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Bill· HRH.R. 5540 (96th)referred
United States · United States Congress · 11 October 1979
Drug Labeling Amendments of 1979 - Amends the Federal Food, Drug, and Cosmetic Act to require specified information on the label of any drug administered or dispensed to or purchased by any individual. Permits practitioners licensed to administer drugs to stipulate when writing a prescription for such drug that specified information not be included. Directs the Secretary of Health, Education, and Welfare to publish a list of priorities for the promulgation of regulations based upon: (1) the frequency of the use of a drug; (2) the frequency of prescriptions of a drug for uses other than the uses prescribed; and (3) the frequency of occurrence of adverse effects from the use of a drug.
Bill· HRH.R. 5458 (96th)referred
United States · United States Congress · 28 September 1979
Amends title XIX (Medicaid) of the Social Security Act to change from December 31, 1977, to December 31, 1978, the date on which the calendar quarter ends during which a State must show to the Secretary of Health, Education, and Welfare its effective control over the utilization of certain inpatient care received in a hospital, skilled nursing facility, or intermediate care facility for the calendar quarters ending after January 1, 1977, and before October 1, 1977, in order to prevent a reduction in the Federal medical assistance percentage to the State.
Bill· HRH.R. 5437 (96th)referred
United States · United States Congress · 27 September 1979
Nitrite Moratorium and Food Safety Act - Forbids the Secretaries of Health, Education, and Welfare, and Agriculture from prohibiting commerce in foods containing a quantity of nitrite which: (1) is acceptable under the tolerance levels in effect on May 1, 1979, unless a rule proposing lower levels has been published by such date; or (2) is shown to be safe or necessary to protect such food against the development of botulism. Permits the continued use of an unsafe quantity of nitrite under such conditions until an alternative and feasible means of preventing the development of botulism is available. States that a food shall be deemed adulterated if it contains quantities of nitrite in excess of those permitted under this Act. Directs the Secretaries of Health, Education, and Welfare and Agriculture to annually review the regulations issued under this Act. Requires that all action taken under the Federal Meat Inspection Act, the Poultry Products Inspection Act, or the Federal Food, Drug, and Cosmetic Act be consistent with the provisions of this Act.
Bill· SS. 1812 (96th)referred
United States · United States Congress · 25 September 1979
National Health Plan Act - Sets forth the following three major structural elements of a National Health Plan established by this Act for the benefit of individuals who live or work in the United States: (1) health insurance required to be provided by all employers to employees and their families; (2) Healthcare, a Federal health insurance program for the aged, disabled, poor, and for other individuals who cannot obtain health insurance elsewhere; and (3) health systems reform, designed to enhance competition in the health care system, reduce excess capacity in hospitals, and improve access to essential health resources. Title I: Protection Against Medical Expenses - Replaces title XVIII (Medicare) of the Social Security Act with a National Health Plan. Provides coverage under the Plan for the following items and services when reasonable and needed to diagnose, treat, or aid in rehabilitation from disease, injury, or malformation: (1) inpatient hospital items and services; (2) inpatient skilled nursing items and services; (3) home health items and services; (4) physician's services; (5) outpatient physical therapy services; (6) health care practitioner items and services; (7) x-ray, radium, and radioactive isotope therapy services; (8) certain ambulance services; (9) chiropractor's services; and (10) the following items as specified by a physician: certain supplies furnished as an incident to a physician's professional services, diagnostic tests, x-ray, radium, and radioactive isotope therapy items, devices used for the reduction of fractures or dislocations, durable medical equipment, non-dental prosthetic devices, colostomy care supplies, blood, body organs, allergen extracts, portable devices for monitoring cardiac failure and portable respirators, dialysis items for chronic renal disease, and braces for the leg, arm, neck, and back. Provides coverage under the Plan for the following items and services when reasonable and needed for the maintenance of good health: (1) family planning items and services; (2) immunizations; (3) items and services related to pregnancy, to delivery, to care of a child for one year after birth, or to care of a women through 60 days after termination of pregnancy; (4) items and services for entitled individuals under 18 as prescribed by the Secretary of Health, Education, and Welfare; and (5) dental, vision, and hearing items and services for certain eligible individuals under 18. Excludes the following items and services from coverage under the Plan: (1) items and services needed solely to diagnose, treat, or aid in rehabilitation from disease, accident, or malformation in relation to teeth or structures directly supporting teeth, other than oral surgery in case of accident or malformation; (2) eyeglasses, eye examinations for the purpose of prescribing, fitting, or changing eyeglasses, and procedures performed to determine the refractive state of the eyes; (3) hearing aids or examinations for hearing aids, except for certain eligible individuals under 18; (4) personal comfort items that are not supplied to all patients of an entity or are not found to promote higher quality care; (5) cosmetic surgery, except as required for the prompt repair of accidental injury or for improvement of a malformed body member; (6) items and services furnished to an individual by an immediate relative or a member of the individual's household; (7) items and services for the treatment of flat foot conditions, the treatment of subluxations of the foot, or routine foot care; (8) surgery performed by an uncertified physician; (9) diagnostic tests for environmental or occupational diseases; (10) elective surgery; (11) items and services that a physician has not certified; (12) custodial care; and (13) items and services furnished by the Veterans' Administration to a disabled veteran for a military service-connected disability. Requires every employer to provide coverage under a qualified plan or under Healthcare for each employee family member, unless an individual is covered under a qualified plan or under Healthcare with another employer and chooses not to accept coverage. Requires every employer not providing coverage under Healthcare to employee family members in a geographic area to designate one qualified plan as the employer's primary plan in that geographic area. Requires every employer to offer a health benefit, whether or not part of a qualified plan, to each employee family member in a geographic area if the employer offers that health benefit to any other employee family member in that geographic area. Requires every employer to provide for the payment of required premiums on behalf of employee family members to the entity administering a qualified plan, or, to the Secretary if coverage is under Healthcare. Prohibits an employer requiring any employee covered under the employer's primary plan or under Healthcare from contributing more than 25 percent of the premium payments for his or her family members attributable to the minimum benefits required by a plan under this Act. Provides that the employer's total share of premium or other payments for health benefits provided to an employee's family in a geographic area shall be equal to the employer's share of premium payments under the primary plan or Healthcare for a family of the same size and composition in that geographic area. Requires a plan, in order to be certified by the Secretary as qualified, to, among other things: (1) be administered by an entity certified by the Secretary; (2) cover at a minimum the items and services covered by the National Health Plan; (3) provide for rates of payment under the plan for items and services such that the rates in the aggregate insure access to items and services; (4) provide a certain level of quality of items and services; (5) provide specified rates of payment; and (6) prohibit total coinsurance and deductibles for items and services covered by the National Health Plan for the family members of any employee from exceeding $2,500 subject to certain adjustments and stipulations. Provides that services prescribed by a health maintenance organization (HMO) shall be considered a qualified plan. Directs the Secretary to certify an entity as a plan administrator only if it meets specified criteria pertaining to: (1) the privacy of medical records; (2) the availability of certain information concerning the plan; (3) access to records; (4) grievance procedures; (5) the purchase of additional insurance; (6) premiums; (7) solvency; and (8) control of the entity. Establishes in the Treasury a Health Reinsurance Fund to make reinsurance available and to be used for any Federal insolvency program. Directs the Secretary to report to Congress on the adequacy of State programs for assuring the solvency of health insurers. Authorizes the Secretary to establish a Federal insolvency program for any State that does not have an adequate program for assuring the solvency of health insurers. Directs the Secretary to establish an Insurance Standards Advisory Board to advise the Secretary with respect to: (1) standards for qualified plans; (2) implementation of the certification process; (3) appeals from plans or administrators denied certification; and (4) other matters as requested by the Secretary. Directs the Secretary to pay to any employer whose premium payments for the required minimum benefits exceed five percent of his or her payroll the difference between those payments and five percent of the payroll, if such payments are reasonable in relation to the benefits provided. Sets forth civil penalties for employers who fail to provide coverage and make premium payments as required by this Act. Entitles the following individuals to Healthcare: (1) individuals age 65 or older who are entitled to benefits under title II (Old Age, Survivors and Disability Insurance) of the Social Security Act or are qualified to receive railroad retirement benefits; (2) disabled individuals entitled to benefits under title II or the Railroad Retirement Act; (3) every individual who is fully or currently insured under title II or the Railroad Retirement Act or is the spouse or dependent child of such individual and certain individuals who have end stage renal disease (ESRD); (4) kidney donors; (5) family members of U.S. citizens and aliens admitted for permanent residence; (6) individuals covered by a Healthcare employer agreement; (7) individuals and family members of individuals who are at or below 55 percent of the poverty level, as reduced according to this Act; (8) individuals eligible under title XIX (Medicaid) of the Act whose income, reduced as provided for in this Act, does not exceed specified levels; and (9) individuals eligible for assistance under titles I (Old-Age and Medical Assistance), X (Aid to the Blind), XIV (Aid to the Permanently and Totally Disabled), IV (part A, Aid to Families with Dependent Children), or XVI (Supplemental Security Income) of the Act and who are residents of States which, if eligible, participate in Medicaid. Provides that an individual required to make Healthcare premium payments shall cease to be entitled to Healthcare benefits if the individual: (1) files notice that he or she no longer wishes to participate in Healthcare; or (2) fails to make a required payment. Provides that the Secretary shall make payments for items and services furnished to individuals covered by the National Health Plan. Prohibits payments for: (1) more than 100 days of inpatient skilled nursing items and services annually; (2) more than 30 days annually of inpatient hospital items and services for a mental or nervous condition, alcoholism, or drug abuse; (3) more than $1,000 annually for outpatient items and services related to a mental or nervous condition, alcoholism, or drug abuse; and (4) more than 200 home health visits annually. Sets the monthly premium for individuals age 65 and older, disabled individuals, railroad retirement beneficiaries, and certain other individuals at $8.70, to be indexed from 1980 to the cost of health care. Limits premiums, coinsurance, and deductibles for this group, after 1983, to $1,250 indexed from 1980 to take into account the increase in per capita expenses for health. Provides that individuals eligible for Healthcare because of low-income shall not be subject to any premium, coinsurance, or deductible. Provides that the premium for any citizen or alien admitted for permanent residence seeking coverage under the Plan and who is not otherwise covered through an employer plan or Healthcare shall be set by the Secretary using a community rating system. Limits out of pocket expenses for this group to $2,500. Provides that the premium paid by an employer with more than nine employees shall be five percent of the payroll for employees covered by an agreement under this Act. Provides that premiums for individuals receiving payments under title II of the Act or the Railroad Retirement Act shall be deducted from such payments. Establishes the Healthcare Trust Fund. Appropriates to the Fund employer, employee, and self-employment Hospital Insurance taxes collected pursuant to the Internal Revenue Code. Establishes the Board of Trustees of the Trust Fund to be composed of the Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health, Education, and Welfare, all ex officio. Directs the Board of Trustees to: (1) hold the Trust Fund; (2) report to Congress concerning the status of the Trust Fund; and (3) review the general policies followed in managing the Trust Fund, and recommend changes in such policies. Requires each State with an approved Medicaid plan to participate in the costs of services provided for by this Act. Directs each State to pay, for fiscal years 1983 and 1984, an amount equal to 90 percent of its Medicaid payments to the Healthcare Trust Fund, and as according to a specified formula for each succeeding year. Prohibits Federal funding to a State for programs under titles V (Maternal and Child Health) and XX (Grants to States for Services) of the Act or for any program for delivery of health care services under the Public Health Service Act if such State is eligible to participate in Medicaid but does not participate. Directs the Secretary to pay for inpatient hospital items and services and for the services of a hospital based physician on the basis of reasonable cost; inpatient skilled nursing items and services and for home health items and services on the basis of reasonable cost or on the basis of prospectively set rates, outpatient services on the basis of a prospectively set, all-inclusive rate per visit, physician's services on the basis of a fee schedule, and for all other covered items and services on such basis as the Secretary of Health, Education, and Welfare finds reasonable. Authorizes the Secretary to enter into contracts with public and private entities to provide for the administration of benefits under this Act with maximum efficiency and convenience. Directs the Secretary to determine annually a per capita rate of payment for each class of individuals entitled to benefits under this Act and who are enrolled pursuant to this Act with an HMO. Directs the Secretary to define classes of members based on such factors as age, sex, institutional status, disability status and place of residence, and cost sharing requirements. Provides a rate for each class equal to 95 percent of the adjusted average per capita cost for that class. Defines the term "adjusted average per capita cost" to mean the average per capita amount that the Secretary estimates would be payable for services furnished under the program established by this Act, if the services were to be furnished by other than an HMO. Provides that every individual entitled to benefits under this Act shall be eligible to enroll with an HMO with which the Secretary has contracted to provide services. Sets limits on an HMO's premium rate and the actuarial value of its other charges for individuals enrolled under this Act. Authorizes the Secretary to contract with any HMO that can provide the benefits required by this Act. Permits a provider to obtain a hearing with respect to a claim for payment with a Provider Reimbursement Review Board which the Secretary shall establish if: (1) the reimbursement offered a provider is not satisfactory or a timely determination is not made as to the amount of reimbursement due; (2) the amount in controversy is $10,000 or more; and (3) the provider requests a hearing within 180 days after a reimbursement determination has been made. Directs the Secretary to establish procedures to assure that: (1) all individuals have an opportunity to apply for the benefits provided by this Act; (2) determinations of eligibility are made promptly; and (3) individuals determined ineligible for benefits or certain items and services are granted a fair hearing concerning such determination. Requires a provider to be certified by the Secretary in order to participate in the programs established by this Act. Sets forth general requirements for certification as a provider of items and services covered under this Act. Sets forth further requirements which must be met to be certified as a provider of the following specific items and services: (1) inpatient hospital items and services; (2) inpatient hospital items and services furnished to an individual with a mental or nervous condition, alcoholism, or drug abuse; (3) inpatient skilled nursing items and services; and (4) home health items and services. Requires every provider to have in effect a specified agreement with the Secretary pertaining to payment for items and services, filing information and reports with the Secretary, non-discrimination, certification requirements, and termination of the agreement. Authorizes the Secretary to revoke the certification of a provider which no longer meets the requirements of this Act, or to impose other sanctions as appropriate. Authorizes the Secretary to define various kinds of health care practitioners other than physicians and to certify an individual as a qualified health care practitioner of a certain kind. Sets forth the definitions of terms used in this Act. Provides for penalties of up to $25,000, or imprisonment for up to five years, or both for any individual seeking to obtain benefits or payments under this Act by fraud or abuse. Authorizes the Secretary to prescribe regulations to carry out this Act. Directs the Secretary to conduct studies on and to report to Congress concerning: (1) the health care of the American people including studies of the adequacy of existing personnel and facilities for health care, efficient and economic alternatives to inpatient hospital care, and the various effects of deductions and coinsurance; and (2) the operation and administration of the insurance programs established under this Act. Makes conforming amendments to the Medicaid program including redefining "medical assistance" and eligibility requirements. Repeals provisions of title XIX under which certain SSI recipients are not required to be covered under a State's Medicaid plan. Amends the Internal Revenue Code to permit a deduction for medical expenses for those medical expenses which exceed ten percent of adjusted gross income. Increases the earned income tax credit. Includes as members of the National Professional Standards Review Council one dentist, one registered nurse, one health care practitioner not a physician, one individual representative of insurance companies operated for profit, one individual of representative of nonprofit insurance companies, one individual representative of employers self-funded with respect to the provision of employee health benefits, and one individual representative of health maintenance organizations. Amends title XIII (Health Maintenance Organizations) of the Public Health Service Act to require employers to offer membership in an HMO serving an area in which at least 25 of the employer's employees reside. Authorizes the Secretary to waive compliance with the requirements of titles X, XVIII, and XIX of the Act to the extent necessary to conduct specified experiments or demonstration projects. Provides for the transfer of funds in the Medicare trust funds to the Healthcare Trust Fund. Title II: Health System Reform - Amends title XV (National Health Planning and Development) of the Public Health Service Act to direct the Secretary to annually set a national limit for certificates and reports of need to be issued for major increases in hospital capital stock. Sets the limit at $3,000,000,000 to be increased to reflect a rise in construction prices and adjusted further to reflect population changes. Defines a "major increase in hospital capital stock" as the establishment of a new hospital or an acquisition or improvement by an existing hospital that exceeds $150,000 in value, would increase the number of short term non-federal hospital beds, or would substantially change institutional health services offered. Stipulates that a certificate of need authorizing new short term non-federal hospital beds in a health service area where the number of such beds per 1,000 persons in the area exceeds the bed limit for that area may only be issued if two existing beds would be eliminated for each new bed established. Requires a certificate of need authorizing a major increase in hospital capital stock to specify the maximum dollar amount authorized. Prohibits the total value of such certificates issued in a State from exceeding the State's total allocation from the national limit, with certain adjustments. Permits exceptions to meet an emergency situation or if needed to assist in serving individuals from other States. Amends part A of title XI (General Provisions) of the Social Security Act to increase by a factor of ten the reduction in Federal payments under titles V, XVIII, and XIX of the Act for an increase in health care facility capital stock or a change in health care facility bed function made without an appropriate certificate of need. Directs the Secretary to allocate to each State a maximum dollar amount for: (1) all major increases in hospital stock in the State; (2) increases that will not result in an increase in the number of short term non-federal hospital beds; and (3) for other increases.
