Health USA Act of 1991

Summary

Health USA Act of 1991 - Title I: Universal Eligibility and Enrollment - Declares eligible for health care services and long-term services, under the State program in the State of primary residence, each individual who is a U.S. resident and is a U.S. citizen and national or a lawful resident alien. Provides for enrollment, including requiring coverage of an eligible individual who otherwise is not enrolled in any State. Title II: Benefits and Providers - Lists covered health care services, including hospital care, physician and other professional medical services, tests, drugs, preventive services, mental health, drug and alcohol treatment, hospice care, and post-hospital skilled nursing facility services. Provides for limitations, including those necessary to allocate expenditures in a manner that will optimize improvements in the health and well being of the population. Lists covered long-term care services, including institutional and noninstitutional services and respite care services for the health, social, and personal needs of individuals with limited self-care capabilities in order to promote maximum functional independence. Requires individual needs to be determined by care managers through standardized assessments. Requires the National Health Care Commission, established under title IV of this Act, to prescribe rules similar to those under specified provisions of title XVIII (Medicare) of the Social Security Act regarding the conditions of participation for health care providers in State programs. Requires that each State program provide for the approval of health services plans in the State and sets forth minimum requirements for approval. Requires each State program to have at least one approved plan, either operated by the State program or under contract with a private plan. Title III: Financing - Subtitle A: Budget Process - Requires the Commission to: (1) recommend to the Congress an annual fiscal year budget which estimates total expenditures to be made by States and the Federal Government for health care services, long-term care services, and care management services; and (2) compute the national average per capita cost for each such service, with adjustments by risk group and by State. Sets the Federal contribution at 87 percent of the aggregate, with payments to a State ranging from 82 to 92 percent of that State's expenditures. Provides for payments to States. Requires all revenues (including State revenues) for the State program to be deposited into a Care Fund for the State. Requires each Care Fund to have prevention, capital, and education and research special accounts. Subtitle B: Payments to Approved Plans, Providers, and Care Managers - Provides for payments: (1) on a monthly basis from States to approved plans; and (2) to individual and institutional providers. Requires providers who receive funding under this Act to accept the payment amount recognized under the State program as payment in full. Requires approved plans to pay providers for: (1) the care of all individuals enrolled in the plan; (2) all eligible individuals in the State not enrolled in any other approved plan; and (3) the costs of approved experimental treatment, regardless of the plan in which the individuals are enrolled. Requires provider payment to be based on schedules established by each State program. Allows alternative payment mechanisms so long as aggregate payments do not exceed the aggregate under the schedules. Requires care managers to: (1) be paid under schedules; and (2) accept the schedule amount as payment in full. Subtitle C: Sources of Revenues - Amends the Internal Revenue Code (IRC) to impose: (1) an income tax on employees; (2) an excise tax on employers; and (3) an income tax on self-employed individuals. Allows employers to elect to pay the employee tax. Amends provisions relating to railroad retirement tier 1 taxes to add references to the taxes imposed by these provisions. Defines the applicable contribution base for purposes of the taxes imposed by these provisions. Increases the top marginal individual income tax rate to a specified percentage. Imposes taxes on: (1) individual unearned income; and (2) the amount paid or incurred by employers for individual or family health care coverage of retired employees. Amends title II (Old-Age, Survivors, and Disability Insurance) (OASDI) of the Social Security Act to increase the OASDI taxable wage base. Amends the IRC to increase: (1) the percentage of Social Security benefits which are subject to taxation; (2) the maximum corporate income tax rate; (3) taxes on cigarettes; and (4) taxes on distilled spirits. Imposes taxes on cigarettes. Requires the Commission to recommend to the Congress increases in other excise taxes under the IRC. Makes each State responsible for establishing a financing program for the implementation of the State program. Entitles each State to: (1) receive start-up funds from the National Health Care Trust Fund established in this title; and (2) funding from the Commission in the amounts provided for in subtitle A of this title. Provides for cost-sharing, including deductibles and copayments. Establishes in the Treasury the National Health Care Trust Fund (Trust Fund). Transfers to the Trust Fund: (1) the taxes imposed by or received as a result of specified provisions of the IRC or this Act; and (2) funds in the Federal Hospital Insurance Trust Fund and the Federal Supplemental Medical Insurance Trust Fund. Applies certain provisions of title XVIII (Medicare) of the Social Security Act to the Trust Fund as they apply to the Federal Supplemental Medical Insurance Trust Fund. Authorizes additional appropriations as required to make payments to States and other expenditures under this Act. Prohibits including the receipts and disbursements of the Trust Fund and the associated taxes in the totals of the Federal budget and exempts them from any general budget limitation imposed by statute on expenditures and net lending. Title IV: Administration - Establishes in the Department of Health and Human Services the National Health Care Commission. Makes the Commission responsible for the overall administration of this Act and guidelines to permit States to carry out this Act. Sets forth other Commission duties, including those relating to minimum standards, uniform reporting, technology assessment, effectiveness research, practice guidelines, services to medically underserved areas, service delivery, and malpractice and liability reform. Mandates a National Advisory Board to advise the Commission. Requires each State (or neighboring States) to submit its State program (their regional program) to the Commission for approval. Prescribes sanctions for failure to achieve and maintain approval, including censure, reduction in Federal payments of up to a specified percentage, and placing the State program in receivership under the jurisdiction of the Commission. Requires each State program to provide for the appointment of a State Commission on Quality to implement national minimum standards. Establishes a Resource Enhancement Fund, to be administered by the Commission, to augment the capability of any medically underdeveloped area to provide services under this Act and to strengthen the area's abilities to provide local services. Authorizes appropriations. Title V: Effective Date; Repeals; Transition; Relation to ERISA - Sets forth the effective date of the program established under this Act. Repeals: (1) titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act; (2) certain provisions of Federal law relating to health insurance for Federal officials and employees; and (3) specified provisions of the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). Authorizes appropriations for financial assistance to States in planning and developing State programs. Declares that the provisions of the Employee Retirement Income Security Act (ERISA) are superseded to the extent inconsistent with this Act.

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2 official files

• Introduced in Senate (text)

  Introduced in Senate · EN

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• Introduced in Senate

  summary · EN · 11 July 1991

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