[Congressional Record Volume 141, Number 1 (Wednesday, January 4, 1995)]
[Extensions of Remarks]
[Pages E5-E8]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


   COMPREHENSIVE PREVENTIVE HEALTH AND PROMOTION ACT OF 1995, H.R. 23

                                 ______


                        HON. BENJAMIN A. GILMAN

                              of new york

                    in the house of representatives

                       Wednesday, January 4, 1995
  Mr. GILMAN. Mr. Speaker, I rise today to introduce H.R. 23, 
legislation which will help produce a healthier nation. This measure 
will cover individuals for periodic health exams, as well as counseling 
and immunizations.
  The Comprehensive Preventive Health and Promotion Act of 1995 will 
direct the Secretary of Health and Human Services [HHS] to establish a 
schedule of preventive health care services and to provide for coverage 
of these services under private health insurance plans and health 
benefit programs of the Federal Government.
  More specifically, the Secretary of HHS, in consultation with 
representatives of the major health care groups, will establish a 
schedule of recommended preventive health care services. The list of 
preventive services will follow the guidelines published in the ``Guide 
to Clinical Preventive Services'' and the ``Year 2000 Health 
Objectives.'' The preventive services will cover periodic health exams, 
health screening, counseling, immunizations, and health promotion. 
These services will be specified for males and females, and specific 
age groups.
  Additionally, HHS will publish and disseminate information on the 
benefits of practicing preventive health care, the importance of 
undergoing periodic health examinations, and the need to establish and 
maintain a family medical history to businesses, providers of health 
care services, and other appropriate groups and individuals.
  Moreover, prevention and health promotion workshops will be 
established for corporations and businesses, as well as for the Federal 
Government. A wellness program will be established to make grants over 
a 5-year period to 300 eligible employers to establish and conduct on-
site workshops on health care promotion for employees. The wellness 
workshops can include: Counseling on nutrition and weight management, 
clinical sessions on avoiding back injury, programs on smoking 
cessation, and information on stress management.
  Finally, my legislation directs HHS to set up a demonstration project 
which will go to 50 counties over a 5-year period to provide preventive 
health care services at health clinics. This program will cover 
preventive health care services for all children, and adults under a 
certain income level. If above the determined income level, fees will 
be based on a sliding scale. Additionally, the project will entail both 
urban and rural areas in different regions of our Nation to educate the 
public on the benefits of practicing preventive health care, the need 
for periodic health exams, and the need for establishing a medical 
history, as well as providing services.
  Mr. Speaker, we can all agree that our current health care system 
needs to be improved, and our Nation needs to become healthier. Experts 
have concluded that practicing pre- 
[[Page E6]] ventive health care does work, and will produce a healthier 
nation. Although there is a consensus on the benefits of practicing 
preventive health care, only approximately 20 percent of health 
insurance companies offer coverage for periodic health exams.
  The Comprehensive Preventive Health and Promotion Act of 1995 has all 
the necessary ingredients that will be needed in a national health care 
plan, and will be applicable to that plan.
  Accordingly, to all my colleagues who share my concern regarding the 
importance of producing a healthier nation, I invite and urge you to 
cosponsor this measure, sending a clear message to our Nation's 
citizens that Congress is taking steps to improve our Nation's health 
care system.
  At this point I request that the full text of my bill be inserted in 
the Record for review by my colleagues:

                                H.R. 23
       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Comprehensive Preventive 
     Health and Promotion Act of 1995''.

     SEC. 2. ESTABLISHMENT OF SCHEDULE OF PREVENTIVE HEALTH CARE 
                   SERVICES.