Bill· HRH.R. 5400 (96th)referred
United States · United States Congress · 25 September 1979
National Health Plan Act - Sets forth the following three major structural elements of a National Health Plan established by this Act for the benefit of individuals who live or work in the United States: (1) health insurance required to be provided by all employers to employees and their families; (2) Healthcare, a Federal health insurance program for the aged, disabled, poor, and for other individuals who cannot obtain health insurance elsewhere; and (3) health systems reform, designed to enhance competition in the health care system, reduce excess capacity in hospitals, and improve access to essential health resources. Title I: Protection Against Medical Expenses - Replaces title XVIII (Medicare) of the Social Security Act with a National Health Plan. Provides coverage under the Plan for the following items and services when reasonable and needed to diagnose, treat, or aid in rehabilitation from disease, injury, or malformation: (1) inpatient hospital items and services; (2) inpatient skilled nursing items and services; (3) home health items and services; (4) physician's services; (5) outpatient physical therapy services; (6) health care practitioner items and services; (7) x-ray, radium, and radioactive isotope therapy services; (8) certain ambulance services; (9) chiropractor's services; and (10) the following items as specified by a physician: certain supplies furnished as an incident to a physician's professional services, diagnostic tests, x-ray, radium, and radioactive isotope therapy items, devices used for the reduction of fractures or dislocations, durable medical equipment, non-dental prosthetic devices, colostomy care supplies, blood, body organs, allergen extracts, portable devices for monitoring cardiac failure and portable respirators, dialysis items for chronic renal disease, and braces for the leg, arm, neck, and back. Provides coverage under the Plan for the following items and services when reasonable and needed for the maintenance of good health: (1) family planning items and services; (2) immunizations; (3) items and services related to pregnancy, to delivery, to care of a child for one year after birth, or to care of a women through 60 days after termination of pregnancy; (4) items and services for entitled individuals under 18 as prescribed by the Secretary of Health, Education, and Welfare; and (5) dental, vision, and hearing items and services for certain eligible individuals under 18. Excludes the following items and services from coverage under the Plan: (1) items and services needed solely to diagnose, treat, or aid in rehabilitation from disease, accident, or malformation in relation to teeth or structures directly supporting teeth, other than oral surgery in case of accident or malformation; (2) eyeglasses, eye examinations for the purpose of prescribing, fitting, or changing eyeglasses, and procedures performed to determine the refractive state of the eyes; (3) hearing aids or examinations for hearing aids, except for certain eligible individuals under 18; (4) personal comfort items that are not supplied to all patients of an entity or are not found to promote higher quality care; (5) cosmetic surgery, except as required for the prompt repair of accidental injury or for improvement of a malformed body member; (6) items and services furnished to an individual by an immediate relative or a member of the individual's household; (7) items and services for the treatment of flat foot conditions, the treatment of subluxations of the foot, or routine foot care; (8) surgery performed by an uncertified physician; (9) diagnostic tests for environmental or occupational diseases; (10) elective surgery; (11) items and services that a physician has not certified; (12) custodial care; and (13) items and services furnished by the Veterans' Administration to a disabled veteran for a military service-connected disability. Requires every employer to provide coverage under a qualified plan or under Healthcare for each employee family member, unless an individual is covered under a qualified plan or under Healthcare with another employer and chooses not to accept coverage. Requires every employer not providing coverage under Healthcare to employee family members in a geographic area to designate one qualified plan as the employer's primary plan in that geographic area. Requires every employer to offer a health benefit, whether or not part of a qualified plan, to each employee family member in a geographic area if the employer offers that health benefit to any other employee family member in that geographic area. Requires every employer to provide for the payment of required premiums on behalf of employee family members to the entity administering a qualified plan or to the Secretary if coverage is under Healthcare. Prohibits an employer from requiring any employee covered under the employer's primary plan or under Healthcare from contributing more than 25 percent of the premium payments for his or her family members attributable to the minimum benefits required by a plan under this Act. Provides that the employer's total share of premium or other payments for health benefits provided to an employee's family in a geographic area shall be equal to the employer's share of premium payments under the primary plan or Healthcare for a family of the same size and composition in that geographic area. Requires a plan, in order to be certified by the Secretary as qualified, to, among other things: (1) be administered by an entity certified by the Secretary; (2) cover at a minimum the items and services covered by the National Health Plan; (3) provide for rates of payment under the plan for items and services such that the rates in the aggregate insure access to items and services; (4) provide a certain level of quality of items and services; (5) provide specified rates of payment; and (6) prohibit total coinsurance and deductibles for items and services covered by the National Health Plan for the family members of any employee from exceeding $2,500, subject to certain adjustments and stipulations. Provides that services prescribed by a health maintenance organization (HMO) shall be considered a qualified plan. Directs the Secretary to certify an entity as a plan administrator only if it meets specified criteria pertaining to: (1) the privacy of medical records; (2) the availability of certain information concerning the plan; (3) access to records; (4) grievance procedures; (5) the purchase of additional insurance; (6) premiums; (7) solvency; and (8) control of the entity. Establishes in the Treasury a Health Reinsurance Fund to make reinsurance available and to be used for any Federal insolvency program. Directs the Secretary to report to Congress on the adequacy of State programs for assuring the solvency of health insurers. Authorizes the Secretary to establish a Federal insolvency program for any State that does not have an adequate program for assuring the solvency of health insurers. Directs the Secretary to establish an Insurance Standards Advisory Board to advise the Secretary with respect to: (1) standards for qualified plans; (2) implementation of the certification process; (3) appeals from plans or administrators denied certification; and (4) other matters as requested by the Secretary. Directs the Secretary to pay to any employer whose premium payments for the required minimum benefits exceed five percent of his or her payroll the difference between those payments and five percent of the payroll, if such payments are reasonable in relation to the benefits provided. Sets forth civil penalties for employers who fail to provide coverage and make premium payments as required by this Act. Entitles the following individuals to Healthcare: (1) individuals age 65 or older who are entitled to benefits under title II (Old Age, Survivors and Disability Insurance) of the Social Security Act or are qualified to receive railroad retirement benefits; (2) disabled individuals entitled to benefits under title II or the Railroad Retirement Act; (3) every individual who is fully or currently insured under title II or the Railroad Retirement Act or is the spouse or dependent child of such individual and certain individuals who have end stage renal disease (ESRD); (4) kidney donors; (5) family members of U.S. citizens and aliens admitted for permanent residence; (6) individuals covered by a Healthcare employer agreement; (7) individuals and family members of individuals who are at or below 55 percent of the poverty level, as reduced according to this Act; (8) individuals eligible under title XIX (Medicaid) of the Act whose income, reduced as provided for in this Act, does not exceed specified levels; and (9) individuals eligible for assistance under titles I (Old-Age and Medical Assistance), X (Aid to the Blind), XIV (Aid to the Permanently and Totally Disabled), IV (part A, Aid to Families with Dependent Children), or XVI (Supplemental Security Income) of the Act and who are residents of States which, if eligible, participate in Medicaid. Provides that an individual required to make Healthcare premium payments shall cease to be entitled to Healthcare benefits if the individual: (1) files notice that he or she no longer wishes to participate in Healthcare; or (2) fails to make a required payment. Provides that the Secretary shall make payments for items and services furnished to individuals covered by the National Health Plan. Prohibits payments for: (1) more than 100 days of inpatient skilled nursing items and services annually; (2) more than 30 days annually of inpatient hospital items and services for a mental or nervous condition, alcoholism, or drug abuse; (3) more than $1,000 annually for outpatient items and services related to a mental or nervous condition, alcoholism, or drug abuse; and (4) more than 200 home health visits annually. Sets the monthly premium for individuals age 65 and older, disabled individuals, railroad retirement beneficiaries, and certain other individuals at $8.70, to be indexed from 1980 to the cost of health care. Limits premiums, coinsurance, and deductibles for this group, after 1983, to $1,250 indexed from 1980 to take into account the increase in per capita expenses for health. Provides that individuals eligible for Healthcare because of low-income shall not be subject to any premium, coinsurance, or deductible. Provides that the premium for any citizen or alien admitted for permanent residence seeking coverage under the Plan and who is not otherwise covered through an employer plan or Healthcare shall be set by the Secretary using a community rating system. Limits out of pocket expenses for this group to $2,500. Provides that the premium paid by an employer with more than nine employees shall be five percent of the payroll for employees covered by an agreement under this Act. Provides that premiums for individuals receiving payments under title II of the Act or the Railroad Retirement Act shall be deducted from such payments. Establishes the Healthcare Trust Fund. Appropriates to the Fund employer, employee, and self-employment Hospital Insurance taxes collected pursuant to the Internal Revenue Code. Establishes the Board of Trustees of the Trust Fund to be composed of the Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health, Education, and Welfare, all ex officio. Directs the Board of Trustees to: (1) hold the Trust Fund; (2) report to Congress concerning the status of the Trust Fund; and (3) review the general policies followed in managing the Trust Fund, and recommend changes in such policies. Requires each State with an approved Medicaid plan to participate in the costs of services provided for by this Act. Directs each State to pay, for fiscal years 1983 and 1984, an amount equal to 90 percent of its Medicaid payments to the Healthcare Trust Fund, and as according to a specified formula for each succeeding year. Prohibits Federal funding to a State for programs under titles V (Maternal and Child Health) and XX (Grants to States for Services) of the Act or for any program for delivery of health care services under the Public Health Service Act if such State is eligible to participate in Medicaid but does not participate. Directs the Secretary to pay for inpatient hospital items and services and for the services of a hospital based physician on the basis of reasonable cost, inpatient skilled nursing items and services and for home health items and services on the basis of reasonable cost or on the basis of prospectively set rates, outpatient services on the basis of a prospectively set, all-inclusive rate per visit, physician's services on the basis of a fee schedule, and for all other covered items and services on such basis as the Secretary of Health, Education, and Welfare finds reasonable. Authorizes the Secretary to enter into contracts with public and private entities to provide for the administration of benefits under this Act with maximum efficiency and convenience. Directs the Secretary to annually determine a per capita rate of payment for each class of individuals entitled to benefits under this Act and who are enrolled pursuant to this Act with an HMO. Directs the Secretary to define classes of members based on such factors as age, sex, institutional status, disability status and place of residence, and cost sharing requirements. Provides a rate for each class equal to 95 percent of the adjusted average per capita cost for that class. Defines the term "adjusted average per capita cost" to mean the average per capita amount that the Secretary estimates would be payable for services furnished under the program established by this Act, if the services were to be furnished by other than an HMO. Provides that every individual entitled to benefits under this Act shall be eligible to enroll with an HMO with which the Secretary has contracted to provide services. Sets limits on an HMO's premium rate and the actuarial value of its other charges for individuals enrolled under this Act. Authorizes the Secretary to contract with any HMO that can provide the benefits required by this Act. Permits a provider to obtain a hearing with respect to a claim for payment with a Provider Reimbursement Review Board which the Secretary shall establish if: (1) the reimbursement offered a provider is not satisfactory or a timely determination is not made as to the amount of reimbursement due; (2) the amount in controversy is $10,000 or more; and (3) the provider requests a hearing within 180 days after a reimbursement determination has been made. Directs the Secretary to establish procedures to assure that: (1) all individuals have an opportunity to apply for the benefits provided by this Act; (2) determinations of eligibility would be made promptly; and (3) individuals determined ineligible for benefits or certain items and services would be granted a fair hearing concerning such determination. Requires a provider to be certified by the Secretary in order to participate in the programs established by this Act. Sets forth general requirements for certification as a provider of items and services covered under this Act. Sets forth further requirements which must be met to be certified as a provider of the following specific items and services: (1) inpatient hospital items and services; (2) inpatient hospital items and services furnished to an individual with a mental or nervous condition, alcoholism, or drug abuse; (3) inpatient skilled nursing items and services; and (4) home health items and services. Requires every provider to have in effect a specified agreement with the Secretary pertaining to payment for items and services, filing information and reports with the Secretary, non-discrimination, certification requirements, and termination of the agreement. Authorizes the Secretary to revoke the certification of a provider which no longer meets the requirements of this Act, or to impose other sanctions as appropriate. Authorizes the Secretary to define various kinds of health care practitioners other than physicians and to certify an individual as a qualified health care practitioner of a certain kind. Sets forth the definitions of terms used in this Act. Provides for penalties of up to $25,000, or imprisonment for up to five years, or both for any individual seeking to obtain benefits or payments under this Act by fraud or abuse. Authorizes the Secretary to prescribe regulations to carry out this Act. Directs the Secretary to conduct studies on and to report to Congress concerning: (1) the health care of the American people including studies of the adequacy of existing personnel and facilities for health care, efficient and economic alternatives to inpatient hospital care, and the various effects of deductions and coinsurance; and (2) the operation and administration of the insurance programs established under this Act. Makes conforming amendments to the Medicaid program including redefining "medical assistance" and eligibility requirements. Repeals provisions of title XIX under which certain SSI recipients were not required to be covered under a State's Medicaid plan. Amends the Internal Revenue Code to permit a deduction for medical expenses for those medical expenses which exceed ten percent of adjusted gross income. Increases the earned income tax credit. Includes as members of the National Professional Standards Review Council one dentist, one registered nurse, one health care practitioner who is not a physician, one individual representative insurance companies operated for profit, one individual of representative of nonprofit insurance companies, one individual representative of employers self-funded with respect to the provision of employee health benefits, and one individual representative of health maintenance organizations. Amends title XIII (Health Maintenance Organizations) of the Public Health Service Act to require employers to offer membership in an HMO serving an area in which at least 25 of the employer's employees reside. Authorizes the Secretary to waive compliance with the requirements of titles X, XVIII, and XIX of the Act to the extent necessary to conduct specified experiments or demonstration projects. Provides for the transfer of funds in the Medicare trust funds to the Healthcare Trust Fund. Title II: Health System Reform - Amends title XV (National Health Planning and Development) of the Public Health Service Act to direct the Secretary to annually set a national limit for certificates and reports of need to be issued for major increases in hospital capital stock. Sets the limit at $3,000,000,000 to be increased to reflect a rise in construction prices and adjusted further to reflect population changes. Defines a "major increase in hospital capital stock" as the establishment of a new hospital or an acquisition or improvement by an existing hospital that exceeds $150,000 in value, would increase the number of short term non-federal hospital beds, or would substantially change institutional health services offered. Stipulates that a certificate of need authorizing new short term non-federal hospital beds in a health service area where the number of such beds per 1,000 persons in the area exceeds the bed limit for that area may only be issued if two existing beds would be eliminated for each new bed established. Requires a certificate of need authorizing a major increase in hospital capital stock to specify the maximum dollar amount authorized. Prohibits the total value of such certificates issued in a State from exceeding the State's total allocation from the national limit, with certain adjustments. Permits exceptions to meet an emergency situation or if needed to assist in serving individuals from other States. Amends part A of title XI (General Provisions) of the Social Security Act to increase by a factor of ten the reduction in Federal payments under titles V, XVIII, and XIX of the Act for an increase in health care facility capital stock or a change in health care facility bed function made without an appropriate certificate of need. Directs the Secretary to allocate to each State a maximum dollar amount for: (1) all major increases in hospital stock in the State; (2) increases that will not result in an increase in the number of short term non-federal hospital beds; and (3) other increases.
Bill· HRH.R. 5395 (96th)referred
United States · United States Congress · 25 September 1979
Title I: Meat Labeling and Inspection - Amends the Federal Meat Inspection Act to require the labeling as imported of any imported meat or meat product, which is capable for use as human food, or its container. Requires that such products: (1) meet the same health standards as domestically produced meat; and (2) be tested in the exporting country. Requires periodic tests of such products in the United States by the Department of Agriculture as well. Title II: Requirement of Certain Eating Establishments to Inform Customers that Imported Meat or Meat Food Products are Served in Such Establishment - Requires eating establishments serving imported meat to inform customers of this fact.
Bill· HRH.R. 5373 (96th)referred
United States · United States Congress · 24 September 1979
Authorizes chiropractic care in medical facilities of the uniformed services and under the CHAMPUS (Civilian Health and Medical Plan of the Uniformed Services) program.
Bill· SS. 1794 (96th)referred
United States · United States Congress · 21 September 1979
Reye's Syndrome Act of 1979 - Amends title XI of the Public Health Service Act (Genetic Disease, Hemophilia Programs, and Sudden Infant Death Syndrome) to authorize the Secretary of Health, Education, and Welfare to establish, through the National Institute of Neurological, Communicative Disorders, and Stroke, the Reye's Syndrome Coordinating Committee to make grants to and enter into contracts with public and nonprofit private entities for a three-year project to establish two comprehensive Reye's syndrome diagnostic and treatment centers. Includes among the duties of such centers: (1) the conduct of basic and clinical research; (2) the development of new and improved treatments; (3) the provision of physician training programs; and (4) informational services, with respect to the detection, diagnosis, and treatment of Reye's syndrome. Directs the Secretary to submit a report to Congress within six months of the end of the project with respect to its accomplishments. Authorizes the Committee to provide financial assistance to public agencies, nonprofit private entities, and individuals not associated with the centers, to conduct research on Reye's syndrome.
Bill· HRH.R. 5317 (96th)referred
United States · United States Congress · 18 September 1979
Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health, Education, and Welfare to provide for demonstration projects for the provision of preventive health services to the elderly through traveling health care practitioners.
Bill· HRH.R. 5320 (96th)referred
United States · United States Congress · 18 September 1979
Hospital Full Disclosure and Cost Review Act of 1979 - Establishes a 15-member National Commission on Hospital Cost Containment to make recommendations to the Secretary of Health, Education, and Welfare with respect to: (1) implementation of this Act; (2) modifications of hospital reimbursement under Medicare on the basis of retrospectively determined costs; (3) the rate of increases in hospital expenses and the success of the voluntary efforts of hospitals to lower such rate; (4) the costs to hospitals of Government regulatory requirements with recommendations for the most cost-effective regulations; (5) the impact of technology on hospital costs and quality of services; and (6) any other matters affecting hospital expenses or revenues. Directs the Commission to consult with appropriate professional organizations in the conduct of its activities. Directs the Commission to study: (1) the effect of policies and procedures (including use of deductibles, coinsurance, cost- or risk-sharing, tax deductions and exclusions, and prepaid health plans) relating to payment of hospital services on (A) consumer and physician awareness of the cost and quality of different hospital services, and (B) the utilization and quality of hospital services; and (2) the desirability of increasing the use of such methods in federally funded and other health insurance programs. Directs the Commission to submit such study and recommendations to the appropriate congressional committees within two years of its appointment. Authorizes the Secretary of Health, Education, and Welfare to provide financial assistance for up to 50 percent of the expenses involved with the planning, establishment, or operation of State voluntary or mandatory hospital cost containment programs. Sets forth requirements with respect to such programs. Sets forth a finding of Congress that existing philanthropic support for hospitals is a strength which should be preserved and enhanced. Amends title XI of the Social Security Act (General Provisions) to provide that gifts, grants, and endowments shall not be deducted from any operating costs of nonprofit hospitals for purposes of determining under the Maternal and Child Health, Medicare, and Medicaid programs the reasonable costs of services furnished by such hospitals. Prohibits a State from establishing a law or regulation respecting the limitations upon the revenues of hospitals which treat as revenues amounts attributable to specified types of grants, gifts, or endowments. Applies such restriction to any Federal law providing for the containment or control of hospital costs.
Bill· HRH.R. 5287 (96th)referred
United States · United States Congress · 14 September 1979
Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health, Education, and Welfare to: (1) conduct a study, containing specified analyses, with regard to the cost effectiveness of the hourly salary equivalent reimbursement system which is currently required for determining the payment to providers for therapy services or services of health-related personnel (other than physicians); and (2) report such study to the appropriate congressional committees within two years of enactment. Suspends the guidelines for respiratory therapy services under Medicare pending submission of such study, and requires that Medicare costs for reimbursement of respiratory therapy services furnished under arrangements be evaluated so that such costs do not exceed what a prudent and cost- conscious buyer would pay for the given service in accordance with current Federal regulations.
Bill· HRH.R. 5217 (96th)referred
United States · United States Congress · 7 September 1979
Amends title IV of the Public Health Service Act (National Research Institutes) to stipulate that the institute currently authorized to conduct research on neurological diseases shall be named the "National Institute of Neurological and Communicative Disorders and Stroke." Requires at least $16,000,000 of the sums appropriated for such Institute to be obligated for research in the area of regeneration of the spinal cord.
