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501 records in US in 1993
United States · United States Congress · 9 March 1993
Designates the month of May in 1993 and 1994 as National Trauma Awareness Month.
United States · United States Congress · 9 March 1993
Amends part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services to determine whether individuals entitled to benefits under Medicare part A (Hospital Insurance) qualify for Medicaid payment of their Medicare out-of-pocket expenses.
United States · United States Congress · 9 March 1993
TABLE OF CONTENTS: Title I: All-Payer Fraud and Abuse Program Title II: Revisions to Current Sanctions for Fraud and Abuse Title III: Administrative and Miscellaneous Provisions National Health Care Anti-Fraud and Abuse Act of 1993 - Title I: All-Payer Fraud and Abuse Program - Requires the Secretary of Health and Human Services to establish a national program to control health care fraud and abuse and facilitate Federal, State, and local enforcement of Medicare and Medicaid (titles XVIII and XIX of the Social Security Act (SSA)) fraud and abuse programs. Creates in the Treasury the Anti-Fraud and Abuse Trust Fund. Authorizes appropriations. Amends SSA title XI to provide for the application of sanctions under the Medicare and Medicaid fraud and abuse programs for specified violations to similar violations by any health benefit plan. Requires the Secretary to establish a program through which Medicare beneficiaries may report allegations of fraud by providers under Medicare. Requires the annual notice of benefits mailed to Medicare beneficiaries to contain a description of such programs. Title II: Revisions to Current Sanctions for Fraud and Abuse - Makes revisions in specified current sanctions for fraud and abuse under Medicare and Medicaid and transfers certain of them for application under the new national program created above. Title III: Administrative and Miscellaneous Provisions - Requires providers to submit claims in a uniform claims format according to standards prescribed by the Secretary. Amends SSA title XI part A to direct the Secretary to publish in the Federal Register a listing of all final adverse actions taken during the quarter. Requires the Secretary to study and report to the Congress on electronic reporting of provider ownership information under the new program.
United States · United States Congress · 9 March 1993
Designates the week beginning April 12, 1993, as National Public Safety Telecommunicators Week.
United States · United States Congress · 9 March 1993
Designates November 28 through December 4, 1993, and November 27 through December 3, 1994, as National Home Care Week.
United States · United States Congress · 9 March 1993
Sets forth the rule for the consideration of H.R. 4 (National Institutes of Health programs).
United States · United States Congress · 5 March 1993
Amends title XVIII (Medicare) of the Social Security Act to revise procedures under Medicare part B (Supplementary Medical Insurance) with regard to extra-billing limits, with changes including imposition of sanctions against physicians who fail to refund charges collected in excess of the applicable limiting charge. Requires the Secretary of Health and Human Services' report to the Congress monitoring charges for physician services to include the extent to which actual charges exceed limiting charges. Directs the Secretary to appoint a Medicare Beneficiary Advisory Council to discuss proposed regulations, carrier manual instructions, and other issues with an impact on Medicare services.
United States · United States Congress · 5 March 1993
Amends title XVIII (Medicare) of the Social Security Act (SSA) to revise procedures under Medicare part B (Supplementary Medical Insurance) with regard to durable medical equipment, including requirements for: (1) national standards and supplier numbers for suppliers of medical equipment and supplies; (2) standardized certificates of medical necessity and uniform national coverage and utilization review criteria for certain medical equipment and supplies; (3) limited Medicare beneficiary liability for items and services for which payment is prohibited by reason of a supplier's failure to meet such national standards or lack of a valid supplier number; (4) the treatment of nebulizers and aspirators as miscellaneous items of durable medical equipment; and (5) payment of ostomy supplies, tracheostomy supplies, urologicals, surgical dressings, and other medical supplies. Amends SSA title XI to modify anti-kickback provisions. Provides for a freeze under Medicare part B in reasonable charges for parenteral and enteral nutrients, supplies, and equipment during 1994. Requires the Comptroller General to study and report to the Congress on: (1) services and supplies furnished to Medicare-eligible nursing facility residents; and (2) changes made to descriptions relating to codes for medical equipment and supplies.
United States · United States Congress · 5 March 1993
Amends title XVIII (Medicare) of the Social Security Act to prohibit the use of claim sampling to deny claims or recover overpayments under Medicare except when fraud has been determined, in which case claim sampling may be used for the purpose of assessing civil monetary penalties.
United States · United States Congress · 4 March 1993
Directs the Secretary of Health and Human Services to waive retroactively to October 1, 1992, with respect to the District of Columbia Chartered Health Plan, Inc., the requirement under the Social Security Act that Medicare and Medicaid beneficiaries constitute less than 75 percent of the membership of a participating health maintenance organization, if the Secretary determines that such entity continues to make progress towards achieving compliance with such requirement.
United States · United States Congress · 4 March 1993
Directs the Secretary of Defense to establish a program to assist eligible members of the armed forces to obtain employment by State or local law enforcement agencies or by health care providers upon discharge or release from active duty. Makes eligible for such assistance members: (1) selected for involuntary separation, separated under a special separation benefits program, or given early retirement during a four-year period beginning on October 1, 1993; (2) having certain educational degrees or certification; and (3) having a military occupational specialty, training, or experience related to law enforcement or health care. Provides for the making of grants to law enforcement agencies and health care providers in order to facilitate such employment.
United States · United States Congress · 4 March 1993
Designates May 1993 and May 1994 as National Trauma Awareness Month.
United States · United States Congress · 4 March 1993
Designates April 1993 as National African American Health Awareness Month. Directs the Secretary of Health and Human Services to: (1) make information available to the public on the health problems currently facing minority populations and on the careers and contributions of minority health professionals; and (2) present public service announcements on health promotion and disease prevention among African Americans.
United States · United States Congress · 4 March 1993
Expresses the sense of the Congress that any health care reform program enacted by the Congress should include provisions to prohibit discrimination in the provision of and payment for health care services against individuals who suffer from mental illness or substance abuse.
United States · United States Congress · 3 March 1993
Medicaid Substance Abuse Treatment Act of 1993 - Amends title XIX (Medicaid) of the Social Security Act to provide federally reimbursed Medicaid coverage of alcoholism and drug dependency residential treatment services for pregnant women whose family income is below 185 percent of the Federal poverty level and for their Medicaid-eligible children and spouses. Lists the required services included in such coverage. Requires that such coverage continue for at least 12 months, except in certain circumstances, such as where the coverage of pregnant women must continue for one year following the end of pregnancy. Limits the size of a residential treatment facility. Allows a State agency to grant exceptions to such limit. Prohibits the facility from being licensed as a hospital. Caps the number of nationwide beds for which Federal assistance may be provided under such residential treatment programs. Increases such annual bed cap for calendar years 1994 through 1998. Addresses treatment needs of pregnant addicted Indian and Alaska Native women in Indian Health Service areas.
