H.R. 2071 (104^th): Health Care Improvement Act of 1995

HR 2071 IH

104th CONGRESS

1st Session

H. R. 2071

To promote cost containment and reform in health care.

IN THE HOUSE OF REPRESENTATIVES

July 19, 1995

Mr. PETERSON of Florida (for himself, Mr. MORAN, Mr. DOOLEY, Mr. CLEMENT, Mr. POSHARD, Mr. STENHOLM, Mr. MARTINEZ, Mr. GIBBONS, Mrs. MEEK of Florida, and Mr. COLEMAN) introduced the following bill; which was referred to the Committee on Commerce, and in addition to the Committees on Ways and Means, Economic and Educational Opportunities, and the Judiciary, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

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A BILL

To promote cost containment and reform in health care.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) SHORT TITLE- This Act may be cited as the ‘Health Care Improvement Act of 1995’.

(b) TABLE OF CONTENTS- The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I--ASSURING AVAILABILITY AND CONTINUITY OF HEALTH COVERAGE

Subtitle A--Insurance Reform

Part 1--Guaranteed Access to Health Coverage

Sec. 1001. Guaranteed offer by carriers.

Sec. 1002. Guaranteed issue by carriers.

Sec. 1003. Guaranteed renewal.

Sec. 1004. Restricting preexisting condition exclusions.

Sec. 1005. Enrollment periods.

Part 2--Provision of Benefits

Sec. 1011. Standards for managed care arrangements.

Sec. 1012. Utilization review.

Sec. 1013. Medical savings accounts.

Part 3--Fair Rating Practices

Sec. 1021. Use of fair rating practices.

Sec. 1022. Coordination with premium assistance certificate program.

Sec. 1023. Establishment of risk adjustment mechanisms.

Part 4--Consumer Protections

Sec. 1031. Requirement for provision of information.

Sec. 1032. Prohibition of improper incentives.

Sec. 1033. Written policies and procedures respecting advance directives.

Subtitle B--Benefits

Sec. 1101. Qualified health coverage.

Sec. 1102. Standard coverage.

Sec. 1103. High-deductible coverage.

Sec. 1104. Actuarial valuation of benefits.

Sec. 1105. Limitation on offering supplemental benefits.

Sec. 1106. Family coverage option; supplemental coverage.

Sec. 1107. Level playing field for providers.

Subtitle C--Standards and Certification; Enforcement; Preemption; General Provisions

Sec. 1201. Establishment of standards.

Sec. 1202. Application of standards to carriers through States.

Sec. 1203. Application to group health plans.

Sec. 1204. Enforcement.

Sec. 1205. Limitation on self insurance for small employers.

Subtitle D--Definitions; General Provisions

Sec. 1901. General definitions.

Sec. 1902. Definitions relating to employment.

Sec. 1903. Definitions relating to health coverage, plans, and carriers.

Sec. 1904. Definitions relating to residence and immigration status.

Sec. 1905. Effective dates.

TITLE II--REMOVAL OF FINANCIAL BARRIERS TO ACCESS

Subtitle A--Tax Deductibility for Individuals and Self-Employed

Sec. 2001. Deduction for health insurance costs of self-employed individuals increased and made permanent.

Sec. 2002. Deduction for health insurance costs of individuals who are not self-employed.

Sec. 2003. Restrictions on health benefits provided through cafeteria plans and flexible spending arrangements.

Subtitle B--Premium and Cost-Sharing Subsidy Program and Supplemental Benefits Program for Low-Income Individuals

Sec. 2101. State premium and cost-sharing subsidy programs and supplemental benefits programs.

‘TITLE XXI--STATE ACUTE CARE BENEFITS PROGRAMS FOR LOW-INCOME INDIVIDUALS

‘Part A--State Premium and Cost-Sharing Subsidy Programs

‘Sec. 2101. Establishment of State programs.

‘Sec. 2102. Eligibility.

‘Sec. 2103. Premium and cost-sharing assistance.

‘Sec. 2104. Eligibility determinations.

‘Sec. 2105. End-of-year reconciliation for premium assistance.

‘Sec. 2106. Payments to States.

‘Sec. 2107. Federal title XXI matching percentage.

‘Part B--State Supplemental Acute Care Benefits Programs

‘Sec. 2121. Establishment of State supplemental acute care benefits programs.

‘Sec. 2122. Eligibility.

‘Sec. 2123. Scope and provision of benefits; benefits administration.

‘Sec. 2124. Payments to States.

‘Part C--General Provisions

‘Sec. 2141. Nature of payment obligation.

‘Sec. 2142. Audits.

‘Sec. 2143. Demonstration project authority.

‘Sec. 2144. Definitions and determinations of income.

Sec. 2102. Division of medicaid benefits into core benefits and supplemental benefits for AFDC, SSI, and non-cash beneficiaries; limitation on Federal financial participation for core and supplemental benefits.

Sec. 2103. Operation of program as State plan requirement under medicaid.

Sec. 2104. Application of miscellaneous provisions.

TITLE III--ACCESS IMPROVEMENTS

Subtitle A--Improved Access in Rural Areas

Part 1--Grants to Encourage Community Rural Health Networks

Sec. 3001. Assistance for development of access plans for chronically underserved areas.