Bill· SS. 1720 (96th)referred
United States · United States Congress · 6 September 1979
Health Care for All Americans Act - Establishes a comprehensive "national health insurance system" (defined as the programs established by this Act and Medicare for the financing of health-care services). States the findings and purposes of this Act. Enumerates the rights of eligible individuals, providers, insurers and health maintenance organizations (HMOs). Requires that such individuals and entities have their views considered with respect to actions under this Act affecting them. Gives such an individual the right to: (1) choose any participating provider with respect to a covered service; (2) the prompt and accurate making of decisions under this Act; (3) be heard on any grievance related to benefits under this Act; and (4) confidential treatment and use of information collected under this Act. Gives such a provider the right to: (1) decide whether or not to participate in the system; (2) the prompt and accurate payment for services; and (3) choose the mode and place of practice (with respect to a physician provider). Gives such an insurer and HMO the right to: (1) decide whether or not to participate in the system; and (2) carry on a supplemental health insurance business. Defines terms used in this Act. Title I: Eligibility, Entitlement, and Enrollment - Extends eligibility for the benefits of this Act to: (1) U.S. citizens; (2) aliens lawfully admitted or permanently residing in the U.S. under color of law, including refugees; (3) aliens admitted to the U.S. as employees of a foreign government or international organization which has entered into an agreement with the U.S.; and (4) aliens admitted as temporary visitors from a foreign government which has entered into such an agreement. Directs the National Health Board (established by this Act), after consultation with the Secretary of State, to recommend to the President that executive agreements be entered into: (1) with foreign governments and international organizations to make their employees and officers eligible for health benefits in return for a payment of the national community-rated premium plus an amount equal to what would otherwise be payable as the Medicare hospital insurance payroll tax, if such employees were so taxed; and (2) with foreign governments upon a determination that it is in the national interest to make nationals or citizens of such nations who visit the U.S. eligible for benefits in return for comparable treatment of U.S. citizens abroad. Entitles each eligible individual to: (1) enroll in a qualified plan offered by an insurer or HMO and to change enrollment during certain periods; (2) have payment made on such individual's behalf and not be charged any fee for basic covered services; and (3) be issued a health insurance enrollment card. Stipulates that such a card shall not identify the category or basis for the individual's enrollment. Requires enrollment information to be available and provided: (1) by employers to employees; (2) by or through the Board to Medicare-eligible individuals; (3) by the Secretaries of Defense, Transportation, Commerce, and HEW to active-duty uniformed service personnel under their jurisdiction; (4) by the Social Security Commissioner to Supplemental Security Income (SSI)- eligible individuals; (5) by managers of Federal and State institutions to residents; (6) by State welfare agencies to Aid to Families with Dependent Children (AFDC)-eligible persons; and (7) by or through State health boards to other individuals. Directs the Board to notify State health boards of the identity of eligible individuals who, in certain Federal information returns, have failed to indicate enrollment under a qualified plan. Requires providers to transmit to their respective health boards requests for payment for eligible persons who did not indicate enrollment at the time of receiving services. Directs State health boards to make special efforts to locate such persons and provide for their enrollment. Defines "first general open enrollment period", "general open enrollment period", and "special enrollment period" for purposes of the program. Stipulates that all members of a family (other than those who are Medicare or SSI-eligible or residents of a Federal or State institution) be enrolled at any time in only one qualified plan. Requires employers to offer qualified employees during specified enrollment periods the choice of enrollment under: (1) at least one plan offered by an insurer belonging to (A) the Blue Cross-Blue Shield consortium or (B) the commercial insurance consortium; and (2) at least one plan offered by an HMO belonging to (A) the individual group practice HMO consortium or (B) the prepaid group practice HMO consortium (if such a plan is available in the area in which the employees obtain health care services). Allows the employer to also offer enrollment in plans offered by a self-insurer. Requires an offer of enrollment to be made first to a collective bargaining representative or other employee representative designated under law. Requires each employee to elect a plan in accordance with procedures established by the Board. Directs the employer to enroll such employee in a plan in accordance with procedures in the absence of such an election. Requires any employer offering in conjunction with a qualified plan a plan with benefits supplemental to basic services to provide employees with written information regarding additional employee costs for such supplemental plan. Limits a family which is offered a choice of plans to enroll under only one qualified plan. Subjects an employer who knowingly fails to comply with these requirements to a civil penalty which may be assessed by the Board and collected by civil suit in a district court. Requires active-duty members of the uniformed services to enroll in a plan from among such health plans offered by or through the Department of Defense as the Secretary of Defense, after consultation with the Secretaries of HEW, Transportation, Commerce, and the Board, finds are consistent with the statutory requirements regarding uniformed services medical care and with policy requiring provision of basic and other covered health services to such members and their families. Requires Medicare-eligible individuals to enroll with the Board or a participating HMO in accordance with the Medicare program. Allows SSI-eligible individuals, residents of Federal or State institutions not otherwise enrolled, AFDC-eligible individuals, or other individuals not otherwise enrolled to enroll during specified periods in any qualified health plan available to such individuals. Provides for the mandatory enrollment of such individuals who fail to enroll in a plan, in accordance with regulations of the Board and rules and procedures of the State health boards. Title II: Benefits and Providers - Includes as basic covered services: (1) inpatient and outpatient hospital services (and inpatient mental health services up to (A) 150 consecutive days for Medicare-eligible individuals, or (B) 45 consecutive days for other eligible individuals, during certain periods of treatment as determined under Medicare); (2) physicians' services, including hospital-based physicians (and services for the treatment of mental illness and outpatient mental health services to the extent that expenses for such services do not exceed the fee-equivalent of 20 psychiatric visits per year, as determined under Medicare); (3) post-hospital extended care services up to 100 days during any spell of illness; (4) the following preventive health services: (A) basic immunizations; (B) pre-and post-natal maternal care; (C) well-child care (including periodic physical examinations, hearing and vision screening, and developmental screening and examinations) for persons up to the age of 18 years; and (D) such other services as the Board may add on a year-by-year basis after consultation with appropriate experts and a determination by the Board that such services will be cost-effective (but limits the expenditure for such additional preventive services to $500,000,000 for the first effective year (defined as the third year after the year of enactment) and for subsequent years an increase tied to the average annual rate of increase in the gross national product). Includes as additional basic services: (1) outpatient physical therapy services, outpatient speech pathology services, and outpatient occupational therapy services, and outpatient occupational therapy services; (3) home dialysis supplies; (4) diagnostic X-ray tests and other diagnostic tests; (5) X-ray therapy; (6) durable medical equipment used in the patient's home; (7) ambulance service, to the extent provided by regulations; (8) prosthetic devices (other than dental), including lens after cataract surgery and replacements; (9) leg, arm, back, and neck braces, and artificial legs, arms, and eyes, including replacements; (10) insulin and outpatient prescription drugs for treatment of chronic conditions (but for Medicare-eligible individuals only to the extent provided under such program); (11) one audiological examination per individual per year and the provision of one hearing aid per individual for any three-year period; and (12) mental health day care services to the extent of two days for each day of inpatient mental health services permitted by this program. Excludes as basic services: (1) items and services for which payment may not be made under Medicare; and (2) for other than Medicare-eligible individuals payment for (A) orthopedic shoes or other supportive devices for the feet, (B) certain physician services described under Medicare, and (C) certain inpatient hospital services described under Medicare. Authorizes the Board, after consultation with the Commission on Health-Care Benefits and the Commission on Quality of Health Care (established by this Act), to exclude payment for an item or service under a plan under this program and Medicare on the basis of cost-effectiveness, notwithstanding any other provision. Makes specified provisions of title XI (General Provisions and Professional Standards Review) and title XVIII (Medicare) of the Social Security Act applicable to basic services provided under qualified plans to the same extent as they apply under Medicare. Authorizes the Board, after consultation with the Commissions on Health-Care Benefits and Quality of Health Care, to establish a list of high-risk, high-cost, elective, or overutilized items or services for which payment may be made only if one or more of the following conditions are met: (1) the provider is board-certified in the relevant specialty; (2) the diagnosis and recommended service are supported by a second opinion or specific objective findings; (3) the provider-institution is adequately equipped and staffed; (4) the specialist or institution is providing care upon referral by a primary-care physician; or (5) the provider has demonstrated through statistical services that it provides high-quality services and properly uses appropriate methods and technologies. Title III: Financing and Planning - Part A, Budget and Planning Process - Specifies the annual timetable for the budget process for the national health insurance system as follows: (1) by January 15th proposed annual State budgets are to be prepared by the State Health Boards, in accordance with regulations and after consultation with specified interests, and submitted to the Board; (2) the Board shall transmit for inclusion without change in the Budget presented by the President an estimate of the anticipated Federal expenditures related to the appropriate Annual Budgets; (3) by March 1st a comprehensive Annual Budget is to be prepared and adopted by the Board and transmitted to the President, Congress, the States, and the public; (4) the Congressional Budget Office shall submit to the appropriate congressional committees as soon as practicable after receipt of the Annual Budget an analysis of its impact on the Federal Budget; (5) by July 1st the annual State budgets are to be adopted by the State Health Boards, taking into consideration the State Health Care Improvement Plan mandated by this Act, and transmitted to the Board; and (6) on the following January 1st the budget year begins. Specifies the contents of the Annual Budget and annual State Budgets, including enumerated items in the following categories: (1) anticipated expenditures; (2) anticipated revenues; (3) separate schedules, including Medicare and other public programs; (4) premium rates, including the national community-rated and group-rated premium amounts and national premium rate; and (5) five-year projections. Places the following limitations on expenditures under this program: (1) total anticipated expenditures for a year may not exceed the amount of the estimated expenditures by more than the average annual rate of increase in the gross national product for the three-year period ending with the year before the year in which the Annual Budget is adopted; (2) the amounts budgeted for covered health- care services for the U.S. and for any State are the maximum amounts that may be expended for such services (except for costs associated with uniformed service members); (3) a State Health Board may not provide for total expenditures for items covered in the budget in excess of those contained in the Annual Budget with respect to the State; (4) the total anticipated expenditures for the U.S. and for any State for the provision of basic services within a category of services or of providers are the maximum amounts that may be expended for such purposes (within percentage variations that the Board may permit); and (5) the percentage increase in the anticipated expenditures per capita for covered health-care services over the actual expenditures for such services for the previous year are limited according to specified formulas. Directs the Board, in consultation with the President's Commission on the Health of Americans, to prepare and annually revise, before the adoption of each Annual Budget, a National Health Care Improvement Plan which describes: (1) needs over a five-year period relating to the accessibility, quality, and cost of health care; (2) the effect of the provisions of this program on meeting such needs; and (3) recommendations. Directs the Governor of each State to prepare and annually revise a State Health Care Improvement Plan in accordance with Board standards and guidelines which describes: (1) needs over a five-year period relating to the accessibility, quality, and cost of health care; and (2) specific actions for meeting such needs. Requires such State Plan to include to the extent appropriate the objectives of: (1) the State health plan in effect under title XV of the Public Health Service Act (National Health Planning and Development); (2) the State medical assistance plan in effect under Medicaid; and (3) any plan submitted by the State to receive assistance under the Public Health Service Act and the Community Mental Health Centers Act. Title III - Part B, Payments to Providers - Provides for payment to providers as follows: (1) insurers and HMOs shall make payments to providers furnishing services to (A) their respective enrollees and (B) individuals not enrolled at the time of services but who are subsequently enrolled; (2) the Board shall make payments to providers furnishing services to a Medicare-eligible individual who is not enrolled in a plan offered by a HMO; and (3) the Secretary of Defense shall pay for services furnished to a member of the uniformed services on active duty. Requires each insurer or HMO to provide for payments of such allocated portion of the approved prospective budget (required under this Act) of the provider as reflects, in accordance with Board regulations, the proportion of the costs in the budget used to provide such services to such enrollees. Prohibits payment for expenditures by an institutional provider for covered services it furnishes to the extent such expenditures are not included in such approved prospective budget. Requires Board regulations to provide for methods of cost apportionment among insurers and HMOs in accordance with specified criteria. Allows such methods to include apportionment based on: (1) the number of treatments of particular conditions or diagnoses; (2) the relative value of the health-care services furnished (with respect to indices of relative values to be established by the Board); or (3) the number of admissions, patient days, diagnoses, or other easily determinable factor that may fairly allocate costs. Allows a State health board, when regulations provide for more than one apportionment method, to select and require the use of one such method. Requires each institutional provider in a State with an approved prospective budget to transmit annually to the State Health Board an experience report which shows the differences between the actual expenditures and services provided by the provider and those allowed for in its approved prospective budget. Directs the State Health Board to provide for: (1) the retention by the provider of one-half of savings produced by actions which lowered expenditures below those predicted; and (2) adjustments, to the extent appropriate, in the amounts of payments made by insurers and HMOs or in the prospective budget for the following year to correct unintended differences in the amount or source of payments to a provider. Provides for payment to a provider, other than an institutional provider (defined as including hospitals, skilled nursing facilities, home health agencies, community health centers and clinics, and, to the extent provided by the National Health Board, HMOs), for covered services (other than drugs, hearing aids, durable medical equipment, or laboratory services) in accordance with the lowest of: (1) the fee charged by the provider; (2) the fee agreed upon between the provider and the insurer or HMO; or (3) the applicable maximum fee schedule for the service (established by this Act). Allows the National Health Board, upon the recommendation of a State Health Board, to increase the payment to a physician provider on an individual basis to recognize performance of unusual merit by such physician. Allows such a provider to elect to be paid on a salary or fee-for-time basis if the total amount payable in a year is not greater than the total amount payable for the equivalent amount of services as computed by the applicable maximum fee schedule. Provides for payment to a provider for: (1) durable medical equipment and laboratory services in accordance with the lowest of: (A) the charge for such service; (B) the charge agreed upon between the provider and the insurer or HMO; or (C) maximum reasonable cost for such service; and (2) drugs and hearing aid; (B) the charge agreed upon between the provider and insurer or HMO; or (C) the highest fee permitted under the applicable fee schedule. Provides for payment to a provider for other covered services in accordance with the lowest of: (1) the charge for the service; (2) the charge agreed upon between the provider and the insurer or HMO; or (3) the maximum reasonable cost of the service, as established by the State Health Boards in accordance with national guidelines and standards. Allows the National Health Board to permit experimental or demonstration methods of reimbursement which will further the purposes of this Act. Provides for periodic review of reimbursement methods. Sets forth procedures with respect to the budget limitations, including the following: (1) monitoring by the State Health Boards, the consortia (all the clearinghouses certified under this Act with respect to the financing of covered services), insurers, and HMOs of payment made to providers; (2) reporting by insurers and each consortium of excessive payments; (3) investigation and corrective actions by the State Health Boards; (4) shifting of funds among categories of services or providers and use of contingency funds for excess expenditures due to unforeseen circumstances; (5) modification of reimbursement methods; (6) additional certifications by State Health Boards of the need for particular services; and (7) requiring insurers and HMOs to make payments for services during certain periods. Allows philanthropic contributions and supplemental payments by State and local governments to finance services additional to those reimbursed under this Act. Stipulates that capital expenditures assisted by such assistance shall not be recognized by a State Health Board in its review of prospective budgets and maximum fee schedules. Requires each institutional provider to submit to the State Health Board its proposed prospective budget for the subsequent year which covers all medical services (not merely covered services) and includes the following: (1) anticipated costs, broken down by schedules for specified costs; (2) the proportion of such costs associated with covered services; and (3) anticipated revenues, broken down by source with respect to each class of items of anticipated costs. Authorizes the National Health Board to require accompanying documentation relating to specified factors for purposes of review. Specifies the manner in which certain costs shall be treated in such prospective budgets, including the following provisions: (1) the costs of all physicians' services under contract with the provider shall be included and the amount budgeted for such services shall be reasonable in relation to the cost of obtaining such services on a salaried or other basis, whichever is less; (2) the total cost of wages and fringe-benefits for nonsupervisory employees shall be included and shall reflect any existing collective-bargaining agreement; (3) the costs of furnishing basic services to ineligible individuals shall be included if no other reimbursement is obtained by the provider; (4) depreciation costs shall not be included, except for certain capital costs, debt repayments, and costs associated with the closing of a facility; and (5) a reasonable rate of return on equity capital with respect to certain proprietary institutions shall be included. Directs the National Health Board, after appropriate consultation, to establish guidelines respecting review and approval by State Health Boards of proposed prospective budgets of institutional providers. Requires such guidelines to include: (1) standards to determine which budgets and budgetary elements may be approved without individual scrutiny; and (2) the detailed review of a random sample. Specifies standards which may be included with respect to providers of inpatient services. Requires the guidelines to provide for the collection and reporting of data in such uniform manner as the Board may set. Establishes procedures for the review and approval of prospective budgets by the State Health Boards, including the following provisions: (1) each review shall be made public and shall (A) assess whether changes in services or capital expenditures conform to the current plan of the health systems agency in the area (mandated under title XV of the Public Health Service Act) and the most recent State Health Care Improvement Plan; (B) review the quality, accessibility, and effectiveness of provider services, taking into consideration any relevant findings of professional standards review organizations (PSROs) and of any national provider accreditation organization for that category of provider; (2) a provider shall be given the opportunity to comment on any pending disapproval; (3) the State Health Board shall consider any timely recommendations submitted by consumer groups, the provider, and employee organizations, including negotiated recommendations; (4) a State Health Board may delegate its review functions to an independent entity; and (5) such budgets may not provide for any capital acquisition or expenditure unless the provider has participated in a planning process in accordance with regulations. Requires a State Health Board to approve a budget without modification, taking into account the following factors: (1) total limits on anticipated expenditures; (2) the health systems agency plan; (3) demographic factors; (4) the impact of inflation on budget costs; (5) the effects of any approved capital expenditure or reduction, service modification plans, or future wage increases; and (6) certain other efficiency and cost-effectiveness objectives. Requires resubmission of a budget to the State Health Board if a modification is required for excess expenditures. Disallows payments to an institutional provider for covered services not included in its approved prospective budget. Requires each State Health Board to develop maximum fee schedules for covered services (other than durable medical equipment and laboratory services) after opportunity for negotiations with participating providers. Directs the National Health Board to develop guidelines for such schedules which: (1) establish the relative value of particular services, taking into account specified factors; (2) provide for geographical variations in fees, taking into consideration certain criteria; (3) set the maximum fee for a service which can be provided by two or more categories of health personnel at the lowest of the maximum fees authorized for such categories; and (4) include a formula for allowing annual changes in such schedules. Requires payment for the provision of: (1) durable medical equipment and laboratory services to be the lower of (A) the charge, or (B) the reasonable cost of the equipment or service; and (2) drugs and hearing aids to be the lower of (A) the charge, or (B) the reasonable cost of the drug or aid, plus a reasonable professional fee. Directs the National Health Board to establish guidelines for the reasonable cost of durable medical equipment, laboratory services, drugs, and hearing aids which shall be the lowest cost at which any such item of comparable quality is (or could be made) generally available in an accessible area. Provides for the computation of the professional fee with respect to drugs and hearing aids. Outlines procedures for the use of negotiations to determine the amounts of payments to providers. Directs the National Health Board to establish criteria for the selection of the negotiating groups for each of the following groups of providers: (1) hospitals; (2) skilled nursing facilities; (3) home health care agencies; (4) other institutional providers, including community health centers, migrant health centers, and health clinics; (5) physicians; (6) other non-institutional providers, such as pharmacists, physical and occupational therapists; and (7) hospital employees. Sets forth requirements for representation within such groups. Requires that the selection guidelines by the National Health Board shall provide for: (1) differences in the sizes of the various negotiating groups; (2) proportional representation for each type of health- care provider; (3) three-year terms for each representative; and (4) nomination and election methods. Provides that such negotiations shall concern: (1) limitations with respect to payments made to institutional providers on the basis of approved prospective budgets; (2) maximum-fee schedules; (3) reasonable cost levels with respect to durable medical equipment, laboratory services, drugs, and hearing aids; and (4) other cost control methods. Allows a State Health Board to incorporate within its annual State budget the provision of any agreement reached as the result of such negotiations which would keep expenditures within the budgetary limits. Title III- Part C, Determining Amounts of Premiums and Incentive Payments and Benefits - Directs the National Health Board to establish, in conjunction with the adoption of the Annual Budget and after negotiations with consortia, participating insurers, and HMOs: (1) a national community-rated premium; and (2) a national premium rate. Requires the national community-rated premium to be set so that, if such amount were paid by the members of each family enrolled through an employer plan, the total premiums paid would equal the anticipated expenditures under the Annual Budget, including payments to providers for basic services and administrative costs, but excluding administrative costs for the National and State Health Boards, PSROs, contingency funding, and the costs of covered services to persons who are Medicare-SSI-AFDC-eligible, residents of Federal or State institutions, or members of the uniformed services on active duty. Requires that the national premium rate be set so that the sum of all wage-related and non-wage related premiums, the government payment for unpaid private premiums, and the voluntary premiums under international agreements equals the anticipated expenditures for covered services to Medicare-eligible, SSI-eligible, and AFC-eligible individuals, and residents of Federal and State institutions. Directs the Board to establish a group-related premium for SSI-eligible individuals and for residents of Federal and State institutions who are enrolled in a qualified plan. Requires that: (1) such premium be set so that the total amounts paid on behalf of such individuals equals the expenditures for furnishing care to such persons; and (2) such premium be adjusted annually to reflect the actual cost experience with respect to such expenditures. Provides that the national community-rated premium and the national premium rate are to apply as the State community-rated premium and the premium rate for each State, unless a State is able to provide for reduced premiums by negotiating a lower level of approved expenditures than would otherwise be provided for in the national budget. Requires each State to establish a group-rated premium for AFDC-eligible individuals and residents of State institutions. Requires that such premium: (1) be set so that the total amounts paid on behalf of such individuals equals the expenditures for furnishing care to such persons; and (2) be adjusted annually to reflect the actual cost experience with respect to such expenditures. Permits