United States · United States Congress · 3 March 1993
TABLE OF CONTENTS: Title I: Establishment of a State-Based American Health Security Program; Universal Entitlement; Enrollment Title II: Comprehensive Benefits, Including Preventive Benefits and Benefits for Long Term Care Title III: Provider Participation Title IV: Administration Subtitle A: General Administrative Provisions Subtitle B: Control Over Fraud and Abuse Title V: Quality Assessment Title VI: Health Security Budget; Payments; Cost Containment Measures Subtitle A: Budgeting and Payments to States Subtitle B: Payments by States to Providers Subtitle C: Mandatory Assignment and Administrative Provisions Title VII: Promotion of Primary Health Care; Development of Health Service Capacity; Programs to Assist the Medically Underserved Subtitle A: Promotion and Expansion of Primary Care Professional Training Subtitle B: Direct Health Care Delivery Subtitle C: Primary Care and Outcomes Research Title VIII: Financing Provisions; American Health Security Trust Fund Subtitle A: American Health Security Trust Fund Subtitle B: Increases in Corporate and Individual Income Tax Rates; Health Security Premium; and Surtax on Individuals with Income Over $1,000,000 Subtitle C: Employment Tax Changes Subtitle D: Other Revenue Increases Primarily Affecting Individuals Subtitle E: Other Revenue Increases Primarily Affecting Businesses Subtitle F: Estimated Tax Provisions Subtitle G: Alternative Taxable Years Subtitle H: Deduction for Charitable Contribution of Appreciated Property Limited to Adjusted Basis Subtitle I: Minimum 5 Percent Rate of Tax on Interest Paid to Foreign Persons American Health Security Act of 1993 - Title I: Establishment of a State-Based American Health Security Program; Universal Entitlement; Enrollment - Establishes in the United States an American Health Security Program (AHSP) to be administered by the States (including the District of Columbia and, if they so choose, U.S. territories) in accordance with Federal standards established under this Act. Requires a State to establish a State health security program in accordance with this Act to receive Federal health care funding. (Sec. 102) Entitles every individual who is a resident of the United States and is a U.S. citizen or national or a lawful resident alien to benefits for health care services under this Act under the appropriate State program. Sets forth provisions regarding the treatment of nonimmigrants and other individuals. (Sec. 103) Requires each State program to: (1) provide a mechanism for the enrollment of individuals entitled or eligible for benefits (which includes a process for the automatic enrollment of individuals at the time of birth, immigration, or other acquisition of lawful resident status in the United States and provides for the enrollment of all individuals who are eligible to be enrolled as of January 1, 1995); and (2) issue a health security card, to enrolled individuals. (Sec. 104) Makes benefits portable when enrollees move or travel between States. Prohibits imposition of a minimum residence or waiting period in excess of three months for program benefit eligibility. Allows reciprocal arrangements between programs in adjacent States for coverage for enrollees residing in the border region. (Sec. 105) Makes benefits available under this Act for items and services furnished on or after January 1, 1995. (Sec. 106) Supersedes Medicare, Medicaid, the Federal Employee Health Benefits Program, and CHAMPUS, which must pay for completion of services they covered before January 1, 1995. Specifies that nothing in this Act affects the eligibility of veterans for Veterans Administration health benefits and services, or of Indians for benefits and services of the Indian Health Service. Title II: Comprehensive Benefits, Including Preventive Benefits and Benefits for Long Term Care - Entitles all eligible individuals to have payment made (if medically necessary and appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition) for inpatient and outpatient hospital services, professional services of State-authorized practitioners, community-based primary health services, preventive services, long-term and chronic care services, prescription drugs, biologicals, insulin, and medical foods, mental health services, substance abuse treatment services, diagnostic tests, and other specified items and services, including outpatient therapy, durable medical equipment, home dialysis, ambulance, prosthetic devices, and other items and services specified by the American Health Security Standards Board (Board) (established by title IV of this Act). Specifies that: (1) no deductibles, coinsurance, or copayments may be charged for benefits; (2) no provider may charge a patient for covered services; (3) no private insurance may duplicate program benefits; and (4) States and employers may provide additional benefits at their own expense. (Sec. 203) Covers home and community-based long-term care services for qualifying individuals unable to perform at least two of five listed activities of daily living without assistance. Limits the cost of such services to 65 percent (or an alternative percentage determined by the Board) of the cost of nursing home care for an individual in the same area in which the services were provided. (Sec. 204) Makes mental health, substance abuse, nursing facility, and home health services subject to utilization review. Directs the Board to make national determinations on coverage of experimental services, with professional and public input. Specifies that where the Board has recognized practice guidelines, coverage is limited to services provided according to the guidelines or any exceptions process established by the Board. Allows the Board to limit quantities of eyeglasses, contact lenses, hearing aids, and durable medical equipment that will be covered. Excludes from coverage cosmetic procedures, personal comfort items, and services furnished in non-participating facilities. Specifies that: (1) nursing facility and home health services (other than post-hospital services) furnished to an individual who is not qualifying are not covered services unless the services are determined to meet specified standards and, with respect to nursing facility services, to be provided in the least restrictive and most appropriate setting; and (2) benefits are not available under this Act with respect to services involving unapproved capital expenditures. Title III: Provider Participation - Requires providers, to receive payment, to agree: (1) not to discriminate based on race, national origin, income, religion, age, sex or sexual orientation, disability, handicapping condition, or (subject to the professional qualifications of the provider) illness; (2) not to charge patients for covered services; (3) to furnish necessary information to the Board or program; (4) not to expend any amounts on, or bill the program for any services for which benefits are not available because of, unapproved capital expenditures; (5) not to employ other providers whose participation has been terminated for cause; and (6) to submit bills within a specified time frame. (Sec. 302) Considers a health care provider to be qualified if it is licensed or certified and meets State law requirements, applicable Federal requirements, and additional standards that the Board may specify. Requires: (1) the Board to establish, evaluate, and update national minimum standards to assure the quality of services provided and to monitor efforts by programs to assure such quality; (2) a reasonable transition period for any new standards; and (3) the Board to provide for an exchange of information among programs with respect to quality assurance and cost containment. (Sec. 303) Defines a "comprehensive health service organization" (CHSO) as a public or private organization which, in return for a fee for service, furnishes or arranges a full range of health services and out-of-area coverage in the case of urgently needed services to an identified population in a specified service area which enrolls voluntarily in the organization. Sets forth various CHSO requirements regarding enrollment, withdrawal for cause, marketing of services, accessibility of services, continuity of care, consumer and provider representation on the board of directors, a patient grievance program, health education, medical standards committees, use of allied health professionals, premiums, utilization and bonus information, provision of services to enrollees at institutions operating under global budgets, limitation on capital expenditures, and provision of emergency services to nonenrollees. (Sec. 304) Extends current Medicare prohibitions on physician self-referrals for clinical laboratory services to other services and applies such prohibitions to AHSP. Title IV: Administration - Subtitle A: General Administrative Provisions - Establishes the American Health Security Standards Board to develop policies and procedures for enrollment, benefits, provider participation, national and State funding levels, determination of medical necessity and appropriateness (including the coverage of new technologies and the application of medical practice guidelines), quality assurance, assisting programs with planning for capital expenditures and service delivery, and other functions and to establish uniform reporting standards for health services and programs. Authorizes the Board to make statistical and other studies, test alternative payment methods, and develop and test information and budget systems. Provides for the appointment of an Executive Director of the Board and an Inspector General. (Sec. 402) Directs the Board to provide for an American Health Security Advisory Council to advise the Board on matters of general policy, in the formulation of regulations, and in the performance of the Board's duties and to study the operation of, and utilization of health services under, this Act. (Sec. 403) Directs the Board to appoint advisory committees on benefits, cost containment, primary care and the medically underserved, mental health and substance abuse treatment, prescription drugs, and rehabilitation and chronic care management. Authorizes the Board to appoint other temporary advisory committees. (Sec. 404) Establishes an American Health Security Quality Council which shall be responsible for quality review activities (under title V). Directs the Quality Council to report to the Board annually. (Sec. 405) Requires: (1) each State to submit to the Board a plan for a program for providing health care services to residents of the State (but allows neighboring States to join in regional plans); (2) the Board to provide incentives for States to develop regional planning mechanisms to promote the rational distribution of, adequate access to, and efficient use of, tertiary care facilities, equipment, and services; (3) State programs to meet Federal standards, including establishment of a State Health Security Advisory Council (SHSAC), single-agency administration, a State health security budget and establishment of an approval process for capital expenditures, provider payment and quality review methodologies consistent with Federal standards, freedom to choose providers, a procedure for carrying out long-term regional management and planning functions, including establishment of District Health Advisory Councils (DHACs), a consumer ombudsman, an annual report, and a fraud and abuse prevention and control unit; and (4) the Governor of each State to provide for appointment of a SHSAC to advise and make recommendations to the Governor and State regarding program implementation. Allows: (1) programs not meeting Federal requirements, after notice, to be placed in receivership under the Board's jurisdiction; and (2) States to use fiscal agents, after competitive bidding, to process claims. (Sec. 406) Directs each program to establish DHACs covering distinct geographic areas for purposes of: (1) advising and making