Text: H.R.2500 — 101st Congress (1989-1990)All Information (Except Text)

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HR 2500 IH
101st CONGRESS
1st Session
 H. R. 2500
To establish a United States Health Service to provide high quality
comprehensive health care for all Americans and to overcome the deficiencies
in the present system of health care delivery.
IN THE HOUSE OF REPRESENTATIVES
May 25, 1989
Mr. DELLUMS introduced the following bill; which was referred jointly, to
the Committees on Energy and Commerce, Armed Services, Banking, Finance and
Urban Affairs, the District of Columbia, Education and Labor, the Judiciary,
Post Office and Civil Service, Veterans' Affairs, and Ways and Means
A BILL
To establish a United States Health Service to provide high quality
comprehensive health care for all Americans and to overcome the deficiencies
in the present system of health care delivery.
  Be it enacted by the Senate and House of Representatives of the United
  States of America in Congress assembled,
short title
  SECTION 1. This Act may be cited as the `U.S. Health Service Act'.
TABLE OF CONTENTS
Sec. 1. Short title.
Sec. 2. Findings.
Sec. 3. Purposes.
Sec. 4. Definitions.
TITLE I--ESTABLISHMENT AND OPERATION OF THE UNITED STATES HEALTH SERVICE
Part A--Initial Organization
Sec. 101. Establishment of the Service.
Sec. 102. Appointment of Interim National Health Board.
Sec. 103. Powers and duties of the Interim National Health Board.
Sec. 104. Authorization.
Part B--Organization of Area Health Boards
Sec. 111. Establishment of health care delivery regions.
Sec. 112. Appointment of interim regional health boards.
Sec. 113. Establishment of health care delivery districts and health care
delivery communities.
Sec. 114. Election of community health boards.
Sec. 115. Appointment of district health boards.
Sec. 116. Appointment of regional health boards.
Sec. 117. Appointment of the National Health Board.
Sec. 118. Subsequent election and appointment of members of health boards.
Sec. 119. Modification of the boundaries of health care delivery areas.
Part C--General Provisions Regarding Health Boards
Sec. 121. Definitions.
Sec. 122. Membership of health boards.
Sec. 123. Meetings and records of health boards.
Sec. 124. Procedures for establishment of national guidelines and standards.
Sec. 125. Assistance to area health board members.
TITLE II--DELIVERY OF HEALTH CARE AND SUPPLEMENTAL SERVICES
Part A--Patients Rights in Health Care Delivery
Sec. 201. Basic health rights.
Sec. 202. Right to paid leave to receive health care services.
Part B--Eligibility for, Nature of, and Scope of Services Provided by
the Service
Sec. 211. Eligibility for services.
Sec. 212. Entitlement to services.
Sec. 213. Provision of health care and supplemental services.
Part C--Health Care Facilities and Delivery of Health Care Services
Sec. 221. Establishment of health care facilities and distribution of delivery
of health care and other services.
Sec. 222. Operation and inspection of health care facilities.
Sec. 223. Provision of health services relating to reproduction and
child-bearing.
TITLE III--HEALTH LABOR FORCE
Part A--Job Categories and Certification
Sec. 301. Effect of State law.
Sec. 302. Qualifications of health workers.
Sec. 303. Establishment of job categories and certification standards.
Part B--Education of Health Workers
Sec. 311. Health team schools.
Sec. 312. Service requirement.
Sec. 313. Payment for certain educational loans.
Part C--Employment and Labor-Management Relations Within the Service
Sec. 321. Employment, transfer, promotion, and receipt of fees.
Sec. 322. Applicability of laws relating to Federal employees.
Sec. 323. Applicability of Federal labor-management relations laws.
Sec. 324. Defense of certain malpractice and negligence suits.
TITLE IV--OTHER FUNCTIONS OF HEALTH BOARDS
Part A--Advocacy, Grievance Procedures, and Trusteeships
Sec. 401. Advocacy and legal services program.
Sec. 402. Grievance procedures and trusteeships.
Part B--Occupational Safety and Health Programs
Sec. 411. Functions of the National Health Board.
Sec. 412. Community occupational safety and health activities.
Sec. 413. Regional occupational safety and health programs.
Sec. 414. Workplace health facilities.
Sec. 415. Employee rights relating to occupational safety and health.
Sec. 416. Definitions.
Part C--Health and Health Care Delivery Research
Sec. 421. Principles and guidelines for research.
Sec. 422. Establishment of institutes.
Part D--Health Planning, Distribution of Drugs and Other Medical Supplies,
and Miscellaneous Functions
Sec. 431. Health planning and budgeting.
Sec. 432. Distribution of drugs and other medical supplies.
Sec. 433. Miscellaneous functions of the National Health Board.
TITLE V--FINANCING OF THE SERVICE
Part A--Health Service Taxes
Sec. 501. Individual and corporate income taxes.
Sec. 502. Other changes in the Internal Revenue Code of 1954.
Sec. 503. Existing employer-employee health benefit plans.
Sec. 504. Workers compensation programs.
Part B--Health Service Trust Fund
Sec. 511. Establishment of health service trust fund.
Sec. 512. Transfer of funds to the health service trust fund.
Sec. 513. Administration of health service trust fund.
Part C--Preparation of Plans and Budgets
Sec. 521. Determination of fund availability.
Sec. 522. Preparation of area plans and budgets.
Part D--Allocation and Distribution of Funds
Sec. 531. National budget.
Sec. 532. Regional budgets.
Sec. 533. District budgets.
Sec. 534. Special operating expense fund.
Sec. 535. Distribution of funds.
Sec. 536. Annual statement, records, and audits.
Part E--General Provisions
Sec. 541. Issuance of obligations.
Sec. 542. Definitions.
TITLE VI--MISCELLANEOUS PROVISIONS
Sec. 601. Effective date of health services.
Sec. 602. Repeal of provisions.
Sec. 603. Transition provisions.
Sec. 604. Amendment to Budget and Accounting Act.
Sec. 605. Separability.
findings
  SEC. 2. The Congress makes the following findings:
  (1) The health of the Nation's people is a foundation of their well-being.
  (2) High quality health care is a right of all people.
  (3) Many of the Nation's people are unable fully to exercise this right
  because of the inability of the present health care delivery system to make
  high quality health care available to all individuals regardless of race,
  sex, age, national origin, income, marital status, sexual orientation,
  religion, political belief, place of residence, or previous health status.
  (4) The present health care system has failed to address the basic
  deterioration in occupational, environmental, and social conditions
  affecting the health of the people of this Nation.
  (5) Unnecessary and excessive profits and administrative expenses have
  inflated the cost of health care.
  (6) The health professions have failed to control the cost of their services
  and the imbalance in the number of health workers among geographic areas
  or health care specialties.
  (7) The present health care system has failed to make full and efficient
  use of allied health workers.
  (8) A United States Health Service is the best means to implement the
  right to high quality health care and to overcome the deficiencies in the
  present health care delivery system.
purposes
  SEC. 3. The purposes of this Act are:
  (1) To create a United States Health Service to provide without charge
  to all residents, regardless of race, sex, age, national origin, income,
  marital status, sexual orientation, religion, political belief, place of
  residence, or previous health status, comprehensive health care services
  delivered by salaried health workers and emphasizing the promotion and
  maintenance of health as well as the treatment of illness.
  (2) To establish representative and democratic governance of the Service
  through community boards chosen through community elections, district and
  regional boards selected by the community and district boards, respectively,
  and a National Health Board selected by the regional boards, subject to
  the approval of the President.
  (3) To provide health workers in the Service with fair and reasonable
  compensation, secure employment, opportunities for full and equal
  participation in the governance of health facilities, and opportunities
  for advancement without regard to race, sex, age, national origin, sexual
  orientation, religion, or political belief.
  (4) To increase the availability and continuity of health care by linking
  local health care facilities to hospitals and specialized care facilities.
  (5) To implement local, regional, and national planning for the establishing,
  equipping, and staffing of health care facilities needed to overcome
  present shortages and redistribute health resources, especially for
  currently deprived inner-city and rural populations, minority groups,
  prisoners, and occupational groups.
  (6) To finance the Service through progressive taxation of individuals and
  employer contributions, and to distribute these revenues on a capitation
  basis, supplemented by allocations to meet special health care needs.
definitions
  SEC. 4. For the purposes of this Act, unless the context implies otherwise:
  Service
  (1) The term `Service' means the United States Health Service established
  in section 101.
  National Health Board; Interim National Health
  Board; Appropriate National Health Board
  (2)(A) The term `National Health Board' means the National Health Board
  of the Service.
  (B) The term `Interim National Health Board' means the Interim National
  Health Board, appointed under section 102, of the Service.
  (C) The term `appropriate National Health Board' means--
  (i) the Interim National Health Board, prior to the initial meeting of
  the National Health Board under section 117, and
  (ii) the National Health Board, at and after such meeting.
  Health Board; Area Health Board
  (3)(A) The term `health board' means the Interim National Health Board,
  National Health Board, an interim regional health board, a regional health
  board, a district health board, or a community health board established
  under this Act.
  (B) The term `area health board' means a regional health board, a district
  health board, or a community health board established under this Act.
  Community; District; Region; Area
  (4)(A) The term `community' means a health care delivery community
  established under title I.
  (B) The term `district' means a health care delivery district established
  under title I.
  (C) The term `region' means a health care delivery region established
  under title I.
  (D) The term `area' means, with respect to an area health board or an area
  health care facility--
  (i) in the case of a community board or a health care facility established
  by a community board, the community for which such board is established
  or in which the facility is located;
  (ii) in the case of a district board or a health care facility established
  by a district board, the district for which such board is established or
  in which the facility is located; and
  (iii) in the case of a regional board or a health care facility established
  by a regional board, the region for which such board is established or in
  which the facility is located.
  Interim Regional Board; Regional Board; District
  Board; Community Board
  (5)(A) The term `interim regional board' means an interim regional health
  board established in accordance with section 112.
  (B) The term `regional board' means a regional health board established
  in accordance with title I.
  (C) The term `district board' means a district health board established
  in accordance with title I.
  (D) The term `community board' means a community health board established
  in accordance with title I.
  Respective Regional and District Board
  (6)(A) The terms `respective regional board' and `respective interim regional
  board' mean, with respect to a community board or a district board, the
  regional board or interim regional board, respectively, for the region
  which contains the community or district for which such community board
  or district board is established.
  (B) The term `respective district board' means, with respect to a community
  board, the district board for the district which contains the community
  for which such community board is established.
  User; Registered User; Eligible User;
  User Member
  (7)(A) The term `user' means an individual who is eligible under section
  211 to receive health care services from the Service under this Act.
  (B) The term `registered user' means, with respect to an area, a user
  who resides in the area and is registered to vote in the area in general
  elections for Federal, State, or local officials.
  (C) The term `eligible user' means, for purposes of sections 114 through
  118, with respect to a community, district, or region, an individual who
  (i) is 18 years of age or older, (ii) resides in the community, district,
  or region, respectively, and (iii) is not a health worker (as defined
  in paragraph (8)(A)), an indirect provider of health care (as defined in
  subparagraph (E)), or a member of the immediate family of such a worker
  or indirect provider.
  (D) The term `user member' means, with respect to a health board, an
  eligible user elected or appointed by users or user members to the health
  board under sections 114 through 118.
  (E) The term `indirect provider of health care' means an individual who--
  (i) receives (either directly or through his or her spouse) more than
  one-tenth of his or her gross annual income from any one or combination of--
  (I) fees or other compensation for provision of, research into, or
  instruction in, the provision of health care,
  (II) entities engaged in the provision of health care or in such research
  or instruction,
  (III) producing or supplying drugs or other articles for individuals or
  entities for use in the provision of or in research into or instruction
  in the provision of health care, or
  (IV) entities engaged in producing drugs or such other articles;
  (ii) holds a fiduciary position with, or has a fiduciary interest in,
  any entity described in subclause (II) or (IV) of clause (i); or
  (iii) is engaged in issuing any policy or contract of individual or group
  health insurance or hospital or medical service benefits.
  Health Worker; Authorized Health Worker; Eligible
  Health Worker; Worker Member
  (8)(A) The term `health worker' includes--
  (i) any employee of the Service; and
  (ii) any individual who for remuneration delivers, administers any program
  in, provides supporting services for, teaches the subject matter of,
  or performs research in, health care services.
  (B) The term `authorized health worker' means, with respect to a specified
  health care service, an individual who is an employee of the Service and
  is authorized by a health board to deliver the service.
  (C) The term `eligible area health worker' means, for purposes of sections
  114 through 118 with respect to a community, district, or region, a health
  worker who is employed by the community, district, or regional health board
  (respectively) or, in the case of sections 114 through 117, is scheduled
  to be employed by such board on the effective date of health services.
  (D) The term `worker member' means, with respect to a health board, an
  eligible area health worker elected or appointed by health workers or
  worker members to the health board under sections 114 through 118.
  Health Care Facility; Area Health Care
  Facility
  (9)(A) The term `health care facility' means an administrative unit
  composed of specified staff, equipment, and premises and established by
  a health board as an appropriate unit of organization for the delivery of
  specified health care or supplemental services under this Act.
  (B) The term `area health care facility' means, with respect to an area
  health board, a health care facility established by the area health board.
  Health Care Service; Supplemental Services
  (10)(A) The term `health care services' means the services described in
  paragraphs (1) through (5) of section 213(a).
  (B) The term `supplemental services' means the services described in
  paragraphs (1), (2), and (3) of section 213(b).
  Number of Residents
  (11) The term `number of residents' means the number of residents in
  a health care delivery area as determined by the most recent decennial
  national census.
  Effective Date of Health Services
  (12) The term `effective date of health services' means the effective date
  of health services under this Act as specified in section 601.
TITLE I--ESTABLISHMENT AND OPERATION OF THE UNITED STATES HEALTH SERVICE
Part A--Initial Organization
establishment of the service
  SEC. 101. (a) There is established, as an independent establishment of
  the executive branch of the United States, the United States Health Service.
  (b)(1) The authority of the Service shall be exercised by the appropriate
  National Health Board and, in accordance with this Act and guidelines
  established by such Board, by area health boards.
  (2) The Service shall have the authority, under the power of eminent domain,
  to acquire by condemnation under judicial process real estate for the Service
  for public purposes whenever it is necessary or advantageous to do so.
appointment of interim national health board
  SEC. 102. (a) The President shall, no later than 30 days after the date
  of enactment of this Act, appoint 21 individuals--
  (1) who are 18 years of age or older,
  (2) who are concerned about the health care problems of the Nation,
  (3) who approximate the Nation's population by race, sex, income, language,
  and region of residence, and
  (4) no more than seven of whom are or have been health workers, indirect
  providers of health care, or members of the immediate family of such workers
  or indirect providers within 24 months of the date of such nomination.
