Pepper Commission Health Care Access and Reform Act of 1991

Summary

Pepper Commission Health Care Access and Reform Act of 1991 - Title I: Access To Private or Public Health Insurance For Basic Health Services Through Employment - Amends the Social Security Act to add a new title XXI entitled "Access to Private or Public Health Insurance For Basic Health Services Through Employment". Requires, under the new title, that employers enroll their employees and family members in a qualified employer health plan or in the public health insurance plan discussed in title II of this Act. Sets forth requirements relating to employee premiums and cost-sharing. Title II: Access to Health Insurance for Basic Health Services Through a Public Health Insurance Plan - Amends the Social Security Act to add a new title XXII entitled "Access to Health Insurance for Basic Health Services Through a Public Health Insurance Plan." Provides, under title XXII, for a new public health insurance program to be administered by the Health Care Financing Administration through the use of fiscal agents in the same manner as under Medicare (title XVIII of the Social Security Act) to process claims. Requires program coverage of basic health services, including preventive services, subject, except with respect to preventive services, to specified deductible and coinsurance requirements, with an overall annual limit on cost-sharing of $3,000. Makes U.S. residents and citizens who are not Medicare beneficiaries or enrolled under the qualified employer health plan described under title I or any other qualified health insurance plan eligible to enroll in the public health insurance program. Makes low-income individuals enrolling in the program eligible for assistance to limit or eliminate their financial obligations under the program. Requires the program to provide early and periodic screening, diagnosis, and treatment services (EPSDT) services for children. Allows Medicare beneficiaries to obtain Medicare supplemental (Medigap) coverage under the public health insurance program. Prohibits payment under title XXII for services furnished which are not reasonable and medically necessary. Allows provision of covered services without limitation, except as specified under prescribed guidelines. Provides for the use of Medicare payment rules for purposes of benefit payments under title XXII. Sets forth provisions for: (1) determining the amount of premiums to be charged individuals and employers for enrollment under title XXII; and (2) collecting premiums. Creates in the Treasury the Public Health Insurance Trust Fund to support the public health insurance program through the premiums charged under this Act. Authorizes appropriations each fiscal year to cover the Government's share of program costs. Outlines requirements established under part F (Qualified Health Plans) of title XXII respecting basic benefits, limits on pre-existing condition exclusions and on cost-sharing, and other protections which private health insurance plans must afford consumers in order to be certified by the Secretary of Health and Human Services as qualified for issuance or sale. Outlines administrative provisions. Directs the Secretary to provide information via a toll-free telephone number on low-income assistance and other information concerning the public health insurance program. Title III: Quality Assurance and Cost Containment - Authorizes the Secretary to waive the requirements of titles XVIII and XXII of the Social Security Act insofar as they prevent the use of State uniform payment rates, under prescribed conditions. Requires the Administrator for Health Care Policy and Research to design, implement, and evaluate studies on medical malpractice issues and demonstration projects related to medical malpractice reform for the purpose of making recommendations to the Congress respecting: (1) incentives to improve the quality of care; and (2) cost-effective methods of providing efficient and appropriate compensation to individuals injured in adverse medical occurrences. Authorizes appropriations. Directs the Secretary to submit to the Congress a report on requiring use of uniform claims forms. Title IV: Group Health Insurance Reform - Subtitle A: General Reforms - Amends the Social Security Act to add a new title XXIII entitled "Group Health Insurance Standards." Requires States to enforce the minimum Federal standards required to be established under the new title for employment-related health plans. Requires the Secretary to certify such plans as meeting such requirements if the applicable State has not established a regulatory program to enforce the standards. Prohibits employment-related health plans from denying or limiting coverage of basic health services on the basis of an individual's health status or lack of insurability. Sets forth additional requirements applicable to all employment-related health plans. Requires small employer health plans to offer a basic benefit package, use community rating, guarantee issue and renewal of policies, and meet certain information disclosure and recordkeeping requirements. Subtitle B: Reinsurance Systems - Directs the National Association of Insurance Commissioners to develop several models of legislation for the enactment of reinsurance systems that may be used by States with respect to health insurance policies (including small employer health plans). Subtitle C: Encouraging Establishment of Managed Care - Preempts State law restricting the use of managed care plans and utilization review programs that meet Federal standards. Title V: Expansion of Primary Care and Public Health Delivery Capacity in Meeting Health Objectives - Amends the Public Health Service Act to extend the authorization of appropriations for programs related to immunization, tuberculosis, lead poisoning, sexually transmitted diseases, migrant health centers, community health centers, health services for the homeless, health services for residents of public housing, family planning, and HIV disease. Amends title XXII (Access to Health Insurance for Basic Health Services Through a Public Health Insurance Plan) of the Social Security Act, as added by title II of this Act, to direct the Secretary of Health and Human Services, from amounts in the Public Health Insurance Trust Fund established by this Act, to make grants to plan and develop primary care centers and public health clinics, defined as migrant or community health centers or other entities qualified to receive a grant under specified provisions of the Public Health Service Act. Directs the Secretary to report to the Congress every five years on the impact of this Act in meeting the goals in the report "Healthy People, 2000." Requires each report to include recommendations regarding changes in qualified health plan benefits and payment policies to promote achievement of national health promotion and disease prevention goals and objectives. Title VI: Financing and Tax-Related Provisions - Amends the Internal Revenue Code to: (1) provide a full deduction for qualified health plan insurance costs of self-employed individuals; (2) make such deduction permanent; (3) impose an excise tax on entities for willful and uncorrected violations of requirements applicable to employment-related health plans under title XXIII of the Social Security Act; (4) allow very small businesses a refundable credit against income taxes for qualified employer health plan costs; and (5) repeal provisions imposing an excise tax for the failure of group health plans to satisfy coverage requirements. Requires the Secretary of Health and Human Services to review and report to the Congress on the impact of this Act, and the tax credits provided above, on employers of ten or fewer full-time employees. Requires the public health insurance plan to be funded through one or more funding means in a manner which is: (1) progressive in the aggregate; (2) sufficient, each year, over time, and in the aggregate, to cover the net costs of the plan; and (3) not derived from any one age group of society. Title VII: Medicare and Medicaid Amendments - Subtitle A: Medicare - Amends the Medicare program to assure coordination of enrollment with qualified health plans. Subtitle B: Medicaid - Amends the Medicaid program (title XIX of the Social Security Act) to continue Medicaid benefits not covered under such public health insurance program and to discontinue those benefits covered under the program. Title VIII: Conforming Changes to ERISA - Amends the Employee Retirement Income Security Act of 1974 to repeal provisions regarding continuation coverage under group health plans.

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2 official files

• Introduced in Senate (text)

  Introduced in Senate · EN

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• Introduced in Senate

  summary · EN · 23 May 1991

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