       (a) Initial Schedule.--
       (1) Proposed schedule.--Not later than 6 months after the 
     date of the enactment of this Act, the Secretary of Health 
     and Human Services, in consultation with representatives of 
     individuals described in subsection (d), shall establish a 
     proposed initial schedule of recommended preventive health 
     care services. In accordance with section 553 of title 5, 
     United States Code, the Secretary shall publish such proposed 
     schedule in the Federal Register and provide for a 90-day 
     period for receiving public comment on the schedule.
       (2) Final schedule.--The proposed schedule of recommended 
     preventive health care services established under paragraph 
     (1) shall become effective for the first calendar year that 
     begins 90 or more days after the expiration of the period for 
     receiving public comment described in paragraph (1).
       (b) Annual Adjustment.--Not later than October 1 of every 
     year (beginning with the first year for which the schedule 
     established under subsection (a) is in effect), the 
     Secretary, in consultation with representatives of 
     individuals described in subsection (d) and in accordance 
     with section 553 of title 5, United States Code, may revise 
     the schedule of preventive health care services established 
     under this section for the following calendar year.
       (c) Use of Sources for Establishing Schedule.--In 
     establishing the initial schedule of recommended preventive 
     health care services under subsection (a) and in revising the 
     schedule for subsequent years under subsection (b), the 
     Secretary shall take into consideration the recommendations 
     for preventive health care services contained in the Guide to 
     Clinical Preventive Services presented to the Department of 
     Health and Human Services by the United States Preventive 
     Services Task Force and the Year 2000 Health Objectives of 
     the United States Public Health Service.
       (d) Individuals Serving as Consultants.--The individuals 
     described in this subsection are as follows:
       (1) Hospital administrators.
       (2) Administrators of health benefit plans.
       (3) General practice physicians.
       (4) Mental health practitioners.
       (5) Pediatricians.
       (6) Chiropractors.
       (7) Physicians practicing in medical specialty areas.
       (8) Nutritionists.
       (9) Nurses.
       (10) Experts in scientific research.
       (11) Dentists.
       (12) Representatives of manufacturers of prescription 
     drugs.
       (13) Health educators.

     SEC. 3. APPLICATION TO INDIVIDUALS ENROLLED IN PRIVATE HEALTH 
                   INSURANCE PLANS.

       (a) Requirement for Carriers and Plans.--
       (1) In general.--Each carrier and employer health benefit 
     plan shall include in the services covered for each 
     individual enrolled with the carrier or plan the preventive 
     health care services applicable to the individual under the 
     schedule of preventive health care services established under 
     section 2.
       (2) Definitions.--In this section:
       (A) The term ``carrier'' means any entity which provides 
     health insurance or health benefits in a State, and includes 
     a licensed insurance company, a prepaid hospital or medical 
     service plan, a health maintenance organization, the plan 
     sponsor of a multiple employer welfare arrangement or an 
     employee benefit plan (as defined under the Employee 
     Retirement Income Security Act of 1974), or any other entity 
     providing a plan of health insurance subject to State 
     insurance regulation, but such term does not include for 
     purposes of section 103 an entity that provides health 
     insurance or health benefits under a multiple employer 
     welfare arrangement.
       (B)(i) Subject to clause (ii), the term ``employer health 
     benefit plan'' means a health benefit plan (including an 
     employee welfare benefit plan, as defined in section 3(1) of 
     the Employee Retirement Income Security Act of 1974) which is 
     offered to employees through an employer and for which the 
     employer provides for any contribution to such plan or any 
     premium for such plan are deducted by the employer from 
     compensation to the employee.
       (ii) A State may provide (for a plan in a State) that the 
     term ``employer health benefit plan'' does not include an 
     association plan (as defined in clause (iii)).
       (iii) For purposes of clause (ii), the term ``association 
     plan'' means a health benefit plan offered by an organization 
     to its members if the organization was formed other than for 
     purposes of purchasing insurance.
       (C) The term ``full-time employee'' means, with respect to 
     an employer, an individual who normally is employed for at 
     least 30 hours per week by the employer.
       (D) The term ``health benefit plan'' means any hospital or 
     medical expense incurred policy or certificate, hospital or 
     medical service plan contract, or health maintenance 
     subscriber contract, or a multiple employer welfare 
     arrangement or employee benefit plan (as defined under the 
     Employee Retirement Income Security Act of 1974) which 
     provides benefits with respect to health care services, but 
     does not include--
       (i) coverage only for accident, dental, vision, disability 
     income, or long-term care insurance, or any combination 
     thereof,
       (ii) medicare supplemental health insurance,
       (iii) coverage issued as a supplement to liability 
     insurance,
       (iv) worker's compensation or similar insurance, or
       (v) automobile medical-payment insurance,
        or any combination thereof.
       (E) The term ``small employer carrier'' means a carrier 
     with respect to the issuance of an employer health benefit 
     plan which provides coverage to one or more full-time 
     employees of an entity actively engaged in business which, on 
     at least 50 percent of its working days during the preceding 
     year, employed at least 2, but fewer than 36, full-time 
     employees. For purposes of determining if an employer is a 
     small employer, rules similar to the rules of subsection (b) 
     and (c) of section 414 of the Internal Revenue Code of 1986 
     shall apply.
       (b) Enforcement Through Excise Tax.--
       (1) In general.--Chapter 43 of the Internal Revenue Code of 
     1986 (relating to qualified pension, etc., plans) is amended 
     by adding at the end thereof the following new section:

     ``SEC. 4980C. FAILURE TO COMPLY WITH EMPLOYER HEALTH BENEFIT 
                   PLAN STANDARDS REGARDING PREVENTIVE HEALTH 
                   CARE.

       ``(a) Imposition of Tax.--
       ``(1) In general.--There is hereby imposed a tax on the 
     failure of a carrier or an employer health benefit plan to 
     comply with section 3(a)(1) of the Comprehensive Preventive 
     Health and Promotion Act of 199.
       ``(2) Exception.--Paragraph (1) shall not apply to a 
     failure by a small employer carrier or plan in a State if the 
     Secretary of Health and Human Services determines that the 
     State has in effect a regulatory enforcement mechanism that 
     provides adequate sanctions with respect to such a failure by 
     such a carrier or of such a plan.
       ``(b) Amount of Tax.--
       ``(1) In general.--Subject to paragraph (2), the tax 
     imposed by subsection (a) shall be an amount not to exceed 25 
     percent of the amounts received by the carrier or under the 
     plan for coverage during the period such failure persists.
       ``(2) Limitation in case of individual failures.--In the 
     case of a failure that only relates to specified individuals 
     or employers (and not to the plan generally), the amount of 
     the tax imposed by subsection (a) shall not exceed the 
     aggregate of $100 for each day during which such failure 
     persists for each individual to which such failure persists 
     for each individual to which such failure relates. A rule 
     similar to the rule of section 4980B(b)(3) shall apply for 
     purposes of this section.
       ``(c) Liability for Tax.--The tax imposed by this section 
     shall be paid by the carrier.
       ``(d) Exceptions.--
       ``(1) Corrections within 30 days.--No tax shall be imposed 
     by subsection (a) by reason of any failure if--
       ``(A) such failure was due to reasonable cause and not to 
     willful neglect, and
       ``(B) such failure is corrected within the 30-day period 
     beginning on earliest date the carrier knew, or exercising 
     reasonable diligence would have known, that such failure 
     existed.
       ``(2) Waiver by secretary.--In the case of a failure which 
     is due to reasonable cause and not to willful neglect, the 
     Secretary may waive part or all of the tax imposed by 
     subsection (a) to the extent that payment of such tax would 
     be excessive relative to the failure involved.
       ``(2) Definitions.--For purposes of this section, the terms 
     `carrier', `employer health benefit plan', and `small 
     employer carrier' have the respective meanings given such 
     terms in section 3(a)(2) of the Comprehensive Preventive 
     Health and Promotion Act of 1995.''
       (2) Clerical amendment.--The table of sections for chapter 
     43 of such Code is amended by adding at the end thereof the 
     following new items:

``Sec. 4980C. Failure to comply with employer health plan standards 
              regarding preventive health care.''.