To serve as members of the Interim National Health Board of the Service.
  (b) The President shall, at the time of such appointments, designate two
  nominees to the Interim National Health Board who are not and have not
  been health workers, indirect providers of health care, or members of the
  immediate family of such workers or indirect providers within 24 months
  of the date of such appointment as chairperson and vice chairperson of
  such Board.
powers and duties of the interim national health board
  SEC. 103. (a) The members of the Interim National Health Board shall serve
  as the National Health Board of the Service until the National Health
  Board holds its initial meeting in accordance with section 117(c)(2).
  (b) The Interim National Health Board shall--
  (1) establish the boundaries of health care delivery regions, in accordance
  with section 111;
  (2) select interim regional health boards in accordance with section 111;
  (3) assist interim regional health boards in the performance of their
  functions;
  (4) coordinate the initial election of community health boards, under
  section 114; and
  (5) carry out such duties of the National Health Board as it deems necessary
  and consistent with the timetable given under this Act and the purposes of
  the Service, except that no staff member may be appointed and no employee may
  be hired by the Interim National Health Board for a period extending beyond
  90 days after the appointment of the National Health Board under section 117.
  (c) The Interim National Health Board shall operate in a manner consistent
  with the provisions of part C.
  (d) The Interim National Health Board shall submit a report to Congress on
  its performance under this Act no later than 30 days after the appointment
  of the National Health Board under section 117.
authorization
  SEC. 104. There are authorized to be appropriated to the Service
  $4,000,000,000 to carry out the provisions of this Act with respect to
  the establishment of the Service. Funds appropriated under this section
  shall remain available until expended.
Part B--Organization of Area Health Boards
establishment of health care delivery regions
  SEC. 111. (a) No later than 6 months after the appointment of members of
  the Interim National Health Board, such Board shall establish, in accordance
  with this section, health care delivery regions throughout the United States.
  (b) Each health care delivery region shall meet the following requirements:
  (1) The region shall be a contiguous geographic area appropriate for
  the effective governance, planning, and delivery of all health care and
  supplemental services under this Act for residents of the region.
  (2) The region shall have a population of not less than 500,000 and of
  not more than 3,000,000 individuals, except that--
  (A) the population of a region may be more than 3,000,000 if the region
  includes a standard metropolitan statistical area (as determined by the
  Office of Management and Budget) with a population of more than three
  million; and
  (B) the population of a region may be less than 500,000 if the Interim
  National Health Board determines that this is necessary to facilitate
  the delivery of health care and supplemental services or the effective
  governance of the health program within such region.
  (3) The boundaries of each region shall take into account--
  (A) any economic or geographic barrier to the receipt of health care and
  supplemental services in nonmetropolitan areas, and
  (B) the differences in needs between nonmetropolitan and metropolitan areas
  in the planning, development, and delivery of health care and supplemental
  services.
  (c) At least 60 days prior to the establishment of the boundaries of any
  region, the Interim National Health Board shall provide for--
  (1) notice in the area which would be affected by the establishment of such
  boundaries of the boundaries proposed to be established, and of the date,
  time, and location of the public hearing on such establishment as provided
  in paragraph (2); and
  (2) a public hearing at which individuals can speak or present written
  statements relating to the establishment of such boundaries.
  (d) The boundaries of regions shall be modified in accordance with
  section 119.
appointment of interim regional health boards
  SEC. 112. (a) No later than 60 days after the establishment of health
  care delivery regions under section 111, the Interim National Health Board
  shall appoint an interim regional board for each such region.
  (b) Each interim regional board shall be composed of nine members--
  (1) who are 18 years of age or older;
  (2) who are concerned about the health care problems of their region;
  (3) who approximate the region's population by race, sex, income, and
  language; and
  (4) no more than three of whom are or have been health workers, indirect
  providers or health care, or members of the immediate family of such workers
  or indirect providers within 24 months of the date of such appointment.
  (c) The Interim National Health Board shall, at the time of appointment of
  each interim regional board, designate two members of the board who are
  not and have not been health workers, indirect providers of health care,
  or members of the immediate family of such workers or indirect providers
  within 24 months of the date of such appointment as chairperson and vice
  chairperson of such board.
  (d) A vacancy in the membership of an interim regional board shall be
  filled in the same manner as the original appointment.
  (e) The members of an interim regional board shall serve until the
  certification of appointment of a regional board in its region in accordance
  with section 116.
  (f) Each interim regional board shall--
  (1) establish the boundaries of health care delivery districts and of health
  care delivery communities within its region in accordance with section 113;
  (2) conduct elections for voting members of community boards within its
  region, in accordance with section 114; and
  (3) carry out such functions of a regional board, set out under this Act,
  as the Interim National Health Board deems appropriate for the purposes
  of this Act.
  (g) Each interim regional board shall operate in a manner in accordance
  with part C of this title.
establishment of health care delivery districts and health care delivery
communities
  SEC. 113. (a) No later than 6 months after its appointment under section
  112, each interim regional board shall establish, in accordance with this
  section, health care delivery districts and health care delivery communities
  throughout its region.
  (b) Each region shall be divided into three or more health care delivery
  districts. Each such district shall meet the following requirements:
  (1) The district shall be a contiguous geographic area appropriate for the
  effective governance, planning, and delivery of all health care services,
  except for highly specialized health services, for residents of such
  district.
  (2) The district shall have a population of not less than 100,000 and
  of not more than 500,000 individuals, except that a district may have a
  population of less than 100,000 if the interim regional board or regional
  board (as appropriate) determines that a lesser population would facilitate
  the delivery of health care and supplemental services or the effective
  governance of the health program within such district or its region.
  (c) Each district shall be divided into three or more health care delivery
  communities. Each such community shall meet the following requirements:
  (1) The community shall be a contiguous geographic area appropriate for
  the effective governance, planning, and delivery of comprehensive primary
  health care services, described in section 221(a)(2), for residents of
  such community.
  (2) The residents of the community shall, to the maximum extent feasible,
  have a commonality of interest, language, and ethnic and racial composition
  sufficient to support and maintain a community health program under this Act.
  (3) The community shall have a population of not less than 25,000 and
  of not more than 50,000 individuals, except that a community may have a
  population of less than 25,000 if the interim regional board or regional
  board (as appropriate) determines that a lesser population would facilitate
  the delivery of health care and supplemental services or the effective
  governance of the health program within such community or the district in
  which it is located.
  (d) At least 60 days prior to the establishment of the boundaries of any
  district or community within its region, the interim regional board shall
  provide for--
  (1) notice in the district or community which would be affected by
  the establishment of such boundaries of the boundaries proposed to be
  established and of the date, time, and location of the public hearing on
  such establishment as provided in paragraph (2); and
  (2) a public hearing at which individuals residing within the region
  can speak or present written statements relating to the establishment of
  such boundaries.
  (e) The boundaries of districts and communities shall be modified in
  accordance with section 119.
election of community health boards
  SEC. 114. (a)(1) The Interim National Health Board shall arrange with State
  and local governments for the initial elections for user members of each
  community board to be held on a date not later than 9 months after the
  appointment of interim regional boards under section 112.
  (2) Elections for worker members of each community board shall first be held
  as soon as possible after the selection of health workers for employment
  by the user members of such community boards. Such elections shall be held,
  to the extent feasible, in accordance with subsection (c)(2)(B).
  (b)(1) The number of user members to be elected in an election in a
  community under subsection (a) shall be six, plus one user member for each
  5,000 individuals residing in such community in excess of 30,000 residents.
  (2) The number of worker members to be elected in an election in a
  community under subsection (a) shall be three, plus one member for each
  10,000 individuals residing in such community in excess of 30,000 residents.
  (c)(1) The Interim National Health Board shall establish procedures for the
  nomination and election under this section of user members of community
  boards and worker members of area health boards. Each interim regional
  board shall conduct and supervise such nominations and elections in its
  region in accordance with such procedures.
  (2)(A) Such procedures for election of user members shall provide, except
  as otherwise provided in this part, for--
  (i) the nomination for election as a user member to a community board of
  any eligible user, upon presentation to the respective interim regional
  board of a petition or petitions signed by at least one percent of the
  registered users in the community;
  (ii) the full disclosure by each nominee, at the time of presentation of a
  petition or petitions under clause (i), to the respective interim regional
  board of any financial interest of the nominee and such nominee's family
  in the delivery of health care services, in research on health or health
  care services, or in the provision of drugs or medical supplies;
  (iii) the opportunity, regardless of race, sex, language, income level, or
  health condition, for all registered users in each such community to nominate
  eligible users for, and for all eligible users in each such community to
  run for and to serve as user members of, such users' community board;
  (iv) the right of all registered users in each such community, regardless of
  race, sex, language, income level, or health condition, to vote in elections
  for user members of such users' community board, and the right of registered
  users who are not physically or mentally capable of voting themselves to
  designate other registered users to vote proxies on their behalf;
  (v) public meetings sponsored by the respective interim regional board in
  each such community within its region, at which all users nominated for
  election to the community board in the community may present their views;
  (vi) the preparation and distribution within each such community by the
  respective interim regional board of literature presenting the qualifications
  and views of, and disclosing information described in clause (ii) for,
  each nominee for election as a user member of the community board in the
  community; and
  (vii) the election of the nominees receiving the greatest number of votes.
  (B) Such procedures for election of worker members shall provide for--
  (i) the nomination for election as a worker member of an area health board
  of any eligible area health worker, upon presentation to the respective
  interim regional board of a petition (or petitions) signed by at least 1
  percent of the eligible area health workers, and
  (ii) the full participation of eligible area health workers of all job
  categories and skill levels in the nomination and election process.
  (d)(1) Unless an election is set aside under section 402(d)(1) (relating
  to grievance procedures), individuals who have been elected to a community
  board for a community under this section, including user members until
  worker members have been elected, shall be certified by the interim regional
  board as constituting, on the date of such certification, the community
  board for the community.
  (c) With respect to each group of individuals constituting a community
  board under paragraph (1), the respective interim regional board shall
  select a time, date, and location within the community of such community
  board for the holding of the initial meeting of such community board, which
  date shall not be later than 30 days after the date of the election, and
  shall notify the newly elected and approved members of such board and the
  residents of such community of the time, date, and location of such meeting.
appointment of district health boards
  SEC. 115. (a)(1) Not later than 60 days after the initial meeting of each
  community board, called pursuant to section 114(d)(2), the user members
  of each such board shall appoint two eligible users in the community to
  serve as user members of their respective district board.
  (2) As soon as feasible, the worker members of each such board shall
  appoint an eligible community health worker to serve as a worker member
  of their respective district board.
  (3) As soon as feasible, the eligible district health workers shall, in
  accordance with section 114(c)(2)(B), elect an eligible district health
  worker to serve as a worker member of their respective district board.
  (4) The user and worker members of each such community board shall
  promptly notify their respective interim regional board of appointments
  under this subsection.
  (b)(1) Not later than 15 days after the date a majority of the initial
  community boards within a district have notified their respective interim
  regional board of the appointment of user members for their respective
  district boards under subsection (a)(1), such interim regional board
  shall certify the users so appointed as constituting, on the date of such
  certification, the district board for the district.
  (2) With respect to each district board certified under paragraph (1),
  its respective interim regional board shall select a time, date, and
  location within the district of such district board for the holding of
  the initial meeting of such district board, which date shall not be later
  than 15 days after the date of such certification, and shall notify the
  approved members of such board and the residents of such district of the
  time, date, and location of such meeting.
appointment of regional health boards
  SEC. 116. (a)(1) Not later than 60 days after the initial meeting of each
  district board, called pursuant to section 115(b)(2), the user members of
  each such board shall appoint two eligible users in the district to serve
  as user members of their respective regional board.
  (2) As soon as feasible, the worker members of each such board shall
  appoint an eligible district (or community, in the district) health worker
  to serve as a worker member of their respective regional board.
  (3) As soon as feasible, the eligible regional health workers shall, in
  accordance with section 114(c)(2)(B), elect an eligible regional health
  worker to serve as a worker member of their respective regional board.
  (4) The user and worker members of each such district board shall promptly
  notify their respective interim regional board and the Interim National
  Health Board of such appointments.
  (b) Not later than 15 days after the date a majority of the initial
  certified district boards within a region have notified their respective
  interim regional board of the appointment of user members for their
  respective regional board under subsection (a)(1), such interim regional
  board shall certify the users so appointed as constituting, on the date
  of such certification, the regional board for the region.
  (2) With respect to each regional board certified under paragraph (1), the
  interim regional board that certified such board shall select a time, date,
  and location within its region for the holding of the initial meeting of
  such regional board, which date shall not be later than 15 days after the
  date of such certification, and shall notify the appointed and approved
  members of such board and the residents of its region of the time, date,
  and location of such meeting.
appointment of the national health board
  SEC. 117. (a) The Interim National Health Board shall, for purposes of
  appointing members of the National Health Board, assign each region to
  one of three groups of regions, each group having (to the extent possible)
  an equal number and balanced geographic distribution of regions.
  (b)(1) Not later than 60 days after the initial meeting of each regional
  board, called pursuant to section 116(b)(2), each such board for a region
  in the first two groups of regions (established under subsection (a))
  shall appoint (subject to the approval of the President) an eligible user
  in the region to serve as a user member of the National Health Board.
  (2) As soon as feasible, each such board for any other region shall appoint
  (subject to approval of the President) an eligible regional (or community
  or district, in the region) health worker to serve as a worker member of
  the National Health Board.
  (3) Each regional board shall promptly notify the Interim National Health
  Board and the President of each appointment under this subsection. The
  President shall approve or disapprove the appointment of such a member
  within the 10-day period beginning on the date of his notification of the
  appointment; and the appointment of such a member shall be considered as
  having been approved by the President unless he disapproves the appointment
  of the member within such time period.
  (c)(1) No later than 15 days after the date a majority of the appointments
  under subsection (b)(1) by initially certified regional boards have
  been approved by the President, the Interim National Health Board shall
  certify the individuals so approved as constituting, on the date of such
  certification, the National Health Board, and shall promptly notify the
  President and the Congress of such certification.
  (2) The Interim National Health Board shall select a time, date, and
  location for the holding of the initial meeting of the National Health
  Board, which date shall not be later than 15 days after the date of the
  certification under paragraph (1), and shall notify appointed and approved
  members and the public of the time, date, and location of such meeting.
subsequent election and appointment of members of health boards
  SEC. 118. (a) Members of health boards elected or appointed in accordance
  with sections 114 through 117 shall serve until their successors are
  certified in accordance with this section.
  (b)(1) The National Health Board shall arrange with State and local
  governments for an election for user members of each community board to be
  held on the date of, and in conjunction with, each election for Members of
  the United States House of Representatives that occurs after the effective
  date of health services.
