA746B9ABFB1482853BB9E3"><enum>(C)</enum><text>sections 206
through 210 of such Act (relating to national emergencies) shall, for purposes
of this Act, have the phrases <quote>the President of the United States</quote>
and <quote>the President</quote>, wherever they appear, replaced by the phrase
<quote>the National Health Board (or a committee thereof to which it has
delegated such authority)</quote> and the phrase <quote>national health or
safety</quote> replaced by the phrase <quote>health or safety of the residents
of any region</quote>; and</text>
</subparagraph><subparagraph id="HEB42D116CE15460AAC08917557523C90"><enum>(D)</enum><text>section 213
(providing for intervention in a strike or lockout by the Director of the
Federal Mediation and Conciliation Service) shall not apply.</text>
</subparagraph></paragraph><paragraph id="H792965941FB84FFD92B48682E312D745"><enum>(2)</enum><header>Strikes
permitted</header><text>Paragraphs (3) and (4) of <external-xref legal-doc="usc" parsable-cite="usc/5/7311">section 7311</external-xref> 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.</text>
</paragraph></subsection><subsection id="H2E46DA86A94C470FB7C078A877C36CF8"><enum>(b)</enum><header>Neutrality in
union matters</header><text>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.</text>
</subsection><subsection id="H96047D4496A04F6BBC731748E0BF65BE"><enum>(c)</enum><header>Collective
bargaining</header>
<paragraph id="H6E640446E1B24586A651F2598DD933E"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph id="HFFF9D82F12DA4C2D0033E7608D386B64"><enum>(2)</enum><header>Alternative
procedures</header><text>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—</text>
<subparagraph id="H94FB37C6B81840DCB28772FFE5DFD271"><enum>(A)</enum><text>of grievances and
adverse actions arising under collective bargaining agreements, and</text>
</subparagraph><subparagraph id="H09A2428F29F5435C8D0022F8547144B4"><enum>(B)</enum><text>of disputes or
impasses arising in the negotiation of such agreements.</text>
</subparagraph></paragraph></subsection><subsection id="H732245C1610F46648EBA93CB2189723D"><enum>(d)</enum><header>Conforming
amendment</header><text>Section 3(e) of the Labor-Management Reporting and
Disclosure Act of 1959 (<external-xref legal-doc="usc" parsable-cite="usc/42/402">42 U.S.C. 402(e)</external-xref>) is amended by inserting <quote>the
United States Health Service and</quote> after <quote>and
includes</quote>.</text>
</subsection></section><section id="H71F091EE17204DBC951EB5A5ADFD2615"><enum>324.</enum><header>Defense of
certain malpractice and negligence suits</header>
<subsection id="HA4DAE0ADFC7543CA9111EA48B6CBB28"><enum>(a)</enum><header>Exclusive
remedy</header><text>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.</text>
</subsection><subsection id="H6E6DDCEDA1C8412798E9D8EBAEE5BA"><enum>(b)</enum><header>Defense</header><text>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.</text>
</subsection><subsection id="HD47D1A93EE224305BE77FFF295F93748"><enum>(c)</enum><header>Procedure</header>
<paragraph id="H1ED76524152645F600A5DFF9389C3EF8"><enum>(1)</enum><header>Removal from
State courts</header><text>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.</text>
</paragraph><paragraph id="H7E850B71F2E340AFBC0000DB06EB3EC5"><enum>(2)</enum><header>Motions to
remand</header><text>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.</text>
</paragraph><paragraph id="HACC287FA2A4E442C9EDB7D7B6234CBC1"><enum>(3)</enum><header>Effect of
alternative remedies</header><text>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.</text>
</paragraph></subsection><subsection id="H7DB82AEBC0824A7B91FD3FDBA2736D8"><enum>(d)</enum><header>Settlement</header><text>The
Attorney General may compromise or settle any claim asserted in such civil
action or proceeding in the manner provided in <external-xref legal-doc="usc" parsable-cite="usc/28/2677">section 2677</external-xref> of title 28, United
States Code, and with the same effect.</text>
</subsection><subsection id="HC28EF6FC38ED46B082F67C762045E6D4"><enum>(e)</enum><header>Limitation</header><text>For
purposes of this section, the provisions of <external-xref legal-doc="usc" parsable-cite="usc/28/2680">section 2680(h)</external-xref> 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.</text>
</subsection><subsection id="H77D2B8F7DEC74ACCA888B1FB9D0381C"><enum>(f)</enum><header>Liability
insurance</header><text>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 <external-xref legal-doc="usc" parsable-cite="usc/28/2679">section 2679(b)</external-xref> of title 28, United States Code, for such
damage or injury.</text>
</subsection></section></subtitle><enum>IV</enum><header>Other Functions
of Health Boards</header>
<subtitle id="H5BC027A83481472B96F48901D730FBE9"><enum>A</enum><header>Advocacy,
Grievance Procedures, and Trusteeships</header>
<section id="HCD01A2B82C914CA8A12785AB24256526"><enum>401.</enum><header>Advocacy and
legal services program</header>
<subsection id="HC720EF5C4A6147A8B447B1A2C6E192C1"><enum>(a)</enum><header>Establishment of
program</header><text>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—</text>
<paragraph id="H0914F763E9B24B4080F3F7B43229471"><enum>(1)</enum><text>the employment of
individuals having basic legal knowledge and skills as health advocates;</text>
</paragraph><paragraph id="H04BBE95707714B9CA99590A993E0FDF"><enum>(2)</enum><text>the presence of
health advocates—</text>
<subparagraph id="HF9F9520BB6B6412BAFD73942FC579B48"><enum>(A)</enum><text>in inpatient
health care facilities at all times; and</text>
</subparagraph><subparagraph id="HB88961776B6540E89D8061AA383BFAE4"><enum>(B)</enum><text>in other health
care facilities during the provision of health care services;</text>
</subparagraph></paragraph><paragraph id="H6299B84A25E743BB948FAE6956A4A3F9"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph id="H1DCCFB86860440AC8C35FA382790173B"><enum>(4)</enum><text>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</text>
</paragraph><paragraph id="H5D2DC20A764D4FA8841C77823581B726"><enum>(5)</enum><text>appropriate action
by the National Health Board to ensure that infractions of such rights are
promptly and sufficiently corrected.</text>
</paragraph></subsection><subsection id="HB3923BF8B3444425A2C4191E745E3274"><enum>(b)</enum><header>Health rights
legal services</header>
<paragraph id="HD0E8E2186F6E40668D00E893B92B5343"><enum>(1)</enum><header>Establishment of
program</header><text>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.</text>
</paragraph><paragraph id="H3DC05A8CC00B4DBB8E46BC3448BEC5D"><enum>(2)</enum><header>Services</header><text>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—</text>
<subparagraph id="H39E4FB1F1B8C4B268CFF0793CEB2D00"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph id="H91D01FCF780E40CE9CFD790FF9BA2F0"><enum>(B)</enum><text>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).</text>
</subparagraph></paragraph><paragraph id="HC7E11E2C6DBE419CB420E03353FA3D88"><enum>(3)</enum><header>Use of
contracts</header><text>The National Health Board may carry out the functions
described in paragraph (1)(B) directly, by contract, or otherwise.</text>
</paragraph></subsection></section><section id="HAF48868C92924785BC02A908D1ED4E22"><enum>402.</enum><header>Grievance
procedures</header>
<subsection id="H6AC2D55740604FCF8FE2CDC2006C641B"><enum>(a)</enum><header>Grievance
proceedings</header>
<paragraph id="H6CC46E56D2CE4B1EB48475CB485B14ED"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph id="HD16A17A3F76E4CEA84CA638FB3B3611C"><enum>(2)</enum><header>Grievances
against National Health Board</header><text>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.</text>
</paragraph></subsection><subsection id="HC51BA033292E4D1DAF1D33AF666FC882"><enum>(b)</enum><header>Review</header>
<paragraph id="H211616E1D2564AB591F37429C66CCB38"><enum>(1)</enum><header>By National
Health Board</header><text>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.</text>
</paragraph><paragraph id="HA611E59B74A640CFBCF55DB4E32971B9"><enum>(2)</enum><header>Limitation once
suit commenced</header><text>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.</text>
</paragraph><paragraph id="H84CD9DD01AA4474FB1D3ACDEC6F37778"><enum>(3)</enum><header>Time
limit</header><text>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.</text>
</paragraph></subsection><subsection id="H3AFCA5129DF1457BA2FBF5A6D46DB69F"><enum>(c)</enum><header>Investigation</header><text>Whenever
a grievance proceeding is commenced under subsection (a), the entity before
which the proceeding is held shall investigate the grievance.</text>