       (3) Effective date.--The amendments made by this subsection 
     shall apply to plan years beginning after December 31, 1995.
     [[Page E7]] SEC. 4. COVERAGE OF PREVENTIVE HEALTH CARE 
                   SERVICES UNDER MEDICARE.

       (a) In General.--Section 1861(s)(2) of the Social Security 
     Act (42 U.S.C. 1395x(s)(2)) is amended--
       (1) by striking ``and'' at the end of subparagraph (O);
       (2) by striking the semicolon at the end of subparagraph 
     (P) and inserting ``; and''; and
       (3) by adding at the end the following new subparagraph:
       ``(Q) in the case of an individual, services applicable to 
     the individual under the schedule of preventive health care 
     services established under the Comprehensive Preventive 
     Health and Promotion Act of 1995 (to the extent such services 
     are not otherwise covered with respect to the individual 
     under this title);''.
       (b) Conforming Amendments.--Section 1862(a) of such Act (42 
     U.S.C. 1395y(a)) is amended--
       (1) in paragraph (1)--
       (A) in subparagraph (E), by striking ``and'' at the end,
       (B) in subparagraph (F), by striking the semicolon at the 
     end and inserting ``, and'', and
       (C) by adding at the end the following new subparagraph:
       ``(G) in the case of items or services described in section 
     1861(s)(2)(Q), which are not provided in accordance with the 
     schedule of preventive health care services established under 
     the Comprehensive Preventive Health and Promotion Act of 
     1995;''; and
       (2) in paragraph (7), by striking ``paragraph (1)(B) or 
     under paragraph (1)(F)'' and inserting ``subparagraphs (B), 
     (F), or (G) of paragraph (1)''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to services furnished on or after January 1, 
     1995.

     SEC. 5. COVERAGE UNDER STATE MEDICAID PLANS.

       (a) In General.--
       (1) Inclusion in medical assistance.--Section 1905(a) of 
     the Social Security Act (42 U.S.C. 1396d(a)) is amended--
       (A) by striking ``and'' at the end of paragraph (21);
       (B) in paragraph (24), by striking the comma at the end and 
     inserting semicolon;
       (C) by redesignating paragraphs (22), (23), and (24) as 
     paragraphs (25), (22), and (23), respectively, and by 
     transferring and inserting paragraph (25) after paragraph 
     (23), as so redesignated; and
       (D) by inserting after paragraph (23) the following new 
     paragraph:
       ``(24) services applicable to the individual under the 
     schedule of preventive health care services established under 
     the Comprehensive Preventive Health and Promotion Act of 1995 
     (to the extent such services are not otherwise covered with 
     respect to the individual under the State plan under this 
     title); and''.
       (2) Coverage made mandatory.--(A) Section 1902(a)(10)(A) of 
     such Act (42 U.S.C. 1396a(a)(10)(A) is amended by striking 
     ``(17) and (21)'' and inserting ``(17), (21), and (24)''.
       (B) Section 1902(a)(10(C)(iv) of such Act (42 U.S.C. 
     1396a(a)(10)(C)(iv)) is amended--
       (i) by striking ``(5) and (17)'' and inserting ``(5), (17), 
     and (24)''; and
       (ii) by striking ``through (21)'' and inserting ``through 
     (24)''.
       (C) Section 1902(j) of such Act (42 U.S.C. 1396a(j)) is 
     amended by striking ``through (22)'' and inserting ``through 
     (24)''.
       (b) Effective Date.--(1) Except as provided in paragraph 
     (2), the amendments made by subsection (a) shall apply to 
     calendar quarters beginning on or after January 1, 1995, 
     without regard to whether or not final regulations to carry 
     out such amendments have been promulgated by such date.
       (2) In the case of a State plan for medical assistance 
     under title XIX of the Social Security Act which the 
     Secretary of Health and Human Services determines requires 
     State legislation (other than legislation appropriating 
     funds) in order for the plan to meet the additional 
     requirements imposed by the amendments made by subsections 
     (a) and (b), the State plan shall not be regarded as failing 
     to comply with the requirements of such title solely on the 
     basis of its failure to meet these additional requirements 
     before the first day of the first calendar quarter beginning 
     after the close of the first regular session of the State 
     legislature that begins after the date of the enactment of 
     this Act. For purposes of the previous sentence, in the case 
     of a State that has a 2-year legislative session, each year 
     of such session shall be deemed to be a separate regular 
     session of the State legislature.