  (2) An election for worker members of each community board shall be held
  on or about the date of each election specified in paragraph (1) and shall
  be held, to the extent feasible and consistent with section 114(c)(2)(B),
  in conjunction with the election under paragraph (1).
  (3) The provisions of section 114 (other than subsection (a) thereof) shall
  apply to elections of members of community boards under this subsection,
  except that for purposes of this subsection--
  (A) the term of each member elected under this subsection shall be 4 years,
  except that, in the case of the elections first held under this section,
  the term of half of the user members and of half of the worker members or,
  in the case of an odd number of user or worker members, the term of half
  plus one of such members shall be 2 years;
  (B) the individuals whose term of office does not expire following an
  election, as well as individuals elected in the election, are deemed to
  constitute the community board under section 114(d)(1); and
  (C) any reference to an interim regional board or to the Interim National
  Health Board in section 114 shall be considered as a reference to a regional
  board or to the National Health Board.
  (c)(1) Each regional board shall, for purposes of appointing worker members
  of district boards within its region, assign each community to one of
  two groups of communities within each district, each group having (to
  the extent possible) an equal number and balanced geographic distribution
  of communities.
  (2) Not later than 60 days after the initial meeting of each community board
  (newly certified after an election under subsection (b))--
  (A) in the case of the first new certification of such a board--
  (i) user members of each such board shall appoint two eligible users in the
  community, one of whom shall serve a 4-year term as a user member of their
  respective district board and the other a 2-year term on such board; and
  (ii) worker members of each such board for a community in the first group
  of communities (established under paragraph (1)) shall appoint an eligible
  community health worker to serve a 4-year term as a worker member of their
  respective district board, and worker members of each such board for a
  community in the second group of communities shall appoint an eligible
  community health worker to serve a 2-year term on such board;
  (B) in the case of a subsequent new certification of such a board--
  (i) user members of each such board shall appoint an eligible user for a
  4-year term; and
  (ii) worker members of each such board for a community in a group of
  communities that did not appoint a worker member to serve a 4-year term
  after the previous certification shall appoint an eligible community health
  worker to serve a 4-year term; and
  (C) beginning with the first new certification of such a board, and every 4
  years thereafter, the eligible district health workers shall, in accordance
  with section 114(c)(2)(B), elect an eligible district health worker to
  serve a 4-year term as a worker member of their respective district board.
The user and worker members of each such community board shall promptly
notify their respective regional board of such appointments.
  (3) Not later than 15 days after the date a majority of the newly certified
  community boards within a district have notified their respective regional
  board of the appointment or election of individuals for their respective
  district boards under paragraph (2), such regional board shall certify
  the users and workers whose term of office does not expire at the time of
  such appointments or elections, as well as individuals newly appointed or
  elected, as constituting, on the date of such certification, the district
  board for the district.
  (4) For each district board certified under paragraph (3), the respective
  regional board shall select a time, date, and location within the district
  of such district board for the holding of the initial meeting of such
  new board, which date shall be not later than 15 days after the date of
  such certification, and shall notify the members of such board appointed
  under this subsection and the residents of the district of the time, date,
  and location of such meeting.
  (d)(1) The National Health Board shall, for purposes of appointing worker
  members of regional boards, assign each district to one of two groups of
  districts within each region, each group having (to the extent possible)
  an equal number and balanced geographic distribution of districts.
  (2) Not later than 60 days after the initial meeting of each newly certified
  district board (held pursuant to subsection (c)(4))--
  (A) in the case of the first new certification of such a board--
  (i) user members of each such board shall appoint two eligible users in the
  district, one of whom shall serve a 4-year term as a user member of their
  respective regional board and the other a 2-year term on such board; and
  (ii) worker members of each such board for a district in the first group
  of districts (established under paragraph (1)) shall appoint an eligible
  district (or community, within the district) health worker to serve a
  4-year term as a worker member of their respective regional board, and
  worker members of each such board for a district in the second group of
  districts shall appoint an eligible district (or community, within the
  district) health worker to serve a 2-year term on such board;
  (B) in the case of a subsequent new certification of such a board--
  (i) user members of each such board shall appoint an eligible user for a
  4-year term; and
  (ii) worker members of each such board for a district in a group of districts
  that did not appoint a worker member to serve a 4-year term after the
  previous certification shall appoint an eligible district (or community,
  within the district) health worker to serve a 4-year term; and
  (C) beginning with the first new certification of such a board, and every 4
  years thereafter, the eligible regional health workers shall, in accordance
  with section 114(c)(2)(B), elect an eligible regional healthworker to
  serve a 4-year term as a worker member of their respective regional board.
The user and worker members of each such district board shall promptly notify
the National Health Board of such appointments.
  (3) Not later than 15 days after the date a majority of the newly certified
  district boards within a region have notified the National Health Board of
  the appointment or election of individuals for their respective regional
  boards under paragraph (2), the National Health Board shall certify the
  users and workers whose term of office does not expire at the time of
  such appointments or elections, as well as individuals newly appointed or
  elected, as constituting, on the date of such certification, the regional
  board for the region.
  (4) For each regional board newly certified under paragraph (3),
  the previously certified regional board shall select a time, date, and
  location within the region for the holding of the initial meeting of such
  new board, which date shall not be later than 15 days after the date of
  such certification, and shall notify the members of such board appointed
  and approved under this subsection and the residents of the region of the
  time, date, and location of such meeting.
  (e)(1) Not later than 60 days after the initial meeting of each newly
  certified regional board, held pursuant to subsection (d)(4)--
  (A) in the case of the first new certification of such a board--
  (i) each such board for a region in the first group of regions (established
  under section 117(a)) shall appoint (subject to the approval of the
  President) an eligible regional (or community or district, in the region)
  health worker, and
  (ii) each such board for any other region shall appoint (subject to the
  approval of the President) an eligible user in the region,
to serve a 4-year term as a member of the National Health Board; and
  (B) in the case of a subsequent new certification of such a board occurring
  when the terms of office of members of the National Health Board are
  expiring--
  (i) each such board for a region in a group of regions that has appointed
  an eligible user to serve as a member of the National Board for the
  previous two appointments under this subsection or section 117(b) shall
  appoint (subject to the approval of the President) an eligible regional
  (or community or district, in the region) health worker, and
  (ii) each such board for any other region shall appoint (subject to the
  approval of the President) an eligible user in the region,
to serve a 4-year term as a member of the National Health Board. Each such
board shall promptly notify the National Health Board and the President of
such appointment. The President shall approve or disapprove the appointment
of such a member within the 10-day period beginning on the date of his
notification of the appointment; and the appointment of such a member shall
be considered as having been approved by the President unless he disapproves
the appointment of the member within such time period.
  (2) No later than 15 days after the date a majority of the appointments
  under paragraph (1) by newly certified regional boards have been approved by
  the President, the National Health Board shall certify the individuals so
  approved as constituting, on the date of such certification, the National
  Health Board and shall promptly notify the President and Congress of such
  certification.
  (3) The previously certified National Health Board shall select a time,
  date, and location for the holding of the initial meeting of the new
  National Health Board, which date shall not be later than 15 days after
  the date of certification of such Board under paragraph (2), and shall
  notify the members appointed and approved under this subsection and the
  public of the time, date, and location of such meeting.
modification of the boundaries of health care delivery areas
  SEC. 119. (a) No later than 2 years after each decennial national census,
  and at such other times as it deems necessary, the National Health Board
  shall review the appropriateness of the boundaries of each health care
  delivery region and may, in accordance with subsection (b), modify the
  boundary of any region in which there has been a substantial shift of
  population justifying such modification, if such modification is approved
  in a referendum of registered users residing in an area whose regional
  identification would be changed by making such modification.
  (b) At least 60 days before the modification by referendum of the boundary
  of any region, the National Health Board shall provide for--
  (1) notice in the area whose regional identification would be changed by
  the modification of such boundaries--
  (A) of existing boundaries and of the proposed modification, and
  (B) of the date, time, and location of the public hearing on such
  modification, as required in paragraph (2), and
  (2) a public hearing at which individuals can speak or present written
  statements relating to the modification of such boundaries.
  (c)(1) After the establishment of regional health boards under section 116--
  (A) no later than 2 years after each decennial national census,
  (B) upon receipt of a petition for modification of a boundary of a district
  or community within the region of such board, which petition is signed
  by not less than 15 percent of the registered users residing in an area
  whose district or community identification would be changed by adoption
  of such petition, and
  (C) at such other times as it deems appropriate,
each regional board shall review the appropriateness of the boundaries of
districts and communities within its region.
  (2) Any review conducted under paragraph (1) shall comply with the procedures
  of subsection (d) (relating to open hearings and public participation).
  (3) A regional board, after reviewing the boundaries of a district or
  community within its region under paragraph (1), may modify the boundary
  of any such district or community if--
  (A) there has been a substantial shift of population justifying such
  modification, or
  (B) such modification would better carry out the purposes of this Act, and
if such modification is approved in a referendum, held after notice and
a public hearing in accordance with subsection (d), of registered users
residing in an area whose district or community identification would be
changed by adoption of the proposed modification.
  (d) At least 60 days before the modification by referendum of the boundary of
  any district or community, the respective regional board shall provide for--
  (1) notice in the area whose district or community identification would
  be changed by the modification of such boundaries--
  (A) of existing boundaries and of the boundaries proposed to be modified, and
  (B) of the date, time, and location of the public hearing on such
  modification, as required in paragraph (2), and
  (2) a public hearing at which individuals can speak or present written
  statements relating to the modification of such boundaries.
Part C--General Provisions Regarding Health Boards
definitions
  SEC. 121. As used in this part, the term `full member' means, with respect
  to a health board, a member of such board other than an associate member
  described in section 122(a)(4).
membership of health boards
  SEC. 122. (a) Each health board shall be composed of--
  (1) members elected or appointed and approved in accordance with this part B;
  (2) one member--
  (A) in the case of a community board, appointed by the occupational
  safety and health action council established under section 412 for such
  community, and
  (B) in the case of a regional board, appointed by the occupational safety
  and health action council established under section 413 for such region;
  (3) such voting user members as the members of the board described in
  paragraphs (1) and (2) may determine from time to time (in consultation
  with elements of the population from which the members are being selected)
  to be necessary in order to ensure that (1) the user members of the board
  approximate the population within its area by race, sex, income level,
  and language and (2) segments of the population having special health
  needs (such as the physically and mentally handicapped and the aged)
  are appropriately represented; and
  (4) such nonvoting associate members as the members of such board may
  determine from time to time to be necessary to provide appropriate
  representation of appropriate units of State, territorial, and local
  government and of segments of the population having special health needs;
  and in the case of the Interim National Health Board and National Health
  Board, to carry out the purposes of this Act.
  (b)(1) Except as provided in paragraph (2), no individual may serve as
  a full member of a health board in a community, district, or region,
  or of the National Health Board, for more than four consecutive years,
  exclusive of any time that might be served as a member by election or
  appointment (A) before the effective date of health services, (B) for a
  2-year term under section 118(b)(3)(A), 118(c)(2)(A), or 118(d)(2)(A), or
  (C) by appointment under subsection (d) to fill a vacancy.
  (2) Full members of a health board shall serve until their successors are
  certified in accordance with this Act.
  (c)(1)(A) Within 60 days of the date of the presentation to the appropriate
  regional board of a petition, signed by at least 15 percent of the number
  of registered users residing in a community or of eligible area health
  workers, requesting the recall of a user member or elected worker member,
  respectively, of a board elected and approved in accordance with this title,
  such regional board shall conduct an election on the recall of such member.
  (B) The provisions of section 114 (except for subsection (a) thereof) and
  procedures established thereunder regarding elections of user and worker
  members shall apply with respect to recall elections conducted under this
  paragraph, except that for the purposes of this paragraph, any reference
  in such section to an interim regional board or to the Interim National
  Health Board shall be considered as a reference to a regional board or to
  the National Health Board, respectively.
  (2) A member of a district or regional board or an interim regional board
  appointed in accordance with this title may be recalled from office by the
  affirmative vote of two-thirds of the members of the health board which
  appointed such member.
  (3) A member of the Interim National Health Board or National Health Board
  may be removed from office by the President for inefficiency, neglect of
  duty, malfeasance in office, or, in the case of the National Health Board,
  upon recommendation by the affirmative vote of two-thirds of the members
  of the regional board which nominated such member.
  (d)(1) A vacancy caused by the death, resignation, or removal of a member
  (hereinafter in this subsection referred to as a `vacating member') of a
  health board, elected or appointed in accordance with this title, before
  the expiration of the term for which such vacating member was elected
  or appointed, shall be filled not later than 60 days after the date of
  such vacancy--
  (A) in the case of a member of a community board, by election of an
  eligible individual, in accordance with section 114 (except for subsection
  (a) thereof);
  (B) in the case of a member of a district or regional board, an interim
  regional board, or the National Health Board, by appointment or election
  and, in the case of the National Health Board, Presidential approval of
  an eligible individual by the health board or workers which appointed or
  elected such vacating member; and
  (C) in the case of a member of the Interim National Health Board, by
  appointment by the President.
  (2) Any individual appointed to fill a vacancy under this subsection shall
  serve only for the unexpired term of office of the vacating member.
  (3) For the purposes of this subsection, the term `eligible individual'
  means, with respect to filling the place of a vacating member, an individual
  who is eligible, under the applicable provisions of this Act, to serve on
  a health board in the capacity in which the vacating member was elected
  or appointed.
meetings and records of health boards
  SEC. 123. (a)(1) Each full member of a health board shall have one vote
  in meetings of such board.
  (2) A majority of the full members of each health board shall constitute
  a quorum for the transaction of the business of such board, and such board
  shall act upon the vote of a majority of the full members present and voting.
  (b)(1) Except as otherwise provided in this Act, the full members of each
  health board shall, at the first meeting following the certification of
  such board, elect a chairperson and vice chairperson from among the full
  members of such board.
  (2) The chairperson of each health board shall be responsible for
  convening meetings of such board and for such other duties as such board
  may assign. Upon the written request of two full members of such board,
  the chairperson shall convene a meeting of such board.
  (3) The vice chairperson shall perform the duties of the chairperson in
  the event that the chairperson is unable to perform such functions.
  (c)(1) Each health board shall provide for the recording of the minutes
  of each of its meetings and each of the meetings of its committees and
  advisory groups, and shall make such records available to the public for
  inspection and copying.
  (2) Meetings of each health board and each committee and advisory group
  thereof (except meetings that concern an individual user or health worker,
  and such individual requests that the meeting be closed) shall be open
  to the public and shall be held at such times and in such places as the
  board determines to be convenient to attendance by the public.
  (3) Each health board shall establish a principal office within the area
  it serves.
  (d) Each health board shall disseminate within the area it serves full
  information regarding its activities, including the furnishing of health
  care and supplemental services.
  (e)(1) Each health board may establish such rules, consistent with this
  Act, as it finds necessary for the effective and expeditious transaction
  of its duties and functions.