</subsection><subsection id="H651B84B2BBFC411E8D9FBF58B3A3C500"><enum>(d)</enum><header>Right To
sue</header><text>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.</text>
</subsection></section></subtitle><subtitle id="HF23D730AC18A4B4DA57C6100D5F4645"><enum>B</enum><header>Occupational Safety
and Health Programs</header>
<section id="HBACF0AFEF6BA468A80D653CD20BB2780"><enum>411.</enum><header>Functions of
the National Health Board</header>
<subsection id="H2129328C74A54B3FA22023E873A0DDE0"><enum>(a)</enum><header>Oversight
authority</header><text>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.</text>
</subsection><subsection id="HD386DE8D9AEE4237AF68EB00ACDCB24C"><enum>(b)</enum><header>Conforming
amendments</header>
<paragraph id="H4DDC30D2634843E599A494E38256B83"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph id="H9432BD24867046A4B90986FAD2205600"><enum>(A)</enum><text>in section 3, by
adding at the end the following new paragraph:</text>
<quoted-block id="H77FF3DE79A744C948B00018425385BF2">
<paragraph id="H81E618F9F4064FA0812C5800D5A307EB"><enum>(15)</enum><text>The term
<term>National Health Board</term> means the National Health Board of the
United States Health
Services.</text>
</paragraph><after-quoted-block>;</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="H18B7696A79B041DFAB086642FAEE328E"><enum>(B)</enum><text>by striking
<quote>Secretary of Health and Human Services</quote> each place it appears
(other than in section 22(b)) and inserting <quote>National Health
Board</quote>;</text>
</subparagraph><subparagraph id="HAA6FE32B2FAD4D559800056DB71ED8D9"><enum>(C)</enum><text>in the first
sentence of section 6(b)(1), by inserting <quote>shall request the National
Health Board and</quote> before <quote>may request</quote>;</text>
</subparagraph><subparagraph id="HBCF76B8867574109A2D9BDDD3B7BCC58"><enum>(D)</enum><text>in the second
sentence of section 6(b)(1), by inserting <quote>the Board and</quote> after
<quote>The Secretary shall provide</quote>;</text>
</subparagraph><subparagraph id="HEC4C8F51667A45B2ABD473C1AE1FCB0"><enum>(E)</enum><text>in the third
sentence of section 6(b)(1), by striking <quote>An</quote> and inserting
<quote>The Board and an</quote>;</text>
</subparagraph><subparagraph id="H8664D65B81594C6F00F2CEB650004F60"><enum>(F)</enum><text>in the third
sentence of section 6(b)(1), by striking <quote>its</quote> each place it
appears and inserting <quote>their</quote>;</text>
</subparagraph><subparagraph id="HB51FD633D4624DC795E38CEB00C243C6"><enum>(G)</enum><text>in the fourth
sentence of section 6(b)(6)(A), by inserting <quote>after consultation with the
National Health Board and</quote> after <quote>may be granted
only</quote>;</text>
</subparagraph><subparagraph id="H2553B130CBC9471695D035ABCB1C718D"><enum>(H)</enum><text>in the third
sentence of section 6(d), by inserting <quote>after consultation with the
National Health Board and</quote> before <quote>after opportunity
for</quote>;</text>
</subparagraph><subparagraph id="H81B1D271AAE64C0D9D264CD4458BD98C"><enum>(I)</enum><text>in section
8(g)(2), by striking <quote>The Secretary</quote> and all that follows through
<quote>shall each</quote> and inserting <quote>The Secretary
shall</quote>;</text>
</subparagraph><subparagraph id="H5A626091BB1F44B6A4B6AE204E01FAE8"><enum>(J)</enum><text>in section
8(g)(2), by striking <quote>their</quote> and inserting
<quote>his</quote>;</text>
</subparagraph><subparagraph id="HC0A47ED343DA478B819D253C09230000"><enum>(K)</enum><text>in section 16, by
inserting <quote>after consultation with the National Health Board and</quote>
before <quote>after notice and opportunity</quote>;</text>
</subparagraph><subparagraph id="H9A33A2EE6BD64612AB597F5E41007FD0"><enum>(L)</enum><text>in section 18(c),
by inserting <quote>(after consultation with the National Health Board)</quote>
after <quote>in his judgment</quote>;</text>
</subparagraph><subparagraph id="H32EC4904EF6E44FEAD3F17954CC62236"><enum>(M)</enum><text>in section 19(d),
by inserting <quote>and the National Health Board</quote> after
<quote>Secretary</quote> each place it appears; and</text>
</subparagraph><subparagraph id="H4A3DFE22624E4FCDA38E564E2C85B700"><enum>(N)</enum><text>in section 20(a),
by striking the first sentence of paragraph (5).</text>
</subparagraph></paragraph><paragraph id="HB02B4398CAEB457C8D6C8030DD044245"><enum>(2)</enum><header>Effective
date</header><text>The amendments made by paragraph (1) shall take effect on
the effective date of health services.</text>
</paragraph></subsection><subsection id="H369889C1E26E4EDB8680E03329A78BB1"><enum>(c)</enum><header>Guidelines</header><text>The
National Health Board shall establish guidelines—</text>
<paragraph id="HB613F77F0BC44F828CE87875A6242C7"><enum>(1)</enum><text>for its
participation in the establishment and administration of occupational safety
and health standards under the Occupational Safety and Health Act of 1970;
and</text>
</paragraph><paragraph id="H3F9194013F7047A3A3223CF0A00433E4"><enum>(2)</enum><text>for the
establishment and operation of workplace health facilities under section
413.</text>
</paragraph></subsection></section><section id="H3E8E9032708B41639EA15FFD558EF0A2"><enum>412.</enum><header>Community
Occupational Safety and Health Activities</header><text display-inline="no-display-inline">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—</text>
<paragraph id="H9E9868E242D549B7AFA8474B005F6CE"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph id="HF1FA60C8DA8B4DF8B1DA5CC1E358593"><enum>(2)</enum><text>assist employees in
determining methods of, and requirements for, inspections of workplaces in the
community for safety and health hazards;</text>
</paragraph><paragraph id="H134E590DB7A5486C9F1D47421DE6FD6D"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph id="H7EB7F5D61C1C4DB8B1D1B4335D19F4F8"><enum>(4)</enum><text>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;</text>
</paragraph><paragraph id="HEF462D165B234BA3AC21EC93A6FADA"><enum>(5)</enum><text>conduct baseline and
periodic biologic screening of employees in the region;</text>
</paragraph><paragraph id="H3250D2C782FE441EAC5FB290299921E2"><enum>(6)</enum><text>develop and
maintain environmental monitoring programs to identify and isolate hazardous
workplaces and work areas in the region; and</text>
</paragraph><paragraph id="H8EEFD2192EBC43259F05FBD119089719"><enum>(7)</enum><text>analyze
employment-related injuries and illnesses occurring in the region.</text>
</paragraph></section><section id="HAB6523C30C014C0CBF003FB8CF1F00BF"><enum>413.</enum><header>Workplace
health facilities</header>
<subsection id="HF2F0BB461A63497FA642DD66E052256C"><enum>(a)</enum><header>Establishment</header><text>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.</text>
</subsection><subsection id="H6BBD8F6A00374B138E08E03246003221"><enum>(b)</enum><header>Application of
guidelines</header><text>Each workplace health facility established pursuant to
subsection (a) shall, taking into account guidelines established by the
National Health Board—</text>
<paragraph id="H15E14AD692E74F3EB8528DF73D944420"><enum>(1)</enum><text>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</text>
</paragraph><paragraph id="H8B9BD69DE2AB4206A2CF40FF075CB4C6"><enum>(2)</enum><text>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.</text>
</paragraph></subsection></section><section id="HBC19CB15A6574DA78C00002FE00E400"><enum>414.</enum><header>Employee rights
relating to Occupational Safety and Health</header>
<subsection id="H2956C926C4C84F0882926F13E029FC8"><enum>(a)</enum><header>Workplace
committees</header>
<paragraph id="HA74E90D0B8B342A88EAFB7D47E87F393"><enum>(1)</enum><header>Establishment</header><text>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 <quote>committee</quote>) with members of their
choosing.</text>
</paragraph><paragraph id="HC29963762D1E4E2DAD1913A100DD151E"><enum>(2)</enum><header>Membership</header><text>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—</text>
<subparagraph id="HA4C510937BA1435D9FFED201DCDD114F"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph id="H5B1650D8AA53424BA46D2247BFD25237"><enum>(B)</enum><text>be permitted to
accompany any safety and health inspectors during inspections of the
workplace.</text>
</subparagraph></paragraph></subsection><subsection id="H2F45F13DDA0F4416A3ECAFAAAE7580A5"><enum>(b)</enum><header>Safety-related
rights</header><text>Employees in each workplace shall have the right, without
any loss of pay or other job rights—</text>
<paragraph id="H4154E309ACB54157BA50203ECD7C90D3"><enum>(1)</enum><text>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</text>