recommendations to the State with respect to implementation of the program in that geographic area; (2) receiving and investigating complaints by eligible persons and service providers concerning program administration and taking corrective action; and (3) carrying out district management and planning functions with the program. Sets forth provisions regarding: (1) DHAC assistance and technical support to community organizations and agencies submitting applications for funding under appropriate State and Federal public health programs; and (2) waiver of the requirement that a State establish DHACs under specified circumstances. (Sec. 407) Requires the Secretary of Health and Human Services (Secretary) to direct all activities of the Department of Health and Human Services toward contributions to health of the people in a manner complementary to this Act. Subtitle B: Control Over Fraud and Abuse - Authorizes the Board to exclude providers from participation, impose civil monetary penalties, and seek criminal prosecution for fraud or abuse, based on current Medicaid standards. Requires providers to disclose relevant information about their ownership interest in health facilities and services, based on current Medicaid standards. (Sec. 412) Requires the Board: (1) through the Inspector General, to establish a national health care fraud and abuse data base, including the identity of any provider who has been convicted, had a license revoked, has been excluded or suspended from participation, or has been subjected to a civil penalty with respect to a State program, Medicare, Medicaid, or any other federally funded health program; and (2) to establish rules to protect the confidentiality of information in the data base. Requires States to provide relevant information for this purpose and periodically inquire of the data base to determine provider qualifications to participate in programs. Sets penalties for submitting false information. (Sec. 413) Requires each program to establish and maintain a health care fraud and abuse unit. (Sec. 414) Directs the Board to provide for the assignment of a unique identifier to each participating provider and to each individual eligible for services, which shall be used for claims and payment. Title V: Quality Assessment - Directs the Quality Council to: (1) collect data from outcomes research and develop practice guidelines on the basis of such data and existing clinical knowledge; (2) adopt methodologies for profiling the patterns of practice of health care professionals and for identifying outliers (i.e., health care providers whose patterns of practice suggest quality deficiencies); (3) develop standards for the development of centers of excellence for designated procedures and for education of and sanctions for outliers; and (4) disseminate all quality guidelines and standards to the States for implementation. (Sec. 502) Requires each participating State to establish an entity to conduct quality reviews of persons providing covered services under its program which meet Federal standards for the adoption of practice guidelines, identification of outliers, development of remedial programs and monitoring for outliers, and the application of sanctions. Allows the State to adopt alternative methodologies to those adopted by the Quality Council, provided that the State can demonstrate that the efficacy of such review and education programs meets Federal standards. Mandates that the quality review entity be administratively independent of the individual or board that administers the program and not provide any financial incentive to reviewers to favor one pattern of practice over another. (Sec. 503) Permits a State program to: (1) require, as a condition of payment for institutional health care and other specified services, periodic professional certification; (2) establish a utilization review program and deny coverage and payment for services to the extent the services are determined under such a program not to meet specified coverage standards under certain circumstances; and (3) require, consistent with standards established by the Board, that payment for services exceeding specified levels or duration be provided only as consistent with a plan of care or treatment formulated by providers of the services or other qualified professionals (and such a plan may include utilization review at specified intervals as a further condition of payment for services). Directs the Board to provide for the establishment of Federal standards for utilization review programs conducted by State programs, designed to assure cost-effective and medically appropriate use of services consistent with such standards. (Sec. 504) Requires: (1) each State program to develop and use a uniform electronic data base which uses software designated by the Board and which assures confidentiality for all patient records to enable systematic quality review and outcomes analysis; and (2) the Board to designate such software and establish standards designed to protect the privacy of patients. Limits access by government agencies to patient records. Title VI: Health Security Budget; Payments; Cost Containment Measures - Subtitle A: Budgeting and Payments to States - Directs the Board to establish an American health security budget which specifies the total expenditures to be made by the Federal Government and the States for covered health care services and allocates those expenditures among the States. Prohibits such budget from exceeding the budget for the preceding year increased by the percentage increase in gross domestic product. Divides the budget into capital expenditures, administrative, and operating components. (Sec. 602) Provides for the allocation of funds in the budget by the Board to the States, based on the national average per capita costs of covered services adjusted for differences among the States in costs and the health status of populations. Permits the use of statistical models to estimate State capitation amounts. Sets forth State adjustment factors to reflect differences in relative needs for funds and directs that such factors be applied in a budget-neutral manner resulting in no change in total Federal expenditures from the national per capita average. (Sec. 603) Requires each program to submit to the Board a proposed and final annual budget broken into capital expenditure, administrative, and operating components, with the operating component broken into facility-based services, individual practitioner payments, payments to CHSOs, and payments for other items and services. Sets forth provisions regarding proposed and final budget deadlines, adjustments in allocations, and expenditure limits. (Sec. 604) Provides for programs to receive Federal funds equal to a weighted average of 86 percent of their population-based share of the budget, which the Board may adjust between 81 and 91 percent based on State economic conditions. (Sec. 605) Requires each program to provide for a process for the approval of capital expenditures to: (1) meet the need for covered health care services consistent with State budgets and the development of medical technology; (2) establish an efficient balance between the need for services and the delivery of services; and (3) expand the delivery of services in medically underserved areas. Prohibits approval of expenditures by programs to the extent that they are attributable to a capital expenditure which was subject to, but not approved under, such process. Directs the Board to specify standards for the capital approval process which meet specified requirements. Subtitle B: Payments by States to Providers - Directs that: (1) payment for operating expenses for hospital and nursing facility services under State programs be made directly to each hospital or nursing facility under an annual prospective global budget approved under the program; (2) such budgets take into account discharges by diagnosis-related group, prior expenditures, change in the consumer price index and other price indices, compensation, occupancy levels, past financial and clinical performance, training, technological changes, and incentives to maintain costs without reducing care; (3) capital expenditures be subject to prior approval; (4) a budget of a hospital or nursing facility be subject to prior review by the SHSAC and appropriate DHAC; (5) facility budgets be adjusted to reflect payments made by CHSOs; and (6) the Board promulgate regulations permitting hospitals and nursing facilities to raise funds from private sources to pay for newly constructed facilities, major renovations, and equipment. (Sec. 612) Directs that payments under a program for home health services, hospice care, home and community-based long-term care services, and certain facility-based outpatient services be based on a global budget, a capitation amount, a specified fee schedule, or an alternative prospective payment method approved by the program. (Sec. 613) Entitles every independent health care practitioner to be paid a fee for each billable covered service. Directs the Board to establish models and encourage programs to implement alternative payment methodologies that incorporate global fees for related services or for a basic group of services furnished to an individual over a period of time. Permits a program to deny payment for any service for which it did not receive a bill and supporting documentation from such a practitioner within 30 days. Requires denial of payment for any service attributable to a capital expenditure subject to approval which has not been approved. Prohibits a practitioner from imposing a charge for a service for which such payment is denied. Directs the program to establish, on a prospective basis, a payment schedule for any payment method for a class of services of practitioners, after negotiations with organizations representing the practitioners involved. Sets forth guidelines regarding such schedules based on a national relative value scale. (Sec. 614) Authorizes programs to pay CHSOs based on annual budgets or risk-adjusted capitation payments, plus an amount equal to the amount of capital expenditures approved, reduced by the costs of covered services not provided by the CHSO. Requires that, in the case of a for-profit CHSO, the total amount of capitation payments in a period be reduced by operating profit for the period less a reasonable rate of return on equity capital and that such profit be additionally limited to such amounts as the Board determines are attributable to operating efficiencies and not to any reduction of care provided. (Sec. 615) Directs that programs pay for community-based primary health services based on global budgets, basic primary care capitation amounts for enrollees, a fee schedule (under section 613), or an alternative prospective payment method approved by the program. (Sec. 616) Requires: (1) the Board to establish classifications of prescription drugs based on the recommendations of the Advisory Committee on Prescription Drugs and to negotiate maximum prices with manufacturers; and (2) each program to pay for such drugs based on such maximum prices and to pay separate dispensing fees to pharmacies. (Sec. 617) Directs: (1) the Board to establish a list of approved durable medical equipment and therapeutic devices and equipment; and (2) State programs to pay for such items based on maximum prices determined by the Board. (Sec. 618) Requires State programs to pay for other items and services based on methodologies to be adopted by the Board, consistent with the State health security budget. (Sec. 619) Directs the Prospective Payment Assessment Commission to advise the Board concerning the approval of prospective global budgets for hospitals and nursing facilities. Renames and continues the Physician Payment Review Commission as the Practitioner Payment Review Commission. Requires the Director of the Office of Technology Assessment to provide for the appointment of a: (1) General Health Care Payment Review