  (2) Each health board may establish such committees and advisory groups,
  and appoint to them such individuals (including health workers), as it
  deems necessary to carry out its duties and functions.
  (f)(1) A full member of the Interim National Health Board or National
  Health Board may receive compensation at a rate not to exceed the daily
  equivalent of the annual rate of basic pay in effect for grade GS-18 of
  the General Schedule for each day (including traveltime) during which
  the member is engaged in the actual performance of such member's duties
  plus reimbursement for travel, subsistence, and other necessary expenses
  incurred in the performance of such member's duties.
  (2) A full member of a health board, other than the Interim National
  Health Board of the National Health Board, may receive such amounts per
  diem when engaged in the actual performance of such member's duties, or
  such annual salary, plus reimbursement for travel, subsistence, and other
  necessary expenses incurred in the performance of such member's duties,
  as the appropriate National Health Board may establish.
procedures for establishment of national guidelines and standards
  SEC. 124. (a) In addition to guidelines and standards otherwise required
  to be established by this Act, the National Health Board shall establish
  such guidelines and standards as will facilitate the implementation of the
  objectives of this Act and as will encourage innovation and experimentation
  in the implementation of these objectives.
  (b) The National Health Board shall submit, at least 90 days before the
  date of establishment of a guideline or standard under this Act, each such
  guideline or standard to regional boards for their review and comments.
  (c) The National Health Board and the regional boards shall establish
  programs that provide orientation, education, and technical assistance
  to members of area health boards in the use and application of guidelines
  and standards established by the National Health Board.
assistance to area health board members
  SEC. 125. Each regional board shall provide orientation, education, and
  technical assistance to members of district and community boards in its
  region, and the appropriate National Health Board shall provide such support
  to members of regional boards, to insure that such members are prepared
  to perform their duties as members of such boards with maximum effectiveness.
TITLE II--DELIVERY OF HEALTH CARE AND SUPPLEMENTAL SERVICES
Part A--Patients' Rights in Health Care Delivery
basic health rights
  SEC. 201. The Service, in its delivery of health care services to users,
  shall ensure that every such individual is given the following basic
  health rights:
  (1) The right to receive high quality health care and supplemental services
  without charge and without discrimination on account of race, sex, age,
  religion, language, income, marital status, sexual orientation, dress,
  or previous health status.
  (2) The right to humane, respectful, dignified, and comforting health care,
  and to the reduction of pain and distressful symptoms.
  (3) The right to have health care services delivered in a convenient and
  timely manner.
  (4) The right to choose the health workers who shall be responsible for,
  and the health facilities in which to receive, the individual's health
  care services.
  (5) The right of access to all information, including the individual's
  health records and the medical dictionary produced under section 433(b),
  which promotes an understanding of health, except when a review committee
  (the majority of whose members are users) established by the area health
  board maintaining the information has determined that the provision of
  the specific information would be harmful to the individual.
  (6) The right to have all health care information, reports, and educational
  materials translated into the individual's primary language.
  (7) The right to receive, prior to the delivery of any health care service,
  a careful, prompt, and intelligible--
  (A) explanation of the indications, diagnoses, benefits, side-effects,
  and risks involved in the delivery of such service, and a description of
  alternatives to such service (including no treatment);
  (B) answer to any question relating to such health care service; and
  (C) explanation of one's health rights described in this part, and
the right to have such health care service delivered only with the individual's
prior, voluntary, written consent.
  (8) The right to refuse the initial or continuing delivery of any health
  care service whenever such refusal does not directly endanger the public
  health or, in accordance with State law, of the individual if the individual
  is dangerous to himself or herself.
  (9) The right to have all individually identifiable information and documents
  treated confidentially and not disclosed (except for statistical purposes
  and for the control of communicable diseases, drug abuse, and child abuse)
  without the individual's prior, voluntary, and written consent.
  (10) The right of access at all times to individuals or groups for
  counseling, health information, and assistance on health matters.
  (11) The right to be accompanied and visited at any time by a friend,
  relative, or independent advocate of the individual's choosing, and the right
  to have routine services, such as feeding, bathing, dressing, and bedding
  changes, performed by a friend or relative, if the individual so chooses.
  (12) The right, in the event of terminal illness, to die with a maximum
  degree of dignity, to be provided all necessary symptom relief, to be
  provided (and for the individual's family to be provided) counseling and
  comfort, and to be allowed (if desired) to die at home.
  (13) The right of access to a complaint and grievance system and to legal
  assistance to enforce these rights.
right to paid leave to receive health care services
  SEC. 202. (a) The Fair Labor Standards Act of 1938 is amended by inserting
  after section 7 (29 U.S.C. 207) the following new section:
`minimum health leave compensation
  `SEC. 7A. Each employee of any employer who in any workweek is engaged in
  commerce or in the production of goods for commerce, or is employed in an
  enterprise engaged in commerce or in the production of goods for commerce,
  shall be entitled to receive from the employer, for each 35 hours he is
  employed by the employer (not counting more than 35 hours in any workweek),
  compensation for one hour of employment at the regular rate at which
  the employee is employed (as that term is used in section 7 of this Act)
  for an hour (1) during the period of 52 weeks beginning with the workweek
  with which the entitlement is earned, and (2) during which the employee
  is unable to work because of the need for the employee (or a dependent of
  that employee) to receive necessary health care services.'.
  (b) The Fair Labor Standards Act of 1938 is further amended--
  (1) by striking out `sections 6 and 7' in section 3(o) and inserting in
  lieu thereof `sections 6, 7, and 7A';
  (2)(A) by striking out `and 7' in section 13(a) before paragraph (1)
  and inserting in lieu thereof `, 7, and 7A';
  (B) by striking out `sections 6 and 7' in section 13(a)(3) and inserting
  in lieu thereof `sections 6, 7, and 7A';
  (C) by inserting `7A,' in subsections (d) and (f) of section 13 after `7,'
  each place it appears;
  (3) by striking out `6 and 7' in section 14(d) and inserting in lieu thereof
  `6, 7, and 7A';
  (4) by striking out `section 6 or section 7' in section 15(a) and inserting
  in lieu thereof `section 6, 7, or 7A';
  (5)(A) by striking out `section 6 or section 7' in section 16(b) and
  inserting in lieu thereof `section 6, 7, or 7A';
  (B) by striking out `or their unpaid overtime compensation' in section
  16(b) and inserting in lieu thereof `their unpaid overtime compensation,
  or their unpaid health leave compensation';
  (C) by inserting `or of unpaid health leave compensation' in section 16(b)
  after `amount of unpaid overtime compensation';
  (D) by striking out `section 6 or 7' in the first sentence of section 16(c)
  and inserting in lieu thereof `section 6, 7, or 7A';
  (E) by striking out `unpaid overtime compensation' in the first sentence of
  section 16(c) and inserting in lieu thereof `, unpaid overtime compensation,
  or unpaid health leave compensation';
  (F) by striking out `or overtime compensation' in the second sentence
  of section 16(c) and inserting in lieu thereof `, overtime compensation,
  or health leave compensation';
  (G) by striking out `or unpaid overtime compensation under sections 6 and
  7' in the third sentence of section 16(c) and inserting in lieu thereof
  `, unpaid overtime compensation, or unpaid health leave compensation under
  sections 6, 7, and 7A';
  (6)(A) by inserting `or minimum health leave compensation higher than the
  minimum health leave compensation established under this Act' in the first
  sentence of section 18(a) before `, and no provision'; and
  (B) by inserting `, or justify any employer in reducing health leave
  compensation provided by him which is in excess of the applicable minimum
  health leave compensation under this Act' before the period at the end of
  the second sentence of section 18(a).
Part B--Eligibility for, Nature of, and Scope of Services Provided by
the Service
eligibility for services
  SEC. 211. (a) All individuals while within the United States are eligible
  to receive health care and supplemental services under this Act.
  (b) For purposes of this section, the term `United States' includes the
  District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands,
  Guam, Samoa, and the Northern Mariana Islands.
entitlement to services
  SEC. 212. (a) Except as provided in subsection (b), the Service shall,
  on and after the effective date of health services, provide users with
  all health care services and supplemental services described in section
  213 which the Service determines, in accordance with this title, to be
  necessary or appropriate for the promotion and enhancement of health,
  for the prevention of disease, and for the diagnosis and treatment of,
  and rehabilitation following, injury, disability, or disease.
  (b) Services provided under this Act shall not include personal comfort
  or cosmetic services unless the area health board providing the services
  determines that the services are required for health-related reasons.
provision of health care and supplemental services
  SEC. 213. (a) The Service shall provide in the United States the following
  health care services in or through facilities established by the Service--
  (1) the promotion of health and well-being through health education programs
  to be carried out in facilities of the Service as well as in workplaces,
  schools, and elsewhere utilizing all appropriate media, and by assisting
  other Government agencies in taking appropriate actions to promote health
  and well-being;
  (2) the prevention of illness, injury, and death through education and
  advocacy addressed to the social, occupational, and environmental causes
  of ill-health; through the provision of appropriate preventive services
  including social, medical, occupational, and environmental health services,
  on both an emergency and sustained basis; through screening and other
  early detection programs to identify and ameliorate the primary causes of
  ill-health; and, where appropriate, through actions taken on an emergency
  basis to halt environmental threats to life and health;
  (3) the diagnosis and treatment of illness and injury, including emergency
  medical services, comprehensive outpatient and inpatient health care
  services, occupational health services, mental health services, dental care,
  long-term care, and home health services;
  (4) the rehabilitation of the sick and disabled, including physical,
  psychological, occupational, and other specialized therapies; and
  (5) the provision of drugs, therapeutic devices, appliances, equipment,
  and other medical supplies (including eyeglasses, other visual aids,
  dental aids, hearing aids, and prosthetic devices) certified effective
  in the National Pharmacy and Medical Supply Formulary (published under
  section 432(a)) and furnished or prescribed by authorized health workers.
The Service may not provide such health care services in a region, district,
or community other than under the auspices of a regional, district, or
community board established in accordance with this Act.
  (b) The Service shall provide the following services supplemental to the
  delivery of health care services in or through health care facilities
  established by the Service--
  (1) ambulance and other transportation services to insure ready and timely
  access to necessary health care;
  (2) child care services for individuals who, during the time they receive
  outpatient health care services from the Service or are working in a health
  care facility of the Service, are responsible for a child's care; and
  (3) homemaking and home health services--
  (A) to enable the provision of inpatient health services at a health care
  facility of the Service to an individual who has the sole responsibility
  for the care (i) of a child under 15 years of age, or (ii) of a physically
  or mentally handicapped individual who requires the care of another
  individual, and
  (B) for the bedfast or severely handicapped individual, when provision of
  such services eliminates the need for the individual to receive inpatient
  services; and
  (4) such counseling and social service assistance as will avoid the
  unnecessary provision of health care services.
  (c) The Service shall conduct the functions, especially those related to
  environmental health and the prevention of illness, currently performed
  by the departments of health of the States and localities, to the extent
  consistent with Federal, State, and local law, and shall cooperate with
  State and local governments in its conduct of such functions.
  (d) The Service shall provide, at rates established by the National Health
  Board, for reimbursement of the cost of emergency health care services
  furnished in facilities not operated by the Service or by health workers not
  employed by the Service, when an injury or acute illness requires immediate
  medical attention under circumstances making it medically impractical for
  the ill or injured individual to receive care in a Service facility or by
  an employee of the Service.
Part C--Health Care Facilities and Delivery of Health Care Services
establishment of health care facilities and distribution of delivery of
health care and other services
  SEC. 221. (a)(1) Each community board shall, not later than the effective
  date of health services and to the maximum extent feasible, establish and
  maintain in its community such health care facilities as are necessary for
  the efficient and effective delivery to individuals residing in its community
  of comprehensive primary health care services (defined in paragraph (2)),
  specialized health care services (defined in paragraph (3)), special services
  (defined in paragraph (4)) and community-oriented health measures (defined
  in paragraph (5)). Such health care facilities shall be established and
  maintained in a manner that, as soon as possible and to the greatest extent
  feasible, provides services through a single comprehensive health center.
  (2) As used in paragraph (1), the term `comprehensive primary health care
  services' means those basic outpatient health care services typically
  needed for the promotion of health and the prevention and treatment of
  common illnesses and includes the following health care services--
  (A) general primary medical and dental care, including diagnosis and
  treatment, routine physical examinations, laboratory, and radiologic
  services, and home visits by health workers, as appropriate;
  (B) preventive health services, including immunizations, nutrition counseling
  and consultation, and periodic screening and assessment services;
  (C) children's health services, including assessment of growth and
  development, education and counseling on childrearing and child development,
  and school and day-care center health services;
  (D) obstetrical and gynecological services, including family planning and
  contraceptive services, pregnancy (prenatal and postnatal) and abortion
  counseling and services;
  (E) comprehensive geriatric services;
  (F) vision and hearing examinations and provision of eyeglasses and other
  visual aids and hearing aids;
  (G) 24-hour emergency medical services;
  (H) provision of pharmaceuticals and therapeutic devices, and medical
  appliances and equipment;
  (I) mental health services, including psychological and psychiatric
  counseling;
  (J) home health services; and
  (K) occupational safety and health services, including screening, diagnosis,
  treatment, and education.
  (3) As used in paragraph (1), the term `specialized health care services'
  means those health care services of a specialized nature (whether delivered
  in an inpatient or outpatient setting) which, applying guidelines established
  by the National Health Board and by the respective regional board, may be
  provided most effectively and efficently in a community setting.
  (4) As used in paragraph (1), the term `special services' means supportive
  services and the facilities (including nursing homes and multiservice
  centers) in which such services are provided for individuals who are
  physically or mentally handicapped, mentally ill, infirm, or chronically
  ill, so as to promote the integration and functioning of such individuals
  within the community.
  (5) As used in paragraph (1), the term `community-oriented health measures'
  includes efforts to focus organized community activities upon the promotion
  of health and the prevention of illness and injury, support for self-help
  and mutual aid groups offering health promotion and rehabilitative
  support programs; surveillance of potential threats to community health,
  and prompt action to protect against such threats, and includes outreach
  efforts to ensure that all residents are aware of and able to utilize the
  health services of the Service, as needed.
  (b) Each district board shall, not later than the effective date of health
  services, establish and maintain in its district--
  (1) a general hospital for the efficient and effective delivery of health
  care services to individuals residing in the district requiring inpatient
  diagnosis, treatment, care, and rehabilitation for injury or illness; and
  (2) such other health care facilities as are necessary, using guidelines
  established by the National Health Board and by the respective regional
  board, to promote the efficient and effective delivery of health care
  services within its district.
In addition, each district board shall provide such health care services of a
specialized nature (whether delivered in an inpatient or outpatient setting)
as, taking into account guidelines established by the National Health Board
and its respective regional board, may be provided most effectively and
efficiently at the district level.