a participating insurer or HMO to offer eligible individuals (other than Medicare eligibles) an incentive to enroll in a qualified plan by providing additional services or by paying dividends or cash rebates on premiums. Permits an HMO to offer such incentives to Medicare-eligible persons. Sets forth requirements with respect to such dividend and cash rebates, including that: (1) in the case of employed enrollees, they be divided between the employees and employer in accordance with Board procedures; and (2) they not be treated as taxable income to individuals or income under federally-assisted welfare programs, nor reduce any credit relating to a limit on the amount of private premium payments. Sets a limit on the amount of premiums paid with respect to members of a family unit as employees and by members of the family unit. Provides for a refund to families of amounts in excess of such limit. Title III-Part D, Payment and Collection of Premiums - Requires each employer to pay to the applicable consortium on behalf of each employee for each payroll period an amount equal to the product of the wages paid during such period and the applicable State premium rate. Permits an employer (subject to any collective-bargaining agreement) to require employees to pay up to 35 percent of such amount. Requires an employer to pay any voluntary contributions such employee may wish to have made on his behalf. Permits an employer to obtain certification from the Board as an impacted employer and so qualify for: (1) a payment from the Board if such employer is a State employer or nonprofit employer; or (2) a tax credit with respect to other employers. Specifies the formula for determining such payment or credit. Defines terms for the purposes of this section. Requires all persons (with specified exceptions) to pay to the applicable consortium an amount equal to the product of one-half the State premium rate and the amount of non-wage-related income of such persons' family units. Requires such persons to file quarterly information returns in accordance with Board regulations. Authorizes the Board to impose a collection surcharge for untimely payments. Prescribes the payment procedure for premiums under executive agreements. Requires: (1) the Board to make monthly premium payments to consortia on behalf of SSI-eligible individuals and residents of Federal institutions; and (2) each State to make monthly premium payments to consortia on behalf of AFDC-eligible individuals and residents of State institutions. Sets forth rules regarding Government compensation to consortia for certain uncollected premiums and an assessment against State or local governments which fail to make a required employer payment. Title III-Part E Distribution of Premiums - Requires the consortia to: (1) compute for each capitation individual an amount equal to the average anticipated expenditure in the State budget for the individual, including certain administrative costs and funds for the contingency fund, but excluding the administrative costs of the State health board; and (2) report such amounts to the Board for review. Requires each consortium to adjust capitation amounts to reflect for a specific capitation individual: (1) the relative actual costs of providing covered services in the area of such person's residency; and (2) the actuarial risk associated with the individual's characteristics. Requires that such risk adjustment be made to eliminate financial incentives for insurers or HMOs to practice risk selection or experience rating. Requires that the total of capitation amounts and adjusted capitation amounts for enrollees in a State be equal to the total expenditures in the State budget for the provision and administration of covered services, excluding State health board administrative expenses. Requires each consortium to apportion to its members an adjusted capitation amount for each capitation individual and a group-rated premium for each group-rated individual. Requires these amounts to be paid to members in installments consistent with Board guidelines. Directs the Board to provide supplementary payments from the Health Resources Distribution Fund to participating HMOs in operation for less than five years. Requires consortia to provide, in accordance with Board guidelines, for redistribution of collected premiums to assure that each consortium is provided an adjusted capitation amount for each capitation individual, and a group-rated premium for each group-rated individual. Directs each consortium to maintain a contingency fund for expenditures for unforeseen circumstances beyond the control of insurers or HMOs. Authorizes the Board, in any year when premiums collected are less than amounts provided in the annual budget, to guarantee the principle and interest of loans issued by the consortia to assure adequate revenues. Sets forth requirements with respect to such loans. Directs the Board, in any year when premiums collected are greater than provided for in the annual budget, to provide for the consortia to distribute such excess funds, including appropriate adjustments in subsequent national and State budgets. Title IV: Administration-Part A, National Health Board and State Health Boards Establishes an independent, five-member National Health Board, to be appointed by the President, to (among other specific functions): (1) establish commissions, bureaus, divisions, offices, and other entities required by this Act or deemed appropriate; (2) perform the functions of a participating insurer, HMO, or consortium with respect to any area or group of insurers for which there is no certified insurer or consortium; (3) perform the functions of a State health board with respect to any State in which such a board has not been established; (4) establish administrative procedures with respect to consumer and provider appeals from State health board decisions; (5) be responsible for the general implementation of this Act; and (6) study and evaluate on a continuing basis the operation of this Act. Transfers to the Board all functions of the Secretary of HEW relating to specified provisions of: (1) the Social Security Act (including Maternal and Child Health Services, Professional Standards Review Organizations, Medicaid, and Medicare); (2) the Public Health Service Act (but excluding, among other provisions, certain provisions of title III (Administration), title IV (National Research Institutes), title V (Miscellaneous), title X (Population Research), and title XIV (Safety of Public Water Systems)); (3) the Community Mental Health Centers Act; (4) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970; (5) the Drug Abuse Office and Treatment Act of 1972; and (6) the provision of health care services to Indians (Public Law 94-437). Requires the Board to have: (1) an Ombudsman, to investigate complaints about program operation; (2) an Advocate, to assist consumers in determining and protecting their rights to services; (3) an Inspector General, to direct the auditing and investigative activities of the Board. Directs the Board to establish the following Commissions: (1) Commission on Benefits, to review and make recommendations with respect to the provision of basic covered services under qualified plans and determine their cost and effectiveness in improving public health; (2) Commission on Quality, to review and make recommendations with respect to the quality of health services provided under this Act; (3) Commission on Access, to review and make recommendations with respect to the utilization of covered services by the different categories of eligible individuals; and (4) Commission on Health Care Organization, to review and make recommendations with respect to the cost and effectiveness of methods for the delivery of services. Requires at least one-half of the members of each Commission to be consumers or representatives of consumers and to include appropriate representation of health care providers and other participants. Establishes: (1) a nine-member Commission on the Health of Americans, to be appointed by the President, to conduct an ongoing review of the health status of the U.S. population and to review a broad range of proposals for improving such health status, including research, environmental programs, highway safety, public health programs, and personal health services programs; and (2) under the direction of the National Health Board, a National Institutes of Health Care Research which shall be composed of (A) an Institute of Health Statistics, (B) an Institute of Health Services Research, and (C) an Institute of Health Technology Evaluation. Transfers to such Institutes certain functions of the Secretary under the Public Health Service Act. Requires each State to charter as a public corporation a State health insurance corporation in accordance with Board guidelines. Directs each State health board (that is, the board of directors of the State corporation) to establish an ombudsman, an advocate, and such advisory commissions as are appropriate to carry out its functions. Delineates the duties of such boards. Title IV - Part B Participating Insurers, Health Maintenance Organizations, and Consortia - Directs the Board to certify an insurer or HMO when certain conditions are met, including a participation agreement between the Board and the insurer or HMO containing specified provisions. Requires the insurer or HMO to: (1) become a member of the appropriate consortium; (2) offer enrollment in at least one qualified health plan which provides basic services without a charge other than the premium; (3) accept during open enrollment all eligible persons in the order they apply without restriction, up to its capacity (but permits the Board to provide for enrollment limits to reflect needs for cost-effective services and for special characteristics of self-insurers); (4) issue an enrollment card for each enrolled person; (5) pay participating providers in amounts no greater than permitted under this Act; (6) report to the State health board and its consortium on payments made and expenses incurred; (7) maintain and afford access to records by the consortium, State health boards, and the Board and provide confidential treatment of individually-identifiable records; (8) offer any rebates or other benefits to all enrollees on the same basis; (9) establish hearing procedures for an enrollee or provider who is dissatisfied with respect to certain services or payments; and (10) comply with other reasonable regulations respecting marketing and customer service practices which the Board establishes. Directs the Board to agree that, in return for agreed-upon services and understandings, the insurer or HMO is to be paid by its consortium for each enrollee in a qualified plan. Requires the Board to certify in each State one consortium for each of the following types of insurers or HMOS: (1) a Blue Cross-Blue Shield consortium, representing nonprofit State- chartered medical/hospital service corporations; (2) a commercial insurance carrier consortium, representing profit-making commercial insurers not directly furnishing health care services; (3) a prepaid group practice HMO consortium; (4) an individual practice association HMO consortium; and (5) a self-insurer consortium. Permits an insurer or HMO to serve as a member of a different consortium with the approval of the Board and the consortium. Sets forth requirements with respect to these consortia including: (1) a participation agreement between the Board and the consortium containing specified provisions; (2) that the consortium provide for premium collection and reallocation and pay members for each enrollee; (3) that a contingency fund be maintained; (4) that certain information be reported regularly to the Board; (5) that the consortium negotiate with provider groups in establishing prospective budgets and maximum fee schedules in areas where its members offer plans; (6) that certain review procedures be established for dissatisfied enrollees and providers; and (7) that other regulations be followed. Establishes as a defense in any civil or criminal antitrust action brought with respect to actions by a participating insurer or HMO or consortium that such actions were taken in the course of performing duties required under agreements entered into under this Act. Directs the Board, after consultation with the Attorney General and the Federal Trade Commission, to prescribe standards and procedures for the conduct of insurers, HMOs, and consortia which is consistent with the promotion of competition. Directs the Board to investigate complaints by a participating insurer or HMO that another participating organization has engaged in anticompetitive activity. Title V: Health Care Improvement Program - Directs the National Health Board to establish a program to improve the distribution of health care resources in the United States in order to promote the improvement in the quality, accessibility, and efficiency of services provided under this Act. Establishes in the Treasury the Health Resources Distribution Fund. Directs the Board to make grants to the State health boards from the Fund for projects to achieve the purposes of the program, including: (1) the conversion or closure of health care facilities; (2) the provision of health care services in health manpower shortage areas; (3) renovations of institutional health care facilities; (4) HMO and other delivery systems; (5) educational programs for health professionals to meet projected needs; and (6) continuing professional education programs. Requires that the Board allocate an amount to each State health board based on the State's needs as reflected in the National Health Care Improvement Plan. Requires that each State health board provide for a program for the education of consumers concerning health and their rights and privileges under this Act. Directs the Board to: (1) study the impact of this Act on, and means of improving, the Medicaid programs, and report appropriate recommendations to Congress within five years of enactment; (2) provide for the development and demonstration of methods to improve (A) the coordination of services by different providers, (B) the provision of services, and (C) peer review and control of utilization and quality in the provision of drugs, laboratory services and other services under this Act and Medicare; (3) provide for demonstration projects to evaluate the feasibility of providing hospice services as part of basic covered health-care services; (4) provide for an analysis of provider malpractice and the provision of malpractice insurance, and report recommendations to Congress within two years of enactment. Directs the Board to provide for the conduct of a demonstration project in the organization, delivery, and financing of personal care services to groups likely to require such services. Requires that the Board make grants for establishing and maintaining programs to provide personal care services for a substantial population of persons residing in their homes who would otherwise be required to reside in an institution providing personal care services. Sets forth requirements with respect to such program. Directs the Board to transmit to Congress a comprehensive report with appropriate recommendations within five years of enactment. Title VI - Part A, Effective Dates, Transition Provisions, Amendments for a special national premium rate for the period between October 1 and December 31 of the Sets forth effective dates for provisions of this Act. Provides year before the first effective year. Directs the Board to establish for localities within each State maximum fee schedules applicable to services reimbursed under Medicare Part B for the period between July 1 and January 1 of the first effective year. Requires the Board to establish regulations, guidelines, standards, and procedures providing for the orderly administration of the Act, and to report to Congress within 18 months of enactment its progress in establishing implementation procedures. Directs the General Accounting Office to report to Congress within 18 months of enactment on the Board's progress. Provides that this Act does not alter or affect any contractual or other nonstatutory obligation of an employer to pay for or provide health services to present or former employees if the effect shifts the obligation in any part to such persons. Sets forth provisions relating to transfer of functions. Title VI - Part B, Medicare-Related Amendments - Amends title XVIII of the Social Security Act (Medicare) to conform such Act with the Health Care for All Americans Act. Eliminates the prohibition against Federal supervision or control over the practice of medicine and the compensation of employees and officers of health care providers. Includes the following changes among those relating to eligibility: (1) broadens Medicare entitlement to include citizens of the U.S., persons legally admitted for permanent residence, and certain other persons aged 65 and over; (2) deletes the 24-month waiting period for eligibility for the disabled; and (3) entitles individuals to enroll in a participating HMO. Changes Medicare Part B from a voluntary insurance program to an entitlement program financed by premium payments and Federal funds. Includes the following among the changes relating to the scope of benefits: (1) deletes the limitation on inpatient hospital days; (2) adds mental health day care services; (3) replaces the existing limitation on inpatient psychiatric hospital services with a 150 consecutive day limit for Medicare purposes and a 45 consecutive day limit for purposes of the Health Care for All Americans Act. Limits payment for outpatient psychiatric services and services related to the diagnosis or treatment of mental illness to an annual amount equal to 20 times the fee set forth in the maximum fee schedule for a psychiatrist's visit. Limits to $100 payment for certain outpatient therapy services in the therapist's office or beneficiary's home. Conforms coverage for end-stage renal disease with the provisions of the Health Care for All Americans Act. Includes the following among the changes relating to exclusions from coverage: (1) extends the applicability of exclusions to the Health Care for All Americans Act; (2) stipulates that preventive services are not excluded; (3) excludes hearing aids and related examinations only if they exceed one every three years, and one per individual; (4) eliminates the exclusion relating to orthopedic shoes; (5) permits the waiver, under certain conditions, of the foot care exclusions for persons with diabetes mellitus; and (6) adds a new exclusion for insulin or outpatient prescription drugs for chronic conditions exceeding maximum amounts established by the Board. Makes technical and conforming amendments to Medicare Parts A and B relating to: (1) requirements for certification and requests for payment; (2) agreements with participating providers; (3) the use of State agencies to determine compliance with conditions of participation; (4) PSROs; and (5) payments to HMOs. Requires providers prescribing outpatient prescription drugs to use only generic or other names and specify such amounts as the Board may provide to insure quality and efficiency. Makes certain revisions with respect to payments to institutional and other providers and the administration of benefits. Repeals the deductible and coinsurance provision of the Medicare Part A program and the existing definition of "reasonable cost." Expands the definition of employment subject to the Medicare hospital insurance tax to include employment with Federal, State, and local governments, service performed for charitable organizations, service performed by certain employee representatives, certain students, and other organizations. Repeals provisions relating to the establishment of the Health Insurance Benefits Advisory Council. Applies certain procedural provisions of title II of the Social Security Act (Old-Age, Survivors and Disability Insurance) to Medicare and to the Health Care for All Americans Act. Amends title XIX of the Social Security Act (Medicaid) to establish a new arrangement for the determination of the Federal Medicaid payment, by which payment is to be equal to "excess State payments" according to a specified formula. Increases the Federal share of certain State Medicaid expenditures, including: (1) the training and compensation of skilled professional personnel (from 75 to 90 percent); (2) operation of management information systems (from 75 to 90 percent); and (3) general administration (from 50 to 90 percent). Establishes certain additional State Medicaid plan requirements including that States: (1) continue to provide services (other than those covered under the Health Care for All Americans Act) in the amount, duration, and scope as were covered by the States in the quarter before the first effective year of the program; (2) pay premiums on behalf of AFDC-eligible recipients; and (3) reimburse providers in a manner consistent with methods established by the Board. Requires any State not having a Medicaid program to enter into an agreement with the Board by which the State agrees to pay premiums on behalf of AFDC-eligible recipients and receives financial assistance from the Board. Amends title XI of the Social Security Act (General Provisions and PSROs) to: (1) extend the provisions for uniform reporting and disclosure of ownership and related information to the Health Care for All Americans Act; and (2) repeal the provisions relating to limitations on capital expenditures and programs for determining the qualifications of certain health care personnel. Amends the Internal Revenue Code to eliminate the present deduction for health insurance payments. Permits a deduction for amounts of medical expense not compensated for by insurance, in excess of three percent of adjusted gross income. Adds a new excess health insurance credit for impacted employers. Establishes special rules for computing such credit with respect to controlled groups of corporations and employees of partnerships and proprietorships which are under common control. Amends title XIII of the Public Health Service Act (Health Maintenance Organizations) to make conforming and certain other revisions with respect to the organization and operation of HMOs.
Bill· HRH.R. 5191 (96th)referred
United States · United States Congress · 6 September 1979
Health Care for All Americans Act - Establishes a comprehensive "national health insurance system" (defined as the programs established by this Act and Medicare for the financing of health-care services). States the findings and purposes of this Act. Enumerates the rights of eligible individuals, providers, and insurers and health maintenance organizations (HMOs). Requires that such individuals and entities have their views considered with respect to actions under this Act affecting them. Gives such an individual the right to: (1) choose any participating provider with respect to a covered service; (2) the prompt and accurate making of decisions under this Act; (3) be heard on any grievance related to benefits under this Act; and (4) confidential treatment and use of information collected under this Act. Gives such a provider the right to: (1) decide whether or not to participate in the system; (2) the prompt and accurate payment for services; and (3) choose the mode and place of practice (with respect to a physician provider). Gives such an insurer and HMO the right to: (1) decide whether or not to participate in the system; and (2) carry on a supplemental health insurance business. Defines terms used in this Act. Title I: Eligibility, Entitlement, and Enrollment - Extends eligibility for the benefits of this Act to: (1) U.S. citizens; (2) aliens lawfully admitted or permanently residing in the U.S. under color of law, including refugees; (3) aliens admitted to the U.S. as employees of a foreign government or international organization which has entered into an agreement with the U.S.; and (4) aliens admitted as temporary visitors from a foreign government which has entered into such an agreement. Directs the National Health Board (established by this Act), after consultation with the Secretary of State, to recommend to the President that executive agreements be entered into: (1) with foreign governments and international organizations to make their employees and officers eligible for health benefits in return for a payment of the national community-rated premium plus an amount equal to what would otherwise be payable as the Medicare hospital insurance payroll tax, if such employees were so taxed; and (2) with foreign governments upon a determination that it is in the national interest to make nationals or citizens of such nations who visit the U.S. eligible for benefits in return for comparable treatment of U.S. citizens abroad. Entitles each eligible individual to: (1) enroll in a qualified plan offered by an insurer or HMO and to change enrollment during certain periods; (2) have payment made on such individual's behalf and not be charged any fee for basic covered services; and (3) be issued a health insurance enrollment card. Stipulates that such a card shall not identify the category or basis for the individual's enrollment. Requires enrollment information to be available and provided: (1) by employers to employees; (2) by or through the Board to Medicare-eligible individuals; (3) by the Secretaries of Defense, Transportation, Commerce, and HEW to active- duty uniformed service personnel under their jurisdiction; (4) by the Social Security Commissioner to Supplemental Security Income (SSI)- eligible individuals; (5) by managers of Federal and State institutions to residents; (6) by State welfare agencies to Aid to Families with Dependent Children (AFDC)-eligible persons; and (7) by or through State health boards to other individuals. Directs the Board to notify State health boards of the identity of eligible individuals who, in certain Federal information returns, have failed to indicate enrollment under a qualified plan. Requires providers to transmit to their respective health boards requests for payment for eligible persons who did not indicate enrollment at the time of receiving services. Directs State health boards to make special efforts to locate such persons and provide for their enrollment. Defines "first general open enrollment period", "general open enrollment period", and "special enrollment period" for purposes of the program. Stipulates that all members of a family (other than those who are Medicare or SSI-eligible or residents of a Federal or State institution) be enrolled at any time in only one qualified plan. Requires employers to offer qualified employees during specified enrollment periods the choice of enrollment under: (1) at least one plan offered by an insurer belonging to (A) the Blue Cross-Blue Shield consortium or (B) the commercial insurance consortium; and (2) at least one plan offered by an HMO belonging to (A) the individual group practice HMO consortium or (B) the prepaid group practice HMO consortium (if such a plan is available in the area in which the employees obtain health care services). Allows the employer to also offer enrollment in plans offered by a self-insurer. Requires an offer of enrollment to be made first to a collective bargaining representative or other employee representative designated under law. Requires each employee to elect a plan in accordance with procedures established by the Board. Directs the employer to enroll such employee in a plan in accordance with procedures in the absence of such an election. Requires any employer offering in conjunction with a qualified plan a plan with benefits supplemental to basic services to provide employees with written information regarding additional employee costs for such supplemental plan. Limits a family which is offered a choice of plans to enroll under only one qualified plan. Subjects an employer who knowingly fails to comply with these requirements to a civil penalty which may be assessed by the Board and collected by civil suit in a district court. Requires active-duty members of the uniformed services to enroll in a plan from among such health plans offered by or through the Department of Defense as the Secretary of Defense, after consultation with the Secretaries of HEW, Transportation, Commerce, and the Board, finds are consistent with the statutory requirements regarding uniformed services medical care and with policy requiring provision of basic and other covered health services to such members and their families. Requires Medicare-eligible individuals to enroll with the Board or a participating HMO in accordance with the Medicare program. Allows SSI-eligible individuals, residents of Federal or State institutions not otherwise enrolled, AFDC-eligible individuals, or other individuals not otherwise enrolled to enroll during specified periods in any qualified health plan available to such individuals. Provides for the mandatory enrollment of such individuals who fail to enroll in a plan, in accordance with regulations of the Board and rules and procedures of the State health boards. Title II: Benefits and Providers - Includes as basic covered services: (1) inpatient and outpatient hospital services (and inpatient mental health services up to (A) 150 consecutive days for Medicare-eligible individuals, or (B) 45 consecutive days for other eligible individuals, during certain periods of treatment as determined under Medicare); (2) physicians' services, including hospital-based physicians (and services for the treatment of mental illness and outpatient mental health services to the extent that expenses for such services do not exceed the fee-equivalent of 20 psychiatric visits per year, as determined under Medicare); (3) post-hospital extended care services up to 100 days during any spell of illness; (4) the following preventive health services: (A) basic immunizations; (B) pre-and post-natal maternal care; (C) well-child care (including periodic physical examinations, hearing and