Commission; and (2) Long-Term Care Payment Review Commission. (Sec. 620) Directs the Board to establish model payment methodologies and other incentives to promote the provision of services in medically underserved areas. Permits programs to adjust payment amounts within their budgets to encourage provision of appropriate services in underserved areas. (Sec. 621) Authorizes programs to utilize alternative payment methodologies, provided that such methodologies do not affect the entitlement of individuals to coverage, the weighing of fee schedules to encourage an increase in the number of primary care providers, the ability of individuals to choose among qualified providers, the benefits covered under the Program, or compliance with the State health security budget. Requires States to report on the operation and effectiveness of alternative methodologies to enable the Board to evaluate the appropriateness of the alternative methodology. Subtitle C: Mandatory Assignment and Administrative Provisions - Specifies that participating providers: (1) must accept payment from a program as full payment for covered services; and (2) may not impose additional charges on patients. Permits the Board to exclude from participation and subject to civil penalties violators of such provision. (Sec. 632) Requires programs to establish: (1) procedures for reimbursing providers within 60 days of bill submission; and (2) an appeals process to handle grievances pertaining to provider payments. Title VII: Promotion of Primary Health Care; Development of Health Service Capacity; Programs to Assist the Medically Underserved - Subtitle A: Promotion and Expansion of Primary Care Professional Training - Makes the Board responsible for: (1) coordinating health professional education policies and goals to achieve national goals; (2) developing and maintaining a system to monitor the number and specialties of individuals through their health professional education, any postgraduate training, and professional practice; and (3) developing, coordinating, and promoting other policies that expand the number of primary care practitioners. Sets as national goals that: (1) at least 50 percent of graduate medical residencies be in primary care within five years of this Act's enactment; and (2) there be a certain number, specified by the Board, of midlevel primary care practitioners employed in the health care system as of January 1, 2000. Directs the Board to: (1) establish a method of applying such goals to program goals for each medical residency program or consortium of programs and reducing payments for residency programs failing to meet their goals; (2) advise the Public Health Service on allocations of funding under specified programs to increase the supply of midlevel primary care practitioners; and (3) commission a study of the potential benefits and disadvantages of expanding the scope of practice authorized under State laws for any class of midlevel primary care practitioners. (Sec. 702) Requires the Board to establish an Advisory Committee on Health Professional Education to advise the Board concerning graduate medical education policies under this title. (Sec. 703) Directs the Board to transfer specified revenues from the American Health Security Trust Fund (Trust Fund) for specified existing programs supporting health professional education and nursing education and for the National Health Services Corps. Subtitle B: Direct Health Care Delivery - Requires the Board to transfer specified Trust Fund revenues to the Public Health Service for: (1) maternal and child health block grants, preventive health block grants, grants to States for community mental health services and prevention and treatment of substance abuse, and grants for HIV health care services; and (2) grants to nonprofit community health centers and similar facilities. (Sec. 713) Directs the Board to make grants to plan, develop, and operate primary care centers (i.e., nonprofit community health centers, migrant health centers, and other federally qualified health centers) to serve medically underserved populations in urban and rural areas. Subtitle C: Primary Care and Outcomes Research - Requires the Board to transfer specified Trust Fund revenues to the Agency for Health Care Policy and Research for health outcomes research. (Sec. 722) Amends the Public Health Service Act to establish within the Office of the Director of the National Institutes of Health (NIH) an Office of Primary Care and Prevention Research to be headed by a Director who shall identify and coordinate research activities relating to primary care and prevention, including care provided by multidisciplinary teams. Authorizes appropriations. Requires the Director to establish: (1) a Coordinating Committee on Research on Primary Care and Prevention Research; and (2) an Advisory Committee on Research on Primary Care and Prevention Research. Requires the Director of NIH to establish a national data system and clearinghouse on primary care and prevention research. Title VIII: Financing Provisions; American Health Security Trust Fund - Subtitle A: American Health Security Trust Fund - Amends the Internal Revenue Code to create the American Health Security Trust Fund. Appropriates to the trust fund the increase in tax liabilities attributable to the application of amendments made by this title and receipts from the following programs: Medicare, Medicaid, Federal employee health benefit program, and the CHAMPUS program. Transfers to such trust fund amounts in the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. Subtitle B: Increases in Corporate and Individual Income Tax Rates; Health Security Premium, Surtax on Individuals With Incomes Over $1,000,000 - Increases individual and corporate income tax rates, including the imposition of a health premium on such increased rates. Imposes a surtax on individuals with incomes over $1 million. Subtitle C: Employment Tax Changes - Increases the tax on employers for hospital insurance. Modifies self-employment and railroad retirement tax provisions. Makes State and local employees subject to the hospital insurance tax. Subtitle D: Other Revenue Increases Primarily Affecting Individuals - Makes permanent the overall limitation on itemized deductions for high-income taxpayers. Makes permanent the phaseout of the deduction for personal exemptions for such taxpayers. Removes residence sale, purchase, or lease expenses and meals while traveling from the deduction for moving expenses. Increases the overall dollar limitation for moving expenses in connection with the commencement of work. Makes the highest estate and gift tax rates permanent. Denies any deduction for club membership fees as an entertainment expense. Includes increased social security benefits in gross income. Provides for the collection of a monthly long-term health care premium for the elderly (other than the low-income elderly) for deposit into the American Health Security Trust Fund. Subtitle E: Other Revenue Increases Primarily Affecting Businesses - Applies mark-to-market accounting method rules for certain securities held by dealers in securities (with specified exceptions for certain types of securities such as those held for investment or as a hedge). Increases the applicable recovery period for depreciation of nonresidential real property under the accelerated cost recovery system. Includes imported property income of a controlled foreign corporation or related person as foreign base company income. Requires the separate application of the limitation on the foreign tax credit on imported property income. Applies the look-thru rules in the case of controlled foreign corporations to such income. Repeals: (1) the deduction for intangible drilling and development costs in the case of oil and gas wells and geothermal wells; (2) the percentage depletion for oil and gas wells; and (3) the application of like-kind exchange rules to real property. Disallows the capitalization of a percentage of advertising expenses. Allows the amortization of such disallowed amount. Subtitle F: Estimated Tax Provisions - Increases individual and corporate estimated tax payments. Repeals special rules which denied the use of a previous year's liability safe harbor for certain individuals with significant increases in tax liability from one year to the next. Modifies corporate annualized income installment provisions. Subtitle G: Alternative Taxable Years - Provides that the taxable year for an S corporation or partnership must be the same as an entity's reporting period if an entity has annual reports or statements which ascertain income profit or loss and are provided to shareholders or used for credit purposes. Revises computation of the amount of the required payment that must be made by a partnership or S corporation that elects a taxable year other than the required taxable year. Subtitle H: Deduction for Charitable Contribution of Appreciated Property Limited to Adjusted Basis - Limits the deduction for charitable contribution of appreciated property to the amount which would have been gained had the property been sold by the taxpayer at its fair market value. Subtitle I: Minimum 5 Percent Rate of Tax on Interest Paid to Foreign Persons - Sets a minimum rate of tax on interest paid to foreign persons notwithstanding any treaty obligations.
United States · United States Congress · 3 March 1993
Hospital Cooperative Agreement Act - Amends the Public Health Service Act to establish a demonstration program of up to ten grants for collaboration among hospitals regarding the provision of expensive, capital-intensive medical technology or other highly resource-intensive services. Requires that projects be designed to demonstrate a reduction in costs, an increase in access to care, and improvements in the quality of care. Allows grant funds to be used only to facilitate collaboration and not to purchase facilities or capital equipment. Requires at least three of the grants to be used to demonstrate how such agreements may be used to increase access to or quality of care in rural areas. Authorizes appropriations.
United States · United States Congress · 3 March 1993
Designates November 28 through December 4, 1993, and November 27 through December 3, 1994, as National Home Care Week.
United States · United States Congress · 3 March 1993
TABLE OF CONTENTS: Title I: Development and Implementation of Diagnostic and Treatment Protocols Title II: Medical Malpractice Liability Reform Savings Through Health Protocols and Malpractice Reform Act of 1993 - Title I: Development and Implementation of Diagnostic and Treatment Protocols - Mandates grants or contracts for the operation of four to six centers to develop: (1) diagnostic and treatment protocols for various health conditions; and (2) model programs for training health care providers regarding the protocols. Requires establishment of an advisory council to make recommendations on carrying out this title. Title II: Medical Malpractice Liability Reform - Provides for certification of a State if it has enacted certain medical malpractice liability reforms, including: (1) several and not joint liability for non-economic damages, with determination of percentages of liability; (2) specified dollar limits on noneconomic damages; (3) mandatory offsets for collateral source damages paid; and (4) at least one alternative dispute resolution mechanism. Amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to mandate a reduction in uncertified States and an increase in certified States of: (1) Medicare payments to hospitals for inpatient services; and (2) certain Medicaid payments to States. Amends Federal law relating to tort claims procedures to mandate, with regard to health care liability actions against the United States: (1) several and not joint liability for noneconomic damages, with determination of percentages of liability; (2) specified dollar limits on noneconomic damages; and (3) mandatory offsets for collateral source damages paid.