  (c) Each regional board shall, not later than the effective date of health
  services, establish and maintain in its region--
  (1) a regional medical facility for the efficient and effective delivery
  of highly specialized health care services, using guidelines established by
  the National Health Board, to individuals residing in the region requiring
  highly specialized treatment, care, and rehabilitation for injury or illness;
  (2) health care and supplemental services for individuals whose health care
  needs otherwise cannot be met by community or district boards because of
  occupational or other factors, including individuals residing within the
  region on a temporary or seasonal basis (including migratory agricultural
  workers) and individuals confined to prisons and other correctional
  institutions; and
  (3) such other health care facilities as are necessary to promote the
  efficient and effective delivery of health care services within its region.
  (d) Each area health board, taking into account guidelines established by
  the National Health Board, shall provide the following through its health
  care facilities established pursuant to this section:
  (1) Health promotion through education on personal health matters,
  nutrition, the avoidance of illness, and the effective use of health
  care services with particular emphasis on the appropriate and safe use
  (discouraging the overuse) of drugs and medical techniques.
  (2) Maintenance and appropriate transmission and transferral of personal
  health records for each user of the services of the board consistent with
  section 201(9).
  (3) Referral services, including referrals, where appropriate, to health
  care facilities established by other boards.
  (4) Supplemental services (described in section 213(b)), as appropriate.
  (5) Assistance to individuals who, because of language or cultural
  differences or educational or other handicaps, are unable fully to utilize
  the services available from and delivered by the board.
  (6) Information (A) on the rights ensured under this Act, (B) on the
  guidelines and standards established by the appropriate National Health
  Board, and (C) on how the area health board is implementing such rights
  and applying such guidelines and standards.
  (7) Information on the grievance mechanisms established pursuant to part
  A of title IV and on legal services available to pursue grievances against
  the board.
  (8) Environmental health inspection and monitoring services, including
  investigations relating to the prevention of communicable diseases, in
  cooperation with State and local authorities in the board's area.
  (9) Research and data-gathering on the leading causes of ill-health in
  the board's area and on health care delivery, in accordance with section 421.
  (10) In the case of each inpatient health care facility, discharge
  planning and followup services (A) to identify patients who will need
  continuing care after discharge from the facility and (B) to plan, with
  the patient and the patient's family, arrangements and referrals to meet
  such postdischarge needs.
  (e)(1) Each area health board shall, in establishing health care facilities
  under this section, hire health workers (including administrative personnel)
  in sufficient numbers and with appropriate qualifications to ensure that
  such facilities provide the health care and other services described in
  this section.
  (2) In its establishment of health care facilities under this section,
  each area health board shall purchase or lease such premises as it deems
  necessary and suitable, utilizing, where appropriate, existing health
  facilities, including health centers and clinics, hospitals, nursing homes,
  and medical laboratories.
  (3) In its establishment of health care facilities under this section, each
  area health board shall seek to minimize fragmentation and duplication in
  delivery of health care and other services so as to promote the effective
  and efficient delivery of such services.
  (4) Each regional board, taking into account guidelines established by
  the National Health Board, shall provide for affiliation and coordination
  of the operation and staff of the health care facilities in its region
  with the operation and staff of other appropriate health care facilities
  established within the region such board serves and within adjacent regions.
  (f) The National Health Board shall establish guidelines for distribution
  and coordination of the delivery of health care and other services described
  in this section and shall, before the effective date of health services,
  plan and facilitate the transition to the new distribution of health care
  facilities and health workers to be effected on and after that date.
  (g) In the case that a community or district board fails, on the effective
  date of health services, to substantially and materially provide health care
  and supplemental services in accordance with this section, its respective
  regional board shall take such steps as it deems necessary, consistent
  with the provisions of section 402 (relating to grievance proceedings),
  to provide health care and supplemental services to users in the community
  or district affected. Such steps may include, in addition to appointment
  of a trustee or trustee committee under section 402(d)(3)(D)--
  (1) requiring that the community or district board in an adjacent community
  or district provide such services to users residing in the community or
  district affected, or
  (2) providing reimbursement for the provision of specified health care
  services in accordance with procedures and schedules in effect under title
  XVIII of the Social Security Act immediately before the effective date
  of health services (except that only users in the affected community or
  district shall be considered as entitled to receive such specified services
  under such title).
Paragraph (2) shall not apply on and after three years after the effective
date of health services.
operation and inspection of health care facilities
  SEC. 222. (a)(1) Each health board, with respect to each health care
  facility it has established, shall establish policies and organizational
  plans consistent with this section and with parts A and C of title III
  (relating to the health labor force) for the operation of such facility
  and shall establish procedures to ensure that the facility is operated in
  accordance with such policies and plans.
  (2) In establishing, implementing, and modifying such policies and plans,
  each health board shall seek the fullest possible participation of health
  workers who are employed in, and users who receive health care services
  from, health care facilities affected by such policies and plans.
  (3) If a health board that has established more than one health care facility
  determines that it cannot itself effectively manage the operation of all such
  facilities or if a facility serves principally a population with special
  health needs which is not appropriately represented on the health board,
  the health board may provide for the establishment of a health care facility
  board or boards, composed of users and health workers (or representatives
  of users or workers of a facility or facilities) in an appropriate number
  and in a proportion approximating that on the health board, to assume the
  duties of the health board with respect to the operation of the facility
  or facilities involved.
  (b) Such policies and plans shall provide for--
  (1) the management of each facility by the workers in such facilities
  through mechanisms which provide full participation of health workers of
  all job categories and skill levels employed in such facility;
  (2) the elimination of dominance by health professionals and the
  encouragement of cooperation and mutual respect among all health workers; and
  (3) regular accountability of the health workers to the health board
  which established the facility for the efficient and effective operation
  of the facility.
  (c)(1) On and after 3 years after the effective date of health services,
  a health board may not permit a health care facility it has established
  to be used for the private delivery of inpatient or outpatient health
  care services.
  (2) No individual employed by a health board may engage in the private
  delivery of health care services.
  (3) For the purposes of this subsection, the term `private delivery of
  health care services' means the delivery of health care services for which
  an individual, group, or organization receives remuneration from any source
  other than the Health Service Trust Fund established in section 511.
  (d) Each health board shall ensure that any health care facility that it
  operates which provides health care services on an outpatient basis is
  open during hours that will permit all users to make use of such services.
  (e)(1) Each health board shall ensure that any health care facility that
  it operates which provides (or is designed to provide) substantial health
  care services on an inpatient basis to individuals over a continuous period
  of 30 days or longer--
  (A)(i) provides comfortable living quarters for inpatients that are clean
  and adequately heated, cooled, and ventilated;
  (ii) provides adequate staff for its inpatients;
  (iii) provides nutritional food for its inpatients;
  (iv) provides inpatients with opportunities for creative activity and
  recreation;
  (v) establishes and maintains a review committee in accordance with paragraph
  (2); and
  (vi) informs an inpatient of all decisions involving the inpatient's health
  and well-being and permits the inpatient (and the review committee upon
  the inpatient's request) to participate fully in such decisions;
  (B) and does not--
  (i) censor or harass communication between an inpatient and others by
  telephone, letter, or in person;
  (ii) confiscate personal property of an inpatient, unless possession of
  such property would interfere with the provision of health care;
  (iii) deny an inpatient the social and sexual life of such individual's
  preference;
  (iv) require that an inpatient work;
  (v) pay an inpatient less than minimum wage for work performed while
  receiving health care services;
  (vi) physically restrain an inpatient involuntarily for a period exceeding
  72 hours without the facility's review committee (described in paragraph
  (2)) determining, within 72 hours of its initiation and not less often than
  every 2 weeks during which such restraint is continued, that such restraint
  is required for the physical safety of the inpatient or of others; or
  (vii) take punitive or discriminatory action (including transfer between
  or within facilities, changes in physical comforts and diets, changes in
  opportunities for social interaction and communication, or restriction
  of full participation in recreational and creative activities) without
  the prior approval, and renewed approval not less often than every week
  thereafter, of the facility's review committee (described in paragraph (2)).
  (2)(A) Each health board shall provide that at least once each year the
  inpatients at that time of each health care facility it operates which
  provides (or is designed to provide) health care services on an inpatient
  basis to individuals over a continuous period of 30 days or longer shall
  elect, from among themselves and any representatives of user associations
  which have a demonstrated interest in the care of such inpatients, a review
  committee (hereinafter in this paragraph referred to as the `committee')
  of not less than 3 members.
  (B) Any member of the committee may be recalled by a vote of two-thirds
  of the number of inpatients in the facility.
  (C) In any election or recall under this paragraph any inpatient who is
  not able to vote for any reason shall be permitted to appoint another
  individual to vote as proxy.
  (f) In order to assure that quality care is provided in health care
  facilities of the Service--
  (1) each area health board shall conduct regular inspections of health
  care facilities it has established,
  (2) each regional board shall conduct regular inspections of district and
  community health care facilities established in its region, and
  (3) the National Health Board shall conduct regular inspections of area
  and national health care facilities,
and the results of such inspections of a facility shall be reported to the
appropriate area health board and users of the facility and shall be made
available to the public.
provisions of health services relating to reproduction and childbearing
  SEC. 223. (a)(1) Area health boards, as appropriate, shall provide the
  following services:
  (A) Complete information on contraception and provision of birth control
  materials or medication of the individual's choosing.
  (B) Complete and effective evaluation and treatment of venereal diseases
  and diseases of the reproductive organs.
  (C) Complete information and counseling with respect to pregnancy,
  childbearing, and possible outcomes involving genetically induced anomalies.
  (2) Area health boards, as appropriate, shall provide the following services:
  (A) Complete and effective pregnancy testing.
  (B) Prenatal services, including physical examination, counseling, and
  instruction of expectant parents in nutrition, childrearing, and children's
  health care services.
  (C) Safe, comfortable, and convenient abortion services.
  (D) Counseling by women in conjunction with the provision of all gynecologic,
  female contraceptive, and abortion services and counseling by men for male
  fertility-related services.
  (3) The services described in paragraphs (1) and (2) shall be delivered
  without coercion or harassment, with complete confidentiality, and without
  prior approval of individuals other than the individual receiving the
  services.
  (4) An individual shall be permitted to be accompanied by a person of
  the individual's choice during the provision of the services described in
  paragraphs (1) and (2) to the extent this would not significantly increase
  the medical risk to the individual.
  (b) No area health board may perform upon an individual a treatment or
  procedure (other than a treatment or procedure required to preserve the
  life of the individual) which could reasonably be expected to affect the
  individual's capacity to reproduce children, unless (1) the individual has
  given voluntary written consent to the treatment or procedure after being
  given complete information on the effect of the treatment or procedure
  on the individual's reproductive capacity, and on possible alternative
  treatments and procedures, at least 30 days before beginning the treatment
  or procedure, and (2) the individual has, after such 30-day waiting period,
  again given written consent to the performance of the treatment or procedure,
  except that in the case of a woman who has given initial written consent
  to a sterilization she may be sterilized in less than 30 days following
  such consent (but in no case in less than 72 hours) if (A) she had given
  initial written consent at least 30 days before her anticipated delivery
  date, she delivers before the anticipated date, and the sterilization is
  performed at the time of delivery, or (B) she undergoes emergency abdominal
  surgery within the 30-day waiting period and the sterilization is concurrent
  with the abdominal surgery.
  (c) An area health board shall insure that, before a mastectomy or
  other breast cancer treatment is performed on a woman, the woman shall be
  provided with complete information on the complete range of medical options
  available for treatment of her condition and the risks and side effects
  of each option and an opportunity to consult individuals of her choice,
  and shall have given voluntary written consent to such procedure.
  (d) An area health board shall provide that a woman giving birth to an
  infant shall have the right to choose from a complete range of childbirth
  options including--
  (1) giving birth at home, in a birth center (if available), or in a hospital;
  (2) the presence during childbirth of a person or persons of her choosing;
  (3) the position for labor and delivery which she chooses;
  (4) caring for her infant at her bedside;
  (5) feeding her infant according to the method and schedule of her choice;
  and
  (6) selecting the birth attendant of her own choice.
She shall be provided with information on the benefits, risks, and side
effects of each option and an opportunity to consult individuals and groups
of her choosing for information and assistance on these options.
TITLE III--HEALTH LABOR FORCE
Part A--Job Categories and Certification
effect of state law
  SEC. 301. Notwithstanding any law of a State or political subdivision to
  the contrary, the Service, acting in accordance with the provisions of
  this Act, shall be the sole judge of the qualifications of its employees.
qualifications of health workers
  SEC. 302. (a) Each area health board shall, taking into account guidelines
  established by the National Health Board, establish procedures which will
  ensure that, except in emergency situations, any work which is classified
  under a job category established under this part is performed by a health
  worker who at the time of such work was (1) certified (in accordance with
  this part) as competent to perform the work under such job category, and
  (2) authorized to perform such work by the area health board which employs
  such worker.
  (b) Each area health board that employs health workers who perform work
  classified under a job category established under this part shall provide
  for the periodic review and assessment of the competency of such workers to
  perform the work within such job category, and shall provide opportunities
  for health workers to be assessed and certified with respect to skills
  required for advancement to other job categories.
  (c) In order to assure that health workers provide high quality health
  care services in the Service--
  (1) each regional board shall provide for periodic review and assessment
  of the performance of health workers employed by district and community
  boards in its region, and
  (2) the National Health Board shall provide for periodic review and
  assessment of the performance of health workers employed by regional boards
  and the National Health Board,
and the results of such examinations of health workers shall be reported to
the appropriate area health board and the users residing in the areas in which
the health workers are employed and shall be made available to the public.
establishment of job categories and certification standards
  SEC. 303. (a)(1) The National Health Board shall establish such guidelines
  for the classification, certification, and employment of health workers
  by job category as it determines to be necessary (A) to ensure that health
  workers who perform work for the Service which requires specialized skills
  have demonstrated that they possess such skills, (B) to expand the roles
  of health workers to enable them to participate in health care delivery
  to the maximum extent consistent with their skills, and (C) to provide for
  affiliation of health workers with health care facilities at the community,
  district, and regional levels. These guidelines shall permit alternative
  approaches to healing, and practitioners skilled in such approaches,
  when these approaches have not been demonstrated to be injurious to health.
  (2) In establishing guidelines under paragraph (1), the National Health
  Board shall provide for (A) sufficient flexibility to permit regional health
  boards to utilize health workers most effectively to meet the health needs
  of the region, and (B) sufficient uniformity to permit mobility of health
  workers among the regions.
  (3) In establishing guidelines under paragraph (1)(C), and as appropriate
  to the job responsibilities of the respective health workers, the National
  Health Board shall require that each health worker employed by a community
  board must work part of the time in a health care facility operated by
  the respective district or regional board, and that each health worker
  (including the faculty of health team schools) employed by a district
  or regional board must work part of the time in a health care facility
  operated by a community board within the district or region.