vision screening, and developmental screening and examinations) for persons up to the age of 18 years; and (D) such other services as the Board may add on a year-by-year basis after consultation with appropriate experts and a determination by the Board that such services will be cost-effective (but limits the expenditure for such additional preventive services to $500,000,000 for the first effective year (defined as the third year after the year of enactment) and for subsequent years an increase tied to the average annual rate of increase in the gross national product. Includes as additional basic services: (1) outpatient physical therapy services, outpatient speech pathology services; (2) health clinic services, including rural health clinic services; (3) home dialysis supplies; (4) tests and other diagnostic tests; (5) X-ray therapy; (6) durable medical equipment used in the patient's home; (7) ambulance service, to the extent provided by regulations; (8) prosthetic devices (other than dental), including lenses after cataract surgery and replacements; (9) leg, arm, back, and neck braces, and artificial legs, arms, and eyes, including replacements; (10) insulin and outpatient prescription drugs for treatment of chronic conditions (but for Medicare-eligible individuals only to the extent provided under such program); (11) one audiological examination per individual per year and the provision of one hearing aid per individual for any three-year period; and (12) mental health day care services to the extent of two days for each day of inpatient mental health services permitted by this program. Excludes as basic services: (1) items and services for which payment may not be made under Medicare; and (2) for other than Medicare-eligible individuals payment for (A) orthopedic shoes or other supportive devices for the feet, (B) certain physician services described under Medicare, and (C) certain inpatient hospital services described under Medicare. Authorizes the Board, after consultation with the Commission on Health-Care Benefits and the Commission on Quality of Health Care (established by this Act), to exclude payment for an item or service under a plan under this program and Medicare on the basis of cost-effectiveness, notwithstanding any other provision. Makes specified provisions of title XI (General Provisions and Professional Standards Review) and title XVIII (Medicare) of the Social Security Act applicable to basic services provided under qualified plans to the same extent as they apply under Medicare. Authorizes the Board, after consultation with the Commissions on Health-Care Benefits and Quality of Health Care, to establish a list of high-risk, high-cost, elective, or overutilized items or services for which payment may be made only if one or more of the following conditions are met: (1) the provider is board-certified in the relevant specialty; (2) the diagnosis and recommended service are supported by a second opinion or specific objective findings; (3) the provider-institution is adequately equipped and staffed; (4) the specialist or institution is providing care upon referral by a primary-care physician; or (5) the provider has demonstrated through statistical services that it provides high-quality services and properly uses appropriate methods and technologies. Title III: Financing and Planning - Part A, Budget and Planning Process - Specifies the annual timetable for the budget process for the national health insurance system as follows: (1) by January 15th proposed annual State budgets are to be prepared by the State Health Boards, in accordance with regulations and after consultation with specified interests, and submitted to the Board; (2) the Board shall transmit for inclusion without change in the Budget presented by the President an estimate of the anticipated Federal expenditures related to the appropriate Annual Budgets; (3) by March 1st a comprehensive Annual Budget is to be prepared and adopted by the Board and transmitted to the President, Congress, the States, and the public; (4) the Congressional Budget Office shall submit to the appropriate congressional committees as soon as practicable after receipt of the Annual Budget an analysis of its impact on the Federal Budget; (5) by July 1st the annual State budgets are to be adopted by the State Health Boards, taking into consideration the State Health Care Improvement Plan mandated by this Act, and transmitted to the Board; and (6) on the following January 1st the budget year begins. Specifies the contents of the Annual Budget and annual State Budgets, including enumerated items in the following categories: (1) anticipated expenditures; (2) anticipated revenues; (3) separate schedules, including Medicare and other public programs; (4) premium rates, including the national community-rated and group-rated premium amounts and national premium rate; and (5) five-year projections. Places the following limitations on expenditures under this program: (1) total anticipated expenditures for a year may not exceed the amount of the estimated expenditures by more than the average annual rate of increase in the gross national product for the three-year period ending with the year before the year in which the Annual Budget is adopted; (2) the amounts budgeted for covered health-care services for the U.S. and for any State are the maximum amounts that may be expended for such services (except for costs associated with uniformed service members); (3) a State Health Board may not provide for total expenditures for items covered in the budget in excess of those contained in the Annual Budget with respect to the State; (4) the total anticipated expenditures for the U.S. and for any State for the provision of basic services within a category of services or of providers are the maximum amounts that may be expended for such purposes (within percentage variations that the Board may permit); and (5) the percentage increase in the anticipated expenditures per capita for covered health-care services over the actual expenditures for such services for the previous year are limited according to specified formulas. Directs the Board, in consultation with the President's Commission on the Health of Americans, to prepare and annually revise, before the adoption of each Annual Budget, a National Health Care Improvement Plan which describes: (1) needs over a five-year period relating to the accessibility, quality, and cost of health care; (2) the effect of the provisions of this program on meeting such needs; and (3) recommendations. Directs the Governor of each State to prepare and annually revise a State Health Care Improvement Plan in accordance with Board standards and guidelines which describes: (1) needs over a five-year period relating to the accessibility, quality, and cost of health care; and (2) specific actions for meeting such needs. Requires such State Plan to include to the extent appropriate the objectives of: (1) the State health plan in effect under title XV of the Public Health Service Act (National Health Planning and Development); (2) the State medical assistance plan in effect under Medicaid; and (3) any plan submitted by the State to receive assistance under the Public Health Service Act and the Community Mental Health Centers Act. Title III - Part B, Payments to Providers - Provides for payment to providers as follows: (1) insurers and HMOs shall make payments to providers furnishing services to (A) their respective enrollees and (B) individuals not enrolled at the time of services but who are subsequently enrolled; (2) the Board shall make payments to providers furnishing services to a Medicare-eligible individual who is not enrolled in a plan offered by a HMO: and (3) the Secretary of Defense shall pay for services furnished to a member of the uniformed services on active duty. Requires each insurer or HMO to provide for payments of such allocated portion of the approved prospective budget (required under this Act) of the provider as reflects, in accordance with Board regulations, the proportion of the costs in the budget used to provide such services to such enrollees. Prohibits payment for expenditures by an institutional provider for covered services it furnishes to the extent such expenditures are not included in such approved prospective budget. Requires Board regulations to provide for methods of cost apportionment among insurers and HMOs in accordance with specified criteria. Allows such methods to include apportionment based on: (1) the number of treatments of particular conditions or diagnoses; (2) the relative value of the health-care services furnished (with respect to indices of relative values to be established by the Board); or (3) the number of admissions, patient days, diagnoses, or other easily determinable factor that may fairly allocate costs. Allows a State health board, when regulations provide for more than one apportionment method, to select and require the use of one such method. Requires each institutional provider in a State with an approved prospective budget to transmit annually to the State Health Board an experience report which shows the differences between the actual expenditures and services provided by the provider and those allowed for in its approved prospective budget. Directs the State Health Board to provide for: (1) the retention by the provider of one-half of savings produced by actions which lowered expenditures below those predicted; and (2) adjustments, to the extent appropriate, in the amounts of payments made by insurers and HMOs or in the prospective budget for the following year to correct unintended differences in the amount or source of payments to a provider. Provides for payment to a provider, other than an institutional provider (defined as including hospitals, skilled nursing facilities, home health agencies, community health centers and clinics, and, to the extent provided by the National Health Board, HMOs), for covered services (other than drugs, hearing aids, durable medical equipment, or laboratory services) in accordance with the lowest of: (1) the fee charged by the provider; (2) the fee agreed upon between the provider and the insurer or HMO; or (3) the applicable maximum fee schedule for the service (established by this Act). Allows the National Health Board, upon the recommendation of a State Health Board, to increase the payment to a physician provider on an individual basis to recognize performance of unusual merit by such physician. Allows such a provider to elect to be paid on a salary or fee-for-time basis if the total amount payable in a year is not greater than the total amount payable for the equivalent amount of services as computed by the applicable maximum fee schedule. Provides for payment to a provider for: (1) durable medical equipment and laboratory services in accordance with the lowest of: (A) the charge for such service; (B) the charge agreed upon between the provider and the insurer or HMO; or (C) the maximum reasonable cost for such service; and (2) drugs and hearing aids in accordance with the lowest of: (A) the provider's fee charged for dispensing the drug or hearing aid; (B) the charge agreed upon between the provider and the insurer or HMO; or (C) the highest fee permitted under the applicable fee schedule. Provides for payment to a provider for other covered services in accordance with the lowest of: (1) the charge for the service; (2) the charge agreed upon between the provider and the insurer or HMO; or (3) the maximum reasonable cost of the service, as established by the State Health Boards in accordance with national guidelines and standards. Allows the National Health Board to permit experimental or demonstration methods of reimbursement which will further the purposes of this Act. Provides for periodic review of reimbursement methods. Sets forth procedures with respect to the budget limitations, including the following: (1) monitoring by the State Health Boards, the consortia (all the clearinghouses certified under this Act with respect to the financing of covered services), insurers, and HMOs of payment made to providers; (2) reporting by insurers and each consortium of excessive payments; (3) investigation and corrective actions by the State Health Boards; (4) shifting of funds among categories of services or providers and use of contingency funds for excess expenditures due to unforeseen circumstances; (5) modification of reimbursement methods; (6) additional certifications by State Health Boards of the need for particular services; and (7) requiring insurers and HMOs to make payments for services during certain periods. Allows philanthropic contributions and supplemental payments by State and local governments to finance services additional to those reimbursed under this Act. Stipulates that capital expenditures assisted by such assistance shall not be recognized by a State Health Board in its review of prospective budgets and maximum fee schedules. Requires each institutional provider to submit to the State Health Board its proposed prospective budget for the subsequent year which covers all medical services (not merely covered services) and includes the following: (1) anticipated costs, broken down by schedules for specified costs; (2) the proportion of such costs associated with covered services; and (3) anticipated revenues, broken down by source with respect to each class of items of anticipated costs. Authorizes the National Health Board to require accompanying documentation relating to specified factors for purposes of review. Specifies the manner in which certain costs shall be treated in such prospective budgets, including the following provisions: (1) the costs of all physicians' services under contract with the provider shall be included and the amount budgeted for such services shall be reasonable in relation to the cost of obtaining such services on a salaried or other basis, whichever is less; (2) the total cost of wages and fringe-benefits for nonsupervisory employees shall be included and shall reflect any existing collective-bargaining agreement; (3) the costs of furnishing basic services to ineligible individuals shall be included if no other reimbursement is obtainable by the provider; (4) depreciation costs shall not be included, except for certain capital costs, debt repayments, and costs associated with the closing of a facility; and (5) a reasonable rate of return on equity capital with respect to certain proprietary institutions shall be included. Directs the National Health Board, after appropriate consultation, to establish guidelines respecting review and approval by State Health Boards of proposed prospective budgets of institutional providers. Requires such guidelines to include: (1) standards to determine which budgets and budgetary elements may be approved without individual scrutiny; and (2) the detailed review of a random sample. Specifies standards which may be included with respect to providers of inpatient services. Requires the guidelines to provide for the collection and reporting of data in such uniform manner as the Board may set. Establishes procedures for the review and approval of prospective budgets by the State Health Boards, including the following provisions: (1) each review shall be made public and shall (A) assess whether changes in services or capital expenditures conform to the current plan of the health systems agency in the area (mandated under title XV of the Public Health Service Act) and the most recent State Health Care Improvement Plan; (B) review the quality, accessibility, and effectiveness of provider services, taking into consideration any relevant findings of professional standards review organizations (PSROs) and of any national provider accreditation organization for that category of provider; (2) a provider shall be given the opportunity to comment on any pending disapproval; (3) the State Health Board shall consider any timely recommendations submitted by consumer groups, the provider, and employee organizations, including negotiated recommendations; (4) a State Health Board may delegate its review functions to an independent entity; and (5) such budgets may not provide for any capital acquisition or expenditure unless the provider has participated in a planning process in accordance with regulations. Requires a State Health Board to approve a budget without modification, taking into account the following factors: (1) total limits on anticipated expenditures; (2) the health systems agency plan; (3) demographic factors; (4) the impact of inflation on budget costs; (5) the effects of any approved capital expenditure or reduction, service modification plans, or future wage increases; and (6) certain other efficiency and cost-effectiveness objectives. Requires resubmission of a budget to the State Health Board if a modification is required for excess expenditures. Disallows payments to an institutional provider for covered services not included in its approved prospective budget. Requires each State Health Board to develop maximum fee schedules for covered services (other than durable medical equipment and laboratory services) after opportunity for negotiations with participating providers. Directs the National Health Board to develop guidelines for such schedules which: (1) establish the relative value of particular services, taking into account specified factors; (2) provide for geographical variations in fees, taking into consideration certain criteria; (3) set the maximum fee for a service which can be provided by two or more categories of health personnel at the lowest of the maximum fees authorized for such categories; and (4) include a formula for allowing annual changes in such schedules. Requires payment for the provision of: (1) durable medical equipment and laboratory services to be the lower of (A) the charge, or (B) the reasonable cost of the equipment or service; and (2) drugs and hearing aids to be the lower of (A) the charge, or (B) the reasonable cost of the drug or aid, plus a reasonable professional fee. Directs the National Health Board to establish guidelines for the reasonable cost of durable medical equipment, laboratory services, drugs, and hearing aids which shall be the lowest cost at which any such item of comparable quality is (or could be made) generally available in an accessible area. Provides for the computation of the professional fee with respect to drugs and hearing aids. Outlines procedures for the use of negotiations to determine the amounts of payments to providers. Directs the National Health Board to establish criteria for the selection of the negotiating groups for each of the following groups of providers: (1) hospitals; (2) skilled nursing facilities; (3) home health care agencies; (4) other institutional providers, including community health centers, migrant health centers, and health clinics; (5) physicians; (6) other non-institutional providers, such as pharmacists, physical and occupational therapists; and (7) hospital employees. Sets forth requirements for representation within such groups. Requires that the selection guidelines by the National Health Board shall provide for: (1) differences in the sizes of the various negotiating groups; (2) proportional representation for each type of health-care provider; (3) three-year terms for each representative; and (4) nomination and election methods. Provides that such negotiations shall concern: (1) limitations with respect to payments made to institutional providers on the basis of approved prospective budgets; (2) maximum-fee schedules; (3) reasonable cost levels with respect to durable medical equipment, laboratory services, drugs, and hearing aids; and (4) other cost control methods. Allows a State Health Board to incorporate within its annual State budget the provision of any agreement reached as the result of such negotiations which would keep expenditures within the budgetary limits. Title III- Part C, Determining Amounts of Premiums and Incentive Payments and Benefits - Directs the National Health Board to establish, in conjunction with the adoption of the Annual Budget and after negotiations with consortia, participating insurers, and HMOs: (1) a national community-rated premium; and (2) a national premium rate. Requires the national community-rated premium to be set so that, if such amount were paid by the members of each family enrolled through an employer plan, the total premiums paid would equal the anticipated expenditures under the Annual Budget, including payments to providers for basic services and administrative costs, but excluding administrative costs for the National and State Health Boards, PSROs, contingency funding, and the costs of covered services to persons who are Medicare-, SSI-, AFDC-eligible residents of Federal or State institutions, or members of the uniformed services on active duty. Requires that the national premium rate be set so that the sum of all wage-related and non-wage related premiums, the government payment for unpaid private premiums, and the voluntary premiums under international agreements equals the anticipated expenditures for covered services to Medicare- eligible, SSI-eligible, and AFC-eligible individuals, and residents of Federal and State institutions. Directs the Board to establish a group-related premium for SSI-eligible individuals and for residents of Federal and State institutions who are enrolled in a qualified plan. Requires that: (1) such premium be set so that the total amounts paid on behalf of such individuals equals the expenditures for furnishing care to such persons; and (2) such premium be adjusted annually to reflect the actual cost experience with respect to such expenditures. Provides that the national community-rated premium and the national premium rate are to apply as the State community-rated premium and the premium rate for each State, unless a State is able to provide for reduced premiums by negotiating a lower level of approved expenditures than would otherwise be provided for in the national budget. Requires each State to establish a group-rated premium for AFDC-eligible individuals and residents of State institutions. Requires that such premium: (1) be set so that the total amounts paid on behalf of such individuals equals the expenditures for furnishing care to such persons; and (2) be adjusted annually to reflect the actual cost experience with respect to such expenditures. Permits a participating insurer or HMO to offer eligible individuals (other than Medicare eligibles) an incentive to enroll in a qualified plan by providing additional services or by paying dividends or cash rebates on premiums. Permits an HMO to offer such incentives to Medicare-eligible persons. Sets forth requirements with respect to such dividend and cash rebates, including that: (1) in the case of employed enrollees, they be divided between the employees and employer in accordance with Board procedures; and (2) they not be treated as taxable income to individuals or income under federally-assisted welfare programs, nor reduce any credit relating to a limit on the amount of private premium payments. Sets a limit on the amount of premiums paid with respect to members of a family unit as employees and by members of the family unit. Provides for a refund to families of amounts in excess of such limit. Title III-Part D, Payment and Collection of Premiums - Requires each employer to pay to the applicable consortium on behalf of each employee for each payroll period an amount equal to the product of the wages paid during such period and the applicable State premium rate. Permits an employer (subject to any collective-bargaining agreement) to require employees to pay up to 35 percent of such amount. Requires an employer to pay any voluntary contributions such employee may wish to have made on his behalf. Permits an employer to obtain certification from the Board as an impacted employer and so qualify for: (1) a payment from the Board if such employer is a State employer or nonprofit employer; or (2) a tax credit with respect to other employers. Specifies the formula for determining such payment or credit. Defines terms for the purposes of this section. Requires all persons (with specified exceptions) to pay to the applicable consortium an amount equal to the product of one-half the State premium rate and the amount of non-wage-related income of such persons' family units. Requires such persons to file quarterly information returns in accordance with Board regulations. Authorizes the Board to impose a collection surcharge for untimely payments. Prescribes the payment procedure for premiums under executive agreements. Requires: (1) the Board to make monthly premium payments to consortia on behalf of SSI-eligible individuals and residents of Federal institutions; and (2) each State to make monthly premium payments to consortia on behalf of AFDC-eligible individuals and residents of State institutions. Sets forth rules regarding Government compensation to consortia for certain uncollected premiums and an assessment against State or local governments which fail to make a required employer payment. Title III-Part E Distribution of Premiums - Requires the consortia to: (1) compute for each capitation individual an amount equal to the average anticipated expenditure in the State budget for the individual, including certain administrative costs and funds for the contingency fund, but excluding the administrative costs of the State health board; and (2) report such amounts to the Board for review. Requires each consortium to adjust capitation amounts to reflect for a specific capitation individual: (1) the relative actual costs of providing covered services in the area of such person's residency; and (2) the actuarial risk associated with the individual's characteristics. Requires that such risk adjustment be made to eliminate financial incentives for insurers or HMOs to practice risk selection or experience rating. Requires that the total of capitation amounts and adjusted capitation amounts for enrollees in a State be equal to the total expenditures in the State budget for the provision and administration of covered services, excluding State health board administrative expenses. Requires each consortium to apportion to its members an adjusted capitation amount for each capitation individual and a group-rated premium for each group-rated individual. Requires these amounts to be paid to members in installments consistent with Board guidelines. Directs the Board to provide supplementary payments from the Health Resources Distribution Fund to participating HMOs in operation for less than five years. Requires consortia to provide, in accordance with Board guidelines, for redistribution of collected premiums to assure that each consortium is provided an adjusted capitation amount for each capitation individual, and a group-rated premium for each group-rated individual. Directs each consortium to maintain a contingency fund for expenditures for unforeseen circumstances beyond the control of insurers or HMOs. Authorizes the Board, in any year when premiums collected are less than amounts provided in the annual budget, to guarantee the principle and interest of loans issued by the consortia to assure adequate revenues. Sets forth requirements with respect to such loans. Directs the Board, in any year when premiums collected are greater than provided for in the annual budget, to provide for the consortia to distribute such excess funds, including appropriate adjustments in subsequent national and State budgets. Title IV: Administration-Part A, National Health Board and State Health Boards Establishes an independent, five-member National Health Board, to be appointed by the President, to (among other specific functions): (1) establish commissions, bureaus, divisions, offices, and other entities required by this Act or deemed appropriate; (2) perform the functions of a participating insurer, HMO, or consortium with respect to any area or group of insurers for which there is no certified insurer or consortium; (3) perform the functions of a State health board with respect to any State in which such a board has not been established; (4) establish administrative procedures with respect to consumer and provider appeals from State health board decisions; (5) be responsible for the general implementation of this Act; and (6) study and evaluate on a continuing basis the operation of this Act. Transfers to the Board all functions of the Secretary of HEW relating to specified provisions of: (1) the Social Security Act (including Maternal and Child Health Services, Professional Standards Review Organizations, Medicaid, and Medicare); (2) the Public Health Service Act (but excluding, among other provisions, certain provisions of title III (Administration), title IV (National Research Institutes), title V (Miscellaneous), title X (Population Research), and title XIV (Safety of Public Water Systems); (3) the Community Mental Health Centers Act; (4) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970; (5) the Drug Abuse Office and Treatment Act of 1972; and (6) the provision of health care services to Indians (PL 94-437). Requires the Board to have: (1) an Ombudsman, to investigate complaints about program operation; (2) an advocate, to assist consumers in determining and protecting their rights to services; and (3) an inspector general, to direct the auditing and investigative activities of the Board. Directs the Board to establish the following Commissions: (1) Commission on Benefits, to review and make recommendations with respect to the provision of basic covered services under qualified plans and determine their cost and effectiveness in improving public health; (2) Commission on Quality, to review and make recommendations with respect to the quality of health services provided under this Act; (3) Commission on Access, to review and make recommendations with respect to the utilization of covered services by the different categories of eligible individuals; and (4) Commission on Health Care Organization, to review and make