Comprehensive Access and Affordability Health Care Act of 1993

Summary

TABLE OF CONTENTS: Title I: Managed Competition in Health Care Plans Subtitle A: Health Plan Purchasing Cooperatives Subtitle B: Accountable Health Plans (AHPs) Subtitle C: Federal Health Board Title II: Primary and Preventive Care Services Title III: Tax Incentives to Increase Health Care Access Title IV: Disclosure of Certain Information to Beneficiaries Under the Medicare and Medicaid Programs Title V: Cooperative Agreements Between Hospitals Title VI: Patient's Right to Decline Medical Treatment Title VII: Insurance Administration Simplification Title VIII: Child Health Care Title IX: Improving Access to Health Care for Rural and Underserved Areas Subtitle A: Revenue Incentives for Practice in Rural Areas Subtitle B: Public Health Service Act Provisions Title X: Primary and Preventive Care Providers Title XI: Malpractice Reform Title XII: Medicare Preferred Provider Demonstration Projects Title XIII: Treatment and Outcomes Research Title XIV: Long-Term Care Subtitle A: Tax Treatment of Qualified Long-Term Care Insurance Policies Subtitle B: Tax Incentives for Purchase of Qualified Long-Term Care Insurance Subtitle C: Medicaid Amendments Title XV: Financing Title XVI: Responsibilities Under Uniform Set of Effective Benefits Title XVII: Enforcement Provisions Comprehensive Access and Affordability Health Care Act of 1993 - Title I: Managed Competition in Health Care Plans - (Sec. 100) Mandates grants to States for the costs under this title. Authorizes appropriations. (Sec. 101) Requires States to establish Health Plan Purchasing Cooperatives (HPPCs) to: (1) make agreements with Accountable Health Plans (AHPs); (2) make agreements with small employers; (3) enroll individuals in AHPs; (4) receive premiums and forward the premiums to AHPs; and (5) coordinate with other HPPCs. (Sec. 104) Requires HPPCs to: (1) distribute comparative AHP information; and (2) add a percentage to premiums to cover the HPPCs' budgets. (Sec. 111) Requires that an AHP: (1) offer the uniform set of effective benefits specified by the Federal Health Board; (2) not discriminate on the basis of health status, claims, or lack of evidence of insurability (regulates preexisting condition exclusions); (3) establish standard premiums; (4) meet solvency protection requirements; and (5) have a grievance procedure for enrollees, restrict physician incentive plans, and meet requirements regarding advance directives. (Sec. 118) Sets forth additional requirements for open AHPs: (1) an agreement with a HPPC; (2) open enrollment; and (3) for "eligible organizations" under title XVIII (Medicare) of the Social Security Act, having a Medicare risk sharing contract for offering benefits to Medicare beneficiaries. Amends the Omnibus Budget Reconciliation Act of 1990 to make existing provisions relating to Medicare select policies effective after a specified date. (Currently, the provisions apply only in 15 States and only during a specified period.) Requires open AHPs to participate in the Federal Employees Health Benefits Program (FEHBP). Prohibits enrollment in a plan under FEHBP unless it is an AHP. Regulates the Federal FEHBP contribution. (Sec. 119) Requires an AHP that does not meet specified requirements of this title to pay the Board amounts as required to put the AHP in the same financial position as the AHP would have been in if it had meet the requirement. (Sec. 120) Preempts State laws or regulations regarding AHPs. (Sec. 121) Limits State restrictions on network plans (plans that: (1) limit coverage to benefits provided by participating providers; or (2) allow the use of non-participating providers, imposing higher cost sharing). (Sec. 122) Preempts State laws or regulations prohibiting or regulating activities under a utilization review program. (Sec. 131) Establishes the Federal Health Board, to be appointed by the President with the advice and consent of the Senate. (Sec. 132) Requires that the uniform set of effective benefits specified by the Board include the full range of: (1) treatment for any condition if the treatment reasonably improves or significantly ameliorates the condition; and (2) preventive services, including counseling. Mandates guidelines concerning nondiscrimination towards individuals with, and coverage for treatment of, severe mental illnesses. Requires uniform deductibles and cost-sharing. (Sec. 133) Requires the Board to establish as nonprofit corporations the Health Benefits and Data Standards Board and the Health Plan Standards Board to make recommendations to the Board. Provides funding through annual AHP registration fees. (Sec. 135) Provides for waivers to permit a State to use funds under title XIX (Medicaid) of the Social Security Act to enroll individuals in an AHP. (Sec. 136) Mandates: (1) rules for risk adjustment of premiums among AHPs by HPPCs; and (2) standards for information reporting by AHPs. (Sec. 138) Requires analysis, rating, and publication regarding the quality of care provided by specialized centers of care. (Sec. 139) Mandates a report on: (1) the extent that AHP enrollees have greater health service needs than the population of those eligible to enroll; (2) methods for reducing adverse impacts resulting from such adverse selection; and (3) the impact of requiring all eligible individuals to enroll. Title II: Primary and Preventive Care Services - (Sec. 201) Authorizes grants: (1) to States for coordinated, multidisciplinary, and comprehensive primary health care and social services for pregnant women and infants; and (2) for the development of model health and nutrition curricula for children in primary and secondary education. Authorizes appropriations. (Sec. 202) Amends the Public Health Service Act to authorize appropriations for: (1) immunization programs; (2) tuberculosis and sexually