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H.R. 1691 (103rd): National Health Security Act of 1993

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The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress.


4/5/1993--Introduced. TABLE OF CONTENTS: Title I: Eligibility and Enrollment Title II: Benefits Subtitle A: Health Care Services Subtitle B: Long-Term Care Services Subtitle C: Modification of Services Title III: Federal and State Administration Subtitle A: Federal Administration Subtitle B: State Administration Title IV: Financing Subtitle A: Health Budgets Subtitle B: Payments to Providers Subtitle C: Revenues Title V: Congressional Consideration Title VI: Private Options Title VII: Expansion of Outcomes Research and Delivery of Services in Underserved Areas Title VIII: Malpractice Reform Title IX: Effective Dates; Terminations; Transition; Relation to ERISA National Health Security Act of 1993 - Title I: Eligibility and Enrollment - Entitles every U.S. resident citizen, national, and lawful resident alien to health care services and long-term care services under this Act. Requires each State program to provide for a mechanism for enrollment and issuance of an identification and processing card. Provides for portability, including mandating use of a uniform claims form. Title II: Benefits - Subtitle A: Health Care Services - Includes as covered services: (1) inpatient and outpatient hospital care; (2) diagnostic and screening tests; (3) services furnished by health care professionals, including medically necessary dental care; (4) preventive care; (5) prescription drugs, biologicals, and devices; (6) substance abuse services; (7) inpatient and outpatient mental health services; (8) hospice care; (9) habilitation and rehabilitation; (10) home medical equipment and prosthetic devices; and (11) approved experimental treatment. (Sec. 202) Prohibits States from limiting the amount, duration, or scope of services except as provided in this Act. Excludes cosmetic surgery and certain inpatient amenities. (Sec. 203) Requires: (1) the Federal Health Board established by this Act to provide, subject to certain requirements, for copayments and out-of-pocket limits; and (2) the Federal Health Priorities Council established by this Act to study specified issues. Subtitle B: Long-Term Care Services - Requires the Board to: (1) set standards for eligibility, long-term care services coverage, income protection, and case management; and (2) establish an income-related cost sharing schedule. (Sec. 212) Provides for the appointment of a Long-Term Care Services Assessment Commission. Authorizes appropriations. Subtitle C: Modification of Services - Requires annual recommendations by the Priorities Council regarding changes in services under this Act. Title III: Federal and State Administration - Subtitle A: Federal Administration - Establishes the Federal Health Board to administer this Act and take other actions, including establishing national minimum quality standards and uniform reporting requirements, developing a uniform claims form, reviewing and approving interstate consortia minimizing fragmented care, and combating fraud and abuse. (Sec. 302) Requires the Board to appoint the Federal Health Advisory Council. (Sec. 303) Establishes the Federal Health Priorities Council to conduct hearings and studies and make recommendations on how health care dollars should be allocated in the context of a publicly funded national health insurance plan. (Sec. 304) Authorizes appropriations. Subtitle B: State Administration - Provides for Board review and approval of State programs. Includes in requirements for State programs: (1) financing of services through a designated fund; (2) designation of a single nonprofit State agency to administer the program; (3) establishment of boards to negotiate with hospitals and practitioners; and (4) freedom of individuals to choose providers. (Sec. 312) Allows States to contract with fiscal intermediaries, in a process of competitive bidding, to administer the State program. (Sec. 313) Provides for waivers for States to: (1) implement alternative and innovative provider reimbursement, cost sharing, and administration; and (2) provide services through a capitation method. (Sec. 314) Allows any group of States to establish a regional consortium in lieu of State programs. Provides for congressional disapproval of the consortium agreement. (Sec. 315) Mandates grants to: (1) cooperative agreements with States for programs, research, and treatment relating to environmental health and health promotion and disease prevention; and (2) States or regional consortia for the establishment and initial operation of the State or regional plan. Authorizes appropriations. Title IV: Financing - Subtitle A: Health Budgets - Requires the Board to establish an annual or biennial budget for Federal and State expenditures under this Act. Entitles each State with an approved State program to a Federal contribution of the Federal share plus that State's total projected expenditures for services under this Act. (Sec. 403) Prohibits a State from restricting timely access to medically necessary and appropriate services under this Act or permitting queues to form that have the potential to be life threatening. Subtitle B: Payments to Providers - Provides for State payments to hospitals and other health care and long-term care institutions for the areas of operating, capital, and health training expenses. (Sec. 412) Requires the State practitioner reimbursement negotiation board to negotiate with the State organizations representing each of the practitioner disciplines to derive a relative value scale fee schedule fulfilling specified principles. Subtitle C: Revenues - Requires the Board: (1) to develop a mechanism for determining and collecting a premium from individuals and employers; and (2) subject to congressional disapproval, to collect premiums from individuals and employers according to certain requirements. (Sec. 422) Amends the Internal Revenue Code to define "accident or health insurance," for purposes of provisions relating to exclusions from gross income, to mean an approved State program under this Act. Removes provisions relating to amounts paid to highly compensated individuals under a discriminatory self-insured medical expense reimbursement plan. (Sec. 423) Establishes in the Treasury the Federal Health Care Trust Fund. (Sec. 424) Makes each State responsible for establishing a financing program for the implementation of the State program. Title V: Congressional Consideration - Sets forth rules, changeable as any other rule of the House of Representatives or the Senate, regarding congressional disapproval resolutions under this Act. Title VI: Private Options - Declares that this Act does not prohibit private insurance coverage supplementing the services covered under this Act. (Sec. 602) Allows private insurance coverage for services covered under this Act, subject to specified limitations. (Sec. 603) Declares that the purchase of any private insurance does not relieve the purchaser of the payment of premiums under this Act. Title VII: Expansion of Outcomes Research and Delivery of Services in Underserved Areas - Amends: (1) the Social Security Act to authorize appropriations for health care outcomes research; and (2) the Public Health Service Act to authorize grants to local communities to finance health-related education of residents, provided such residents agree to practice in a health-related field in that community for at least four years after graduation, and to authorize appropriations for the National Health Service Corps. (Sec. 703) Mandates grants to expand the availability of comprehensive primary health services in medically underserved areas. Title VIII: Malpractice Reform - Requires the Board to make grants to States for the development and implementation of medical malpractice reforms meeting specified criteria. Authorizes appropriations. Title IX: Effective Dates; Terminations; Transition; Relation to ERISA - Repeals: (1) titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act; (2) provisions of the Internal Revenue Code relating to hospital insurance; and (3) specified provisions of Federal law relating to the Civilian Health and Medical Program of the Uniformed Services and to health benefits for Federal officials and employees. (Sec. 903) Requires the Board to recommend to the Congress amendment or repeal of any other Federal program inconsistent with or duplicative of the principles of this Act.