Sec. 3002. Technical assistance grants for networks.

Sec. 3003. Development grants for networks.

Sec. 3004. Definitions.

Part 2--Incentives for Health Professionals to Practice in Rural Areas Through the National Health Service Corps Program

Sec. 3011. National Health Service Corps loan repayments excluded from gross income.

Sec. 3012. Modification in criteria for designation as health professional shortage area.

Sec. 3013. Other provisions regarding National Health Service Corps.

Part 3--Assistance for Institutional Providers

Subpart A--Emergency Medical Systems

Sec. 3021. Emergency medical services.

Sec. 3022. Grants to States regarding aircraft for transporting rural victims of medical emergencies.

Subpart B--Demonstration Projects to Encourage Primary Care and Rural-Based Graduate Medical Education

Sec. 3031. State and consortium demonstration projects.

Sec. 3032. Goals for projects.

Sec. 3033. Definitions.

Subpart C--Medicare Demonstration Regarding Consortia of Hospitals

Sec. 3041. Medicare demonstration regarding consortia of hospitals.

Subtitle B--Public Health Grants

Sec. 3101. Grants to States for public health programs.

Sec. 3102. Scholarship and loan repayment programs regarding service in public health positions.

Subtitle C--Academic Health Centers

Sec. 3201. Study of payments for medical education at sites other than hospitals.

Sec. 3202. Study of funding needs of health professions schools.

TITLE IV--MALPRACTICE REFORM

Subtitle A--Findings; Purpose; Definitions

Sec. 4001. Findings; purpose.

Sec. 4002. Definitions.

Subtitle B--Uniform Standards for Malpractice Claims

Sec. 4101. Applicability.

Sec. 4102. Requirement for initial resolution of action through alternative dispute resolution.

Sec. 4103. Procedural requirements for filing of actions.

Sec. 4104. Treatment of noneconomic and punitive damages.

Sec. 4105. Periodic payments for future losses.

Sec. 4106. Uniform statute of limitations.

Sec. 4107. Special provision for certain obstetric services.

Sec. 4108. Uniform standard for determining liability in actions based on negligence.

Sec. 4109. Jurisdiction of Federal courts.

Sec. 4110. Preemption.

Subtitle C--Requirements for State Alternative Dispute Resolution Systems (ADR)

Sec. 4201. Basic requirements.

Sec. 4202. Certification of State systems; applicability of alternative Federal system.

Sec. 4203. Grants to States.

Sec. 4204. Reports on implementation and effectiveness of alternative dispute resolution systems.

Subtitle D--Grants to States for Development of Practice Guidelines

Sec. 4301. Grants to States.

TITLE V--MARKET INCENTIVES TO CONTAINING COSTS

Subtitle A--Administrative Simplification

Sec. 5000. Purpose.

Sec. 5001. Definitions.

Part 1--Standards for Data Elements and Transactions

Sec. 5011. General requirements on Secretary.

Sec. 5012. Standards for data elements of health information.

Sec. 5013. Information transaction standards.

Sec. 5014. Health information network privacy standards.

Sec. 5015. Timetables for adoption of standards.

Part 2--Requirements With Respect to Certain Transactions and Information

Sec. 5021. Standard transactions and information.

Sec. 5022. Accessing health information for authorized purposes.

Sec. 5023. Ensuring availability of information.

Sec. 5024. Timetables for compliance with requirements.

Part 3--Miscellaneous Provisions

Sec. 5031. Standards and certification for health information network services.

Sec. 5032. Imposition of additional requirements.

Sec. 5033. Effect on State law.

Subtitle B--Antitrust

Sec. 5101. Publication of antitrust guidelines on activities of health plans.

Sec. 5102. Issuance of health care certificates of public advantage.

Sec. 5103. Study of impact on competition.

TITLE VI--MEDICARE

Subtitle A--Increased Beneficiary Choice; Improved Program Efficiency

Part 1--Increased Beneficiary Choice

Sec. 6001. Requirements for health maintenance organizations under medicare.

Sec. 6002. Expansion and revision of medicare select policies.

Sec. 6003. Including notice of available health maintenance organizations in annual notice to beneficiaries.

Sec. 6004. Legislative proposal on enrolling medicare beneficiaries in qualified health plans.

Sec. 6005. Optional interim enrollment of medicare beneficiaries in private health plans.

Part 2--Improved Program Efficiency

Sec. 6011. Improved efficiency through consolidation of administration of parts A and B.

Part 3--Notice of Advance Directive Rights

Sec. 6021. Providing notice of rights regarding medical care to individuals entering medicare.

Subtitle B--Savings

Sec. 6101. Reduction in conversion factor for physician fee schedule for non-primary care services.

Sec. 6102. Reduction in hospital outpatient services through establishment of prospective payment system.

Sec. 6103. Increase in medicare part B premium for individuals with high income.

Sec. 6104. Phased-in elimination of medicare hospital disproportionate share adjustment payments.

Sec. 6105. Imposition of coinsurance on laboratory services.

TITLE I--ASSURING AVAILABILITY AND CONTINUITY OF HEALTH COVERAGE

Subtitle A--Insurance Reform

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