United States · United States Congress · 3 March 1993
TABLE OF CONTENTS: Title I: Establishment of a State-Based American Health Security Program; Universal Entitlement; Enrollment Title II: Comprehensive Benefits, Including Preventive Benefits and Benefits for Long Term Care Title III: Provider Participation Title IV: Administration Subtitle A: General Administrative Provisions Subtitle B: Control Over Fraud and Abuse Title V: Quality Assessment Title VI: National Health Security Budget; Payments; Cost Containment Measures Subtitle A: Budgeting and Payments to States Subtitle B: Payments by States to Providers Subtitle C: Mandatory Assignment and Administrative Provisions Title VII: Promotion of Primary Health Care; Development of Health Service Capacity; Programs to Assist the Medically Underserved Subtitle A: Promotion and Expansion of Primary Care Professional Training Subtitle B: Direct Health Care Delivery Subtitle C: Primary Care and Outcomes Research Title VIII: Financing Provisions, American Health Security Trust Fund Subtitle A: American Health Security Trust Fund Subtitle B: Increases in Corporate and Individual Income Tax Rates; Health Security Premium; and Surtax on Individuals with Incomes Over $1,000,000 Subtitle C: Employment Tax Changes Subtitle D: Other Revenue Increases Primarily Affecting Individuals Subtitle E: Other Revenue Increases Primary Affecting Businesses Subtitle F: Estimated Tax Provisions Subtitle G: Alternative Taxable Years Subtitle H: Deduction for Charitable Contribution of Appreciated Property Limited to Adjusted Basis Subtitle I: Minimum 5 Percent Rate of Tax on Interest Paid to Foreign Persons American Health Security Act of 1993 - Title I: Establishment of a State-Based American Health Security Program; Universal Entitlement; Enrollment - Establishes in the United States an American Health Security Program (AHSP) to be administered by the States (including the District of Columbia and, if they so choose, U.S. territories) in accordance with Federal standards established under this Act. Requires a State to establish a State health security program (program) in accordance with this Act to receive Federal health care funding. (Sec. 102) Entitles every individual who is a resident of the United States and is a U.S. citizen or national or a lawful resident alien to benefits for health care services under this Act under the appropriate State program. Sets forth provisions regarding the treatment of nonimmigrants and other individuals. (Sec. 103) Requires each State program to: (1) provide a mechanism for the enrollment of individuals entitled or eligible for benefits (which includes a process for the automatic enrollment of individuals at the time of birth, immigration, or other acquisition of lawful resident status in the United States and provides for the enrollment of all individuals who are eligible to be enrolled as of January 1, 1995); and (2) issue a health security card to enrolled individuals. (Sec. 104) Makes benefits portable when enrollees move or travel between States. Prohibits imposition of a minimum residence or waiting period in excess of three months for program benefit eligibility. Allows reciprocal arrangements between programs in adjacent States for coverage for enrollees residing in the border region. (Sec. 105) Makes benefits available under this Act for items and services furnished on or after January 1, 1995. (Sec. 106) Supersedes Medicare, Medicaid, the Federal Employee Health Benefits Program, and CHAMPUS, which must pay for completion of services they covered before January 1, 1995. Specifies that nothing in this Act affects the eligibility of veterans for Veterans Administration health benefits and services, or of Indians for benefits and services of the Indian Health Service. Title II: Comprehensive Benefits, Including Preventive Benefits and Benefits for Long Term Care - Entitles all eligible individuals to have payment made (if medically necessary and appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition) for inpatient and outpatient hospital services, professional services of State-authorized practitioners, community-based primary health services, preventive services, long-term and chronic care services, prescription drugs, biologicals, insulin, and medical foods, dental services, mental health services, substance abuse treatment services, diagnostic tests, and other specified items and services, including outpatient therapy, durable medical equipment, home dialysis, ambulance, prosthetic devices, and other items and services specified by the American Health Security Standards Board (Board) (established by title IV of this Act). Specifies that: (1) no deductibles, coinsurance, or copayments may be charged for acute care benefits; (2) no provider may charge a patient for covered services; (3) no private insurance may duplicate program benefits; and (4) States and employers may provide additional benefits at their own expense. (Sec. 203) Covers home and community-based long-term care services for persons unable to perform at least two of five listed activities of daily living without assistance. Limits the cost of such services to 65 percent (or an alternative percentage determined by the Board) of the cost of nursing home care for an individual in the same area in which the services were provided. (Sec. 204) Makes mental health, substance abuse, nursing facility, and home health services subject to utilization review. Directs the Board to make national determinations on coverage of experimental services, with professional and public input. Specifies that where the Board has recognized practice guidelines, coverage is limited to services provided according to the guidelines or any established exception process. Allows the Board to limit quantities of eyeglasses, contact lenses, hearing aids, and durable medical equipment that will be covered. Excludes from coverage cosmetic procedures, personal comfort items, and services furnished in non-participating facilities. (Sec. 205) Specifies that: (1) States may require providers to certify that covered services were provided according to program requirements; (2) quality review programs must meet Federal standards; and (3) States may require plans of care for coverage of certain services. Title III: Provider Participation - Requires providers, to receive payment, to agree: (1) not to discriminate based on race, national origin, income, religion, age, sex or sexual orientation, disability, handicapping condition, or (subject to the professional qualifications of the provider) illness; (2) not to charge patients for covered services; (3) to furnish necessary information to the Board or program; (4) not to employ other providers whose participation has been terminated for cause; and (5) to submit bills within a specified time frame. (Sec. 302) Considers a health care provider to be qualified if it is licensed or certified and meets State law requirements, applicable Federal requirements, and additional standards that the Board may specify. Requires: (1) the Board to establish, evaluate, and update national minimum standards to assure the quality of services provided and to monitor efforts by programs to assure such quality; (2) a reasonable transition period for any new standards; and (3) the Board to provide for an exchange of information among programs with respect to quality assurance and cost containment. (Sec. 303) Defines a "comprehensive health service organization" (CHSO) as a public or private organization which, in return for a capitated payment amount, furnishes or arranges a full range of health services and out-of-area coverage in the case of urgently needed services to an identified population in a specified service area which enrolls voluntarily in the organization. Sets forth various CHSO requirements regarding enrollment, withdrawal for cause, accessibility of services, continuity of care, consumer and provider representation on the board of directors, a patient grievance program, medical standards committees, premiums, utilization and bonus information, provision of services to enrollees at institutions operating under global budgets, marketing of services, and provision of emergency services to nonenrollees. (Sec. 304) Extends current Medicare prohibitions on physician self-referrals for clinical laboratory services to other services and applies such prohibitions to AHSP. Title IV: Administration - Subtitle A: General Administrative Provisions - Establishes the American Health Security Standards Board to develop policies and procedures for enrollment, benefits, provider participation, national and State funding levels, assisting programs with planning for capital expenditures and service delivery, and other functions and to establish uniform reporting standards for health services and programs. Authorizes the Board to make statistical and other studies, test alternative payment methods, and develop and test information and budget systems. Provides for the appointment of an Executive Director of the Board and an Inspector General. (Sec. 402) Directs the Board to provide for an American Health Security Advisory Council to advise the Board on matters of general policy, in the formulation of regulations, and in the performance of the Board's duties and to study the operation of, and utilization of health services under, this Act. (Sec. 403) Directs the Board to appoint advisory committees on benefits, cost containment, primary care and the medically underserved, mental health and substance abuse treatment, and prescription drugs. Authorizes the Board to appoint other temporary advisory committees. (Sec. 404) Establishes an American Health Security Quality Council which shall be responsible for quality review activities (under title V). Directs the Quality Council to report to the Board annually on activities and findings from outcomes research and development of practice guidelines that may affect the Board's determination of coverage of services. (Sec. 405) Requires: (1) each State to submit to the Board a plan for a program for providing health care services to residents of the State (but allows neighboring States to join in regional plans); (2) the Board to provide incentives for States to develop regional planning mechanisms to promote the rational distribution of, adequate access to, and efficient use of, tertiary care facilities, equipment, and services; (3) State programs to meet Federal standards, including single-agency administration, a State health security budget, provider payment and quality review methodologies consistent with Federal standards, freedom to choose providers, a consumer ombudsman, an annual report, and a fraud and abuse prevention and control unit; and (4) the Governor of each State to provide for appointment of a State Health Security Advisory Council to advise and make recommendations to the Governor and State regarding program implementation. Allows: (1) programs not meeting Federal requirements, after notice, to be placed in receivership under the Board's jurisdiction; and (2) States to use fiscal agents, after competitive bidding, to process claims. (Sec. 406) Requires the Secretary of Health and Human Services (Secretary) to direct all activities of the Department of Health and Human Services toward contributions to health of the people in a manner complementary to this Act. Subtitle B: Control Over Fraud and Abuse - Authorizes the Board to exclude providers from participation, impose civil monetary penalties, and seek criminal prosecution for fraud or abuse, based on current Medicaid standards. Requires providers to disclose relevant information about their ownership interest in health facilities and services, based on current Medicaid standards. (Sec. 412) Requires the Board: (1) through the Inspector General, to establish a national health care fraud and abuse data base, including the identity of any provider who has been convicted, had a license revoked, has been excluded or suspended from participation, or has been subjected to a civil penalty with respect to a State program, Medicare, Medicaid, or any other federally funded health program; and (2) to establish rules to protect the confidentiality of information in the data base. Requires States to provide relevant information for this purpose and to periodically inquire of the data base to determine provider qualifications to participate in programs. Sets penalties for submitting false information. (Sec. 413) Requires each program to establish and maintain a health care fraud and abuse unit. (Sec. 414) Directs the Board to provide for the assignment of a unique identifier to each participating provider and to each individual eligible for services, which shall be used for claims and payment. Title V: Quality Assessment - Directs the Quality Council to: (1) collect data from outcomes research on an ongoing basis and develop practice guidelines on the basis of such data and existing clinical knowledge; (2) adopt methodologies for profiling the patterns of practice of health care professionals and for identifying outliers (i.e., health care providers whose patterns of practice suggest quality deficiencies); (3) develop standards for the development of centers of excellence for designated procedures and for education of and sanctions for outliers; and (4) disseminate all quality guidelines and standards to the States for implementation. (Sec. 502) Requires each participating State to establish an entity to conduct quality reviews of persons providing covered services under its program which meet Federal standards for the adoption of practice guidelines, identification of outliers, development of remedial programs and monitoring for outliers, and the application of sanctions. Allows the State to adopt alternative methodologies to those adopted by the Quality Council provided that the State can demonstrate that the efficacy of such review and education programs meets Federal standards. Mandates that the quality review entity be administratively independent of the individual or board that administers the program and not provide any financial incentive to reviewers to favor one pattern of practice over another. (Sec. 503) Expresses the intent to replace random utilization controls with a systematic review of patterns of practice that compromise the quality of care by January 1, 1998. Supercedes all existing Federal utilization review programs, including random case-by-case reviews and programs requiring pre-certification of medical procedures on a case-by-case basis, with exceptions. Specifies that nothing in this section shall preclude case management of catastrophic, mental health, or substance abuse cases where necessary to achieve appropriate, cost-effective, and