transmitted disease prevention programs; (3) migrant and community health centers; (4) health services for the homeless; (5) family planning services; (6) breast and cervical cancer prevention; (7) preventive health and health services block grants; and (8) early intervention services regarding human immunodeficiency virus (HIV) disease. Amends title V (Maternal and Child Health Services Block Grant) of the Social Security Act to authorize appropriations to improve the health of all mothers and children. (Sec. 203) Amends the Elementary and Secondary Education Act of 1965 to replace provisions relating to school health education with provisions mandating grants to States for local programs of comprehensive health education and prevention, early health intervention, and health education in elementary and secondary schools. Establishes the Office of Comprehensive School Health Education. Authorizes appropriations. (Sec. 204) Mandates grants to Head Start training agencies for training and technical assistance regarding health education to Head Start teachers and other child care providers. Reserves funds for the development of innovative model health education programs or curricula. Authorizes appropriations. (Sec. 205) Considers, for purposes of Internal Revenue Code provisions relating to medical care deductions, qualified expenditures for disease prevention and health promotion programs to be amounts paid for medical care. (Sec. 206) Mandates grants to States for assistance to businesses with not over 100 employees for the establishment and operation of work site employee wellness programs. Authorizes appropriations. Title III: Tax Incentives to Increase Health Care Access - (Sec. 301) Amends the Internal Revenue Code to allow a credit for a percentage of accountable health plan costs (amounts paid by individuals for insurance which constitutes Medicare) limited to the reference premium amount applicable in a HPPC area. Allows employers to make advance payments of such costs for employees with eligibility certificates. Coordinates such credit with other health insurance credits and deductions. Terminates the health insurance credit under earned income provisions. (Sec. 302) Disallows a deduction for the excess health plan expenses of any employer. (Sec. 303) Increases and makes permanent the deduction for health insurance costs of self-employed individuals from 25 percent to 100 percent. Limits such deduction to accountable health plan costs. (Sec. 304) Sets forth special rules for the deduction for health plan premium expenses. (Sec. 305) Excludes from the gross income of an employee employer-provided basic coverage under an accountable health plan. Title IV: Disclosure of Certain Information to Beneficiaries under the Medicare and Medicaid Programs - (Sec. 401) Amends title II (Old Age, Survivors, and Disability Insurance) (OASDI) of the Social Security Act to mandate regulations requiring each provider receiving payment under titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to: (1) make available to service recipients an annual report regarding rates of mortality and nosocomial infection, frequently-performed tests, and malpractice claims; (2) make certain information available before an invasive procedure or treatment is performed; and (3) inform individuals of their right to refuse information and treatment, to refuse provider attendance, and to leave the premises. (Sec. 402) Authorizes grants for outreach activities to inform Medicare beneficiaries of the information. Authorizes appropriations. Mandates a Medicaid outreach program. Title V: Cooperative Agreements Between Hospitals - (Sec. 502) Amends the Public Health Service Act to authorize the Attorney General to waive antitrust laws to permit hospitals to enter into cooperative agreements to share medical or high technology equipment or services, including drugs, devices, medical and surgical procedures, and organizational and support systems. Title VI: Patient's Right to Decline Medical Treatment - (Sec. 601) Prohibits State restrictions, except to protect a third party, on the right of: (1) a competent person to consent to or decline medical treatment; or (2) an incompetent person to consent to or decline medical treatment through mandated national forms containing advance directives and durable powers of attorney. Requires all health care providers to honor the forms. Shields providers who act in good faith from criminal or civil liability or professional discipline. Denies Medicare and Medicaid payment for services contrary to advance directives. (Sec. 603) Declares that this title does not permit, condone, authorize, or approve suicide or mercy killing or any affirmative act to end a human life. (Sec. 605) Requires conforming changes to policies relating to Medicare and Medicaid advance directives provisions. (Sec. 606) Requires that information on an individual's right to consent to or decline treatment be provided periodically to beneficiaries under titles II (Old Age, Survivors, and Disability Insurance) (OASDI), XVI (Grants to States for Aid to the Aged, Blind, or Disabled), XVIII (Medicare), and XIX (Medicaid) of the Social Security Act. (Sec. 607) Mandates recommendations to the Congress concerning the medical, legal, ethical, social, and educational issues related to this title. Title VII: Insurance Administration Simplification - (Sec. 701) Amends the Social Security Act to create a new title on health insurance. Establishes the Health Insurance Standards Commission, requiring it to: (1) make recommendations regarding implementation of the title; and (2) develop a long-term plan for computerized billing and eligibility and uniform standards for electronic data interchange. Requires that the resulting system: (1) not be mandatory for a provider in a whole-county nonmetropolitan Health Professional