recommendations with respect to the cost and effectiveness of methods for the delivery of services. Requires at least one-half of the members of each Commission to be consumers or representatives of consumers and to include appropriate representation of health care providers and other participants. Establishes: (1) a nine-member Commission on the Health of Americans, to be appointed by the President, to conduct an ongoing review of the health status of the U.S. population and to review a broad range of proposals for improving such health status, including research, environmental programs, highway safety, public health programs, and personal health services programs; and (2) under the direction of the National Health Board, a National Institutes of Health Care Research which shall be composed of (A) an Institute of Health Statistics, (B) an Institute of Health Services Research, and (C) an Institute of Health Technology Evaluation. Transfers to such Institutes certain functions of the Secretary under the Public Health Service Act. Requires each State to charter as a public corporation a State health insurance corporation in accordance with Board guidelines. Directs each State health board (that is, the board of directors of the State corporation) to establish an ombudsman, an advocate, and such advisory commissions as are appropriate to carry out its functions. Delineates the duties of such boards. Title IV - Part B, Participating Insurers, Health Maintenance Organizations, and Consortia - Directs the Board to certify an insurer or HMO when certain conditions are met, including a participation agreement between the Board and the insurer or HMO containing specified provisions. Requires the insurer or HMO to: (1) become a member of the appropriate consortium; (2) offer enrollment in at least one qualified health plan which provides basic services without a charge other than the premium; (3) accept during open enrollment all eligible persons in the order they apply without restriction, up to its capacity (but permits the Board to provide for enrollment limits to reflect needs for cost-effective services and for special characteristics of self-insurers); (4) issue an enrollment card for each enrolled person; (5) pay participating providers in amounts no greater than permitted under this Act; (6) report to the State health board and its consortium on payments made and expenses incurred; (7) maintain and afford access to records by the consortium, State health boards, and the Board and provide confidential treatment of individually-identifiable records; (8) offer any rebates or other benefits to all enrollees on the same basis; (9) establish hearing procedures for an enrollee or provider who is dissatisfied with respect to certain services or payments; and (10) comply with other reasonable regulations respecting marketing and customer service practices which the Board establishes. Directs the Board to agree that, in return for agreed-upon services and understandings, the insurer or HMO is to be paid by its consortium for each enrollee in a qualified plan. Requires the Board to certify in each State one consortium for each of the following types of insurers or HMOS: (1) a Blue Cross-Blue Shield consortium, representing nonprofit State-chartered medical/hospital service corporations; (2) a commercial insurance carrier consortium, representing profit-making commercial insurers not directly furnishing health care services; (3) a prepaid group practice HMO consortium; (4) an individual practice association HMO consortium; and (5) a self-insurer consortium. Permits an insurer or HMO to serve as a member of a different consortium with the approval of the Board and the consortium. Sets forth requirements with respect to these consortia including: (1) a participation agreement between the Board and the consortium containing specified provisions; (2) that the consortium provide for premium collection and reallocation and pay members for each enrollee; (3)that a contingency fund be maintained; (4) that certain information be reported regularly to the Board; (5) that the consortium negotiate with provider groups in establishing prospective budgets and maximum fee schedules in areas where its members offer plans; (6) that certain review procedures be established for dissatisfied enrollees and providers; and (7) that other regulations be followed. Establishes as a defense in any civil or criminal antitrust action brought with respect to actions by a participating insurer or HMO or consortium that such actions were taken in the course of performing duties required under agreements entered into under this Act. Directs the Board, after consultation with the Attorney General and the Federal Trade Commission, to prescribe standards and procedures for the conduct of insurers, HMOs, and consortia which is consistent with the promotion of competition. Directs the Board to investigate complaints by a participating insurer or HMO that another participating organization has engaged in anticompetitive activity. Title V: Health Care Improvement Program - Directs the National Health Board to establish a program to improve the distribution of health care resources in the United States in order to promote the improvement in the quality, accessibility, and efficiency of services provided under this Act. Establishes in the Treasury the Health Resources Distribution Fund. Directs the Board to make grants to the State health boards from the Fund for projects to achieve the purposes of the program, including: (1) the conversion or closure of health care facilities; (2) the provision of health care services in health manpower shortage areas; (3) renovations of institutional health care facilities; (4) HMO and other delivery systems; (5) educational programs for health professionals to meet projected needs; and (6) continuing professional education programs. Requires that the Board allocate an amount to each State health board based on the State's needs as reflected in the National Health Care Improvement Plan. Requires that each State health board provide for a program for the education of consumers concerning health and their rights and privileges under this Act. Directs the Board to: (1) study the impact of this Act on, and means of improving, the Medicaid programs, and report appropriate recommendations to Congress within five years of enactment; (2) provide for the development and demonstration of methods to improve (A) the coordination of services by different providers, (B) the provision of services, and (C) peer review and control of utilization and quality in the provision of drugs, laboratory services, and other services under this Act and Medicare; (3) provide for demonstration projects to evaluate the feasibility of providing hospice services as part of basic covered health- care services; (4) provide for an analysis of provider malpractice and the provision of malpractice insurance, and report recommendations to Congress within two years of enactment. Directs the Board to provide for the conduct of a demonstration project in the organization, delivery, and financing of personal care services to groups likely to require such services. Requires that the Board make grants for establishing and maintaining programs to provide personal care services for a substantial population of persons residing in their homes who would otherwise be required to reside in an institution providing personal care services. Sets forth requirements with respect to such program. Directs the Board to transmit to Congress a comprehensive report with appropriate recommendations within five years of enactment. Title VI- Effective Dates, Transition Provisions, Amendments - Part A, Effective Dates and Transition Provisions - Sets forth effective dates for provisions of this Act. Provides for a special national premium rate for the period between October 1 and December 31 of the year before the first effective year. Directs the Board to establish for localities within each State maximum fee schedules applicable to services reimbursed under Medicare Part B for the period between July 1 and January 1 of the first effective year. Requires the Board to establish regulations, guidelines, standards, and procedures providing for the orderly administration of the Act, and to report to Congress within 18 months of enactment its progress in establishing implementation procedures. Directs the General Accounting Office to report to Congress within 18 months of enactment on the Board's progress. Provides that this Act does not alter or affect any contractual or other nonstatutory obligation of an employer to pay for or provide health services to present or former employees if the effect shifts the obligation in any part to such persons. Sets forth provisions relating to transfer of functions. Title VI: - Part B, Medicare-Related Amendments - Amends title XVIII of the Social Security Act (Medicare) to conform such Act with the Health Care for All Americans Act. Eliminates the prohibition against Federal supervision or control over the practice of medicine and the compensation of employees and officers of health care providers. Includes the following changes among those relating to eligibility: (1) broadens Medicare entitlement to include citizens of the U.S., persons legally admitted for permanent residence, and certain other persons aged 65 and over; (2) deletes the 24-month waiting period for eligibility for the disabled; and (3) entitles individuals to enroll in a participating HMO. Changes Medicare Part B from a voluntary insurance program to an entitlement program financed by premium payments and Federal funds. Includes the following among the changes relating to the scope of benefits: (1) deletes the limitation on inpatient hospital days; (2) adds mental health day care services; (3) replaces the existing limitation on inpatient psychiatric hospital services with a 150 consecutive day limit for Medicare purposes and a 45-consecutive-day limit for purposes of the Health Care for All Americans Act. Limits payment for outpatient psychiatric services and services related to the diagnosis or treatment of mental illness to an annual amount equal to 20 times the fee set forth in the maximum fee schedule for a psychiatrist's visit. Limits to $100 payment for certain outpatient therapy services in the therapist's office or beneficiary's home. Conforms coverage for end-stage renal disease with the provisions of the Health Care for All Americans Act. Includes the following among the changes relating to exclusions from coverage: (1) extends the applicability of exclusions to the Health Care for All Americans Act; (2) stipulates that preventive services are not excluded; (3) excludes hearing aids and related examinations only if they exceed one every three years, and one per individual; (4) eliminates the exclusion relating to orthopedic shoes; (5) permits the waiver, under certain conditions of the foot care exclusions for persons with diabetes mellitus; and (6) adds a new exclusion for insulin or outpatient prescription drugs for chronic conditions exceeding maximum amounts established by the Board. Makes technical and conforming amendments to Medicare Parts A and B relating to: (1) requirements for certification and requests for payment; (2) agreements with participating providers; (3) the use of State agencies to determine compliance with conditions of participation; (4) PSROs; and (5) payments to HMOs. Requires providers prescribing outpatient prescription drugs to use only generic or other names and specify such amounts as the Board may provide to insure quality and efficiency. Makes certain revisions with respect to payments to institutional and other providers and the administration of benefits. Repeals the deductible and coinsurance provision of the Medicare Part A program and the existing definition of "reasonable cost". Expands the definition of employment subject to the Medicare hospital insurance tax to include employment with Federal, State, and local governments, service performed for charitable organizations, service performed by certain employee representatives, certain students, and other organizations. Repeals provisions relating to the establishment of the Health Insurance Benefits Advisory Council. Applies certain procedural provisions of title II of the Social Security Act (Old-Age, Survivors and Disability Insurance) to Medicare and to the Health Care for All Americans Act. Amends title XIX of the Social Security Act (Medicaid) to establish a new arrangement for the determination of the Federal Medicaid payment, by which payment is to be equal to "excess State payments" according to a specified formula. Increases the Federal share of certain State Medicaid expenditures, including: (1) the training and compensation of skilled professional personnel (from 75 to 90 percent); (2) operation of management information systems (from 75 to 90 percent); and (3) general administration (from 50 to 90 percent). Establishes certain additional State Medicaid plan requirements including that States: (1) continue to provide services (other than those covered under the Health Care for All Americans Act) in the amount, duration, and scope as were covered by the States in the quarter before the first effective year of the program; (2) pay premiums on behalf of AFDC-eligible recipients; and (3) reimburse providers in a manner consistent with methods established by the Board. Requires any State not having a Medicaid program to enter into an agreement with the Board by which the State agrees to pay premiums on behalf of AFDC-eligible recipients and receives financial assistance from the Board. Amends title XI of the Social Security Act (General Provisions and PSROs) to: (1) extend the provisions for uniform reporting and disclosure of ownership and related information to the Health Care for All Americans Act; and (2) repeal the provisions relating to limitations on capital expenditures and programs for determining the qualifications of certain health care personnel. Amends the Internal Revenue Code to eliminate the present deduction for health insurance payments. Permits a deduction for amounts of medical expense not compensated for by insurance, in excess of three percent of adjusted gross income. Adds a new excess health insurance credit for impacted employers. Establishes special rules for computing such credit with respect to controlled groups of corporations and employees of partnerships and proprietorships which are under common control. Amends title XIII of the Public Health Service Act (Health Maintenance Organizations) to make conforming and certain other revisions with respect to the organization and operation of HMOs.
Bill· HRH.R. 5170 (96th)referred
United States · United States Congress · 5 September 1979
Extends until October 1, 1982, the funding of State Medicaid (title XIX of the Social Security Act) fraud control units.
Law· SS. 1658 (96th)open
United States · United States Congress · 2 August 1979
Asbestos School Hazard Detection and Control Act of 1979 - States the purposes of this Act to be to: (1) establish a Federal task force to ascertain the extent of the danger from asbestos materials in schools to children or employees; (2) require States to establish programs for asbestos inspection in schools; (3) provide scientific and technical assistance to States and local school boards; (4) provide loans for the mitigation of serious asbestos hazards in schools; and (5) assure that no disciplinary action be taken against employees for calling attention to such hazards. Establishes the Asbestos Hazards School Safety Task Force. States that such Task Force's duties shall include: (1) compiling and disseminating medical, scientific, and technical materials to State and local entities; (2) reviewing and approving State applications for grants and loans; and (3) assisting in formulating standards and safety procedures. Requires State educational agencies which seek administrative funds to submit to the Secretary a plan which: (1) describes the manner such State shall disseminate information on the health hazards of asbestos fibers; (2) describes the content of such information; and (3) describes the procedures to be used by the State in maintaining records on asbestos. Authorizes the Secretary to make grants to local educational agencies for the Federal share of the costs of carrying out an asbestos detection program meeting the standards of this Act. Prohibits the making of such grants unless an application has been submitted to and approved by the Secretary after consultation with the task force. Authorizes the Secretary to allocate up to 20 percent of such asbestos detection funds for use in education and technical assistance programs. Requires recipients of such asbestos detection funds to file a report with the Secretary describing detection and testing activities undertaken, the results, and the plan for correcting any discovered asbestos hazards. Establishes an Asbestos Hazards Control Loan Program in the Department of Health, Education, and Welfare. Stipulates that loans from such program shall be: (1) available only to correct imminent asbestos hazards in schools to school children or school employees; (2) limited to projects covering more than 2,500 square feet; (3) for a period not exceeding 20 years; and (4) interest free. Requires applications for such loans to describe: (1) the nature of the asbestos problem; (2) the results of preliminary testing; and (3) the methods to be used to correct such problem. Requires the Secretary to report annually to the appropriate House and Senate committees regarding such loan program. Directs the Secretary to promulgate and distribute to the States safety standards and procedures for testing the level of asbestos in schools, for determining the likelihood of the leakage of asbestos into the school environment, and for determining which contractors are qualified to carry out testing and evaluation procedures. Stipulates that no employer receiving funds under this Act shall discharge or discriminate against any worker who focuses public attention on an asbestos problem in his or her school district. Stipulates that nothing in this Act shall restrict any other legal rights in connection with the purchase or installation of asbestos materials in schools, or with any claim of disability or death from exposure to asbestos in a school setting. Grants the United States a right of recovery for claims under this Act.
Bill· SS. 1642 (96th)referred
United States · United States Congress · 2 August 1979
Health Professions Training Amendments of 1979 - Amends title VII of the Public Health Service Act (Health Research and Teaching Facilities and Training of Professional Health Personnel) to authorize specified appropriations through fiscal year 1983 to the student loan insurance and interest payment fund to carry out the Federal program of insured loans and interest payments to graduate students in health professions schools. Eliminates as an eligibility requirement for participation in the Health Education Assistance Loan (HEAL) program that a student not be receiving funds from certain loans under programs assisted under title IV of the Higher Education Act of 1965. Directs the Secretary of Health, Education, and Welfare to pay to the holders of HEAL loans the total amount on the interest which accrues prior to the beginning of the repayment period (for a period of up to seven years). Eliminates the current financial need requirement with respect to Health Professions Student Loans, thus allowing the schools to determine the terms and conditions of such loans. Extends the repayment period for such loans from ten to 15 years. Authorizes the Secretary to make loan payments on behalf of individuals who serve in fields of health care determined to be lacking adequate professional manpower, in addition to designated health manpower shortage areas as currently provided. Extends the authorization of appropriations for such program through fiscal year 1983. Extends the authorization of appropriations for the exceptional need scholarship program through fiscal year 1983.
Bill· HRH.R. 5148 (96th)referred
United States · United States Congress · 2 August 1979
Hospital Capital Stock Increase Limitation Act of 1979 - Amends title XV of the Public Health Service Act (National Health Planning and Development) to direct the Secretary of Health, Education, and Welfare to promulgate annually a national limit for certificates and reports of need to be issued in that year for "major increases in hospital capital stock." Sets the limit for any year at $3,000,000,000, to be adjusted according to increases in construction prices, changes in population growth, and previous estimates. Directs the Secretary to allocate such limit among the States according to appropriate factors. Defines "major increase in hospital capital stock" to include: (1) the construction or development of a non-Federal hospital which (A) has an average duration of stay of less than 30 days, (B) is not primarily engaged in providing psychiatric services, and (C) is not wholly owned by a health maintenance organization (HMO); or (2) an improvement or acquisition by such a hospital which (A) exceeds $150,000 in value, (B) will increase the number of short-term non-Federal beds in the State, or (C) will substantially change institutional health services offered. Applies the certificate-of-need program administered by the State health planning and development agency (State Agency) to: (1) new institutional health services (provided for in the current law); (2) increases in health care facility capital stock; and (3) changes in health care facility bed function proposed to be made in the State. Defines "increase in health care facility capital stock" to mean: (1) the construction or development of a new health care facility; or (2) an improvement or acquisition by a facility, involving capital expenditures according to generally accepted accounting principles. Prohibits a State Agency from granting a certificate-of-need which authorizes the establishment of any new short-term non-Federal hospital beds if the number of such beds in the health service area exceeds the limit for such area, unless two existing beds are to be eliminated for each new one to be established. Sets such limit at four beds per 1,000 individuals, or the limit set forth for such area in the State health plan. Requires any certificate-of-need authorizing a major increase in hospital capital stock to specify the maximum dollar amount authorized. Prohibits the sum of such maximum amounts so authorized, or covered in reports pursuant to the capital expenditure limitation provision set forth in title XI of the Social Security Act, from exceeding the limit allocated to such State by the Secretary under this Act. Allows such sum to be increased by specified formulas or by exceptions granted by the Secretary to meet emergency situations or the needs of individuals residing in other States. Revises the capital expenditure limitation provision set forth in title XI of the Social Security Act (General Provisions). Directs the Secretary to make an agreement with the chief executive of each State which: (1) does not have a certificate-of- need program meeting the requirements of the Public Health Service Act; and (2) does have a designated State Agency under such Act that is willing and able to carry out a report of need program. Requires such agreement to carry out a report of need program which meets the requirements of a certificate-of-need program, with the exception that findings with respect to proposed services shall be made to the Secretary. Authorizes the Secretary to determine the need for services in a State having neither a certificate-of-need nor a report of need program. Prohibits the making of Federal payments under the Maternal and Child Health, Medicare, and Medicaid programs with respect to new institutional health services which have not been found to be needed by the Secretary or pursuant to the certificate-of-need or report of need programs. Directs the Secretary to exclude a specified amount in determining Federal payments under such programs for expenses related to an increase in health care facility capital stock or a change in health care facility bed function, unless such increase or change has been found to be needed by the Secretary or pursuant to the certificate-of-need or report of need programs. Directs the Secretary to estimate, after consultation with the State Agencies and health systems agencies, the number and value of major increases in hospital capital stock contracted for in 1977 through 1979 (up to the date of enactment), and of proposed increases in such stock, in each State in the following categories: (1) increases needed to meet Federal, State, or local safety regulations, or to comply with State or voluntary licensure or accreditation standards; (2) increases not resulting in an increase in the number of short-term non-Federal hospital beds; and (3) other increases. Requires the Secretary to allocate to each State maximum dollar amounts for such increases, taking into account the relatively greater importance of (1) over (2), and (2) over (3). Directs the Secretary to: (1) request the State Agencies to recommend which increases should be approved; (2) approve those increases so recommended (or, if no recommendations are submitted, to determine whether to approve such increases); and (3) exclude a specified amount in determining Federal payments under the Maternal and Child Health, Medicare, and Medicaid programs for expenses related to a major increase in hospital capital stock which was: (A) contracted for, or actually begun, before the 91st day after enactment, or (B) was not approved by the Secretary.
Bill· HRH.R. 5151 (96th)referred
United States · United States Congress · 2 August 1979
Federal Employees Dental Benefits Act of 1979 - Directs the Office of Personnel Management (OPM) to contract for the following dental benefits plans for Federal employees: (1) a service benefit plan; (2) an indemnity benefit plan; (3) employee organization plans; and (4) health maintenance organization plans. Requires that the benefits under such plans include: (1) diagnostic services; (2) preventive care; (3) emergency dental care services; (4) fillings; and (5) extractions. Permits a plan, subject to approval of the OPM, to: (1) offer additional benefits; (2) require copayments not exceeding 50 percent of the value of such additional benefits; (3) limit the amount a beneficiary may be paid during a calendar year under such a plan; and (4) impose a calendar year deductible for each beneficiary. Allows the OPM to enter into contracts for such plans without regard to specified provisions of Federal law requiring competitive bidding. Sets forth requirements concerning: (1) the length and rates of such a contract; and (2) obligations of any carrier of such a plan. States that such contracts are not subject to the Federal Procurement Regulations. Directs the OPM to establish audit requirements which do not conflict with such Regulations to carry out the purposes of this Act. Allows an employee to enroll in a dental benefits plan as an individual or for self and family. Permits certain annuitants to continue enrollment in such a plan under conditions of eligibility prescribed by regulations of the OPM. Prohibits an individual from enrolling both as an employee or annuitant and as a member of the family. Specifies conditions under which an employee may change enrollment. Specifies the biweekly contributions of the Government and the enrolled individual toward the subscription charge of a dental benefits plan. Directs the OPM to provide individuals who are eligible for such a plan with sufficient information to enable the individual to make an informed choice among the types of plans. Requires that each enrolled individual receive a document summarizing: (1) the benefits of the plans; (2) the procedure for obtaining benefits; and (3) all provisions of the plan affecting the individual. Creates the Employees Dental Benefits Fund into which the contributions of the Government and enrolled individuals shall be paid. Directs the OPM to: (1) administer this Act; (2) make a continuing study of the operation of this Act and of the plans under this Act; and (3) transmit an annual report of its findings to Congress. Authorizes expenditures from the Employees Life Insurance Fund to pay administrative expenses of the OPM in carrying out provisions of this Act. Requires the reimbursement of such expenditures plus interest from the Federal Employees Dental Benefits Fund.
Bill· HRH.R. 5086 (96th)referred
United States · United States Congress · 2 August 1979
Hospital Full Disclosure and Cost Review Act of 1979 - Establishes a 15-member National Commission on Hospital Cost Containment to study: (1) the effect of policies and procedures (including use of deductibles, coinsurance, cost- or risk-sharing, tax deductions and exclusions, and prepaid health plans) relating to payment of hospital services on (A) consumer and physician awareness of the cost and quality of different hospital services, and (B) the utilization and quality of hospital services; and (2) the desirability of increasing the use of such methods in federally funded and other health insurance programs. Directs the Commission to submit such study and recommendations to the appropriate congressional committees within two years of its appointment. Directs the Commission to prepare a report on measures to control costs in the health care industry, such as changes in methods of third-party reimbursement, physician reimbursement, payment for drugs and medical supplies, utilization of health facilities and services, and capital expenditures, and to submit such report to Congress within one year of enactment. Authorizes the Secretary of Health, Education, and Welfare to provide financial assistance for up to 50 percent of the expenses involved with the planning, establishment, or operation of State mandatory hospital cost containment programs.