beneficial comprehensive medical care. (Sec. 504) Requires: (1) each State program to develop and use a uniform electronic data base which uses software designated by the Board and which assures confidentiality for all patient records to enable systematic quality review and outcomes analysis; and (2) the Board to designate such software and establish standards designed to protect the privacy of patients. Limits access by government agencies to patient records. Title VI: Health Security Budget; Payments; Cost Containment Measures - Subtitle A: Budgeting and Payments to States - Directs the Board to establish a national health security budget which specifies the total expenditures to be made by the Federal Government and the States for covered health care services, and allocates those expenditures among the States. Prohibits such budget from exceeding the budget for the preceding year increased by the percentage increase in gross domestic product. Divides the budget into quality assessment, professional education, administrative, and operating components. (Sec. 602) Provides for the allocation of funds in the budget by the Board to the States, based on the national average per capita costs of covered services adjusted for differences among the States in costs and the health status of populations. Permits the use of statistical models to estimate State capitation amounts. Sets forth State adjustment factors to reflect differences in relative needs for funds and directs that such factors be applied in a budget-neutral manner resulting in no change in total Federal expenditures from the national per capita average. (Sec. 603) Requires each program to submit to the Board a proposed and final annual budget broken into quality assessment, professional training, administrative, and operating components, with the operating component broken into facility-based services, individual practitioner payments, payments to CHSOs, and payments for other items and services. Sets forth provisions regarding proposed and final budget deadlines, adjustments in allocations, and expenditure limits. Permits programs to provide for a process for the approval of capital expenditures based on information derived from regional planning agencies. (Sec. 604) Provides for programs to receive Federal funds equal to a weighted average of 86 percent of their population-based share of the budget, which the Board may adjust between 81 and 91 percent based on State economic conditions. (Sec. 605) Requires each program to establish a separate budget account for health professional education expenditures and to distribute funds consistent with the achievement of specified national and program goals, including the receipt by the Board of reports to monitor compliance, and taking into account the potentially higher costs of placing health professional students in clinical education programs in health professional shortage areas. Subtitle B: Payments by States to Providers - Directs that: (1) payment for operating expenses for institutional and facility-based care under State programs be made directly to each institution or facility under an annual prospective global budget approved under the program; (2) such budgets take into account discharges by diagnosis-related group, prior expenditures, the extent to which debt service for capital expenditures has been included in the proposed operating budget, change in the consumer price index and other price indices, compensation, occupancy levels, past financial and clinical performance, training, technological changes, and incentives to maintain costs without reducing care; and (3) facility budgets be adjusted to reflect payments made by CHSOs. Allows programs to permit institutions and facilities to raise funds from private sources to pay for newly constructed facilities, major renovations, and equipment. (Sec. 612) Requires: (1) State programs to pay individual practitioners on a fee-for-service basis, as negotiated between States and practitioner representatives; (2) the Board to establish models for such payment and for global fee payment methodologies to encourage payment for combinations of services; and (3) practitioners to bill State programs within 30 days of providing services. Permits States to require electronic billing. (Sec. 613) Authorizes programs to pay CHSOs based on annual budgets or risk-adjusted capitation payments, reduced by the costs of covered services not provided by the CHSO. (Sec. 614) Directs that programs pay for community-based primary health services based on global budgets, basic primary care capitation amounts for enrollees, or fee-for-service, taking into account costs of serving non-covered patients, providing case management, transportation, and translation, and providing health professional education programs. (Sec. 615) Requires: (1) the Board to establish a list of approved prescription drugs based on the recommendations of the Advisory Committee on Prescription Drugs and to negotiate maximum prices with manufacturers; and (2) each program to pay for such drugs based on such maximum prices and to pay separate dispensing fees to pharmacies. (Sec. 616) Directs the Board to establish a list of approved durable medical equipment and therapeutic devices and equipment and programs to pay for such items based on maximum prices determined by the Board. (Sec. 617) Requires State programs to pay for other items and services based on methodologies to be adopted by the Board, consistent with the State health security budget. (Sec. 618) Directs the Board to establish model payment methodologies and other incentives to promote the provision of services in medically underserved areas. Permits programs to adjust payments amounts within their budgets to encourage provision of appropriate services in underserved areas. (Sec. 619) Authorizes programs to utilize alternative payment methodologies, provided that such methodologies do not affect the entitlement of individuals to coverage, the weighting of fee schedules to encourage an increase in the number of primary care providers, the ability of individuals to choose among qualified providers, the benefits covered under the Program, or compliance with the State health security budget. Requires States to report on the operation and effectiveness of alternative methodologies to enable the Board to evaluate the appropriateness of applying such methodologies to other States. Subtitle C: Mandatory Assignment and Administrative Provisions - Specifies that participating providers: (1) must accept payment from a program as full payment for covered services; and (2) may not impose additional charges on patients. Permits the Board to exclude from participation and subject to civil penalties violators of such provision. (Sec. 632) Requires programs to establish: (1) procedures for reimbursing providers within 60 days of bill submission; and (2) an appeals process to handle grievances pertaining to provider payments. Title VII: Promotion of Primary Health Care; Development of Health Service Capacity; Programs to Assist the Medically Underserved - Subtitle A: Promotion and Expansion of Primary Care Professional Training - Makes the Board responsible for: (1) coordinating health professional education policies and goals to achieve national goals; (2) overseeing program health professional education expenditures; (3) developing and maintaining a system to monitor the number and specialties of individuals through their health professional education, any postgraduate training, and professional practice; and (4) developing, coordinating, and promoting other policies that expand the number of primary care practitioners. Sets as national goals that: (1) at least 50 percent of graduate medical residencies be in primary care within five years of this Act's enactment; and (2) there be a certain number, specified by the Board, of midlevel primary care practitioners employed in the health care system as of January 1, 2000. Directs the Board to: (1) establish a method of applying such goals to program goals for each medical residency program or consortium of programs and reducing payments for residency programs failing to meet their goals; (2) advise the Public Health Service on allocations of funding under specified programs to increase the supply of midlevel primary care practitioners; and (3) commission a study of the potential benefits and disadvantages of expanding the scope of practice authorized under State laws for any class of midlevel primary care practitioners. (Sec. 702) Requires the Board to establish an Advisory Committee on Health Professional Education to advise the Board concerning graduate medical education policies under this title. (Sec. 703) Directs the Board to transfer specified revenues from the American Health Security Trust Fund (Trust Fund) for specified existing programs supporting health professional education and nursing education and for the National Health Service Corps. Subtitle B: Direct Health Care Delivery - Requires the Board to transfer specified Trust Fund revenues to the Public Health Service for: (1) maternal and child health block grants, preventive health block grants, grants to States for community mental health services and prevention and treatment of substance abuse, and grants for HIV health care services; and (2) grants to nonprofit community health centers and similar facilities. (Sec. 713) Directs the Board to make grants to primary care centers (i.e., nonprofit community health centers, migrant health centers, and other federally qualified health centers) to serve medically underserved populations in urban and rural areas. Specifies that grant funds may be used to plan, develop, and deliver primary care in such areas. Subtitle C: Primary Care and Outcomes Research - Requires the Board to transfer specified Trust Fund revenues to the Agency for Health Care Policy and Research for health outcomes research. (Sec. 722) Amends the Public Health Service Act to establish within the Office of the Director of the National Institutes of Health (NIH) an Office of Primary Care and Prevention Research to be headed by a Director who shall identify and coordinate research activities relating to primary care and prevention, including care provided by multidisciplinary teams. Authorizes appropriations. Requires the Director of NIH to establish a national data system and clearinghouse on primary care and prevention research. Title VIII: Financing Provisions; American Health Security Trust Fund - Subtitle A: American Health Security Trust Fund - Amends the Internal Revenue Code to create the American Health Security Trust Fund. Appropriates to the trust fund the increase in tax liabilities attributable to the application of amendments made by this title and receipts from the following programs: Medicare, Medicaid, Federal employees health benefit program, and the CHAMPUS program. Transfers to such trust fund amounts in the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. Subtitle B: Increases in Corporate and Individual Income Tax Rates; Health Security Premium; Surtax on Individuals With Incomes Over $1,000,000 - Increases individual and corporate income tax rates, including the imposition of a health premium on such increased rates. Imposes a surtax on individuals with incomes over $1 million. Subtitle C: Employment Tax Changes - Increases the tax on employers for hospital insurance. Modifies self-employment and railroad retirement tax provisions. Makes State and local employees subject to the hospital insurance tax. Subtitle D: Other Revenue Increases Primarily Affecting Individuals - Makes permanent the overall limitation on itemized deductions for high-income taxpayers. Makes permanent the phaseout of the deduction for personal exemptions for such taxpayers. Removes residence sale, purchase, or lease expenses and meals while traveling from the deduction for moving expenses. Increases the overall dollar limitation for moving expenses in connection with the commencement of work. Makes the highest estate and gift tax rates permanent. Denies any deduction for club membership fees as an entertainment expense. Includes increased social security benefits in gross income. Provides for the collection of a monthly long-term health care premium for the elderly (other than the low-income elderly) for deposit into the American Health Security Trust Fund. Subtitle E: Other Revenue Increases Primarily Affecting Businesses - Applies mark-to-market accounting method rules for certain securities held by dealers in securities (with specified exceptions for certain types of securities such as those held for investment or as a hedge). Increases the applicable recovery period for depreciation of nonresidential real property under the accelerated cost recovery system. Includes imported property income of a controlled foreign corporation or related person as foreign base company income. Requires the separate application of the limitation on the foreign tax credit on imported property income. Applies the look-thru rules in the case of controlled foreign corporations to such income. Repeals: (1) the deduction for intangible drilling and development costs in the case of oil and gas wells and geothermal wells; (2) the percentage depletion for oil and gas wells; and (3) the application of like-kind exchange rules to real property. Disallows the capitalization of a percentage of advertising expenses. Allows the amortization of such disallowed amount. Subtitle F: Estimated Tax Provisions - Increases individual and corporate estimated tax payments. Repeals special rules which denied the use of a previous year's liability safe harbor for certain individuals with significant increases in tax liability from one year to the next. Modifies corporate annualized income installment provisions. Subtitle G: Alternative Taxable Years - Provides that the taxable year for an S corporation of partnership must be the same as an entity's reporting period if an entity has annual reports or statements which ascertain income profit or loss and are provided to shareholders or used for credit purposes. Revises computation of the amount of the required payment that must be made by a partnership or S corporation that elects a taxable year other than the required taxable year. Subtitle H: Deduction for Charitable Contribution of Appreciated Property Limited to Adjusted Basis - Limits the deduction for charitable contribution of appreciated property to the amount which would have been gained had the property been sold by the taxpayer at its fair market value. Subtitle I: Minimum 5 Percent Rate of Tax on Interest Paid to Foreign Persons - Sets a minimum rate of tax on interest paid to foreign persons notwithstanding any treaty obligations.