Shortage Area; and (2) apply to participants under titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act. Title VIII: Children's Health Care - (Sec. 801) Establishes a program under which local educational agencies receiving Federal assistance are required to offer basic health insurance coverage to eligible students in schools. Sets forth student eligibility requirements, including: (1) being uninsured for at least six months; and (2) not being covered by title XIX (Medicaid) of the Social Security Act. Authorizes withholding from a noncomplying local educational agency a specified percentage of Federal educational assistance. (Sec. 802) Amends the Internal Revenue Code to allow a tax credit for qualified amounts paid for policies under this Act. Phases out the credit as income goes from 100 percent to 200 percent of the poverty line. (Sec. 803) Requires development of a single model uniform application form and process for benefits under the Special Supplemental Food Program (WIC Program) of the Child Nutrition Act of 1966, the Maternal and Child Health Service Block Grant Program (title V) of the Social Security Act, and Medicaid (the Programs). (Sec. 804) Mandates grants to not more than five States for demonstration projects to encourage women to obtain prenatal and well-baby care under the Programs. (Sec. 805) Authorizes appropriations to carry out this title. Title IX: Improved Access to Health Care for Rural and Underserved Areas - (Sec. 901) Amends the Internal Revenue Code to allow a tax credit for service by a physician, physician assistant, or nurse practitioner who: (1) provides primary health services to individuals in a rural health professional shortage area; and (2) is not receiving a National Health Service Corps scholarship or loan repayment and is not fulfilling service obligations under those programs. Excludes National Health Service Corps loan repayments from gross income. Allows, with regard to elections to expense depreciable business assets, a higher aggregate cost to be taken into account for rural health care property in a rural health professional shortage area. Allows a deduction for interest paid on medical education loans by an individual performing services under an agreement to perform professional services in a rural community. Allows use of the deduction in computing adjusted gross income. (Sec. 911) Amends the Public Health Service Act to authorize appropriations to carry out provisions relating to the National Health Service Corps scholarship and loan repayment program. Earmarks certain portions to carry out provisions of this Act relating to federally qualified health centers (FQHCs). (Sec. 912) Mandates: (1) allotments to States for community based primary health care entities providing services to pregnant women and children to age three; and (2) grants to FQHCs and other entities for providing services for medically underserved populations or in high impact areas not currently served by an FQHC. Authorizes appropriations. Requires a study of the relationship and interaction between community health centers and hospitals in medically underserved areas. Authorizes appropriations. (Sec. 914) Authorizes grants for development and implementation of a plan for rural mental health outreach. Authorizes appropriations. (Sec. 915) Requires giving priority, in making grants under provisions of the Public Health Service Act relating to health professions education or to nurse education, to factors relating to medically underserved areas. Mandates grants to: (1) health professions institutions to expand training for individuals desiring to practice in or serve medically underserved communities; and (2) regional consortia to enhance and expand coordination among health professions programs, particularly in medically underserved rural areas. Authorizes appropriations. (Sec. 916) Authorizes grants for the development of networks among rural and urban health care providers to preserve and share resources and enhance the quality and availability of rural health care. Authorizes appropriations. (Sec. 917) Authorizes grants to develop and administer rural cooperatives to establish a case management and reimbursement system supporting the economic viability of essential public or private health services, facilities, health care systems, and resources. Requires the cooperative to: (1) facilitate negotiations among member providers and third party payers concerning reimbursement rates; (2) identify and implement a malpractice insurance program and pay a portion of the premiums of provider members; and (3) establish joint case management and patient care practice standards programs that members must meet in order to participate in the negotiations. Allows employers to join the cooperative in order to provide, through a third party payer, health insurance to their employees. Authorizes appropriations. Title X: Primary and Preventive Care Providers - (Sec. 1001) Amends Medicare provisions to modify or establish payment requirements regarding certified nurse midwives, nurse practitioners, clinical nurse specialists, and physician assistants. Mandates bonus payments for such individuals and for certified registered nurse anesthetists for service in health professional shortage areas. (Sec. 1002) Includes physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists in the Medicaid definition of "medical assistance" for which payment will be made. (Sec. 1003) Amends the Public Health Service Act to establish grants programs to: (1) provide medical (including osteopathic medical) students for programs to interest high school or college students in careers in general medical practice; and (2) develop strategies for recruiting and placing medical students interested in practicing general medicine. Authorizes appropriations. (Sec. 1004) Amends Medicare provisions to