</paragraph><paragraph id="HFAC112642C224C0985587922EBE22BB"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection id="H1A4F2E8C51CC422680FB5250789D2311"><enum>(c)</enum><header>Safe
workplaces</header><text>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.</text>
</subsection><subsection id="H37041682C37B455CB823CB042E522B76"><enum>(d)</enum><header>Right To inspect
medical records</header><text>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.</text>
</subsection><subsection id="H48FCA969689B4C7197495E52D90075B"><enum>(e)</enum><header>Copies of
reports</header><text>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.</text>
</subsection><subsection id="HA4FA54E29139486E98E5351EF8E801A7"><enum>(f)</enum><header>Right To
negotiate standards</header><text>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.</text>
</subsection></section><section id="HE3E8D6E21E4341F58E26CE6212C7A3"><enum>415.</enum><header>Definitions</header>
<subsection id="HA87DD644B8C540E1AA5337EE30F946A1"><enum>(a)</enum><header>Workplace</header><text>For
purposes of this subtitle, the term <term>workplace</term> means the regular
location where work is performed by one or more employees of an
employer.</text>
</subsection><subsection id="HFF4A433020D84B5C9BAB05F11F9CEE90"><enum>(b)</enum><header>Employer;
employee</header><text>For the purposes of sections 413 and 414, the terms
<term>employer</term> and <term>employee</term> have the same meanings those
terms have in section 3 of the Occupational Safety and Health Act of 1970 (42
U.S.C. 653).</text>
</subsection></section></subtitle><subtitle id="HF8D198046F764856AB42C45E11C56B12"><enum>C</enum><header>Health and health
care delivery research, quality assurance, and health equity</header>
<section id="H542A2817794A47EF9D5762D2B9BB42DF"><enum>421.</enum><header>Principles and
guidelines for research</header>
<subsection id="HCD252DCB8FAB4FE7A9C791C548A4D287"><enum>(a)</enum><header>Conduct</header><text>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:</text>
<paragraph id="H89F55469B3234AF2A328965096DCD35B"><enum>(1)</enum><text>The research
shall, to the maximum extent possible, be performed under the direction of, and
in association with, agencies representative of the population.</text>
</paragraph><paragraph id="HBB15BFC62BB14735923FCBA0E25EFF00"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph id="H8EBBBF86AA064D68A2A3AC1FC8D4E6D3"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph id="H3B43525278504F2A839BE2F028C91C8D"><enum>(4)</enum><text>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.</text>
</paragraph><paragraph id="H15967F4B19BC408ABEEE0076EF1736B6"><enum>(5)</enum><text>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.</text>
</paragraph><paragraph id="H7A505829EDAB4CDE9F49D0D623466C72"><enum>(6)</enum><text>No research shall
be conducted on a human subject without the subject’s informed written
consent.</text>
</paragraph><paragraph id="H8A4B38358A6940C08D6223CC0680C319"><enum>(7)</enum><text>No research shall
be conducted on a human subject while the subject is involuntarily confined to
an institution.</text>
</paragraph><paragraph id="H3BCE41D1BEBD408BBD6D1FEEF09D7B2"><enum>(8)</enum><text>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.</text>
</paragraph><paragraph id="H2C9B439AAF61407C99E529F3C894A313"><enum>(9)</enum><text>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.</text>
</paragraph></subsection><subsection id="H09588113AFA147B8B200754378C8957D"><enum>(b)</enum><header>Guidelines</header><text>The
National Health Board shall establish guidelines for the conduct of research in
conformance with the principles described in subsection (a).</text>
</subsection></section><section id="H4C86292CDFA74311AD9E08C427F572F6"><enum>422.</enum><header>Establishment
of Institutes</header>
<subsection id="H5330F1EEB54247A99BDC6FBB7FD6DCF"><enum>(a)</enum><header>In
general</header><text>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
<act-name parsable-cite="PHSA">Public Health Service Act</act-name>), and the
Substance Abuse and Mental Health Services Administration. In addition, the
National Health Board shall establish the following institutes:</text>
<paragraph id="HBB9AF67A186F4DB99EC7BE52B75DB244"><enum>(1)</enum><header>National
Institute of Epidemiology</header><text>A National Institute of Epidemiology,
which shall—</text>
<subparagraph id="H8468DF3C7859422896EA5DDE4245A56B"><enum>(A)</enum><text>gather and analyze
disease-related statistics collected by the Service;</text>
</subparagraph><subparagraph id="HE32D50E27D784506B96E09CCA829A1EC"><enum>(B)</enum><text>plan, conduct,
support, and assist in epidemiologic research conducted by the Service;</text>
</subparagraph><subparagraph id="H062CE4F4C863409FBC00CD36A1E649C0"><enum>(C)</enum><text>conduct and
support research on epidemiologic methodology and experimental
epidemiology;</text>
</subparagraph><subparagraph id="H2E3FF644FE9D4E35AFF718E1F2AB78BB"><enum>(D)</enum><text>establish and
maintain an early warning system for the detection of new diseases and
epidemics;</text>
</subparagraph><subparagraph id="H19F553CF17A043BBB0D839B42019008D"><enum>(E)</enum><text>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; and</text>
</subparagraph><subparagraph id="H9A7D8EC3FD104EE4923F6733B7E83EBF"><enum>(F)</enum><text>provide technical
assistance and support to regional and local jurisdictions related to measures
to prevent and curtail outbreaks of illness and injury.</text>
</subparagraph></paragraph><paragraph id="H1442C202D9724B1F00C87443B9BB8EA3"><enum>(2)</enum><header>National
Institute of Evaluative Clinical Research</header><text>A National Institute of
Evaluative Clinical Research, which shall—</text>
<subparagraph id="H09DA6735C40E4A51B053B62BB48BD8A6"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph id="H4B360AD9C9A546878DF29957E979A462"><enum>(B)</enum><text>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;</text>
</subparagraph><subparagraph id="H5D49632629E945E59C5E54F70208843C"><enum>(C)</enum><text>analyze evidence
on newly discovered or proposed preventive, diagnostic, and therapeutic methods
and agents;</text>
</subparagraph><subparagraph id="H107D3FF3C49842AFA4FE81D18EB4A3D2"><enum>(D)</enum><text>plan and conduct
clinical trials, in conformance with the limitations of subtitle A of title
II;</text>
</subparagraph><subparagraph id="H865CCF80F72A41B4A9846F5551035C3F"><enum>(E)</enum><text>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;</text>
</subparagraph><subparagraph id="HA8385EE5F0AD42DD84521CD0291B1E53"><enum>(F)</enum><clause commented="no" display-inline="yes-display-inline" id="H5559EFA9F2D14F4A00D57EFE92D162FE"><enum>(i)</enum><text>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;</text>
</clause><clause id="H22A2DAE15435475B8172BFE887CB43D5" indent="up1"><enum>(ii)</enum><text>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);</text>
</clause><clause id="HDBEDD9AFE6CF4D0689727BAC00FA768B" indent="up1"><enum>(iii)</enum><text>regularly monitor and report to
the National Health Board for further action the extent of inappropriate care,
including underservice and overservice, and its consequences;</text>
</clause><clause id="H230DC85094154B5789F413EBDF1F6005" indent="up1"><enum>(iv)</enum><text>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;</text>
</clause></subparagraph><subparagraph id="H3E31C859EF20470A80393021DB1653B0"><enum>(G)</enum><text>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</text>
</subparagraph><subparagraph id="H4FAA48A952E04A778409B6ACF425823D"><enum>(H)</enum><text>provide education
for users on clinical effectiveness guidelines and the most effective
preventive, diagnostic, and treatment practices.</text>
</subparagraph></paragraph><paragraph id="HC8ED9655AB07483CA5EAF45C78C5A686"><enum>(3)</enum><header>National
Institute of Health Care Services</header><text>A National Institute of Health
Care Services, which shall—</text>
<subparagraph id="H731E2128764D4A1B87C3D89B098B5DB9"><enum>(A)</enum><text>analyze data and
statistics on the health care resources and needs of the Nation and on the
quality of present services;</text>
</subparagraph><subparagraph id="HA792E003B48B480CB156A76429ADCA30"><enum>(B)</enum><text>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;</text>
</subparagraph><subparagraph id="HDEAA5D2ACF67488DB8EE1E4DBDD1DB7"><enum>(C)</enum><text>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</text>
</subparagraph><subparagraph id="HDC0C9C3136C44AF2B1549DAAD417FC00"><enum>(D)</enum><text>assist the
National Health Board in formulating national policies to improve the quality