United States · United States Congress · 3 March 1993
Medicare Diabetes Outpatient Self-Management Training Services Coverage Act of 1993 - Amends title XVIII (Medicare) of the Social Security Act to provide for Medicare coverage of diabetes outpatient self-management training services.
United States · United States Congress · 2 March 1993
Designates the month of November in 1993 and 1994 as National Hospice Month.
United States · United States Congress · 2 March 1993
Amends the Federal Food, Drug, and Cosmetic Act to permit the extra-label use of drugs in animals if such use is upon the order of a licensed veterinarian, is in compliance with appropriate regulations, and is in the context of a veterinarian-client-patient relationship. Prohibits such use if it results in unacceptable residues of a drug in food.
United States · United States Congress · 2 March 1993
Research on Human Fetal Tissue Amendments of 1993 - Amends the Public Health Service Act to authorize and regulate research on human fetal tissue transplantation without regard to whether the tissue is obtained after a spontaneous or induced abortion or a stillbirth in accordance with State law. Imposes criminal penalties for: (1) transferring such tissue for valuable consideration affecting interstate commerce; or (2) soliciting or receiving a directed donation.
United States · United States Congress · 2 March 1993
Designates May 1993 as National Community Residential Care Month.
United States · United States Congress · 2 March 1993
Declares that it is the sense of the Congress that: (1) access to health care services is a fundamental human right; (2) all legislative proposals by the President and the Congress concerning national health care reform and any initiatives to improve the delivery of health care should be based upon recognition of such right; and (3) legislative proposals should be specifically developed which make policy changes necessary to protect and guarantee such right.
United States · United States Congress · 25 February 1993
Amends title XIX (Medicaid) of the Social Security Act to provide for Medicaid coverage of services furnished by all certified nurse practitioners or clinical nurse specialists which are authorized under State law to be performed by such a nurse, regardless of whether or not such services are performed under the supervision of a physician or other health care provider. Defines "clinical nurse specialist" as an individual who: (1) is a registered nurse licensed to practice nursing in the State in which the clinical nurse specialist services are performed; and (2) holds a master's degree in a defined clinical area of nursing from an accredited institution.
United States · United States Congress · 25 February 1993
Amends title XVIII (Medicare) of the Social Security Act to provide payment for the home health care services currently covered under Medicare where an individual attends an adult day center through the assistance of other individuals or specialized transportation.
United States · United States Congress · 25 February 1993
Chemical Control Amendments Act of 1993 - Amends the Comprehensive Drug Abuse Prevention and Control Act of 1970 to: (1) replace references to "listed precursor chemicals" with "list I chemicals" and "listed essential chemicals" with "list II chemicals"; and (2) revise the definitions of "regulated person" (to include individuals who act as brokers or traders for international transactions involving a listed chemical, tableting machine, or encapsulating machine) and "regulated transaction" (to include international transactions involving shipment of a threshold amount of a listed chemical and to exclude specified transactions). Removes the exemption for products in which ephedrine is the only active medicinal ingredient in therapeutic amounts. Permits the Attorney General to remove the exemption for other drugs containing listed chemicals if it is determined that they are being diverted for use in the illicit production of a controlled substance, with exceptions. Provides registration requirements for list I chemicals, including the authority to revoke or deny based on public interest grounds, immediate suspension in cases of imminent danger to the public health or safety, and criminal penalties for distribution, importation, or exportation without the required registration. Authorizes the Attorney General to reduce controls on the importation of specified chemicals by modifying or eliminating the advance notice requirement. Adds specific criminal penalties for: (1) attempting to evade reporting requirements by falsely claiming that a shipment is destined for a country for which a waiver has been established; and (2) smuggling of listed chemicals. Makes it a felony for a person who possesses a listed chemical with intent that it be used in the illegal manufacture of a controlled substance to manage the listed chemical or waste from the manufacture of a controlled substance other than as required under the Solid Waste Disposal Act. Specifies that a person who violates such prohibition shall be assessed costs of the initial cleanup and disposal of the listed chemical and contaminated property, as well as the cost of restoring property damaged by exposure to such chemical. Subjects listed chemicals to the same forfeiture provisions which apply to controlled substances. Amends the Health Care Quality Improvement Act of 1986 to require the Secretary of Health and Human Services to make available to the Attorney General information in the national practitioner data bank.
United States · United States Congress · 25 February 1993
Designates the week of June 1 through 7, 1993, as National Polio Awareness Week.
United States · United States Congress · 24 February 1993
Amends title XVIII (Medicare) of the Social Security Act to limit Medicare coverage of chiropractic services to diagnostic x-rays, physical examinations, and certain spinal manipulations conducted by State-licensed chiropractors who are legally authorized by the State to provide such services.
United States · United States Congress · 24 February 1993
Designates the weeks of September 19 through 25, 1993, and September 18 through 24, 1994, as National Rehabilitation Week.
United States · United States Congress · 24 February 1993
Makes additional appropriations to the Secretary of Health and Human Services for peer review activities and activities to reduce waste and fraud under the Medicare program under title XVIII of the Social Security Act.
United States · United States Congress · 24 February 1993
Amends the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 to direct the President, in selecting remedial actions for hazardous waste cleanup sites, to give a preference to the use of institutional controls, containment methods, and other interim measures, rather than permanent treatment technologies, if such measures are sufficient to protect health, welfare, and the environment.
United States · United States Congress · 24 February 1993
Designates the week beginning April 18, 1993, as Primary Immune Deficiency Awareness Week.
United States · United States Congress · 24 February 1993
Declares that it is the sense of the Congress that any legislation enacted to reform the health care system must: (1) ensure that every person has access to coverage for medically and psychologically necessary treatments for mental disorders that is equitable to the coverage provided for treatments of physical illnesses; and (2) meet specified requirements concerning coverage, consumer choice, financial protection, financing policies, and coordination across Federal, State, and local programs.
United States · United States Congress · 23 February 1993
Senior Citizens Health Insurance Standards Act of 1993 - Directs each State to submit to the Secretary of Health and Human Services a plan specifying certain minimum standards applicable to the sale of health insurance to the elderly. Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary to conduct studies for the purposes of making recommendations to the Congress concerning: (1) a uniform approach for regulating all private health insurance sold to the aged and disabled; and (2) the feasibility of additional health insurance coverage under Medicare.
United States · United States Congress · 23 February 1993
Amends title XVIII (Medicare) of the Social Security Act to require the governing boards of hospitals and skilled nursing facilities having an average duration of patient stay of more than 30 days to establish written policies guaranteeing specified rights of patients, including: (1) information on services and charges; (2) information on and participation in medical treatment; (3) conditions of transfer or discharge; (4) grievances; (5) management of personal financial affairs; (6) freedom from abuse and restraints; (7) confidentiality of records; and (8) freedom of association. Directs the Secretary of Health and Human Services to establish civil penalties for the violation of such rights. Sets forth provisions concerning the processing and investigation of complaints arising from such violations.
United States · United States Congress · 23 February 1993
Amends title XVIII (Medicare) of the Social Security Act to include, as a home health service, nutritional counseling provided by or under the supervision of a registered dietitian.