  (4) The National Health Board shall periodically evaluate the job categories
  and certification practices established by area health boards under this
  section and shall make such modifications to its guidelines as it determines
  will promote the delivery of quality health care services.
  (5) The National Health Board shall assist regional boards in applying
  the guidelines established under this subsection.
  (b)(1) For each job category (other than a job category determined by
  the National Health Board to involve highly specialized skills requiring
  advanced specialty training), each regional health board shall, taking
  into account the guidelines established under subsection (a), establish
  certification standards which shall specify--
  (A) the functions performed by a healthworker employed in such job category;
  (B) the skills required in the course of properly performing work under
  such job category;
  (C) the initial and continuing training, experience, and performance
  which must be undertaken or demonstrated by a health worker to achieve
  and maintain competency to perform the work within such job category; and
  (D) the curriculum which a health worker must follow in studies in a health
  team school (established under part B) to demonstrate sufficient competence
  to satisfy the specification of subparagraph (C) for such job category.
Each area health board within the region shall apply such standards to all
health workers employed by it. In applying such standards, such boards shall
recognize health worker training, experience, and performance undertaken or
demonstrated before the establishment of health team schools under part B,
subject to such periodic review and assessment and to such continuing training,
experience, or performance as may be required under this part.
  (2) For each job category established and determined by the National Health
  Board to involve highly specialized skills requiring advanced specialty
  training, the National Health Board shall make the specifications described
  in subparagraphs (A) through (D) of paragraph (1), and area health boards
  shall apply such certification standards to all health workers employed
  by them in such job categories.
  (3) A health board which establishes standards for a job category under this
  subsection shall periodically review such standards and shall supplement,
  modify, or eliminate such standards as it determines will facilitate the
  delivery of quality health care services under this Act.
Part B--Education of Health Workers
health team schools
  SEC. 311. (a)(1) Except as provided in paragraph (2), each regional board,
  in consultation with the community and district boards in its region,
  shall establish a health team school (hereinafter in this part referred
  to as a `school') in accordance with this section to provide programs
  of initial and continuing basic education in health care delivery for
  health workers in all job categories, and to provide initial continuing
  advanced education in health care specialties and health science specialty
  fields. Each school shall be established and functioning not later than
  4 years after the effective date of health services unless the National
  Health Board approves a plan, submitted by the regional board, for the
  establishment of a school within a reasonable time after such deadline.
  (2) If a regional board determines, after consultation with the community
  and district boards in its region, that conducting particular educational
  programs within a school in its region would be inefficient or otherwise
  inappropriate, it may collaborate with one or more regional boards for
  adjacent regions conducting joint educational programs. In the case of
  the establishment of such a joint program, all further references in this
  part to a region or a regional board with respect to a school offering a
  joint program shall refer to the regions included within, and the regional
  boards offering, the joint program.
  (3) Schools shall be funded exclusively by the Service, shall not charge
  nor accept tuition or fees for enrollment, and shall provide each student
  with an adequate allowance for living expenses, educational supplies,
  and any child care expenses.
  (4) The National Health Board shall assist regional boards in the
  establishment and maintenance of schools.
  (b) Schools shall be operated and maintained in accordance with the
  following principles:
  (1) The activities of each school shall be designed to meet the health
  needs of the region, districts, and communities which it serves.
  (2) The number of students enrolled in each educational program in a
  school shall be based on the regional, district, and community boards'
  assessments of the needs for health workers within such region, districts,
  and communities.
  (3) Schools shall integrate the education of health workers in the different
  job categories (established under part A) so as to permit health workers to
  be educated and certified for successively higher levels of health care work.
  (4) Each school's admissions policies, curriculum policies, faculty hiring
  procedures, and governance plan shall be established and implemented by the
  regional board in accordance with subsections (c) through (f), respectively,
  and with the fullest possible participation of the community and district
  boards, health workers, staff, and students in its region.
  (5) A school may not use individuals who are from low-income populations
  or minority groups, or who are women or confined in mental or penal
  institutions, as subjects for training or demonstration in numbers that
  are disproportionate to their numbers in the population of the region,
  and may not use any individuals as subjects for training or demonstration
  in a manner beyond that required for the immediate purpose of the training
  or demonstration.
The National Board shall establish, not later than one year after the effective
date of health services, guidelines for the application of these principles
and for the phased integration of health worker education programs, including
medical, dental, osteopathic, and nursing school programs, in existence on the
date of enactment of this Act into the schools established under this section.
  (c) Each regional board shall establish and implement admissions policies
  for education programs in its school. Such policies shall--
  (1) emphasize previous health-related work experience, as evaluated by
  health workers (including peers), by individuals who have received health
  care services from the applicant, and by faculty members;
  (2) minimize the use of criteria of academic performance other than such
  criteria as have been shown to be significantly related to future work
  performance;
  (3) give preference to segments of the population of the region
  under-represented among health workers;
  (4) to the extent consistent with paragraph (3), provide for admission of
  individuals so that the student body approximates the population of the
  region by race, sex, family income, and language; and
  (5) require that the applicant agree, if accepted into the school, to
  perform health care services in accordance with section 312.
  (d) Each regional board shall establish and implement curriculum policies
  for educational programs in its school. Such policies shall--
  (1) give priority in study and field work to the leading causes of illness
  and death in the region, including environmental, biological, and social
  determinants of mortality and morbidity;
  (2) give special consideration to studying the social, as well as biological,
  causation and prevention of illness and disease, and to the differing
  health care needs of populations facing special health risks and having
  special cultures and lifestyles within the region;
  (3) provide that all students shall take a common, initial sequence of
  courses and that students preparing for more advanced types of health
  work shall take studies that are progressively more specialized and
  differentiated;
  (4) emphasize work-study experience in all types of health care facilities
  in the region, including community and workplace facilities, facilities for
  the aged, mentally ill, and mentally retarded, health care facilities in
  prisons and other correctional institutions, alcohol and drug rehabilitation
  facilities, environmental health facilities, and all other health care
  facilities of the Service in communities and districts in the region;
  (5) emphasize the appropriate and safe use, and discourage the overuse,
  of drugs and medical techniques; and
  (6) facilitate the development by all health workers of skills in
  decisionmaking and assessment of patient needs in cooperation with other
  health workers and with patients.
  (e) Each regional board shall establish and implement faculty hiring
  procedures for its school. Such procedures shall, to the maximum extent
  feasible, create a faculty which approximates the population of the region
  by race, sex, and language.
  (f) Each regional board shall establish and implement a governance plan for
  the management of its school. Such plan shall give significant decisionmaking
  powers to staff and students of the school.
service requirement
  SEC. 312. (a)(1) No individual may be enrolled by a regional board in a
  school unless the individual agrees to perform health care services as an
  employee of the Service in the job category for which training is being
  provided (A) for a period of time equal to the period of such enrollement
  in the school but not less than 2 years, (B) beginning not later than 1
  year after the date of the individual's graduation from the school, and (C)
  for an area health board with the highest priority ranking under subsection
  (c) that agrees to employ the individual.
  (2) An individual's obligation to perform service under an agreement
  described in paragraph (1) shall be deferred only for a period during
  which the individual is physically or mentally incapable of performing
  such service.
  (3) No health board may employ an individual who has made an agreement
  described in paragraph (1), other than in accordance with subsection (c),
  until the individual has completed the period of obligated service in
  accordance with this section.
  (4) Except as provided in paragraph (5), if an individual breaches an
  agreement under paragraph (1) by failing (for any reason) either to begin
  such individual's service obligation or to complete such service obligation,
  the Service shall be entitled to recover from the individual an amount
  determined in accordance with the formula
in which `A' is the amount the Service is entitled to recover; `¡' is an
amount determined by the National Health Board to be the costs to the Service
of the education program and allowance received by the individual and the
interest on such costs which would be payable if at the time the costs were
undertaken they were loans bearing interest at the maximum legal prevailing
rate, as determined by the Treasurer of the United States; `t' is the total
number of months in the individual's period of obligated service; and `s' is
the number of months of such period served by the individual. Any amount of
damages which the Service is entitled to recover under this paragraph shall,
within the 1-year period beginning on the date of the breach of the agreement,
be paid to the Service.
  (5)(A) Any obligation of an individual under this subsection for service
  or payment of damages shall be canceled upon the death of the individual.
  (B) The National Health Board shall provide for the waiver or suspension
  of any obligation of service or payment by an individual under this part
  whenever compliance by the individual is impossible or would involve
  extreme hardship to the individual and if enforcement of such obligation
  with respect to any individual would be unconscionable.
  (C) Any obligation of an individual under this part for payment of damages
  may be released by a discharge in bankruptcy under title 11 of the United
  States code only if such discharge is granted after the expiration of the
  5-year period beginning on the first date that payment of such damages
  is required.
  (b) Each area health board shall periodically assess the ratio of the
  number of health workers employed by the board in each job category
  (established under part A) to the number of residents in the area.
  (c)(1) With respect to an individual obligated to perform service under
  this section as a result of completion of an educational program for a
  job category in a school, the priority ranking (referred to in subsection
  (a)(1)(C)) of area health boards for hiring the individual is as follows:
  (A) The regional board for the region, or a district or community board for
  a district or community in the region, in which the program was completed,
  if the region, district, or community is a health worker shortage area
  (as defined in paragraph (2)) with respect to the job category for which
  the individual received training.
  (B) A regional, district, or community board (other than one described
  in subparagraph (A)) for a region, district, or community which is a
  health worker shortage area with respect to the job category for which
  the individual received training.
  (C) Any other area health board.
  (2) For the purposes of paragraph (1), the term `health worker shortage
  area' means, with respect to a job category for which an individual has
  received training in a school, a region, district, or community which--
  (A) has a ratio of the number of health workers in the job category employed
  by the regional, district or community board, respectively, to the number of
  residents in the region, district, or community (whichever is applicable)
  which is less than two-thirds of the ratio of the total number of health
  workers in the job category employed by all the regional, district, or
  community boards, respectively, in the Nation to the number of residents
  in the Nation, and
  (B) has plans and a budget which provide for the hiring of an individual
  in the job category.
  (3) The National Health board shall establish a program to match the
  locational preferences of graduates of schools with the needs and preferences
  of regional, district, and community boards.
payment for certain educational loans
  SEC. 313. (a) In the case of any individual who has incurred any educational
  loan before the fourth year after the effective date of health services
  and for the individual's costs for an educational program in health care
  delivery, health care specialties, or health science specialty fields, the
  National Health Board shall make payments, in accordance with subsection
  (b), for and on behalf of that individual, on the principal of and interest
  on any such loan which is outstanding on the date the individual begins
  to work for the Service.
  (b) The payments described in subsection (a) shall be made by the National
  Health Board as follows:
  (1) Upon completion by the individual for whom the payments are to be
  made of the first year of employment with the Service, the National Health
  Board shall pay 30 percent of the principal of, and the interest on, each
  loan described in subsection (a) which is outstanding on the date he began
  such employment.
  (2) Upon completion by that individual of the second year of such employment,
  the National Health Board shall pay another 30 percent of the principal of,
  and the interest on, each such loan.
  (3) Upon completion by that individual of a third year of such employment,
  the National Health Board shall pay another 25 percent of the principal of,
  and the interest on, each such loan.
  (4) Upon completion by that individual of a fourth year of such employment,
  the National Health Board shall pay the remaining 15 percent of the
  principal of, and all remaining interest on, each such loan.
No payment may be made under this subsection with respect to a loan unless the
person on whose behalf the payment is to be made has submitted to the National
Health Board a certified copy of the agreement under which such loan was made.
  (c) Notwithstanding the requirement of completion of employment specified
  in subsection (b), the National Health Board shall on or before the due
  date thereof, pay any loan or loan installment which may fall due within
  the period of employment for which the borrower may receive payments under
  this section, upon the declaration of such borrower, at such times and in
  such manner as the National Health Board may prescribe (and supported by
  such other evidence as the National Health Board may reasonably require),
  that the borrower is then employed as described in subsection (b) and that
  the borrower will continue to be so engaged for the period required (in
  the absence of this subsection) to entitle the borrower to have made the
  payments provided by this section for such period, except that not more
  than 85 percent of the principal of any such loan shall be paid pursuant
  to this subsection.
Part C--Employment and Labor-Management Relations Within the Service
employment, transfer, promotion, and receipt of fees
  SEC. 321. (a) Health boards shall, in accordance with this Act and taking
  into account guidelines and standards established by the appropriate National
  Health Board, employ, classify, and fix the salaries and benefits of all
  employees of the Service employed in the Service's facilities.
  (b) The appropriate National Health Board, in establishing guidelines and
  standards under this part, shall, to the extent feasible and consistent
  with the provisions of this part, provide for--
  (1) employment and promotion in the Service in the same manner as is
  provided for employment and promotion under the Federal civil service system;
  (2) meaningful opportunities for career advancement;
  (3) encouragement of health workers to use up to 10 percent of their work
  time for continuing education under part B without loss of pay or other
  job rights; and
  (4) full protection of employees' rights by providing an opportunity for
  a fair hearing on adverse actions with representation of their own choosing.
  (c) Health boards, in hiring employees to fill vacancies in newly created
  positions, shall give preference to individuals who were employed as health
  workers, or self-employed while delivering health services, before the date
  of enactment of this Act. The National Health Board shall ensure, through
  such steps as it deems necessary, that all such individuals desiring to be
  employed within the Service shall find appropriate employment in the Service.
  (d) Employees of the Service shall be eligible for promotion or transfer
  to any position in the Service for which they are qualified. Each regional
  board shall establish and maintain a job placement service to assist health
  workers in its region in identifying suitable employment opportunities
  and in transferring between jobs with different area health boards in the
  region. The authority given by this subsection shall be used to provide
  a maximum degree of career opportunities for employees and to ensure
  continued improvement of health care services.
  (e) A community or district board may not hire an individual to fill a
  job vacancy that is classified under part A in a job category if--
  (1) the community or district board, respectively, has a ratio of the
  number of health workers in the job category employed by such board to the
  number of residents in the community or district (whichever is applicable)
  which is greater than four-thirds of the ratio of the total number of health
  workers in the job category employed by all the community or district boards,
  respectively, in its region to the number of residents in such region; and
  (2) there is a community or district within its region which is a health
  worker shortage area (as defined in section 312(c)(2)) with respect to
  the job category.
  (f) An employee of the Service may not receive any fee or perquisite on
  account of duties performed by virtue of such employment, except from a
  health board established under this Act.
applicability of laws relating to federal employees
  SEC. 322. (a) Chapter 75 of title 5, United States Code (relating to
  adverse actions against employees), apply to employees of the Service
  (other than employees serving on the personal staff of members of health
  boards) except to the extent provided--
  (1) in a collective-bargaining agreement negotiated on behalf of and
  applicable to them; or
  (2) in procedures established by the Service and approved by the Office
  of Personnel Management.