of health care services.</text>
</subparagraph></paragraph><paragraph id="H0ECCA136904A440EB474CD5152DDE4E6"><enum>(4)</enum><header>National
Institute of Pharmacy and Medical Supply</header><text>A National Institute of
Pharmacy and Medical Supply, which shall—</text>
<subparagraph id="H0251C061C81E44DFB9F51EC7EBF5CD1"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph id="HAB842858890A43B495EEF8D7700BED0"><enum>(B)</enum><text>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;</text>
</subparagraph><subparagraph id="H4CFDE7BF192343AEB3C4994876CA00E8"><enum>(C)</enum><text>assist the
National Health Board in issuing a National Pharmacy and Medical Supply
Formulary; and</text>
</subparagraph><subparagraph id="H981446F5614B415E8D509BDAAFA5E316"><enum>(D)</enum><text>conduct a
comprehensive program of pharmaceutical and medical supply research and
utilization education using regional facilities to the maximum extent
possible.</text>
</subparagraph></paragraph><paragraph id="H453EAB0C453445DBB76E909D5E165CB6"><enum>(5)</enum><header>National
Institute of Sociology of Health and Health Care</header><text>A National
Institute of Sociology of Health and Health Care, which shall—</text>
<subparagraph id="HD3C21731969F4724B5EFDBD003945F5"><enum>(A)</enum><text>conduct ongoing
analyses of the basic epistemological assumptions of health and health
care;</text>
</subparagraph><subparagraph id="HE5FDA7750DF44950A797AB0868E4BD23"><enum>(B)</enum><text>assess critically
the effects of scientific medicine and of divisions in institutional and
technical skills in health care;</text>
</subparagraph><subparagraph id="H6EB784FDFC8B417A8CF03EF1D002D45"><enum>(C)</enum><text>evaluate the
effects of health care measures and policies upon population groups and
subgroups in the Nation;</text>
</subparagraph><subparagraph id="H2F16146290EF42AAB08BE6D80072BBED"><enum>(D)</enum><text>identify and
analyze the social, cultural, economic, occupational, distributional, and
environmental factors in modern society affecting health and well-being;</text>
</subparagraph><subparagraph id="H1934EB53829246BA88A4512160194658"><enum>(E)</enum><text>analyze
alternative, holistic approaches to the human body, health, and causality of
ill health and the lack of social and psychological well-being; and</text>
</subparagraph><subparagraph id="HA1D1E82EE0D14FEE801700000095F16F"><enum>(F)</enum><text>assist the
National Health Board in formulating national policies relating to the
promotion of health and the provision of health care.</text>
</subparagraph></paragraph></subsection><subsection id="HD10E8E65E7FD494E8ED8ABD926CAE6B5"><enum>(b)</enum><header>Coordination of
effort</header><text>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.</text>
</subsection></section></subtitle><subtitle id="H8030142B8A504C43A16B00CD84B7E055"><enum>D</enum><header>Health planning,
distribution of drugs and other medical supplies, and miscellaneous
functions</header>
<section id="H684E5F8FECB6498FBA39F745BDEEAA"><enum>431.</enum><header>Health planning
and budgeting</header>
<subsection id="H85B237AC2065433C943FFDB640C47721"><enum>(a)</enum><header>In
general</header><text>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.</text>
</subsection><subsection id="HE08A43DFFB0947E300EEB900CCDD7F2E"><enum>(b)</enum><header>Coordination</header><text>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.</text>
</subsection><subsection id="H53926ECA34D44F299F00D39CADC1C3A0"><enum>(c)</enum><header>Plans</header><text>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.</text>
</subsection></section><section id="H7ACA38B0778C47E3A401EEBAF77C0007"><enum>432.</enum><header>Distribution of
drugs and other medical supplies</header>
<subsection id="HE7D4D759A39D41AF9FC4A757D03F8694"><enum>(a)</enum><header>National
Formulary</header>
<paragraph id="H8661CBF499204F4385A37E00EEC6C625"><enum>(1)</enum><header>Publication</header><text>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 <quote>Formulary</quote>).</text>
</paragraph><paragraph id="H99217D5B2437495BB0612E6190536073"><enum>(2)</enum><header>Contents</header><text>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
<quote>drugs and other medical supplies</quote>). 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.</text>
</paragraph><paragraph id="H7F9DFF56187946E0AE4B069EC108C8EF"><enum>(3)</enum><header>Updating</header><text>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.</text>
</paragraph></subsection><subsection id="HA6BECB1D4ABD402B9059E87DB8D995D3"><enum>(b)</enum><header>Drug purchase
programs</header>
<paragraph id="HBDDF0CB0646D410D919E80787835F0AB"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph id="H00063F31CF574A378C549D6828BDE3E3"><enum>(2)</enum><header>Pricing</header><text>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).</text>
</paragraph><paragraph id="H4A0EB22B60D543749304A566D026C159"><enum>(3)</enum><header>Generic
distribution</header><text>Such program shall provide for the distribution and
dispensing of drugs under their generic names.</text>
</paragraph><paragraph id="H3D490E4B10AA42BEAC72A300046D78DB"><enum>(4)</enum><header>Generic names
defined</header><text>For purposes of paragraph (3), the term <term>generic
names</term> means the established names, as defined in section 502(e)(2) of
the <act-name parsable-cite="FFDCA">Federal Food, Drug, and Cosmetic
Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/21/352">21 U.S.C. 352(e)(2)</external-xref>).</text>
</paragraph></subsection><subsection id="HA12AFB9FB36A436D8EE74B66A62BCF3B"><enum>(c)</enum><header>Authority To
manufacture</header><text>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.</text>
</subsection></section><section id="HDF337AA34F1F496380EC1BBFBF3B8500"><enum>433.</enum><header>Miscellaneous
Functions of the National Health Board</header>
<subsection id="HD9EF2DBCE1854BD400D7A4F9F81F47A7"><enum>(a)</enum><header>Annual
report</header><text>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.</text>
</subsection><subsection id="HE2DF45BEB28C4AD68E84BB12EE82267F"><enum>(b)</enum><header>Dissemination</header><text>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.</text>
</subsection></section></subtitle><enum>V</enum><header>Financing of the
Service</header>
<subtitle id="HC2A6C740A46C4F3D9FE47BA7C3582F7D"><enum>A</enum><header>Health Service
Taxes</header>
<section id="HA9A77620CF904BCAB68694C6515899A5"><enum>501.</enum><header>Individual and
corporate income taxes</header>
<subsection id="H65FA46F40A864B4AB2B82427B8E4FFC8"><enum>(a)</enum><header>Health Service
taxes</header>
<paragraph id="HA25A055ABC084EB3B1F4052310F2D6A"><enum>(1)</enum><header>In
general</header><text>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:</text>
<quoted-block id="H1730BE702D1844B9A5A966F900DDC62D">
<part id="H1026DBD12EE44D51A213F474289766AB"><enum>VIII</enum><header>Health Service
Taxes</header>
<toc regeneration="no-regeneration">
<toc-entry level="section">Sec. 59B. Tax imposed.</toc-entry>
</toc>
<section id="HBB999FA10E3945F2BB02F8BE2D1BFFF6"><enum>59B.</enum><header>Tax
imposed</header>
<subsection id="H98520601632E47BC9F7206346BDFB0B8"><enum>(a)</enum><header>Individuals,
estates, and trusts</header><text>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.</text>
</subsection><subsection id="H7B5005423A0140F9813273CF004E95F2"><enum>(b)</enum><header>Corporation</header><text>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.</text>
</subsection></section></part><after-quoted-block></after-quoted-block></quoted-block>
</paragraph><paragraph id="HE496BACF611647F8BD59B354A742AD89"><enum>(2)</enum><header>Clerical
amendment</header><text>The table of parts of such subchapter A is amended by
adding after the item relating to part VII the following new item:</text>
<quoted-block id="HE19A9424AD1E41B8B01F6BC52E9D08DB" style="USC">
<toc regeneration="no-regeneration">
<toc-entry level="part">Part VIII. Health Service
Taxes</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H4AD11513C8C14D42BA463611E68FA31"><enum>(b)</enum><header>Effective
date</header><text>The amendments made in this section shall apply to taxable
years beginning on or after the effective date of health services.</text>
</subsection></section><section id="H42E6AF23889D4A6188232FCC6B32DC8E"><enum>502.</enum><header>Other changes
in the Internal Revenue Code of 1986</header>
<subsection id="H5B57314719CB4952A8A863FD42BF2110"><enum>(a)</enum><header>Denial of
exclusion from gross income for amounts paid by third parties for medical
care</header><text><external-xref legal-doc="usc" parsable-cite="usc/26/105">Section 105</external-xref> of the Internal Revenue Code of 1986 (relating