United States · United States Congress · 18 February 1993
Life Patenting Moratorium Act of 1993 - Amends Federal patent law to prohibit human beings, organs, or organ subparts or genetically engineered animals from being considered patentable subject matter. Imposes a two-year moratorium on the patentability of human tissues, fluids, cells, genes or gene sequences, or animals or animal organisms (genetically engineered or otherwise). Authorizes the continuation of such moratorium after such time pursuant to the Public Health Service Act. Expresses the sense of the Congress that: (1) legislation addressing the implications of genetic research should be thoroughly studied and passed by the Congress as soon as possible; and (2) the Departments of Commerce and State and the National Institutes of Health should work with the international community to develop international standards relating to the patenting of, and access to, genetic information.
United States · United States Congress · 18 February 1993
Minor Crop Pesticides Act of 1993 - Amends the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) to define "minor use" as the use of a pesticide on an animal or a commercial agricultural crop or site or for the protection of public health where: (1) the use does not provide sufficient economic incentive to support registration; and (2) the Administrator of the Environmental Protection Agency (EPA) has not determined that the use presents an unreasonable adverse environmental effect. Prohibits data that relates solely to a minor use, without the permission of the original data submitter, from being considered by the Administrator to support a minor use application by another person for ten years following the submission of the data. Requires the Administrator, upon the request of a registrant, to extend the deadline for the production of residue chemistry data required solely to support a minor use pesticide up to two years subject to specified conditions. Applies the same extension conditions to data for reregistrations. Permits the Administrator, in handling the registration of a pesticide for a minor use, to waive applicable data requirements if such use does not have an adverse environmental effect. Provides for expedited review (within six months of submission) of applications to support minor use pesticide registrations. Requires the Administrator to conditionally amend a registration to permit additional minor uses even if data is insufficient if the applicant has submitted satisfactory data pertaining to the proposed minor use and amending such registration would not increase environmental risks. Authorizes the Administrator to conditionally register or amend the registration of a pesticide for a minor use if: (1) the active ingredient is being supported for reregistration; (2) the minor use was a registered use of a product that has been canceled, proposed for cancellation, or deleted as a use after December 24, 1988; and (3) the use requires only residue chemistry data for reregistration. Outlines additional requirements for conditional registrations. Directs EPA to assure coordination of minor use issues through the establishment of a minor use program. Establishes and authorizes funding for a Department of Agriculture minor use matching fund program. Requires the program to be utilized to ensure the continued availability of minor use crop protection chemicals. Authorizes appropriations.
United States · United States Congress · 18 February 1993
Gift of Life Congressional Medal Act of 1993 - Directs the Secretary of the Treasury to design and strike a bronze medal in commemoration of organ donors and their families. Declares that any organ donor, or donor's family, is eligible for the medal. Requires the Secretary of Health and Human Services to arrange for medal presentation to eligible individuals through a qualified organ procurement organization. Declares the medals to be national medals. Authorizes the Secretary of the Treasury to enter into an agreement with the entity operating the Organ Procurement and Transplantation Network with respect to the solicitation of donations to offset expenditures relating to medal issuance.
United States · United States Congress · 18 February 1993
TABLE OF CONTENTS: Title I: Imposition and Term of Mandatory National Service Obligation Title II: Administration of National Service Title III: Miscellaneous National Service Programs National American Youth Service Act - Title I: Imposition and Term of Mandatory National Service Obligation - (Sec. 101) Imposes a national service obligation on U.S. citizens or permanent residents, to be satisfied between the ages of 18 and 26 through various types of service. (Sec. 102) Requires registration with the local national service board. (Sec. 103) Sets forth the types of national service to satisfy the obligation, including service as a dollar-per-hour volunteer with an accredited sponsor organization or a new Federal volunteer program; (2) service with the existing Federal volunteer programs; (3) employment as a law enforcement officer or firefighter; (4) service in the armed forces; and (5) participation in and successful completion of the Job Corps or a job training program for the economically disadvantaged under the Job Training Partnership Act or a comparable State job training program. (Sec. 104) Makes individuals who fail to register or complete the national service obligation ineligible for: (1) appointment to a position in a Federal agency; (2) the Medicare program; (3) Federal old-age, survivors, and disability insurance benefits; (4) any student assistance under the Higher Education Act of 1965 or the Public Health Service Act; and (5) job training and employment assistance under the Job Training Partnership Act. (Sec. 105) Provides for exemptions and deferments on the basis of unfitness to serve and temporary hardship deferments. Title II: Administration of National Service - (Sec. 201) Establishes the Office of National Service (ONS) to regulate and oversee registration and performance of national service participants. Requires ONS to be fully operational by October 1, 1995. Establishes a task force on national service to: (1) identify existing opportunities in the Federal Government for volunteer services performance; and (2) consider methods to expand opportunities for national service participants through federally-operated programs. (Secs. 202 and 203) Requires the Director to: (1) establish a system to track and record national service performance by participants; and (2) consider the feasibility of using Selective Service System personnel and facilities and certain Internal Revenue Code statements and records. (Sec. 204) Requires the Director to establish a network, consisting of a State national service office for each State and a local national service board for each congressional district, to: (1) register participants; (2) assist them to find and perform national service in satisfaction of their obligation; and (3) approve sponsor organizations. Authorizes the Director to use State headquarters and local boards of the Selective Service System as part of the network. Requires each State office and local board in the network to: (1) disseminate information on registration and national service obligations; (2) provide information and counseling to participants on service opportunities; and (3) investigate complaints between participants and sponsor organizations. (Sec. 205) Sets forth application and accreditation agreement requirements for nonprofit organizations to serve as sponsor organizations. Requires the State office to establish and maintain a directory of accredited sponsor organizations. Requires that the actual selection of a participant to perform service with a sponsor organization be left to that organization's discretion. (Sec. 206) Authorizes appropriations for titles I and II. Title III: Miscellaneous National Service Programs - (Sec. 301) Amends the National and Community Service Act of 1990 to authorize appropriations to the Commission on National and Community Service for grants under the American Conservation and Youth Service Corps program. (Sec. 302) Amends the Domestic Volunteer Service Act of 1973 to extend the Volunteers in Service to America (VISTA) program. Increases the minimum number of years of VISTA volunteer service (including training and other support) for which funds must be made available first from appropriations for National Volunteer Antipoverty Programs. (Sec. 303) Amends the Peace Corps Act to authorize appropriations for the Peace Corps program. Requires the President to endeavor to maintain a specified minimum Peace Corps enrollment. (Sec. 304) Amends the Elementary and Secondary Education Act of 1965 to direct the Secretary of Education (the Secretary) to establish the Urban Elementary School Literacy Corps (UESLC) to recruit, select, train, and assign volunteers to provide individual attention and instruction in reading and writing to first and second grade students in urban elementary schools. Authorizes appropriations. Amends the Higher Education Act of 1965 to provide for cancellation of certain student loans because of service as an UESLC volunteer.
United States · United States Congress · 18 February 1993
Amends Federal law to disregard cost-of-living adjustments in tier 1 railroad retirement benefits in determining eligibility for under title XIX (Medicaid) of the Social Security Act for those individuals who cease to be eligible for supplemental security income benefits because of such adjustments.
United States · United States Congress · 18 February 1993
Makes expenses incurred during the year after enactment of this Act by the State of Hawaii for operating its State Health Insurance Program eligible for reimbursement from funds appropriated to the Public Health and Social Services Emergency Fund under a specified public law and subsequent appropriations Acts.
United States · United States Congress · 18 February 1993
Amends the Immigration and Nationality Act to exclude aliens infected with the HIV virus from admission into the United States.
United States · United States Congress · 18 February 1993
Designates August 23, 1993, as National Health Unit Coordinator Day.
United States · United States Congress · 18 February 1993
Joint Commission for the United States-Mexico Border Region Resolution - Urges the President to reach an agreement with Mexico on the establishment of a joint commission between the United States and Mexico to help alleviate public health and environmental problems in the U.S.-Mexico border region caused by the lack of environmental infrastructure in the region, the growing shortages of ground and surface water resources shared by both nations, and the increased levels of commerce, trade, and economic development under the North American Free Trade Agreement. Urges the Commission to establish: (1) and oversee a Border Environmental Guaranty Fund to provide financial guarantees for the repayment of debt instruments issued by public and private financial organizations to fund projects to create, replace, or improve the environmental infrastructure in the region; (2) a program to provide for technical assistance and the exchange of personnel for environmental coordination activities between the United States and Mexico; (3) procedures to promote increased public participation and public disclosure relating to public health and environmental issues in the region; and (4) a U.S.-Mexico Border Volunteer Service to work to expand specified activities of the Senior Corps of Retired Executives, provide certain assistance and advice to border area not-for-profit organizations, and promote initiatives aimed at increasing the level of corporate philanthropy among businesses in the region for alleviating public health and environmental problems. Directs the Commission to submit an annual report to both the United States and Mexican Governments regarding its activities.
United States · United States Congress · 18 February 1993
Calls for States to develop procedures that require medical examiners and coroners to make reasonable, good faith efforts to locate and notify the next of kin of deceased persons where the identity of the deceased or the next of kin is unknown.
United States · United States Congress · 17 February 1993
Medicare Bone Mass Measurement Coverage Act of 1993 - Amends title XVIII (Medicare) of the Social Security Act to provide Medicare coverage of bone mass measurements.