allow entities with approved medical residency training programs (as well as hospitals) to receive payments for direct medical education costs. Mandates payments for indirect costs of medical education. Modifies requirements regarding payments to hospitals for such indirect costs. Title XI: Malpractice Reform - Amends the Public Health Service Act to establish a program of grants to assist States in establishing prelitigation panels that identify claims of professional negligence that merit compensation, encourage resolution of meritorious claims prior to suit, and encourage withdrawal or dismissal of nonmeritorious claims. Authorizes appropriations. Title XII: Medicare Preferred Provider Demonstration Projects - (Sec. 1201) Provides for up to ten demonstration projects to test the effectiveness of providing payment under Medicare for primary and specialty procedures and services furnished by preferred provider organizations. Allows waiver of Medicare requirements as necessary. Title XIII: Treatment and Outcomes Research - (Sec. 1301) Authorizes establishment of a program for the conduct of clinical trials regarding promising new drugs and disease treatments. Authorizes appropriations. (Sec. 1302) Authorizes appropriations for the Agency for Health Care Policy and Research. Amends the Internal Revenue Code to impose a tax on health insurance premiums. Establishes the Trust Fund for Medical Treatment Outcomes Research and deposits the revenue from the tax in the Fund, making those amounts available for outcomes research. (Sec. 1303) Amends the Public Health Service Act to prohibit use of guidelines established by the Office of the Forum for Quality and Effectiveness in Health Care in any Federal or State action arising from health care services, except by a provider who is a party to the action. Requires, if introduced, that the guidelines establish a rebuttable presumption that the service prescribed by the guidelines is the appropriate standard of medical care. Title XIV: Long-Term Care - Subtitle A: Tax Treatment of Qualified Long-Term Care Insurance Policies - (Sec. 1403) Amends the Internal Revenue Code to provide for the treatment of qualified long-term care insurance as accident and health insurance for purposes of insurance company taxation. (Sec. 1404) Provides for the exclusion as a death benefit of any amount paid to an individual under a life insurance contract because such individual is terminally ill, has a dread disease, or has been permanently confined to a nursing home. Subtitle B: Tax Incentives for Purchase of Qualified Long-Term Care Insurance - (Sec. 1411) Allows a tax credit for a percentage of qualified long-term care premiums. (Sec. 1412) Allows a deduction for expenses relating to long-term care and an exclusion from gross income of benefits received from long-term care insurance. (Sec. 1414) Allows a deduction for employers of contributions made for long-term care insurance if any refund or premium is applied to reduce the future costs of the plan or increase its benefits. (Sec. 1415) Allows the inclusion of such insurance in cafeteria plans. (Sec. 1416) Excludes from gross income amounts withdrawn from individual retirement accounts and certain employer cash or deferred arrangements to pay long-term care premiums and expenses. Increases the amounts of deductible contributions to individual retirement plans. (Sec. 1417) Excludes from gross income amounts received from the surrender, cancellation, or exchange of any life insurance contract if such amounts are used to pay premiums for long-term care insurance. (Sec. 1418) Authorizes the tax-free use of the gain from the sale of a principal residence for the purchase of long-term health care insurance. Subtitle C: Medicaid Amendments - (Sec. 1421) Amends title XIX of the Social Security Act (Medicaid) to set forth eligibility requirements for long-term care benefits and to require coverage of home and community-based long-term care. Title XV: Financing - (Sec. 1501) Repeals the dollar limitation on the amount of wages subject to hospital insurance tax. Title XVI: Responsibilities Under Uniform Set of Effective Benefits - (Sec. 1601) Requires that employment-related health plans not: (1) deny or condition coverage based on health, claims, or lack of evidence of insurability of an individual; (2) discourage coverage of preexisting conditions; (3) impose waiting periods; and (4) apply differently to employees of different income levels. Requires employer contributions to be the same or higher for employees of a specified low income as for higher-income employees. (Sec. 1602) Requires that, to be eligible for Federal benefits, an individual possess health insurance meeting the standards of this title, except for enrollment under title XVIII (Medicare) of the Social Security Act, the veterans' health care program, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), the Indian health service program, and the Federal employees program. (Sec. 1603) Specifies the matters a self-insured health benefit plan must demonstrate in order to obtain certification as a health plan. (Sec. 1604) Requires providers, as a condition of participation in the health plan, to accept any payment specified by the Federal Health Board as full payment for the service performed. Title XVII: Enforcement Provisions - (Sec. 1701) Amends the Internal Revenue Code to set forth enforcement provisions for health plan carriers, providers, employers, and employees.

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• Introduced in Senate (text)

  Introduced in Senate · EN · 23 March 1993

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  Introduced in Senate · EN · 23 March 1993

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• Introduced in Senate

  summary · EN · 23 March 1993

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