to amounts received under accident and health plans) is amended by striking
subsection (b).</text>
</subsection><subsection id="H839921E728D142C0BB34CFBEA487E52B"><enum>(b)</enum><header>Denial of
exclusion from gross income of certain contributions by the employer to health
plans</header><text>Subsection (a) of section 106 of such Code (relating to
contributions by employer to accident and health plans) is amended to read as
follows:</text>
<quoted-block id="H97221F17937848F695826D1CE1A96DC8">
<subsection id="H1D3308050C324F6CAFBA20000015B253"><enum>(a)</enum><header>General
rule</header><text>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
<short-title>Josephine Butler United States Health Service
Act</short-title>.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H57F65E20633E47788760FB11BE74CEA1"><enum>(c)</enum><header>Denial of
deduction of health care expenses as trade or business
expenses</header><text>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:</text>
<quoted-block id="HF4D04A77581A48679EFE67DEA23CD628">
<subsection id="H1E4F3769A8A843B997DB006832D04DDA"><enum>(p)</enum><header>Payments for
health care</header><text>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
<short-title>Josephine Butler United States Health Service
Act</short-title>.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HA19712B6C39044BE8986FA35D34CB568"><enum>(d)</enum><header>Denial of
deduction for contributions to certain medical and hospital facilities</header>
<paragraph id="HD19BFC4211474BD9B4B7F92B20F74C00"><enum>(1)</enum><text>Paragraph (2) of
section 170(c) of such Code (relating to charitable, etc., contributions and
gifts) is amended by inserting <quote>(other than an organization described in
subsection (b)(1)(A)(iii))</quote> after <quote>(2) A corporation, trust, or
community chest, fund, or foundation</quote>.</text>
</paragraph><paragraph id="H26DBCE71ECF44CBC95FB779FFAE2EF70"><enum>(2)</enum><text>Subsection (e) of
section 501 of such Code (relating to cooperative hospital service
organizations) is amended by striking the last sentence.</text>
</paragraph></subsection><subsection id="HEC51E816CBCB42CF84D100039CB325B5"><enum>(e)</enum><header>Denial of
deduction for medical, dental, etc., expenses</header>
<paragraph id="HCEA883940C124447842BF4E1FC91ED3"><enum>(1)</enum><text>Section 213 of such
Code (relating to medical, dental, etc., expenses) is repealed.</text>
</paragraph><paragraph id="H2741DCD521624730A7969213F059447E"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection id="HF4FA4FBE979B4C4CA4DD32BBCACD1F4B"><enum>(f)</enum><header>Hospital
insurance tax</header>
<paragraph id="H864639D040834CF600A9C884471050E5"><enum>(1)</enum><text>Subsection (b) of
section 1401 of such Code (relating to rate of tax on self-employment income)
is repealed.</text>
</paragraph><paragraph id="H9CCD2189711843599CFCCA7B88C85419"><enum>(2)</enum><text>Subsection (b) of
section 3101 of such Code (relating to rate of tax on employees under the
<act-name parsable-cite="FICA">Federal Insurance Contributions Act</act-name>)
is repealed.</text>
</paragraph><paragraph id="HDD98F23ED32A4F76A22D00989506ACA"><enum>(3)</enum><text>Section 3201(a) of
such Code (relating to rate of tax imposed on employees under the
<act-name parsable-cite="RRTA">Railroad Retirement Tax Act</act-name>) is
amended by striking <quote>the sum of the rates of tax in effect under
subsections (a) and (b) of section 3101</quote> and inserting <quote>the rate
of tax in effect under section 3101(a)</quote>.</text>
</paragraph><paragraph id="H820BF2EFE3E3410C99F2F137DF00EAE9"><enum>(4)</enum><text>Section 3211(a)(1)
of such Code (relating to rate of tax on employee representatives under the
<act-name parsable-cite="RRTA">Railroad Retirement Tax Act</act-name>) is
amended by striking <quote>subsections (a) and (b)</quote> the first place it
appears and inserting <quote>subsection (a)</quote>.</text>
</paragraph><paragraph id="H74F0D1C87D144A34AD444D00E8742228"><enum>(5)</enum><text>Subsection (e) of
section 6051 of such Code (relating to railroad employees) is repealed.</text>
</paragraph></subsection><subsection id="H49C673E9113047E488D1076BE749069B"><enum>(g)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to taxable
years beginning on or after the effective date of health services.</text>
</subsection></section><section id="H93542D8E5DBB4E83AC2C8DFC82B5DC5F"><enum>503.</enum><header>Existing
employer-employee health benefit plans</header><text display-inline="no-display-inline">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.</text>
</section><section id="HB3CBFDA7E9D942B090EB262D0022B707"><enum>504.</enum><header>Workers
compensation programs</header><text display-inline="no-display-inline">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.</text>
</section></subtitle><subtitle id="H28529BB929344B3D943D9696BBC5A0CA"><enum>B</enum><header>Health Service
Trust Fund</header>
<section id="H96FBD16114244562B32B76D09F79BF6"><enum>511.</enum><header>Establishment of
Health Service Trust Fund</header>
<subsection id="HE208808AFE36408A8E07003BD2D32838"><enum>(a)</enum><header>Establishment</header><text>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 <quote>Trust Fund</quote>). 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.</text>
</subsection><subsection id="HA35DDB1482394AE09C4F22F75ED1DFFB"><enum>(b)</enum><header>Appropriation</header><text>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.</text>
</subsection></section><section id="H2F8F113CDAD04776A59DDEEB027B7F00"><enum>512.</enum><header>Transfer of
funds to the Health Service Trust Fund</header>
<subsection id="H34BF182E6B77472D9F5CDCBE19BAC784"><enum>(a)</enum><header>Of medicare
trust funds</header><text>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.</text>
</subsection><subsection id="H98CCC089AD104C13947523D4C33EED00"><enum>(b)</enum><header>Additional
amounts</header><text>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.</text>
</subsection></section><section id="HC1B7F0F30CDE442EBAF00A2B6C0CE00"><enum>513.</enum><header>Administration
of Health Service Trust Fund</header>
<subsection id="H2DD2D5F5D9D842E387ADBAF9791E9B81"><enum>(a)</enum><header>Board of
Trustees</header><text>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 <quote>Board of Trustees</quote>) 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 <quote>Managing Trustee</quote>). 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—</text>
<paragraph id="HBE53299CF0194BB3BF213800A4C5C25B"><enum>(1)</enum><text>hold the Trust
Fund;</text>
</paragraph><paragraph id="H7A29AA9046F64F489F064E2288F33DF1"><enum>(2)</enum><text>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;</text>
</paragraph><paragraph id="H36E3D50313724C50B322B545373857F5"><enum>(3)</enum><text>report immediately
to the Congress whenever the Board is of the opinion that the amount of the
Trust Fund is unduly small; and</text>
</paragraph><paragraph id="H1CD50606F9B2414E94453C9F884B7B36"><enum>(4)</enum><text>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.</text>
</paragraph><continuation-text continuation-text-level="subsection">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.</continuation-text></subsection><subsection id="HD516E7850AB544C1B8A09C74E7D1B16"><enum>(b)</enum><header>Investment</header><text>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.</text>
</subsection><subsection id="H83D5A72E2729404B8C27B961FCE7C211"><enum>(c)</enum><header>Issuance of
obligations</header><text>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.</text>
</subsection><subsection id="HFB8C59C62A6F456487130000B7BBDB03"><enum>(d)</enum><header>Payment of
interest</header><text>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.</text>
</subsection><subsection id="H1195ED8CF7C040FD8839FE77DEA6E6D"><enum>(e)</enum><header>Payments</header><text>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.</text>
</subsection></section></subtitle><subtitle id="H9CE1A34CDFBD4048BE2FC3105733D208"><enum>C</enum><header>Preparation of
plans and budgets</header>
<section id="HE1827B35282D4DC08255C6872D78BFD"><enum>521.</enum><header>Determination of
Fund availability</header>
<subsection id="H0A624A62450C4BA484ED17B93829917D"><enum>(a)</enum><header>Maximum
funds</header>
<paragraph id="H257F8F07E74B46609C5FE64CFC86BCA1"><enum>(1)</enum><header>Fixing</header><text>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.</text>
</paragraph><paragraph id="H89FBB572A36A47E184D9FEDFE5822B09"><enum>(2)</enum><header>Limitation</header><text>Such
amount shall not exceed for a fiscal year the lesser of—</text>