     SEC. 6. COVERAGE OF PREVENTIVE HEALTH CARE SERVICES FOR 
                   VETERANS.

       (a) In General.--Section 1701(6) of title 38, United States 
     Code is amended--
       (1) by striking ``and'' at the end of subparagraph (A);
       (2) by striking the period at the end of subparagraph (B) 
     and inserting ``; and''; and
       (3) by adding at the end the following new subparagraph:
       ``(C) with respect to any veteran, any preventive care 
     services applicable under the schedule of preventive health 
     care services established under the Comprehensive Preventive 
     Health and Promotion Act of 1995, to the extent such services 
     are not otherwise treated as medical services under this 
     paragraph.''.
       (b) Providing Services in Outpatient Setting.--Section 
     1712(a)(5)(A) of such title is amended--
       (1) in the first sentence, by striking the period at the 
     end and inserting the following: ``, or any other medical 
     services applicable to the veteran under the schedule of 
     preventive health care services established under the 
     Comprehensive Preventive Health and Promotion Act of 1995.''; 
     and
       (2) in the second sentence, by inserting after 
     ``admission'' the following: ``or any services applicable to 
     the veteran under the schedule of preventive health care 
     services established under the Comprehensive Preventive 
     Health and Promotion Act of 1995 (other than services 
     applicable under such schedule that are reasonably necessary 
     in preparation for hospital admission)''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to services furnished on or after January 1, 
     1995.

     SEC. 7. COVERAGE OF PREVENTIVE HEALTH CARE SERVICES UNDER 
                   FEDERAL EMPLOYEES HEALTH BENEFIT PLANS.

       (a) In General.--Paragraphs (1) and (2) of section 8904(a) 
     of title 5, United States Code, are each amended by adding at 
     the end the following new subparagraph:
       ``(G) With respect to an individual, any preventive health 
     care services applicable to the
      individual under the schedule of preventive health care 
     services established under the Comprehensive Preventive 
     Health and Promotion Act of 1995.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply with respect to services furnished on or after 
     January 1, 1995.

     SEC. 8. COVERAGE OF PREVENTIVE HEALTH CARE SERVICES FOR 
                   DEPENDENTS OF MEMBERS OF THE UNIFORMED 
                   SERVICES.

       (a) Preventive Health Care Services Included in Authorized 
     Care.--Section 1077(a) of title 10, United States Code, is 
     amended by adding at the end the following new paragraph:
       ``(13) Any preventive care services applicable under the 
     schedule of preventive health care services established under 
     the Comprehensive Preventive Health and Promotion Act of 
     1995, to the extent such services are not otherwise 
     authorized as health care services under this subsection.''.
       (b) Effective Date.--Paragraph (13) of section 1077(a) of 
     title 10, United States Code (as added by subsection (a)), 
     shall apply with respect to health care services furnished on 
     or after January 1, 1995, to dependents of members or former 
     members of the uniformed services authorized to receive such 
     services.

     SEC. 9. PREVENTIVE HEALTH CARE DEMONSTRATION PROJECT.

