Summary: H.R.16 — 101st Congress (1989-1990)All Information (Except Text)

There is one summary for H.R.16. Bill summaries are authored by CRS.

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Introduced in House (01/03/1989)

National Health Insurance Act - Title I: Benefits and Eligibility - Makes medical, dental, podiatric, home-nursing, hospital, and auxiliary services available as benefits to eligible individuals and defines such services.

Directs the National Health Insurance Board, established by this Act, to survey the resources and needs of each State and to develop in each State a program to assure maximum participation and use of health personnel and facilities. Authorizes the Board to limit health services when personnel, facilities, or funds are inadequate to ensure the provision of all services.

Allows every individual eligible for personal health services available under this Act to select the physician, dentist, podiatrist, nurse, medical group, or hospital to render services and to change such selection under certain circumstances.

Sets forth eligibility requirements. States that the United States shall be subrogated to all rights of an individual who receives benefits under this Act with respect to any workers' compensation injury or disability.

States that Federal grants to States under title XIX (Medicaid), and part A of title IV (Aid to Families with Dependent Children) of the Social Security Act shall be available to the States for provision of personal health services for noninsured needy individuals.

Title II: Participation of Physicians, Dentists, Nurses, Hospitals, and Others - Prescribes criteria to govern which physicians, dentists, podiatrists, nurses, hospitals, or providers of auxiliary services will be deemed qualified to perform services under this Act.

Authorizes specified State agencies to enter into agreements with qualified individuals or with organizations for the provision of personal health services. Lists provisions to be included in such agreements, including methods of payment for services.

Sets standards applicable to rates or amounts of payment for services rendered as benefits under this Act. Directs that such rates and amounts be adapted to take into account relevant regional, State, or local conditions and practices.

Authorizes patient limits. Allows health care providers entering into an agreement under this title to accept or reject patients.

Title III: Local Administration - Decentralizes the responsibility for administration of this Act's benefit provisions to local administrative committees or local administrative officers within health-service areas designated by each State. Lists the duties of such local administrative committees or officers.

Requires the establishment in each health-service area of: (1) a local area committee; and (2) local professional committees representative of the health care providers in the area to assist local administrative committees and officers.

Title IV: State Administration - Expresses the intent of the Congress that this Act's benefit provisions be administered by each of the several States, in accordance with an approved plan of operations. Catalogs provisions that must be included in such a plan.

Describes procedures to be followed if a State: (1) fails to submit a plan; or (2) fails to comply with an approved plan.

Title V: National Health Insurance Board; National Advisory Medical Policy Council; General Administrative Provisions - Establishes in the Department of Health and Human Services a National Health Insurance Board to administer the provisions of this Act.

Establishes a National Advisory Medical Policy Council to advise the Board regarding matters of general policy, the formulation of regulations, and the establishment of professional standards.

Requires the Board to undertake certain studies and to make reports to the Congress at specified times.

Title VI: Eligibility Determinations, Complaints, Hearings, and Judicial Review - Requires the Secretary of Health and Human Services to determine benefit eligibility.

Describes procedures for complaint investigation and adjudication.

Title VII: Application of Act to Individuals Covered Under Medicare Program - States that when an individual is entitled to hospital insurance benefits under Medicare, the personal health services available as benefits under this Act shall be limited to those services for which the individual is ineligible under the Medicare program.

Directs the Secretary to carry out a study of the interrelationship between the program of national health insurance under this Act and the Medicare program. Requires that the Secretary submit to the President and to the Congress, within one year of this Act's enactment, a report of such study, along with certain findings and detailed recommendations.

Title VIII: Fiscal Provisions - Creates in the Treasury the Personal Health Services Account. Appropriates to such Account for FY 1990 and for each succeeding year an amount determined according to a specified formula.

Directs the Board to determine: (1) amounts to be made available from the Account during a given fiscal year for the provision of various classes of personal health services benefits; and (2) allotments to be made to the States for the provision of such benefits. Sets standards to govern the Board's determinations.

Authorizes the Board to make grants to: (1) certain educational institutions or agencies in order to fund endeavors that show promise of making valuable contributions to the training of personnel providing or administering benefits under this Act; and (2) certain individuals participating in courses relating to the provision or administration of personal health services benefits. Authorizes appropriations.

Title IX: Miscellaneous Provisions - Defines terms used in this Act. States that personal health services shall first become available as benefits under this Act on October 1, 1990.