  (b) Employees of the Service are covered by subchapter I of chapter 81 of
  title 5, United States Code (relating to compensation for work injuries).
  (c)(1) Chapter 83 of title 5, United States Code (relating to civil
  service retirement), applies to employees of the Service except to the
  extent provided in a collective-bargaining agreement negotiated on behalf
  of and applicable to them.
  (2) The Service shall withhold from pay and shall pay into the Civil Service
  Retirement and Disability Fund the amounts specified in chapter 83 of title
  5, United States Code, as required under paragraph (1). The Service, upon
  request of the Office of Personnel Management, but not less frequently
  than annually, shall pay to the Office the costs reasonably related to
  the administration of Fund activities for employees of the Service.
  (d) Sick and annual leave and compensatory time of employees of the Service,
  whether accrued prior to or after the commencement of operations of the
  Service, shall be obligations of the Service.
  (e)(1) Compensation, benefits, and other terms and conditions of employment
  in effect on the effective date of health services for employees of the
  Federal Government performing functions that are provided under this Act by
  the Service, shall apply to all employees of the Service performing similar
  functions until changed by the Service in accordance with this Act. Subject
  to the provisions of this Act, the provisions of subchapter I of chapter
  85 and chapter 87 of title 5, United States Code (relating to unemployment
  compensation and life insurance), apply to employees of the Service unless
  varied, added to, or substituted for in accordance with paragraph (2).
  (2) No variation, addition, or substitution with respect to fringe
  benefits shall result in a program of fringe benefits which on the whole
  is less favorable to employees of the Service than fringe benefits in
  effect for employees of the Federal Government on the effective date of
  health services. No variation, addition, or substitution with respect
  to fringe benefits of employees for whom there is a collective-bargaining
  representative shall be made except by agreement between such representative
  and the Service.
applicability of federal labor-management relations laws
  SEC. 323. (a)(1) The provisions of the National Labor Relations Act (42
  U.S.C. 141 et seq.) shall apply to the Service and its employees to the
  extent, not inconsistent with subsection (b), to which such provisions
  apply to employers (as defined in section 2(2) of such Act), except that--
  (A) the phrase `or any individual employed as a supervisor' in section
  2(3) of such Act shall not apply (thereby making such Act apply, for these
  purposes, to such individuals);
  (B) section 9(b)(1) of such Act (providing for separate treatment for
  professional and nonprofessional employees) shall not apply;
  (C) sections 206 through 210 of such Act (relating to national emergencies)
  shall, for purposes of this Act, have the phrases `the President of the
  United States' and `the President', wherever they appear, replaced by
  the phrase `the National Health Board (or a committee thereof to which it
  has delegated such authority)' and the phrase `national health or safety'
  replaced by the phrase `health or safety of the residents of any region'; and
  (D) section 213 (providing for intervention in a strike or lockout by the
  Director of the Federal Mediation and Conciliation Service) shall not apply.
  (2) Paragraphs (3) and (4) of section 7311 of title 5, United States Code
  (prohibiting participation in a strike or an organization asserting the
  right to strike), shall not apply to employees of the Service.
  (b)(1) Collective-bargaining agreements between area health boards and
  duly recognized bargaining representatives of employees of the Service may
  include procedures for resolution by the parties of grievances and adverse
  actions arising under the agreement, including procedures culminating in
  binding third-party arbitration.
  (2) Area health boards and duly recognized bargaining representatives of
  employees of the Service may by mutual agreement adopt procedures for the
  resolution by the parties (A) of grievances and adverse actions arising
  under collective-bargaining agreements, and (B) of disputes or impasses
  arising in the negotiation of such agreements.
  (c) Section 3(e) of the Labor-Management Reporting and Disclosure Act of
  1959 (42 U.S.C. 402(e)) is amended by inserting `the United States Health
  Service and' after `and includes'.
defense of certain malpractice and negligence suits
  SEC. 324. (a) The remedy against the United States provided by sections
  1346(b) and 2672 of title 28, United States Code, or by alternative
  benefits provided by the United States where the availability of such
  benefits precludes a remedy under section 1346(b) of such title, for damage
  for personal injury, including death, resulting from the performance of
  medical, surgical, dental, or related functions, including the conduct of
  clinical studies or investigations, by any employee of the Service while
  acting within the scope of the employee's employment, shall be exclusive of
  any other civil action or proceeding by reason of the same subject matter
  against the employee (or the employee's estate) whose act or omission gave
  rise to the claim.
  (b) The Attorney General shall defend any civil action or proceeding
  brought in any court against any person referred to in subsection (a)
  (or the person's estate) for any such damage or injury. Any such person
  against whom such civil action or proceeding is brought shall deliver within
  such time after date of service or knowledge of service as determined by
  the Attorney General, all process served upon the person or an attested
  true copy thereof to the person's immediate superior or to whomever was
  designated by the appropriate National Health Board to receive such papers
  and such person shall promptly furnish copies of the pleading and process
  therein to the United States attorney for the district embracing the place
  wherein the proceeding is brought, to the Attorney General, and to the
  appropriate National Health Board.
  (c)(1) Upon a certification by the Attorney General that the defendant
  was acting in the scope of employment at the time of the incident out of
  which the suit arose, any such civil action or proceeding commenced in
  a State court shall be removed without bond at any time before trial by
  the Attorney General to the district court of the United States of the
  district and division embracing the place wherein it is pending and the
  proceeding deemed a tort action brought against the United States under
  the provision of title 28, United States Code, and all references thereto.
  (2) If a United States district court determines on a hearing on a motion to
  remand held before a trial on the merits that the case so removed is one in
  which a remedy by suit within the meaning of subsection (a) is not available
  against the United States, the case shall be remanded to the State court.
  (3) Where a remedy by suit within the meaning of subsection (a) is not
  available because of the availability of a remedy through proceedings for
  compensation or other benefits from the United States as provided by any
  other law, the case shall be dismissed, but in the event the running of
  any limitation of time for commencing, or filing an application or claim
  in, such proceedings for compensation or other benefits shall be deemed to
  have been suspended during the pendency of the civil action or proceeding
  under this section.
  (d) The Attorney General may compromise or settle any claim asserted in
  such civil action or proceeding in the manner provided in section 2677 of
  title 28, United States Code, and with the same effect.
  (e) For purposes of this section, the provisions of section 2680(h) of title
  28, United States Code, shall not apply to assault or battery arising out
  of negligence in the performance of medical, surgical, dental, or related
  functions, including the conduct of clinical studies or investigations.
  (f) The appropriate National Health Board may, to the extent it deems
  appropriate, hold harmless or provide liability insurance for any employee
  of the Service for damage for personal injury, including death, negligently
  caused by such employee while acting within the scope of employment and
  as a result of the performance of medical, surgical, dental, or related
  functions, including the conduct of clinical studies or investigations,
  if the employee is assigned to a foreign country or detailed to a State
  or political subdivision thereof or to a nonprofit institution, and if
  the circumstances are such as are likely to preclude the remedies of third
  persons against the United States described in section 2679(b) of title 28,
  United States Code, for such damage or injury.
TITLE IV--OTHER FUNCTIONS OF HEALTH BOARDS
Part A--Advocacy, Grievance Procedures, and Trusteeships
advocacy and legal services program
  SEC. 401. (a) Each area health board shall establish a program of health
  advocacy to ensure the full realization of the patient rights enumerated
  in part A of title II. Such a program shall include--
  (1) the employment of individuals having basic legal knowledge and skills
  as health advocates;
  (2) the presence of health advocates (A) in inpatient health care facilities
  at all times, and (B) in other health care facilities during the provision
  of health care services;
  (3) provision for health advocates to (A) inform, on an ongoing basis,
  users and health workers of such patient rights and (B) report to the area
  health board any infraction of such rights which is not promptly corrected;
  (4) provision for regular meetings between health workers and health
  advocates, users, and any user representatives to discuss ways of ensuring
  the fulfillment of such rights through affirmative action of such workers
  and the area health board; and
  (5) appropriate action by the area health board to ensure that infractions
  of such rights are promptly and sufficiently corrected.
  (b)(1) The National Health Board shall establish a health rights legal
  services program and shall provide such program with sufficient legal and
  administrative personnel, funding, and facilities (A) to ensure that users
  and health workers receive, free of charge, high quality legal services
  (including representation in grievance proceedings commenced under section
  402) for legal problems related to health rights and health care services,
  and (B) to improve, through litigation and other activities, the health
  care system and expand the rights of users and health workers.
  (2) The health rights legal services program shall provide directly, by
  contract with the Legal Services Corporation, or by contract with members
  of the private bar, for--
  (A) establishment of a legal services office in each region to provide
  representation (other than representation provided under subparagraph (B))
  of users, health workers, and voluntary associations having a demonstrated
  interest in health care in proceedings and hearings under section 402; and
  (B) establishment of legal services offices in such communities and
  districts as are determined, in accordance with guidelines established by
  the National Health Board, to have inadequate legal services to provide
  the legal services described in paragraph (1)(A).
  (3) The National Health Board may carry out the functions described in
  paragraph (1)(B) directly, by contract, or otherwise.
grievance procedures and trusteeships
  SEC. 402. (a)(1) Each regional and interim regional board shall provide,
  in accordance with this section, that any user, health worker, or any user
  association having a demonstrated interest in health care may commence a
  grievance proceeding before such board (or a person or committee designated
  by such board) with respect to an alleged violation of this Act by a
  district or community board within its region. Each regional and interim
  regional board may commence a grievance proceeding before itself (or a
  person or committee designated by such board) with respect to an alleged
  violation of this Act by a district or community board within its region.
  (2) The appropriate National Health Board shall provide, in accordance
  with this section, that any user, health worker, or any user association
  having a demonstrated interest in health care may commence a grievance
  proceeding before such Board (or a person or committee designated by such
  Board) with respect to an alleged violation of this Act by a regional or
  interim regional board. The appropriate National Health Board may commence a
  grievance proceeding before itself (or a person or committee designated by
  such Board) with respect to an alleged violation of this Act by a regional
  or interim regional board.
  (b)(1) The appropriate National Health Board shall provide, subject
  to paragraphs (3) and (4), for its review (or a review by a person or
  committee designated by the Board), by appeal to the Board by any party to
  a proceeding described in subsection (a)(1) or on its own initiative, of an
  adverse decision by a regional or interim regional board in the proceeding.
  (2) On and after the date a suit with respect to an adverse determination
  in a grievance proceeding or review proceeding is filed under subsection
  (e), no review proceeding respecting such proceeding may be commenced by
  appeal to the Board under paragraph (1), and any such review proceeding
  which was commenced by appeal to the Board under such paragraph before
  the date of filing of such suit and is pending on such date shall promptly
  be discontinued.
  (3) No review of an adverse administrative decision may be made by appeal
  or by initiative under this subsection unless the appeal is filed or notice
  of the initiative is published (as the case may be) not later than 15 days
  after the publication of the decision.
  (c)(1) Whenever a grievance proceeding is commenced under subsection (a), the
  entity before which the proceeding is held shall investigate the grievance.
  (2) An entity before which a proceeding or review proceeding is commenced
  under subsection (a) or (b)--
  (A) shall conduct a full and open public hearing on the grievance as part
  of such proceeding--
  (i) if the grievance is supported by a petition signed by a minimal number
  of residents (as defined in paragraph (4)); or
  (ii) before the entity (or the body which designated it) may set aside
  an election or transfer any functions of a health board under subsection
  (d); and
  (B) may conduct such a hearing if the entity determines that such hearing
  is in the public interest.
  (3) The entity that conducts a hearing under paragraph (2) shall provide
  for timely notice to, and opportunity to be heard by, any party with a
  direct interest in the grievance for which the hearing is conducted.
  (4) As used in paragraph (1), the term `minimal number of residents' means,
  with respect to a grievance which concerns a health board which is--
  (A) a community board, 100 individuals,
  (B) a district board, 300 individuals, and
  (C) a regional or interim regional board, 1,000 individuals,
who are 18 years of age or older and who reside in the area served by
the board.
  (d)(1) With respect to a grievance proceeding begun under subsection
  (a) relating to the conduct of an election of a community board, if the
  entity before which such proceeding is commenced under such subsection,
  or is reviewed under subsection (b), determines that the election (A)
  was not conducted substantially in compliance with this Act or (B) has
  revealed the systematic failure of the user members of such community
  board to approximate the population of the community by race, sex,
  language, and income level, the entity shall set aside the election and,
  unless such determination is reviewed under subsection (b), the entity
  shall require that another election for members of the community board
  be conducted, in accordance with this Act, not later than 60 days after
  the date of such determination. If such election is conducted because of
  a determination under clause (B), the election shall be conducted (and
  subsequent elections may be conducted) in such a manner, including the
  use of geographic or other subdivisions for electoral purposes, as will
  facilitate the representation of significant elements of the population
  of a community by race, sex, language, and income level.
  (2) With respect to a grievance proceeding begun under subsection
  (a) relating to a grievance other than the conduct of an election of a
  community board, if the entity before which such proceeding is commenced
  under such subsection, or is reviewed under subsection (b), determines
  that the grievance represents--
  (A) a failure by a health board to comply substantially and materially with
  this Act, the entity shall require that a new election or appointment,
  in accordance with this Act, of members of the health board be conducted
  or made within 60 days of the date of such determination; or
  (B) a failure by a health board to comply, but not substantially and
  materially, with this Act, the entity may require that a new election or
  appointment, in accordance with this Act, of members of the health board
  be conducted or made if such failure is not corrected within a reasonable
  period of time (specified by the entity) of the date of such determination.
  (3)(A) If an entity determines under paragraph (1) or (2) that a community
  or district board has failed to comply with this Act, the entity shall
  transfer to the regional (or interim regional) board for such community or
  district such functions of the community or district board as it determines
  necessary to carry out this Act until a new election or appointment is
  conducted or made.
  (B) If an entity determines under paragraph (2) that a regional or interim
  regional board has failed to comply with this Act, the entity shall transfer
  to the appropriate National Health Board such functions of the regional
  or interim regional board as it determines necessary to carry out this
  Act until a new regional or interim regional board is appointed.
  (C) If a health board is transferred the functions of another health board
  under this paragraph, until a new election or appointment of the other
  health board has been certified, (i) the health board shall have the powers
  of the other health board to conduct such functions, (ii) the health board
  may appoint a trustee (or trustee committee) to have such powers and carry
  out such functions, and (iii) any expenses that are certified by the health
  board (or by the trustee or trustee committee appointed by it) as having
  been incurred by it in discharging the functions transferred to it under
  this paragraph shall be paid from funds allocated to the other health board.