<subparagraph id="H88C10D6D4B834BB6B85456D516B696A1"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph id="H517A2AA77BA54E11B8B21EF8C29305D1"><enum>(B)</enum><text>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;
or</text>
</subparagraph><subparagraph id="H0065D3B162BD49A690FCAC16525C00C7"><enum>(C)</enum><text>the amount fixed
under subsection (b).</text>
</subparagraph></paragraph><paragraph id="HCD39248F7F2647DC9F959437383894AF"><enum>(3)</enum><header>Refixing</header><text>The
National Health Board may at any time refix such amount to reflect
changes—</text>
<subparagraph id="HA27FACEB502842A7A49EFE1814C4929B"><enum>(A)</enum><text>of one percent or
more in the expected net tax receipts (described in paragraph (2)(A));
or</text>
</subparagraph><subparagraph id="H649F766BE26A43B7901BC255AE006600"><enum>(B)</enum><text>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.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">The National
Health Board shall promptly report to Congress any increase made in such amount
and the reasons therefor.</continuation-text></paragraph></subsection><subsection id="H34EF1ADEFC27479C8DAEC5FEFE6457C"><enum>(b)</enum><header>Lesser
amount</header><text>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—</text>
<paragraph id="H7CDD642EA50B40D88B2EB1BD1CB9CFE9"><enum>(1)</enum><text>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</text>
</paragraph><paragraph id="H9052DB1E571C4830B11B727D535D848D"><enum>(2)</enum><text>improvement in the
organization, delivery, or utilization of such services has lessened their
aggregate cost (or increase in such cost).</text>
</paragraph></subsection><subsection id="H7786C3F2B4EE4CBDABF48B5C3987D23D"><enum>(c)</enum><header>Obligation</header><text>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.</text>
</subsection><subsection id="H25ED109705EC4DE1860000BF920476B2"><enum>(d)</enum><header>Obligation of
borrowed amounts</header><text>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.</text>
</subsection></section><section id="H99CBAC93221E46CE8100D2AFC84425C6"><enum>522.</enum><header>Preparation of
regional budgets</header>
<subsection id="H9CA3A56C975245DCB789B84DD8664B74"><enum>(a)</enum><header>Population
need</header><text>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.</text>
</subsection><subsection id="H7DBDA54F67184C878719ADA675D8A6BF"><enum>(b)</enum><header>Budget
breakdowns</header><text>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.</text>
</subsection></section></subtitle><subtitle id="H2FB379C0943944DE00DBF619DE677C"><enum>D</enum><header>Allocation and
distribution of funds</header>
<section id="H205CA46D724740409DE6757DDAA34BE"><enum>531.</enum><header>National
Budget</header>
<subsection id="H243771600F274057B7510000CBC40248"><enum>(a)</enum><header>Preparation</header><text>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—</text>
<paragraph id="H112AAB8BFF4D4B3E9F5562A7A53E1C8F"><enum>(1)</enum><text>ordinary operating
expenses;</text>
</paragraph><paragraph id="HDD7DAF2606E44853A2797D0089A4C9AA"><enum>(2)</enum><text>preventive health
measures, and which measures shall include primary prevention to improve the
conditions under which people live that affect health status;</text>
</paragraph><paragraph id="H81F497F197644590B3F869ED65BAAC27"><enum>(3)</enum><text>capital
expenses;</text>
</paragraph><paragraph id="H9DA1097B4CF240A5ACAB004364C321A9"><enum>(4)</enum><text>research expenses;
and</text>
</paragraph><paragraph id="HEF07B18101054FADBB436F2C8E87006F"><enum>(5)</enum><text>special operating
expenses, as described in section 532.</text>
</paragraph></subsection><subsection id="HE0A426EB137A4567BF4270EE92B1823D"><enum>(b)</enum><header>Ordinary
operating expenses</header><text>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.</text>
</subsection><subsection id="HAA175C5A881E4CEDBBA8A9E4A4750088"><enum>(c)</enum><header>Capital
expenses</header><text>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.</text>
</subsection></section><section id="H642A55C73CAF4872A188FB36C0DEABE1"><enum>532.</enum><header>Special
operating expense Fund</header>
<subsection id="H00B8CE16D19346ABAF5CEEE5A231CDDA"><enum>(a)</enum><header>In
general</header><text>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 <term>special operating expenses</term> means
operating expenses associated with—</text>
<paragraph id="HB3AF288A8AC74B74BCA5DAFEB757CDC9"><enum>(1)</enum><text>the care and
treatment of users 65 years of age or older;</text>
</paragraph><paragraph id="H5E3DECFBF5DD476900836F1F664BFF13"><enum>(2)</enum><text>the care and
treatment of persons confined to full-time residential care institutions,
including nursing homes and facilities for the treatment of mental
illness;</text>
</paragraph><paragraph id="H50B7A5BB4A8F4E84B26EA94E712C6503"><enum>(3)</enum><text>the special health
care needs of low-income users;</text>
</paragraph><paragraph id="HE24B4BB153104001A0AA6829529403D5"><enum>(4)</enum><text>the special health
care needs of communities of color that experience disparities in health status
compared to white populations;</text>
</paragraph><paragraph id="H7F4C0E35C0AE454BAEA34C11422B4779"><enum>(5)</enum><text>the special health
care needs of residents of rural or frontier areas, or noncontiguous States and
territories;</text>
</paragraph><paragraph id="H906446457CB5410BB8079BDE4EA91C41"><enum>(6)</enum><text>special health
care needs arising from environmental or occupational health conditions;</text>
</paragraph><paragraph id="H437896E53A544ECEA91C92DADDE76905"><enum>(7)</enum><text>special health
care needs arising from unexpected occurrences, including epidemics and natural
disasters; and</text>
</paragraph><paragraph id="H2DD72D405A384005A7BCC8BB8780E763"><enum>(8)</enum><text>the conduct of
environmental health inspection and monitoring services.</text>
</paragraph></subsection><subsection id="HA81BC4C937A54ED18C23D79702C15655"><enum>(b)</enum><header>Allocation</header><text>The
special operating expense fund shall be allocated as follows:</text>
<paragraph id="HD253322886DE4397AD3C8E6610C0F538"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph id="H21713C91D6B44CC199ED1BA6FA679B3F"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph id="HFA22DDD971CA419082F4F5D148B7C4CC"><enum>(3)</enum><text>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).</text>
</paragraph><paragraph id="HFCE587E10CAD463E94A367E8B660300"><enum>(4)</enum><text>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.</text>
</paragraph><paragraph id="H7EFAD451811B4F538093028B18C12E44"><enum>(5)</enum><text>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.</text>
</paragraph><paragraph id="HE99DB2B465BA431AB8EE136E4477B81F"><enum>(6)</enum><text>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 <fraction>1/2</fraction> of 1 percent of the ordinary operating
expense funds allocated in accordance with section 531(a).</text>
</paragraph><paragraph id="H7313C63F94B047838E55C6A525A7F119"><enum>(7)</enum><text>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
<fraction>1/2</fraction> of 1 percent of the ordinary operating expense funds
allocated in such year in accordance with section 531(a).</text>
</paragraph><paragraph id="H88A3A40951E04B978CBE76DAFC812F99"><enum>(8)</enum><text>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.</text>
</paragraph></subsection></section><section id="H48CFE54BFAB3444E906C738B5CBD7EAF"><enum>533.</enum><header>Distribution of
funds</header>
<subsection id="HCA7CA02EB24747BEAAC700AD14F5917D"><enum>(a)</enum><header>In
general</header><text>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.</text>
</subsection><subsection id="HC05BCBF9C835407AB4002650F69B2065"><enum>(b)</enum><header>Payments and
expenditures</header><text>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.</text>
</subsection><subsection id="H5102C9F294BD4A9DAE00FB20B609B0C2"><enum>(c)</enum><header>Accounts</header><text>The
National Health Board shall maintain separate accounts for—</text>
<paragraph id="HE9F5B8D2E60C49C8BF8EDC5F0CA43D8"><enum>(1)</enum><text>funds for operating
expenses, including ordinary operating expenses and special operating
expenses;</text>
</paragraph><paragraph id="HB9D77161982F498195CAA4C71E78EDF"><enum>(2)</enum><text>funds for
preventive health measures;</text>
</paragraph><paragraph id="H3D1522AB4E1B41F3ABD45981417B56DD"><enum>(3)</enum><text>funds for capital
expenses; and</text>
</paragraph><paragraph id="HB96721B4742747A4926F2C8484D9B2D"><enum>(4)</enum><text>funds for research
expenses.</text>