       (a) Establishment.--There is hereby established a 
     demonstration project to demonstrate the effectiveness in 
     providing preventive health care services in improving the 
     health of individuals and reducing the aggregate costs of 
     providing health care, under which the Secretary of Health 
     and Human Services shall--
       (1) make grants over a 5-year period to 50 eligible 
     counties to assist the counties in providing preventive 
     health care services (in accordance with subsection (b)) to 
     individuals who would otherwise be unable to pay (or have 
     payment made on their behalf) for such services;
       (2) conduct the study described in subsection (c); and
       (3) carry out the educational program described in 
     subsection (d).
       (b) Grants to Counties.--
       (1) Services described.--A county receiving a grant under 
     subsection (a)(1) shall provide preventive health care 
     services to individuals at clinics in accordance with the 
     schedule of preventive health care services established under 
     the Comprehensive Preventive Health and Promotion Act of 
     1995, except that--
       (A) the county may furnish services to individuals residing 
     in rural areas at locations other than clinics if no clinics 
     that are able to provide such services are located in the 
     area; and
       (B) the Secretary may revise the schedule of services 
     otherwise required to be provided to take into account the 
     special needs of a participating county.
       (2) Eligibility of counties.--A county is eligible to 
     receive a grant under subsection (a)(1) if it submits to the 
     Secretary, at such time and in such form as the Secretary may 
     require, an application containing such information and 
     assurances as the Secretary may require.
       (3) Geographic balance among counties selected.--In 
     selecting counties to receive grants under subsection (a)(1), 
     the Secretary shall consider the need to select counties 
     representing urban, rural, and suburban areas and counties 
     representing various geographic regions of the United States.
       (c) Study of State Preventive Care Requirements.--
       (1) Study.--The Secretary shall conduct a study of the 
     requirements regarding preventive health care services that 
     are imposed by each State on health benefit plans offered to 
     individuals residing in the State.
       (2) Report.--Not later than 1 year after the date of the 
     enactment of this Act, the Secretary shall submit a report to 
     Congress on the study conducted under paragraph (1).
       (d) Dissemination of Information on Preventive Health 
     Care.--Not later than 2 years after the date of the enactment 
     of this Act, the Secretary, in consultation with experts in 
     preventive medicine and representatives of providers of 
     health care services, shall publish and disseminate 
     information on the benefits of practicing preventive health 
     care, the importance of undergoing periodic health 
     examinations, and the need to estab- 
     [[Page E8]] lish and maintain a family medical history to 
     businesses, providers of health care services, and other 
     appropriate groups and individuals.
       (e) State Defined.--In this section, the term ``State'' 
     means each of the 50 States and the District of Columbia.

     SEC. 10. PROGRAMS TO ESTABLISH ON-SITE WORKSHOPS ON HEALTH 
                   PROMOTION.

       (a) Grants to Businesses.--
       (1) In general.--The Secretary of Health and Human Services 
     shall establish a program under which the Secretary shall 
     make grants over a 5-year period to 300 eligible employers to 
     establish and conduct on-site workshops on health care 
     promotion for employees.
       (2) Eligibility.--An employer is eligible to receive a 
     grant under paragraph (1) if the employer submits an 
     application (at such time and in such form as the Secretary 
     may require) containing such information and assurances as 
     the Secretary may require, including assurances that the 
     employer shall use funds received under the grant only to 
     provide services that the employer does not otherwise provide 
     (either directly or through a carrier) to its employees.
       (3) Information and services provided.--On-site workshops 
     on health care promotion conducted with grants received under 
     paragraph (1) shall include the presentation of such 
     information and the provision of such services as the 
     Secretary considers appropriate, including counseling on 
     nutrition and weight management, clinical sessions on 
     avoiding back injury, programs on smoking cessation, and 
     information on stress management.
       (b) Establishment of Programs for Federal Employees.--The 
     Secretary of Labor shall establish a program under which the 
     Secretary shall conduct on-site workshops on health care 
     promotion for employees of the Federal Government, and shall 
     include in such workshops the presentation of such 
     information and the provision of such services as the 
     Secretary (in consultation with the Secretary of Health and 
     Human Services) considers appropriate, including counseling 
     on nutrition and weight management, clinical sessions on 
     avoiding back injury, programs on smoking cessation, and 
     information on stress management.
     

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