Bill· HRH.R. 5091 (96th)referred
United States · United States Congress · 2 August 1979
Food Additive Safety Amendments of 1979 - Amends the Federal Food, Drug, and Cosmetic Act to deem any food additive safe if the Secretary of Health, Education, and Welfare: (1) makes a finding, based on recommendations of an advisory committee, that the public benefit from permitting the use of such additive would exceed the public risk which might result from such use; (2) gives notice in the Federal Register of such a finding and invites public comment thereon; and (3) issues a final order not earlier than 120 days after such publication in the Federal Register of such findings. Specifies factors the Secretary must take into consideration when evaluating a food additive or its proposed use. Authorize the Secretary to include in any food additive regulation a labelling requirement to identify the additive and its degree of risk. Prohibits the Secretary from denying a petition for a food additive regulation solely on the basis of evidence of tumors developed in test animals where the dosage levels used on such animals exceeds one hundred times the reasonably expected maximum human consumption of such additive. Amends the Saccharin Study and Labeling Act to extend from 18 to 36 months the period following enactment during which restrictions may not be imposed on the sale or distribution of saccharin, or any food, drug, or cosmetic containing it.
Bill· HRH.R. 5052 (96th)referred
United States · United States Congress · 1 August 1979
Correctional Health Care Services Act of 1979 - Directs the Bureau of Prisons to make available to all persons incarcerated in Federal correctional institutions all medical, psychiatric, psychological, dental, surgical, gynecological, alcohol and drug abuse treatment, and related services necessary to maintain basic health at a level comparable to that prevailing in the community at large. Requires all such institutions under the authority of the Attorney General (except for community treatment centers) to maintain a hospital or infirmary under the direction of a Chief Medical Officer. Specifies requirements for such institutions with respect to the medical care of prisoners. Directs the Attorney General to report annually to Congress with respect to compliance with such standards. Makes the remedy against the United States under the Federal Tort Claims Act for personal injury caused by the negligence of medical personnel of the Bureau of Prisons (whether employed by contract or otherwise) exclusive of any other civil action by reason of the same subject matter against such personnel. Directs the Attorney General to defend any civil action or proceeding brought in any court against any such medical personnel. Requires any such civil action or proceeding commenced in a State court to be removed without bond to an appropriate district court, upon certification that the employee was acting in an official capacity. Makes nonapplicable to any such cause of action the current exception to the tort claims procedure which excepts Government employees exercising due care. Authorizes the Director of the Bureau of Prisons to hold harmless or provide liability insurance for medical personnel for personal injury damages under certain circumstances. Allows a physician or medical officer providing care to persons committed to the custody of the Attorney General compensatory time off for services performed at other than regularly scheduled times. Allows an autopsy to be performed on the body of a deceased prisoner by order of the warden or chief executive officer of the institution if consented to in writing by a person authorized under State law to permit such autopsy. Directs such a warden or officer to notify the chief medical officer of the institution or a licensed physician certified or board eligible in anatomic pathology of specified types of deaths of a prisoner of such institutions, such as violent deaths or deaths under suspicious circumstances. Allows such physician who opines that further investigation is required to arrange for an autopsy with the permission of the warden or executive officer.
Bill· SS. 1610 (96th)referred
United States · United States Congress · 31 July 1979
Blood Assurance Act of 1979 - Prohibits any person from: (1) charging or collecting a fee; or (2) requiring the donation or transfer of blood, as a condition to the provision of blood to any individual. Stipulates that a blood supplier may recruit blood donors by offering donors incentives to provide blood, such as a discount on the charge to an individual for the provision of blood as a result of a blood donation or blood drive, but limits such discount to the greater of: (1) the average cost of recruiting a donor in the area; or (2) 20 percent of the cost of processing a unit of blood. Amends title XVIII of the Social Security Act (Medicare) to repeal the provision which requires a reduction of the amount payable to a provider of services by a deduction equal to the cost of the first three pints of whole blood. Requires the regulations which determine the cost of services under such program to take into account the processing fees incurred by a provider of services in the replacement of blood furnished to an individual, but only to the extent the provider demonstrates that it has been able to secure such replacement only through the payment of such fees. Prohibits any person from denying to any health care facility or blood supplier the reciprocal exchange of available blood required as a result of patient needs, unless such exchange would deplete the available blood needed by such establishment. Directs the Secretary of Health, Education, and Welfare, acting through a recognized private entity composed in part of national blood suppliers, to: (1) foster the exchange and availability of blood; and (2) determine the fair and reasonable exchange rates to be charged among blood suppliers for blood. Directs the Secretary to suspend or revoke the license of a person who is licensed under the Public Health Service Act to prepare blood and who violates provisions of this Act. Makes a provider of services who violates this Act ineligible to receive payments under Medicare. Directs the Secretary to carry out health education programs with respect to the nature of, and need for, blood and blood donors and to submit to Congress within two years of enactment a report on such activities.
Bill· HRH.R. 5034 (96th)referred
United States · United States Congress · 31 July 1979
Food Freshness Labeling Act of 1979 - Amends the Federal Food, Drug, and Cosmetic Act to require that the label on any packaged article of food indicate its pull date, expiration date, and any storage instructions prescribed by the Secretary of Health, Education, and Welfare. Requires the labeling on any packaged perishable or semiperishable food which is: (1) a dairy product to indicate any prescribed storage instructions and the expiration date; and (2) a meat food product to indicate any prescribed storage instructions and the quality assurance date. Requires the label on packaged bakery foods to indicate the date on which such food was baked. Requires every retail food distributor to display a sign which explains in easily understood terms the meanings of the dates and other information printed on such labels. Directs the Secretary to promulgate regulations pursuant to this Act within one year after enactment. Defines terms used in this Act.
Bill· SJRESS.J.Res. 99 (96th)passed
United States · United States Congress · 30 July 1979
Authorizes and requests the President to designate the week of September 16 through September 22, 1979, as "National Lupus Week."
Law· HRH.R. 5015 (96th)open
United States · United States Congress · 30 July 1979
Federal Physicians Comparability Allowance Amendments of 1979 - Amends the Federal Physicians Comparability Allowance Act of 1978 to extend by two years: (1) the deadline by which a Federal agency may enter into an agreement providing a bonus allowance for services of a physician; and (2) the termination date of any such agreement. Includes: (1) any physician paid under the Senior Executive Service, the Merit Pay System, or the Panama Canal Commission within the definition of "Government physician"; and (2) the Library of Congress within the definition of "agency" for purposes of such Act. Prohibits the aggregate amount paid by the Government to any such Senior Executive Service physician in a fiscal year from exceeding the annual rate payable for positions at level I of the Executive Schedule.
Bill· HRH.R. 5006 (96th)referred
United States · United States Congress · 30 July 1979
Title I: Amendments to the Consolidated Farm and Rural Development Act - Amends the Consolidated Farm and Rural Development Act to authorize the Secretary of Agriculture to make grants to any water system to enable it to comply with any national primary drinking water regulation, schedule, or other requirement with which it does not currently comply, and to assist such water system to serve its users at a reasonable user rate. Authorizes grants to any association with the legal authority to construct, operate, and maintain a water system in order to construct a proposed water system to comply with such regulations, when such association has been notified by the Environmental Protection Agency that the current drinking water supply of any potential user of such proposed system would not comply with such regulations. Limits the amount of any such grant, in most cases, to that portion (not to exceed 90 percent) of the cost of constructing, installing, operating, or maintaining treatment facilities and equipment necessary to achieve compliance, which cannot be paid through reasonable user rates over a reasonable period of time. Authorizes the Secretary to make grants to any water system which has achieved compliance with all national primary drinking water regulations, for the purpose of assisting such system to serve its users at a reasonable user rate. Limits any such grant to the difference between 75 percent of the development cost of the system and the amount of any previous development grant. Establishes priorities for the making of grants to water systems. Title II: Amendments to Title XIV of the Public Health Service Act - Amends the Public Health Service Act to deem in compliance with national primary drinking water regulations, until any noncompliance is corrected or a grant application under this Act is withdrawn or rejected, any rural public water system: (1) which the Environmental Protection Agency has notified of noncompliance with such regulations; and (2) which has certified to the Administrator in writing that the system is unable to comply because the expense of achieving compliance would require the imposition of an unreasonable user rate; and (3) which certifies that it has applied to the Secretary of Agriculture for a grant under Title I of this Act. Waives specified notice-to-user requirements for a noncomplying system during the period of deemed compliance. Requires the Administrator of the Environmental Protection Agency, at the request of any association with legal authority to construct, operate, and maintain a public or similar water system, to determine whether the drinking water supply of any potential user of such proposed system, if such system were a public system, would be in compliance with all national primary drinking water regulations.
Bill· SS. 1590 (96th)referred
United States · United States Congress · 26 July 1979
Comprehensive Health Care Reform Act - Title I: Cost Containment Incentives - Amends the Public Health Service Act by adding a new title XIX, "Standards for Health Benefit Plans." Disallows a trade or business expense deduction or an exclusion relating to contributions by employers to accident and health plans under the Internal Revenue Code by an employer who fails to meet the requirements of this title. Requires that an employer offer to his or her employees at least one group health benefit plan (to the extent that such a plan is available) for inpatient hospital services having an annual copayment for hospital services of at least 25 percent, to be paid by the employee. Excepts from such copayment requirement a period from the date on which an employee and his or her family have incurred out-of-pocket medical expenses during a calendar year in an amount in excess of 20 percent of such individuals' combined income and ending on the last day of such calendar year. Requires an employer to make the same expenditure per enrollee with respect to each group health benefit plan regardless of the actual premium cost. Requires an employer to rebate to an employee any excess of the employer's expenditure amount over the premium cost either in cash or other benefits. Prohibits an employer from expending an amount for a plan on behalf of an employee in excess of the premium cost of the most costly group health benefit plan in which at least ten percent of the employees are actually enrolled at the time the expenditure is made. Requires an employer having at least 200 full-time employees to offer his employees at least three health benefit plans with different carriers. Requires the offer of a group health benefit plan to be first made to any collective bargaining representative of an employee. Title II: Catastrophic Illness Insurance - Amends title XIX of the Public Health Service Act (as added by title I of this Act) to disallow a trade or business expense deduction or an exclusion relating to contributions by employers to accident and health plans under the Internal Revenue Code by an employer having 50 or more full-time employees who fails to meet the requirements of this title. Requires a health benefit plan to provide for payment without any cost sharing by any individual covered under the plan for medical expenses from the date on which an employee and his or her family have incurred out-of-pocket medical expenses during a calendar year in an amount in excess of 20 percent of such individuals' combined income and ending on the last day of such calendar year. Requires such plan to disregard any preexisting medical conditions of any such persons. Requires such plan to continue coverage for individuals for a period of six months after the member employee becomes unemployed, ceases to be full-time, or dies. Requires carriers to enter into an arrangement in each State in which it conducts business for the purpose of providing catastrophic illness insurance and preventive care coverage to those persons who are not eligible for coverage under titles II and III of this Act, or a government program of health care. Amends title XVIII of the Social Security Act (Medicare) to remove the 150 day limitation on inpatient hospital services. Provides that the amount payable for inpatient hospital services shall be reduced by a coinsurance amount equal to 20 percent of the charges imposed with respect to such individual, but only for days not within the "benefit period" (defined as the period beginning with the day on which the total expenses incurred by the individual for services for which benefits under this title are payable exceed 20 percent of such person's income from wages and net earnings from self-employment for the preceding calendar year). Provides that 100 percent of the charges or costs of the supplementary medical insurance benefits for the aged and disabled shall be paid during such benefit period. Title III: Preventive Care - Amends title XIX of the Public Health Service Act (as added by titles I and II of this Act) to disallow a trade or business expenses deduction or an exclusion relating to contributions by employers to accident and health plans under the Internal Revenue Code by an employer having 50 or more full-time employees who fails to meet the requirements of this title. Specifies the preventive care services which a carrier who enters into an arrangement with a State pursuant to title II must provide, including maternal care, childhood immunizations, and hypertension screening. Title IV: Internal Revenue Code Amendments - Makes: (1) a deduction by an employer in providing a health benefit plan to his or her employees; and (2) an exclusion by an employer for contributions to accident and health plans, conditional upon such employer's compliance with the requirements of title XIX of the Public Health Service Act. Title V: Effective Dates - Establishes the effective dates of this Act.
Bill· SS. 1574 (96th)referred
United States · United States Congress · 25 July 1979
Amends the Federal Food, Drug, and Cosmetic Act to direct the Secretary of Health, Education, and Welfare to prescribe health statements for the labeling of alcoholic beverages. Authorizes Congress to invalidate any regulation prescribing such a statement by joint resolution within 30 days after the regulation's promulgation.
Bill· HRH.R. 4962 (96th)open
United States · United States Congress · 25 July 1979
Child Health Assurance Act of 1979 - Amends title XIX (Medicaid) of the Social Security Act to require the State plan for medical assistance required by such title to provide for making "medical assistance" available to: (1) any individual who is under the age of 18 or, at the option of the State, to any individual over the age of 17 and under 21; and (2) any woman for the period of her pregnancy and for 60 days following the termination of her pregnancy, and to any child born as the result of such pregnancy, if the resources and income of such individual or woman meet the resource and income tests of eligibility set forth in this Act. Stipulates that no enrollment fee or charge will be imposed for any such individual or woman. Includes as "medical assistance": (1) inpatient hospital services; (2) outpatient hospital services; (3) laboratory and x-ray services; (4) skilled nursing facility services; (5) child health assessment services and continuing care services; (6) immunizations clinic services, diagnosis and treatment of vision and hearing problems, (including hearing aids and eyeglasses, prescribed drugs and insulin, prosthetic devices, home health services, physical therapy), and rehabilitative services; (7) ambulatory mental health services delivered in centers funded under the Community Mental Health Centers Act; (8) emergency crisis intervention inpatient mental health services; (9) routine dental care; (10) family planning services and supplies to certain individuals; (11) prenatal and postnatal services; and (12) physicians' services. Directs the Secretary of Health, Education, and Welfare to establish a national child health assurance program (CHAP) income standard and a national maternal income standard for the purpose of establishing the eligibility of, and extent of medical assistance provided to, certain children and pregnant women. Sets the national child health assurance program income standard at two-thirds of the nonfarm income official poverty line and the national maternal income standard at 80 percent of the nonfarm income official poverty line. Requires a State Medicaid plan to assure the provision of outreach to pregnant women eligible for medical assistance. Defines "outreach" to mean the identification and location of pregnant women eligible for assistance and the informing of such women of the services available to them. Requires the provider of a child health assessment to: (1) provide timely and appropriate child health assessments to individuals under 21 who are eligible for Medicaid; (2) provide basic diagnostic and treatment services; (3) provide routine dental care; and (4) be reasonably accessible on a continuing basis to individuals whom it has assessed. Sets forth provisions concerning payments for CHAP services, including payments to health maintenance organizations for those who choose to have such services provided by such an organization. Directs the State agency to assure the compliance of providers with this Act. Requires a State Medicaid plan to develop, with substantial public input, a plan for the implementation of a CHAP which meets certain minimum levels of acceptable performance. Sets forth methods of determining Federal matching percentages and performance standards for the programs established under this Act. Directs the Secretary to report to Congress: (1) the level of performance of each State in implementing its CHAP; (2) the ratio of individuals under the age of 21 enrolled for Medicaid to the number of individuals under 21 whose income is below the nonfarm income official poverty line; and (3) the effectiveness of the performance standards established by this Act. Requires a State to submit a plan for outreach services to certain individuals eligible under the Medicaid program if the ratio of individuals under 21 enrolled in a State's Medicaid program to the number of individuals under 21 in families in that State whose income is below the nonfarm income official poverty line is significantly less than the national average. Requires a State, under part A (Aid to Families with Dependent Children) of title IV of the Act, to inform all families in the State receiving AFDC of the availability of child health assurance services available under title XIX. Prohibits a State's Medicaid plan from excluding aliens lawfully admitted for permanent residence. Directs the Secretary to conduct a study to determine the extent to which other Federal programs duplicate the health services provided under the Medicaid program to children and pregnant women. Directs the Secretary to study and, if necessary, conduct demonstration projects in order to evaluate (1) the participation of health care providers in the CHAP and (2) methods of improving their level of participation in such programs. Directs the Secretary to develop and carry out demonstration projects designed to determine the effect of payment on a capitation basis for services provided under a CHAP. Directs the Secretary to report to Congress on the studies and projects conducted pursuant to this paragraph. Directs the Secretary to study and report to Congress on the effectiveness of the CHAP. Stipulates that certain individuals under the age of 21 shall remain eligible for Medicaid while inmates in certain juvenile institutions.
Bill· HRH.R. 4959 (96th)referred
United States · United States Congress · 25 July 1979
Federal Employees Dental Benefits Act of 1979 - Authorizes the Office of Personnel Management (OPM) to contract for the following dental benefits plans for Federal employees: (1) a service benefit plan; (2) an indemnity benefit plan; (3) employee organization plans; and (4) health maintenance organization plans. Requires that the benefits under such plans include: (1) diagnostic services; (2) preventive care; (3) fillings; and (4) extractions. Permits a plan, subject to approval of the OPM, to offer additional benefits, and to require copayments not exceeding 50 percent of the value of a covered service. Allows the OPM to enter into contracts for plans without regard to specified provisions of Federal law requiring competitive bidding. Sets forth requirements concerning: (1) the length and rates of such a contract; and (2) obligations of any carrier of such a plan. States that such contracts are not subject to the Federal Procurement Regulations. Directs the OPM to establish audit requirements which do not conflict with such regulations to carry out the purposes of this Act. Allows an employee to enroll in a dental benefits plan as an individual or for self and family. Permits certain annuitants to continue enrollment in such a plan under conditions of eligibility prescribed by regulations of the OPM. Prohibits an individual from enrolling both as an employee or annuitant and as a member of the family. Specifies conditions under which an employee may change enrollment. Specifies the biweekly contributions of the Government and the enrolled individual toward the subscription charge of a dental benefits plan. Directs the OPM to provide individuals who are eligible for such a plan with sufficient information to enable the individual to make an informed choice among the types of plans. Requires that each enrolled individual receive a document summarizing: (1) the benefits of the plan; (2) the procedure for obtaining benefits; and (3) all provisions of the plan affecting the individual. Creates the Employees Dental Benefits Fund into which contributions of the Government and enrolled individuals shall be paid. Directs the OPM to: (1) administer this Act; (2) make a continuing study of the operation of this Act and of the plans under this Act; and (3) transmit an annual report of its findings to Congress. Authorizes expenditures from the Employees Life Insurance Fund to pay administrative expenses of the OPM in carrying out provisions of this Act. Requires the reimbursement of such expenditures plus interest from the Federal Employees Dental Benefits Fund.
Bill· SJRESS.J.Res. 98 (96th)passed
United States · United States Congress · 20 July 1979
Designates the week of October 8 through October 14, 1979, as "National Diabetes Week."
Bill· HRH.R. 4894 (96th)referred
United States · United States Congress · 20 July 1979
Clinical Laboratory Improvement Act of 1979 - Title I: Public Health Service Act Amendments and Clinical Laboratory Studies - Directs the Secretary of Health, Education, and Welfare to promulgate national standards for clinical laboratories, designed to assure consistent performance of accurate and reliable tests and other procedures and services. Stipulates that such standards shall: (1) require clinical laboratories subject to the standards to maintain appropriate quality control programs; (2) require such laboratories to maintain records, equipment, and facilities necessary for effective operation; (3) include requirements for periodic proficiency testing of laboratories; and (4) prescribe qualifications for directors, supervisors, and technical personnel employed in laboratories. Provides that the standards may vary on the basis of the type of laboratory services provided or the purposes for which the services are performed. Directs the Secretary to develop within one year of enactment standards for proficiency testing of clinical laboratories subject to the national standards. Applies the national standards to all laboratories engaged in interstate commerce or located in States which do not have primary enforcement responsibility for the regulation of clinical laboratories. Provides that the standards provisions relating to personnel qualifications shall not apply for a two-year period to certain clinical laboratories located in rural areas. Exempts from the national standards any clinical laboratory which: (1) is located in the office of a physician, dentist, or podiatrist and performs services only in connection with the treatment of patients; (2) performs services only for biomedical or behavioral research; or (3) engages exclusively in the assessment of cardiac or pulmonary function. Subjects Federal clinical laboratories under the jurisdiction of the Secretary to the national standards, with certain exceptions. Directs the Secretary to establish a system for the licensing of all clinical laboratories subject to national standards provided for under this Act. Prohibits a clinical laboratory subject to such standards from performing any tests or providing any services without a valid license. Sets forth circumstances under which the Secretary may suspend or revoke a laboratory's license. Enumerates criteria which a State must meet to have primary enforcement responsibility for the regulation of clinical laboratories. Directs the Secretary to review at least every two years the clinical laboratory regulatory activities of a State. Prohibits the solicitation or acceptance of specimens for laboratory tests by a clinical laboratory which is required to be licensed and which either does not have such a license or is not part permitted under such license to perform such service. Authorizes the Secretary to enjoin the continuation of any activity by a clinical laboratory required to be licensed under this Act which constitutes a significant hazard to the public health. Authorizes an inspection procedure with respect to laboratories subject to the national standards. Prohibits an employer from taking action against an employee who has assisted or participated in an investigation of such employer pursuant to this Act. Establishes a procedure for investigating and correcting employers' retaliatory actions against employees. Authorizes the Secretary to enter into agreements with: (1) qualified public or nonprofit private entities to administer tests and make inspections as provided for under this Act; and (2) States to administer the licensure program provided in this Act under the Medicare program. Directs the Secretary to report annually to Congress with respect to the accuracy and costs of laboratory tests and procedures during the previous fiscal year. Requires the Secretary to establish a uniform regulatory program for the administration of the laboratory certification and regulation functions under this Act, Medicare and Medicaid, and the Food, Drug, and Cosmetic Act. Entitles the United States to recover from Alaska the value of certain medical facilities which were constructed with Public Health Service Act grants, if such facilities cease to be publicly owned and operated for the treatment of patients under Alaska's mental health program. Directs the Secretary to conduct studies of: (1) existing voluntary certification standards and State licensure laws for laboratory personnel; (2) qualifications of entities that certify such personnel; (3) existing and proposed public and private mechanisms to determine the continued competence of such personnel; (4) existing laboratory proficiency testing methods; and (5) the relationship of requirements for such personnel and of clinical laboratory proficiency testing requirements with clinical laboratory performance. Specifies analyses to be included in such studies, and directs the Secretary to report to Congress on the results of the studies. Directs the Secretary to provide for a study concerning the quality of performance of exempt laboratories and to report the results to Congress within two years of enactment. Stipulates that if the results of tests performed by laboratories participating in proficiency testing programs are significantly more reliable and accurate than those of non-participants, that participation in such a program be made a condition of continued exemption from national standards. Directs the Secretary to conduct studies of: (1) the quality of the tests and other procedures and services provided by highly specialized clinical laboratories, including highly specialized clinical laboratories exempted from the national standards; and (2) the effect of the amendments made by this Act on the quality and cost of clinical laboratory services. Title II: Social Security Act Amendments and Study and Report - Amends title XI of the Social Security Act (General Provisions) to limit the amounts of certain payments for clinical laboratory services under the Maternal and Child Health program, Medicare, and Medicaid. Requires an independent clinical laboratory to disclose rate information to the Secretary as a condition of participation in such programs and the Grants to States for Services program. Amends title XVIII of such Act (Medicare) to set forth requirements with respect to payment for laboratory tests under Medicare. Requires all clinical laboratories to be licensed under this Act as a condition for Medicare certification. Amends title XIX of such Act (Medicaid) to allow a State to make arrangements for the purchase of certain laboratory services. Directs the Secretary to evaluate such arrangements and submit recommendations to Congress within two years of the date of enactment. Sets forth certain requirements with respect to a State plan's treatment of laboratory services. Directs the Secretary to conduct, and report to Congress the findings of, a study of the financial arrangements entered into by hospitals reimbursed under Medicare and Medicaid for the provision of clinical laboratory services to determine if such arrangements are in the public interest. Directs the Secretary to report to Congress specified billing information with respect to laboratory services under Medicare.