</paragraph><continuation-text continuation-text-level="subsection">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.</continuation-text></subsection><subsection id="H007511985D264966960006267EC99481"><enum>(d)</enum><header>Payment
frequency</header><text>Service providers under this Act shall be paid at such
time or times as the National Health Board finds appropriate.</text>
</subsection><subsection id="H000A53EE7B8C422FBABB6E557D79B0C5"><enum>(e)</enum><header>Allocation of
supplementary payments</header><text>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.</text>
</subsection><subsection id="H1A9831062E2E4A33A858BA6086BFE2A8"><enum>(f)</enum><header>Use of
funds</header><text>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.</text>
</subsection></section><section id="H19C6FE03A0E34F6592EEA953857524"><enum>534.</enum><header>Annual statement,
records, and audits</header>
<subsection id="HE38C3E4123A04CC48E2265D2659473C6"><enum>(a)</enum><header>Annual
statement</header><text>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.</text>
</subsection><subsection id="HB534FB7796014C5B87EAD218F7988F22"><enum>(b)</enum><header>Recordkeeping</header><text>Each
Service provider shall keep such records as determined to be necessary for the
purposes of this Act, including for the facilitation of audits.</text>
</subsection><subsection id="HABC642F340394632BFCE1E202687929B"><enum>(c)</enum><header>Audits</header><text>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.</text>
</subsection></section></subtitle><subtitle id="HA2DBFAF9F1C246C484DE6E84058F40F2"><enum>E</enum><header>General
provisions</header>
<section id="H97DD8D79C25646FE005BC54CCBA6ADDE"><enum>541.</enum><header>Issuance of
obligations</header>
<subsection id="HE5C2519163CF43A49E982F0914EE9FD7"><enum>(a)</enum><header>Borrowing
authority</header><text>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.</text>
</subsection><subsection id="H3F02FE992BD14BA4936524EBA8798182"><enum>(b)</enum><header>Pledging of
assets</header><text>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.</text>
</subsection><subsection id="HE297B91D53D041C390E8802D7BD9A7D1"><enum>(c)</enum><header>Form of
obligations</header><text>Obligations issued by the Service under this
section—</text>
<paragraph id="H8B802BC825144B7A91BBA3E5B3B66004"><enum>(1)</enum><text>shall be in such
forms and denominations;</text>
</paragraph><paragraph id="HA0C0C78E3FE64A708B4BBC481CB50003"><enum>(2)</enum><text>shall be sold at
such times and in such amounts;</text>
</paragraph><paragraph id="H956AB3A47D2541B597C6A0422474A890"><enum>(3)</enum><text>shall mature at
such time or times;</text>
</paragraph><paragraph id="H56032BC6BB754B5FAE7366DB203EC1"><enum>(4)</enum><text>shall be sold at
such prices;</text>
</paragraph><paragraph id="HEA25F8294EAC41A2A94D92005538B85D"><enum>(5)</enum><text>shall bear such
rates of interest;</text>
</paragraph><paragraph id="H820BF4A6D92B4392BD3D464D2815BEDE"><enum>(6)</enum><text>may be redeemable
before maturity in such manner, at such times, and at such redemption
premiums;</text>
</paragraph><paragraph id="HB4444ABCDA7F449F99A4738BA6DFF8CA"><enum>(7)</enum><text>may be entitled to
such relative priorities of claim on the assets of the Service with respect to
principal and interest payments; and</text>
</paragraph><paragraph id="H85460BA6116544CDBDC02C24BADF1194"><enum>(8)</enum><text>shall be subject
to other terms and conditions, as the National Health Board determines.</text>
</paragraph></subsection><subsection id="H6818B610F184463A0027B372F46BA68"><enum>(d)</enum><header>Character of
obligations</header><text>Obligations issued by the Service under this section
shall—</text>
<paragraph id="H0B57753B29D5420393F380BC1F614760"><enum>(1)</enum><text>be negotiable or
nonnegotiable and bearer or registered instruments, as specified therein and in
any indenture or covenant relating thereto;</text>
</paragraph><paragraph id="H99FB25F835424000A01FE68800D7AD38"><enum>(2)</enum><text>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;</text>
</paragraph><paragraph id="H479D3FAC7BF1464CAE708E28A5EBB200"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph id="HA2EDF98882F9416A824BBE11DAC868CB"><enum>(4)</enum><text>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</text>
</paragraph><paragraph id="HAD821A911C91463BB8EE00B00CD2030"><enum>(5)</enum><text>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).</text>
</paragraph></subsection><subsection id="HA06D21769B6E4536B4E5DBB22794533"><enum>(e)</enum><header>Consultation with
Treasury</header><text>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.</text>
</subsection><subsection id="HA08132C0C8424168A0C28D9C025F05E4"><enum>(f)</enum><header>Purchase of
obligations</header><text>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.</text>
</subsection><subsection id="HCFF709DA67434AFBAAB582C491A8A75D"><enum>(g)</enum><header>Full faith and
credit</header><text>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—</text>
<paragraph id="H6C6F80C42B1A4711AF548ED81187E127"><enum>(1)</enum><text>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</text>
</paragraph><paragraph id="H7D05747DB8DD4716AE291F5529C1B8FC"><enum>(2)</enum><text>the Secretary, in
his discretion, determines that it would be in the public interest to do
so.</text>
</paragraph></subsection><subsection id="H2E8A6DAAF95644FAA8A6A762BEDE39C0"><enum>(h)</enum><header>Public debt
transaction</header><text>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.</text>
</subsection></section><section id="H9F325B4762784CD3A83FB75ECFAC53A5"><enum>542.</enum><header>Definitions</header><text display-inline="no-display-inline">For purposes of this title:</text>
<paragraph id="H8C542DD671114DAFAF3B665BD1C21C67"><enum>(1)</enum><header>Operating
expenses</header><text>The term <term>operating expenses</term> 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.</text>
</paragraph><paragraph id="H9E1A1CA47717457AB54B42AF048800D6"><enum>(2)</enum><header>Capital
expenses</header><text>The term <term>capital expenses</term> 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.</text>
</paragraph></section></subtitle><enum>VI</enum><header>Miscellaneous
provisions</header>
<section id="H7D97384ACD9A4B409598E2D411ACFB12"><enum>601.</enum><header>Effective date
of Health Services</header><text display-inline="no-display-inline">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.</text>
</section><section id="H7975085C9339414FA7B02029D689B2F"><enum>602.</enum><header>Repeal of
provisions</header>
<subsection id="HDF370681EBCF43E7BC99AF801D2CE08B"><enum>(a)</enum><header>In
general</header><text>Effective on the effective date of health services, the
following provisions of law are repealed:</text>
<paragraph id="H78ACE1EEF0234E9685B6616F14A48F33"><enum>(1)</enum><text>The
<act-name parsable-cite="PHSA">Public Health Service Act</act-name>, except
for—</text>
<subparagraph id="HD1A6F6963EBE4F08963EC5CB91005231"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph id="H92316769F0CE4E42B61199DC0ACDAAF"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph id="H2BEF028BAEB943F0AE347590DE483C74"><enum>(2)</enum><text>Titles V, XVIII,
XIX, and XXI of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (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.</text>
</paragraph><paragraph id="HD1821157D57449A2BE477F9FC100DD32"><enum>(3)</enum><text>Chapter 89 of
title 5, United States Code (relating to health insurance for Federal
employees).</text>
</paragraph><paragraph id="HC9C84FC820DE4470ABC14D332EAB00E0"><enum>(4)</enum><text>Chapters 17, 73,
and 81 and <external-xref legal-doc="usc" parsable-cite="usc/38/1506">section 1506</external-xref> of title 38, United States Code (relating to medical
benefits and programs relating to veterans).</text>
</paragraph><paragraph id="HBC1957986A3E42268829924DBCBE4F77"><enum>(5)</enum><text>Sections 1079
through 1083 and <external-xref legal-doc="usc" parsable-cite="usc/10/1086">section 1086</external-xref> of title 10, United States Code (relating to the
civilian health and medical program of the uniformed services).</text>
</paragraph><paragraph id="H2A4D9C32325748CC842CD8D5F918EBC"><enum>(6)</enum><text>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
<act-name parsable-cite="CDAPCA70">Comprehensive Drug Abuse Prevention and
Control Act of 1970</act-name> (relating to medical treatment of narcotic
addiction).</text>
</paragraph><paragraph id="H4250FCC8666E49AE9CFA56F0D4D9D4F2"><enum>(7)</enum><text>Public Law 83–568
(<external-xref legal-doc="usc" parsable-cite="usc/42/2001">42 U.S.C. 2001–2004b</external-xref>) (relating to hospital and other health facilities for