Bill· SS. 1541 (96th)referred
United States · United States Congress · 19 July 1979
Amends title XIX (Medicaid) of the Social Security Act to authorize the Secretary of Health, Education, and Welfare to pay to each State which has a plan approved under such title 90 percent of the cost attributable to the administration of so much of such plan as relates to the provision of medical assistance in Indian health service facilities which are eligible for reimbursement pursuant to the Medicaid program.
Bill· SS. 1530 (96th)referred
United States · United States Congress · 17 July 1979
Health Maintenance Organizations Medicare Reimbursement Amendments of 1979 - Amends title XVIII (Medicare) of the Social Security Act to revise provisions relating to payments to and contractual arrangements with health maintenance organizations (HMO) on behalf of individuals eligible for Medicare. Directs the Secretary of Health, Education, and Welfare to determine annually a per capita rate of payment for each class of individuals entitled to benefits under such title who are enrolled pursuant to this Act with a HMO. Directs the Secretary to define classes of members based on such factors as age, sex, institutional status, disability status and place of residence. Provides a rate for each class equal to 95 percent of the adjusted average per capita cost for that class. Defines the term "adjusted average per capita cost" to mean the average per capita amount that the Secretary estimates would be payable for services furnished under the Medicare program, if the services were to be furnished by other than an HMO. Provides that every individual entitled to benefits under parts A (Hospital Insurance) and B (Supplementary Medical Insurance) of title XVIII or part B only shall be eligible to enroll with an HMO with which the Secretary has contracted to provide services. Sets limits on an HMO's premium rate and the actuarial value of its other charges for individuals enrolled under this Act. Authorizes the Secretary to contract with any HMO that can provide the benefits required by this Act.
Bill· HRH.R. 4834 (96th)referred
United States · United States Congress · 17 July 1979
Contraceptive Labeling and Advertising Act - Amends the Federal Food, Drug, and Cosmetic Act to require that the label and advertising for contraceptive drugs and devices state the effectiveness of such drugs and devices in preventing conception in humans. Requires a label also to state directions for use and that professional advice should be sought to determine the most appropriate form of contraception. Directs the Secretary of Health, Education, and Welfare to establish standards for determining the effectiveness of such drugs and devices.
Bill· SS. 1523 (96th)referred
United States · United States Congress · 16 July 1979
Veteran Senior Citizen Health Care Act of 1979 - States the purposes of this Act to be: (1) to provide for the increasing demand for geriatric and extended health care and medical services being placed on the Veterans' Administration (VA) hospital system; and (2) to make the VA hospital system foremost in the area of geriatric health care and the repository of gerontology medical knowledge. Directs that within the Office of the Chief Medical Director of the VA one Assistant Chief Medical Director shall be doctor of geriatrics, and shall be responsible for the VA's geriatric services. Directs the Administrator of Veterans' Affairs to designate 15 VA hospitals as demonstration centers of geriatric research, education, and clinical operations. Stipulates that such centers shall operate until September 30, 1983. Directs the Administrator to provide that: (1) each hospital operating as a geriatric center on the date of enactment of this Act be designated as the location for a demonstration center; and (2) such designated hospitals be geographically dispersed across the United States. Directs the Administrator to establish a Geriatrics and Extended Care Task Force within the VA's Special Medical Advisory Group. Stipulates that such Task Force shall assess: (1) the VA's capability to provide geriatric services on a sustained and growing basis to eligible veterans; and (2) the current and projected needs for geriatric and extended health services among eligible veterans. Requires such Task Force to submit a report to the Administrator and the Special Medical Advisory Group within 18 months after the effective date of this Act. Directs the Administrator to transmit such report, (within 90 days of receipt) along with any comments, to the Senate and House Veterans' Affairs Committees. Requires a final report to be submitted by such Task Force within four years of the effective date of this Act. Authorizes appropriations of: (1) $15,000,000 for fiscal year 1980; (2) $20,000,000 for fiscal year 1981; (3) $25,000,000 for fiscal year 1982; and (4) $25,000,000 for fiscal year 1983.
Bill· HRH.R. 4803 (96th)referred
United States · United States Congress · 16 July 1979
Prohibits the Secretary of Health, Education, and Welfare from promulgating a proposed rule applicable to vitamin and mineral products for over-the-counter human use published on March 16, 1979, or from taking any other action which would have the same effect as such proposed rule.
Bill· HRH.R. 4754 (96th)referred
United States · United States Congress · 11 July 1979
Clinical Laboratory Improvement Act of 1979 - Amends title III of the Public Health Service Act (General Powers and Duties of Public Health Service) to direct the Secretary of Health, Education, and Welfare to establish a system for the licensing of all clinical laboratories subject to national standards provided for under this Act. Prohibits a clinical laboratory subject to such standards from performing any tests or providing any services without a valid license. Sets forth circumstances under which the Secretary may suspend or revoke a laboratory's license. Directs the Secretary to promulgate national standards for clinical laboratories, designed to assure consistent performance of accurate and reliable tests and other procedures and services. Stipulates that such standards shall: (1) require clinical laboratories subject to the standards to maintain appropriate quality control programs; (2) require such laboratories to maintain records, equipment, and facilities necessary for effective operation; (3) include requirements for periodic proficiency testing of laboratories; (4) prescribe qualifications for directors, supervisors, and technical personnel employed in laboratories; and (5) include adequate provisions for the inspection of laboratories and the enforcement of standards. Provides that the standards may vary on the basis of the type of laboratory services provided or the purposes for which the services are performed. Directs the Secretary to develop: (1) job-related proficiency and practical examinations for clinical laboratory personnel; (2) mechanisms to assure the continued competence of such personnel; and (3) standards for the proficiency testing of clinical laboratories. Provides that the standards provisions relating to personnel qualifications shall not apply for a two-year period to certain clinical laboratories located in rural areas. Authorizes the Secretary to exempt from the national standards clinical laboratories which: (1) are operated by a licensed physician, dentist, or podiatrist, or a group of not more than five such practitioners, or in a rural health clinic, and in which only routine tests or procedures are performed; (2) perform tests or procedures primarily for biomedical or behavioral research; or (3) perform tests or procedures only to assist insurers with respect to insurance contracts. Prohibits any State or political subdivision from establishing or continuing a standard for clinical laboratories different from such national standards. Authorizes the Secretary to enter into agreements with: (1) qualified private nonprofit organizations to administer tests and make inspections as provided for under this Act; and (2) States to administer the licensure program provided in this Act under the Medicare program. Subjects Federal clinical laboratories under the jurisdiction of the Secretary to the national standards, with certain exceptions. Prohibits: (1) the solicitation or acceptance of specimens for laboratory tests or procedures by a clinical laboratory which is required to be licensed and which either does not have such a license or is not permitted under such license to perform the planned tests or procedure; (2) misrepresentation with respect to the license application or conversion of an application to an unauthorized use; and (3) the solicitation or receipt, or the offer or payment, of any remuneration (including any kickback, bribe, or rebate) with respect to laboratory services. Authorizes the Secretary to enjoin the continuation of any activity by a clinical laboratory required to be licensed under this Act which constitutes a substantial risk to the public health. Prohibits an employer from taking action against an employee who has assisted or participated in an investigation of such employer pursuant to this Act. Establishes a procedure for investigating and correcting employers' retaliatory actions against employees. Requires the Secretary to establish a uniform regulatory program for the administration of the laboratory verifications and regulation functions under this Act, medicare, and medicaid, and the Food, Drug, and Cosmetic Act. Establishes in the Department of Health, Education, and Welfare an advisory council on clinical laboratories to make recommendations to the Secretary with respect to: (1) the development of uniform guidelines relating to laboratory licensing and personnel performance standards required by such Acts; (2) the implementation and administration of this provision; and (3) the implementation of standards concerning the internal operations of laboratories. Directs the Secretary to provide technical assistance to: (1) States to assist their laboratory enforcement capability; and (2) laboratories, including a training program for employees where deficiencies have been documented. Authorizes the Secretary to make grants and enter into contracts with public and nonprofit private entities for projects and studies on laboratory methodology and utilization. Authorizes appropriations of $10,000,000 for each of fiscal years 1981 through 1983 for these purposes. Directs the Secretary to report annually to Congress with respect to the accuracy and costs of laboratory tests and procedures during the previous fiscal year. Directs the Secretary to conduct studies of: (1) existing voluntary certification standards and State licensure laws for laboratory personnel; (2) qualifications of entities that certify such personnel; (3) existing and proposed public and private mechanisms to determine the continued competence of such personnel; (4) existing laboratory proficiency testing methods; and (5) the relationship of requirements for such personnel and of clinical laboratory proficiency testing requirements with clinical laboratory performance. Specifies analyses to be included in such studies, and directs the Secretary to report to Congress on the results of the studies. Requires the Secretary to reimburse to the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund any amount expended from such funds with respect to the licensing of non-Medicare laboratories. Repeals the Clinical Laboratory Improvement Act of 1967. Directs the Secretary to provide for a study concerning the quality of performance of exempt laboratories and to report the results to Congress within two years of enactment. Stipulates that if the results of tests performed by laboratories participating in proficiency testing programs are significantly more reliable and accurate than of non-participants, participation in such a program be made condition of continued exemption from national standards. Directs the Secretary to provide for a study of certain laboratory tests and to report the results to Congress within 18 months of enactment. Amends title XVIII (Medicare) of the Social Security Act to require all clinical laboratories to be licensed under this Act as a condition for Medicare certification. Sets forth requirements with respect to payment for laboratory tests under medicare. Disallows payments for specified costs included in laboratory services changes.
Bill· HRH.R. 4713 (96th)referred
United States · United States Congress · 10 July 1979
Establishes a seven-member Task Force on Consumer and Physician Incentives Toward Hospital Cost Containment (three members to be appointed by the President, two by the Speaker of the House, and two by the President of the Senate) to study: (1) the effect of policies and procedures (including use of deductibles, coinsurance, cost- or risk-sharing, tax deductions and exclusions, and prepaid health plans) relating to payment of hospital services on (A) consumer and physician cost awareness and (B) the utilization and quality of hospital services; and (2) the desirability of increasing the use of such methods in federally funded and other health insurance programs. Directs the Task Force to submit such study and recommendation to the appropriate congressional committees within two years of its appointment.
Bill· HRH.R. 4708 (96th)referred
United States · United States Congress · 10 July 1979
Amends title III of the Public Health Service Act (General Powers and Duties of Public Health Service) to allow a medical facility which provides emergency medical treatment to any alien who is unlawfully in the United States and who is not eligible for any other public assistance, to receive reimbursement for the value of such treatment upon the approval of the Secretary of Health, Education, and Welfare.
Bill· HRH.R. 4699 (96th)referred
United States · United States Congress · 9 July 1979
Directs the Administrator of the Environmental Protection Agency to conduct an epidemiological study of the occurrence of fluorosis in areas served by public water systems subject to the Safe Drinking Water Act in which fluoride from natural sources occurs in concentrations greater than the maximum contaminant level specified in regulations issued pursuant to such Act. Exempts from such regulations, until the date of submission of the required report, any drinking water system which serves an area described in this Act. Requires a report on the results of the study conducted pursuant to this Act to be submitted to Congress as promptly as possible.
Bill· HRH.R. 4702 (96th)referred
United States · United States Congress · 9 July 1979
Imported Dairy Products Labeling Act - Requires packaged foreign dairy products to be labeled in such a manner as to be readily identifiable as being imported. Permits the Federal Trade Commission to establish labeling requirements for foreign dairy products and to grant exemptions from such requirements. Prohibits any person from importing, offering to import, distributing, or causing to be distributed any improperly labeled imported dairy product. Grants enforcement powers under this Act to the Federal Trade Commission and the Secretary of the Treasury.
Bill· HRH.R. 4653 (96th)referred
United States · United States Congress · 28 June 1979
Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health, Education, and Welfare to provide for demonstration projects for the provision of preventive health services to the elderly through traveling health care practitioners.
Bill· SS. 1430 (96th)referred
United States · United States Congress · 27 June 1979
Maternal and Child Health and Crippled Children's Services Amendments of 1979 - Revises title V (Maternal and Child Health and Crippled Children's Services) of the Social Security Act. States that grants under such title shall be to extend and improve services: (1) to reduce infant mortality and otherwise promote the health of mothers, infants, children, and adolescents; (2) to prevent disease and disability that cripple children and to locate, diagnose, treat, and provide followup services for children who have crippling conditions or who suffer conditions which may lead to crippling; and (3) for locating and identifying mothers, infants, children, adolescents, and crippled children. Authorizes appropriations under title V for each fiscal year ending on or after September 30, 1981 for: (1) maternal and child health services; (2) crippled children services; (3) grants for projects of regional or national significance which may contribute to the advancement of maternal and child health; (4) grants for projects of special county or local significance which contribute to the advancement of maternal and child health; (5) training of personnel for health care and related services for mothers and children; and (6) research projects relating to maternal and child health services or crippled children's services. Sets forth formulas for allotting funds to States for: (1) maternal and child health services; and (2) crippled children's services. Directs the Secretary of Health, Education, and Welfare to conduct a study of such formulas and to report to Congress on such study. Sets forth the requirements for a State plan of maternal and child and crippled childrens' services. Includes requirements for: (1) the establishment of a State advisory council to be appointed by the Governor of the State to advise the State agency administering the plan in matters of policy, consolidation of health care programs in the State, identification of mothers and children in need of care, and bringing care to them; (2) that when services are available in the community, the State health agency shall reimburse an individual practitioner or other private health entity for medical services rendered; (3) for the development of a unified State plan for mothers, infants, children, and adolescents by the maternal and child health and crippled children's program; (4) that the maternal and child health program and the crippled children's program will include basic programs and services as determined by the State advisory council, and a series of special programs and projects; and (5) for the State agency to submit a report annually to the Director of the National Office of Maternal and Child Health Services on the activities conducted pursuant to the State plan. Directs the Secretary to pay, subject to certain stipulations, 75 percent of a State's total expenditures under a plan developed in accordance with this Act. States that the projects of regional or national significance conducted by a State pursuant to this Act may include those which are necessary: (1) to the prospective mother and the developing fetus; (2) to the infant during the first year of life; (3) to the child during the years of growing and development; (4) for the adolescent; and (5) to otherwise promote the health and well-being of women, infants, children, and adolescents. Limits any single grant for such projects to $2,000,000 annually. Authorizes the Secretary to make available from the special grants for underserved counties and local areas up to 75 percent of the cost of programs which: (1) help to reduce the incidence of mental retardation and other handicapping conditions caused by complications associated with child bearing and help to reduce infant and maternal mortality; (2) help to promote the health of preschool and school age children; and (3) foster comprehensive health care for youth and otherwise provide for care, treatment, and counseling for conditions associated with pregnancy, venereal disease, alcoholism, drug addiction, and mental health. Limits any single such grant to $1,000,000 annually. Establishes in the Department of Health, Education, and Welfare an identifiable unit known as the National Office of Maternal and Child Health Services to: (1) monitor the operation of title V; (2) coordinate the activities of the Federal health agencies in the operation of title V; (3) develop guidelines for use by States in developing State plans under title V; (4) develop an organized system of data collection and retrieval as central source of information related to the health of mothers and children; (5) provide technical assistance to a State in carrying out its plan; and (6) develop a long-range program for carrying out the purposes of this title by the States on a voluntary basis. Directs the Secretary to establish an Advisory Committee on Maternal and Child Health to: (1) function as a continuing review body of the programs under this title; (2) advise and assist the Secretary in the preparation of regulations for the administration of title V; (3) make recommendations to the Secretary with respect to the approval of State plans under title V; (4) review the long-range program; and (5) advise and assist the National Office of Maternal and Child Health Services. Directs the Secretary to conduct a study of the Federal health programs for mothers, infants, children, and adolescents.
Bill· HRH.R. 4637 (96th)referred
United States · United States Congress · 27 June 1979
National Catastrophic Health Insurance Program Act of 1979 - Establishes title XXI (National Catastrophic Health Insurance Program) of the Social Security Act to provide catastrophic illness insurance benefits to all individuals, their spouses and dependents whose combined resources are less than $50,000 for their most recent previous tax year. Provides for exclusions from resources in determining eligibility. Establishes the Federal Catastrophic Health Insurance Trust Fund to finance payments for health care services under this Act and provides for a board of trustees to manage the fund. Amends the Internal Revenue Code of 1954 to impose a tax upon individuals who remove natural resources from the Federal lands of ten percent of such resources removed and provides that 100 percent of the revenues collected through such tax shall be deposited into the Federal Catastrophic Health Insurance Trust Fund.
Bill· HRH.R. 4643 (96th)referred
United States · United States Congress · 27 June 1979
Provides that certain persons who served in allied forces during World War I or World War II must be permanent United States residents in order to receive specified veterans' health and medical benefits (presently such persons must have been U.S. citizens for at least ten years). Enlarges the category of such allied forces to include the armed forces of Russia, the Union of Soviet Socialist Republics, Estonia, Latvia, and Lithuania. Limits the requirement of providing a French or British certification of military service to those persons who served in the Polish or Czechoslovakian armed forces.
Bill· HRH.R. 4635 (96th)referred
United States · United States Congress · 27 June 1979
Appropriates the sum of $1,500,855 for fiscal year 1980 for the Department of Health, Education, and Welfare, for the purpose of providing a grant pursuant to the special demonstration program for improving rehabilitation services for handicapped individuals under the Rehabilitation Act of 1973, to the Eastern Carolina Vocational Center, Greenville, North Carolina, to construct a recreational-residential facility.
Bill· HJRESH.J.Res. 369 (96th)referred
United States · United States Congress · 27 June 1979
Authorizes and requests the President to designate August 4, 1979, as "National Health Day."
Bill· HRH.R. 4626 (96th)referred
United States · United States Congress · 26 June 1979
Amends title XVIII (Medicare) of the Social Security Act to increase from $100 to $500 the payment limitation for outpatient physical therapy services under the Medicare program. Stipulates that a physical therapist who furnishes outpatient services exclusively in individuals' homes need not maintain an equipped office if the therapist maintains a single identifiable repository for records and has access to the necessary equipment. States that the term "outpatient physical therapy services" includes the services rendered by a therapist either under the control of an employer or on his or her own responsibility. Provides, as an alternative to the salary plus expenses method of payment for determining the cost of physical therapy services, that such determination may be based on the average professional personnel cost per patient visit furnished in a hospital, home health agency, or skilled nursing facility, plus expenses.