Indians) and <external-xref legal-doc="public-law" parsable-cite="pl/85/151">Public Law 85–151</external-xref> (<external-xref legal-doc="usc" parsable-cite="usc/42/2005-2005f">42 U.S.C. 2005–2005f</external-xref>) (relating to community
hospitals for Indians).</text>
</paragraph><paragraph id="H1FCE8E3B6CDC46ED8D24A49234BE7483"><enum>(8)</enum><text>The District of
Columbia Medical Facilities Construction Act of 1968 and the District of
Columbia Medical and Dental Manpower Act of 1970.</text>
</paragraph><paragraph id="HBC61A3A6F4A4472BB01DADCAE959C52E"><enum>(9)</enum><text>Sections 232 and
242 and title XI of the <act-name parsable-cite="NHA">National Housing
Act</act-name> (relating to mortgage insurance for nursing homes, hospitals,
and group practice facilities).</text>
</paragraph><paragraph id="HF51F9A03E6734F66992859C4F7C626FF"><enum>(10)</enum><text>The Mental
Retardation Facilities and Community Mental Health Centers Construction Act of
1963.</text>
</paragraph><paragraph id="HC0037F920E2B46A8B2F3FBA872836299"><enum>(11)</enum><text>The Family
Planning Services and Population Research Act of 1970.</text>
</paragraph><paragraph id="HCE8E33FE9C62452EBDBDDF00016016DC"><enum>(12)</enum><text>The National
Arthritis Act of 1974 and the National Diabetes Mellitus Research and Education
Act.</text>
</paragraph><paragraph id="H6D4A8CECF1C6452C99F15E837B72D94"><enum>(13)</enum><text>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).</text>
</paragraph><paragraph id="H230B1F6E76074CA2A94C6D959BF1CC94"><enum>(14)</enum><text>The Act of March
2, 1897 (<external-xref legal-doc="usc" parsable-cite="usc/21/41">21 U.S.C. 41–50</external-xref>) (relating to tea importation).</text>
</paragraph><paragraph id="HBD7B7656656245FFAE1FC5B100486C76"><enum>(15)</enum><text>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).</text>
</paragraph></subsection><subsection id="HC2FC03C865EA49B1B43EFE44F8A6E437"><enum>(b)</enum><header>Preparation of
additional list</header>
<paragraph id="H48A334ABB1884A27BCB1111DEA1B50"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph id="H92478F1D8B3B4519A5FE911D7918C9BA"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph id="H5ECA506C9254430F96EB4F335653064B"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph id="H76818F1C286D42B3A7B51D4D3576A96D"><enum>(2)</enum><header>Transfer
authority</header><text>Such legislation shall include the transfers of such
authority of the Secretary of Health and Human Services under the provisions
of—</text>
<subparagraph id="H832F130D9800458B80BB3D0095D2AD64"><enum>(A)</enum><text>the
<act-name parsable-cite="CSA">Controlled Substances Act</act-name>;</text>
</subparagraph><subparagraph id="H69CE0BF82FA4425E84063E1CBBDDC9BC"><enum>(B)</enum><text>chapter 175 of
title 28, United States Code (relating to civil commitment and rehabilitation
of narcotics addicts);</text>
</subparagraph><subparagraph id="H38EF41B1BC0A468383E02C294920A0E9"><enum>(C)</enum><text>chapter 314 of
title 18, United States Code (relating to sentencing of narcotic addicts to
commitment for treatment);</text>
</subparagraph><subparagraph id="H64D7A8EA32C34867AA3686D148BBB9B0"><enum>(D)</enum><text>the Narcotic
Addict Rehabilitation Act of 1966;</text>
</subparagraph><subparagraph id="H5642862F4CB746E0A77EC3D3FA101394"><enum>(E)</enum><text>the Drug Abuse
Office and Treatment Act of 1972;</text>
</subparagraph><subparagraph id="H951A8A7765EA4E28B7C17E1F061EB403"><enum>(F)</enum><text>the Occupational
Safety and Health Act of 1970;</text>
</subparagraph><subparagraph id="H30B2537C5D934A1A893DEAB2E3C9EEBF"><enum>(G)</enum><text>the Lead-Based
Paint Poisoning Prevention Act;</text>
</subparagraph><subparagraph id="HCF99C84C0FC54F00977FF81333C42E59"><enum>(H)</enum><text>the Federal
Cigarette Labeling and Advertising Act;</text>
</subparagraph><subparagraph id="HA47B9705B42D4AC9BBCFE85D3106A412"><enum>(I)</enum><text>the
<act-name parsable-cite="FFDCA">Federal Food, Drug, and Cosmetic
Act</act-name>;</text>
</subparagraph><subparagraph id="H6CFF92DDFA6A4AE782382580A25E13D1"><enum>(J)</enum><text>the Fair Packaging
and Labeling Act;</text>
</subparagraph><subparagraph id="H16C9E0BE8F064B94B30024F50004925E"><enum>(K)</enum><text>the Act of March
4, 1923 (<external-xref legal-doc="usc" parsable-cite="usc/21/61">21 U.S.C. 61–64</external-xref>) (relating to filled milk);</text>
</subparagraph><subparagraph id="H9868BF833F2540C383C69B8FC99C1C85"><enum>(L)</enum><text>the Act of
February 15, 1927 (<external-xref legal-doc="usc" parsable-cite="usc/21/141">21 U.S.C. 141–149</external-xref>) (relating to milk importation);</text>
</subparagraph><subparagraph id="H69A377A09B3E4322BA42CCC0D376F1E"><enum>(M)</enum><text>the Federal Caustic
Poison Act;</text>
</subparagraph><subparagraph id="H15CE7322FE8F4413BA113041A2026E88"><enum>(N)</enum><text>the Federal Coal
Mine Health and Safety Act of 1969 (other than title IV thereof); and</text>
</subparagraph><subparagraph id="H1D42DEB1A88548B9BEB100B596C444C6"><enum>(O)</enum><text>the
<act-name parsable-cite="SWDA">Solid Waste Disposal Act</act-name>,</text>
</subparagraph><continuation-text continuation-text-level="paragraph">to the
Service as the President determines, after consultation with the National
Health Board, to be appropriate.</continuation-text></paragraph></subsection><subsection id="H588067730AAD4E508D68EA04E7803F91"><enum>(c)</enum><header>Review of
programs</header>
<paragraph id="H5AC1B45FB7494F4BBEDEC387DE5D7F33"><enum>(1)</enum><header>In
general</header><text>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
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> and the
other Acts described in subsection (a) and shall determine how the Service
shall carry out the purposes of such programs.</text>
</paragraph><paragraph id="H147712E19F3B472A88FAAC5D5C00382C"><enum>(2)</enum><header>Initial
report</header><text>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).</text>
</paragraph><paragraph id="H9CE78E95BE324B0DA60848AFB9C0836"><enum>(3)</enum><header>Later
report</header><text>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).</text>
</paragraph></subsection><subsection id="H7E0E808E38CB4004904DEB7CC66870ED"><enum>(d)</enum><header>Codification
proposal</header><text>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.</text>
</subsection></section><section id="HC41AFF2EA89246EAB9187284BD4ED061"><enum>603.</enum><header>Transition
provisions</header>
<subsection id="H58E8E68AC3D24EC389F1CB69959CE4A2"><enum>(a)</enum><header>Transfer of
appropriations</header><text>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).</text>
</subsection><subsection id="HE943B2CFFA1B44C79B24BD4090CCFB11"><enum>(b)</enum><header>Transfer of
personnel, assets, etc</header><text>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.</text>
</subsection><subsection id="HDC973694F89D403E9D3CD4EF9019BA"><enum>(c)</enum><header>Lapses of
offices</header><text>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.</text>
</subsection><subsection id="H771EA3D54AEE4B3F8544B78D1547585C"><enum>(d)</enum><header>Application of
amendments</header><text>The amendments made by section 602—</text>
<paragraph id="H36E8DC009AA94691B19D957EDAF383B"><enum>(1)</enum><text>shall not apply
with respect to any contract entered into before the effective date of such
amendments, and</text>
</paragraph><paragraph id="HBB587E90155A4968B0A4AFBD849F2076"><enum>(2)</enum><text>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.</text>
</paragraph></subsection></section><section id="HE9C13CEB8CAA4A47BC52C486965955EF"><enum>604.</enum><header>Amendment to
Budget and Accounting Act</header>
<subsection id="HA22E7DF908144A04AA5C7EFCA785FDF"><enum>(a)</enum><header>Health Service
Budget</header><text>Subsection (h) of <external-xref legal-doc="usc" parsable-cite="usc/31/1105">section 1105</external-xref> of title 31, United States
Code, is amended to read as follows:</text>
<quoted-block id="H95E180DC1DAC453CB97BDA46CD571E77">
<subsection id="H63DC76C3CD4B4DF885E8769436039B09"><enum>(h)</enum><text>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 <short-title>Josephine Butler United States Health Service
Act</short-title>) separately from such items with respect to expenditures and
appropriations relating to other operations of the
Government.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HD28BE6B246534D14B18C49132C558BDC"><enum>(b)</enum><header>Effective
date</header><text>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.</text>
</subsection></section><section id="H2D0EF47AB5684A1483C6C600EE7149CA"><enum>605.</enum><header>Separability</header><text display-inline="no-display-inline">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.</text>
</section>