  (e) Any party to a grievance proceeding or review proceeding commenced
  under this section may bring suit in the United States district court for
  the judicial district in which such proceeding, or review proceeding, was
  brought, for the review of an adverse determination in such proceeding or
  review proceeding. Such court shall affirm such determination unless it
  finds that such determination is not supported by substantial evidence or
  is arbitrary and capricious.
Part B--Occupational Safety and Health Programs
functions of the national health board
  SEC. 411. (a) On and after the effective date of health services, the
  National Health Board shall oversee occupational safety and health programs
  conducted at the regional level, and shall participate in the establishment
  and administration of occupational safety and health standards under the
  Occupational Safety and Health Act of 1970.
  (b) In its participation in the establishment and administration of
  occupational safety and health standards under the Occupational Safety
  and Health Act of 1970, the National Health Board shall seek the advice
  and comments of regional occupational safety and health action councils
  established under section 413.
  (c)(1) To provide for participation of the National Health Board in
  the establishment and administration of occupational safety and health
  standards, the Occupational Safety and Health Act of 1970 (29 U.S.C. 651
  et seq.) is amended--
  (A) by adding at the end of section 3 the following new paragraph:
  `(15) The term `National Health Board' means the National Health Board of
  the United States Health Services.';
  (B) by striking out `Secretary of Health, Education, and Welfare' each
  place it appears (other than in section 22(b)) and inserting in lieu thereof
  `National Health Board';
  (C) by inserting `shall request the National Health Board and' in the
  first sentence of section 6(b)(1) before `may request';
  (D) by inserting `the Board and' in the second sentence of section 6(b)(1)
  after `The Secretary shall provide';
  (E) by striking out `An' in the third sentence of section 6(b)(1) and
  inserting in lieu thereof `The Board and an';
  (F) by striking out `its' each place it appears in the third sentence of
  section 6(b)(1) and inserting in lieu thereof `their';
  (G) by inserting `after consultation with the National Health Board and'
  in the fourth sentence of section 6(b)(6)(A) after `may be granted only';
  (H) by inserting `after consultation with the National Health Board and'
  in the third sentence of section 6(d) before `after opportunity for';
  (I) by striking out `The Secretary' and all that follows through `shall
  each' in section 8(g)(2) and inserting in lieu thereof `The Secretary shall';
  (J) by striking out `their' in section 8(g)(2) and inserting in lieu thereof
  `his';
  (K) by inserting `after consultation with the National Health Board and'
  in section 16 before `after notice and opportunity';
  (L) by inserting `(after consultation with the National Health Board)'
  in section 18(c) after `in his judgment';
  (M) by inserting `and the National Health Board' in section 19(d) after
  `Secretary' each place it appears; and
  (N) by striking out the first sentence of paragraph (5) of section 20(a).
  (2) The amendments made by paragraph (1) shall take effect on the effective
  date of health services.
  (f) The National Health Board shall establish guidelines--
  (1) for its participation in the establishment and administration of
  occupational safety and health standards under the Occupational Safety
  and Health Act of 1970;
  (2) for the election of community occupational safety and health action
  councils under section 412;
  (3) for the establishment of regional occupational safety and health
  programs under section 413;
  (4) for the establishment and operation of workplace health facilities
  under section 414; and
  (5) for the provision of assistance by regional and community boards to
  regional and community occupational safety and health councils, respectively,
  and to workplace safety and health committees established under section 415.
community occupational safety and health activities
  SEC. 412. (a)(1) Each community board shall cooperate with the appropriate
  regional board in the establishment and implementation of an occupational
  safety and health program for its region.
  (2) Each community board shall provide for the organization and operation
  (including staff and support) in its community of a community occupational
  safety and health action council (hereinafter in this part referred to as a
  `COSHAC') in accordance with this section.
  (b) The members of a COSHAC shall be elected by individuals employed in
  the community as follows:
  (1) Employees of each workplace in the community which has 500 or more
  employees shall be entitled to elect one member for each 500 such employees
  in such workplace.
  (2) Employees of workplaces in the community have fewer than 500 employees
  shall be entitled to vote in community-wide elections for a number of
  members equal to (A) the total number of employees in such workplaces
  divided by 500, (B) rounded (if necessary) to the next highest whole number.
The elections of COSHAC members shall be conducted by the community board
for such COSHAC under guidelines established by the National Board.
  (c) Each COSHAC shall--
  (1) appoint one individual to serve, at its pleasure, as a member of the
  community board for such COSHAC;
  (2) appoint one individual to serve, at its pleasure, as a member of the
  regional occupational safety and health action council for its region;
  (3) advise the community board on, and oversee, occupational safety and
  health programs in the community;
  (4) promote and assist in the establishment of workplace occupational
  safety and health committees in workplaces in the community, and advise
  and facilitate such committees' actions relating to safety and health
  hazards in workplaces in the community; and
  (5) assist employees in determining methods of, and requirements for,
  inspections of workplaces in the community for safety and health hazards.
regional occupational safety and health programs
  SEC. 413. (a)(1) Each regional board shall establish an occupational health
  and safety program for its region in accordance with this subsection and
  under guidelines established by the National Health Board.
  (2) A regional occupational health and safety program shall, to the maximum
  extent feasible, use the facilities and resources of community boards in
  the region and shall include--
  (A) training programs to enhance the ability of employees in the region
  to monitor safety and health conditions in their workplaces and to assist
  safety and health inspectors in the conduct of workplace inspections;
  (B) facilitating communication among workers employed in similar industries
  in the region and the Nation with respect to occupational health and safety
  hazards they face in common;
  (C) baseline and periodic biologic screening of employees in the region;
  (D) development and maintenance of environmental monitoring programs to
  identify and isolate hazardous workplaces and work areas in the region;
  (E) the analysis of employment-related injuries and illnesses occurring
  in the region; and
  (F) staff and support for the operation of the regional occupational safety
  and health action council (hereinafter in this part referred to as the
  `ROSHAC') established in the region under this section.
  (b) Each ROSHAC shall--
  (1) appoint one individual to serve, at its pleasure, as a member of the
  regional board for such ROSHAC;
  (2) advise the regional board on, and oversee, occupational safety and
  health programs in the region; and
  (3) advise the National Health Board on the establishment and administration
  of occupational safety and health standards under the Occupational Safety
  and Health Act of 1970.
workplace health facilities
  SEC. 414. (a) The employer in each workplace shall establish and maintain
  a health facility in or near the workplace to provide occupational and
  emergency health care services to individuals employed in the workplace
  in accordance with this section and guidelines and standards for such
  facilities established by the National Health Board.
  (b) Each workplace health facility established pursuant to subsection
  (a) shall, taking into account guidelines established by the National
  Health Board--
  (1) be organized in a manner so as to provide an appropriate number of
  appropriately skilled health workers to meet occupational and emergency
  health care needs of employees in the workplace; and
  (2) be operated by the community board for the community in which the
  workplace is predominantly located, or, where such board deems appropriate,
  by the employer, with the cost in either case borne by the employer in
  each workplace.
employee rights relating to occupational safety and health
  SEC. 415. (a)(1) Employees in each workplace having 25 or more employees
  shall have the right to establish workplace occupational safety and health
  committees (hereinafter in this subsection referred to as `committees')
  with members of their choosing.
  (2) Members of committees (composed of the greater of 3 members or one
  member for each 100 employees in the workplace) shall, without any loss
  of pay or other job rights--
  (A) be permitted to spend eight hours of each month inspecting their
  workplace and conducting such other functions relating to occupational
  safety and health as are determined by the employees in the workplace; and
  (B) be permitted to accompany any safety and health inspectors during
  inspections of the workplace.
  (b) Employees in each workplace shall have the right, without any loss of
  pay or other job rights--
  (1) to monitor safety and health conditions in their workplace whenever
  they reasonably deem it necessary and with whatever reasonable scientific
  instruments and expert assistance they choose; and
  (2) to remove themselves from the site of any hazard to their safety or
  health until an authorized inspector has certified that the hazard has
  been eliminated.
  (c) Employers shall adopt all feasible engineering measures that will
  minimize occupational safety and health hazards in the workplace. Where such
  measures are not adequate to protect employees from such hazards, employers
  shall furnish their employees with, or reimburse their employees for the
  reasonable cost of, equipment and clothing needed to protect an employee
  from any residual occupational safety and health hazards in the workplace.
  (d) Employees or their duly chosen representatives shall have the right to
  inspect all medical records maintained by their employers on the condition
  of their health, and shall have the right to be assisted during such
  inspections by persons of their choosing.
  (e) Employers shall provide their employees with copies of all reports,
  studies, and data concerning conditions affecting the health and safety
  of employees within their workplaces, with annual reports on the morbidity
  and mortality experience of present and former employees, and with timely
  notification of the presence within the workplace of any materials, agents,
  or conditions which may have a deleterious effect on the safety and health of
  their employees, along with relevant information on hazards and precautions,
  symptoms, remedies, and antidotes.
  (f) Employees shall have the right to seek, through collective bargaining,
  occupational safety and health standards, including standards relating to
  physical and mental stress and speed of work, more restrictive than such
  standards established under the Occupational Safety and Health Act of 1970.
definitions
  SEC. 416. (a) For purposes of this part, the term `workplace' means the
  regular location where work is performed by one or more employees of
  an employer.
  (b) For the purposes of sections 414 and 415, the terms `employer' and
  `employee' have the same meanings those terms have in section 3 of the
  Occupational Safety and Health Act of 1970 (42 U.S.C. 653).
Part C--Health and Health Care Delivery Research
principles and guidelines for research
  SEC. 421. (a) On and after the effective date of health services, the
  Service shall conduct a program of research concerning health and health
  care delivery. On and after 2 years after such date, such research program
  shall conform to the following principles:
  (1) The research shall, to the maximum extent possible, be performed
  under the direction of, and in association with, community, district,
  and regional boards.
  (2) No research shall be conducted within, or using the resources of,
  an area health facility until it has been reviewed and approved by the
  area health board responsible for such facility.
  (3) Priority shall be given in health research to the prevention and
  correction of the leading causes of illness and death, particularly
  environmental, occupational, nutritional, social, and economic causes.
  (4) Priority shall be given in health care delivery research to improvement
  of the effectiveness and efficiency of ambulatory and primary health care
  delivery, including research on alternative systems of health care delivery
  and alternative conceptions of health and health care.
  (5) No experimentation to evaluate new preventive, diagnostic, or therapeutic
  methods or agents shall be undertaken upon human subjects until all animal
  research which may effectively contribute to evaluating such methods or
  agents has been undertaken.
  (6) No research shall be conducted on a human subject without the subject's
  informed written consent.
  (7) No research shall be conducted on a human subject while the subject
  is involuntarily confined to an institution.
  (8) Each health board, in planning and conducting research under the program,
  shall cooperate with appropriate officials conducting related research in
  the Department of Health and Human Services, the Environmental Protection
  Agency, other Federal Government agencies, and agencies and departments
  of State, territorial, and local governments.
  (9) The results of research shall be disseminated to the public and to
  area health boards in a manner that will most readily permit the use of
  such results to improve the health of users and the delivery of health
  care services.
  (b) The National Health Board shall establish guidelines for the conduct
  of research in conformance with the principles described in subsection (a).
establishment of institutes
  SEC. 422. On the effective date of health services, the National Institutes
  of Health (established under title IV of the Public Health Service Act)
  are transferred to the National Health Board. In addition, the National
  Health Board shall establish the following institutes:
  (1) A National Institute of Epidemiology, which shall--
  (A) gather and analyze disease-related statistics collected by the Service;
  (B) plan, conduct, support, and assist in epidemiologic research conducted
  by the Service;
  (C) conduct and support research on epidemiologic methodology and
  experimental epidemiology;
  (D) establish and maintain an early warning system for the detection of
  new diseases and epidemics; and
  (E) assist in the formulation of policies to eliminate or reduce the
  causes of illness and injury and to prevent and curtail epidemics of
  these conditions.
  (2) A National Institute of Evaluative Clinical Research, which shall--
  (A) gather and analyze all evidence collected by the Service dealing with
  the effectiveness of preventive, diagnostic, and therapeutic measures and
  the occurrence of iatrogenic illnesses;
  (B) analyze evidence on newly-discovered or proposed preventive, diagnostic,
  and therapeutic methods and agents;
  (C) plan and conduct clinical trials, in conformance with the limitations
  of part A of title II; and
  (D) assist the National Health Board, in cooperation with other bodies,
  including the National Institute of Pharmacy and Medical Supply, in
  developing guidelines and standards for the introduction of new methods
  of prevention, diagnosis, and treatment.
  (3) A National Institute of Health Care Services, which shall--
  (A) analyze data and statistics on the health care resources and needs of
  the Nation and on the quality of present services;
  (B) conduct comparative studies of health care services in the various
  regions of the Nation, and make recommendations for the improvement of
  health care services in areas with inferior quality of health care services;
  (C) plan and conduct research on alternative methods of health care delivery,
  on the functions, tasks, performance and work relationships of various
  kinds and categories of health workers, on patterns of organization of
  health care, and on the effectiveness and benefits of health care in
  relation to costs; and
  (D) assist the National Health Board in formulating national policies to
  improve the quality of health care services.
  (4) A National Institute of Pharmacy and Medical Supply, which shall--
  (A) recommend to the National Health Board standards regarding the quality,
  distribution, and price of all drugs, therapeutic devices, appliances and
  equipment to be used by the Service;
  (B) certify drugs, therapeutic devices, appliances, and equipment for use
  in the health facilities of the Service, and for furnishing to users of
  such health facilities;
  (C) assist the National Health Board in issuing a National Pharmacy and
  Medical Supply Formulary; and
  (D) conduct a comprehensive program of pharmaceutical and medical supply
  research and utilization education using, to the maximum extent possible,
  regional facilities operated in association with the respective regional
  health boards.
  (5) A National Institute of Sociology of Health and Health Care, which
  shall--
  (A) conduct ongoing analyses of the basic epistemological assumptions of
  health and health care;
  (B) assess critically the effects of scientific medicine and of divisions
  in institutional and technical skills in health care;
  (C) evaluate the effects of health care measures and policies upon population
  groups and subgroups in the Nation;
  (D) identify and analyze the social, occupational, and environmental
  factors in modern society affecting health and well-being;
  (E) analyze alternative, holistic approaches to the human body, health,
  and causality of ill health and the lack of social and psychological
  well-being; and
  (F) assist the National Health Board in formulating national policies
  relating to the promotion of health and the provision of health care.
Part D--Health Planning, Distribution of Drugs and Other Medical Supplies,
and Miscellaneous Functions
health planning and budgeting
  SEC. 431. (a) Each area health board shall, under guidelines established
  by the National Health Board, collect data on the supply of and demand for
  health workers in facilities under its supervision, and on the delivery
  of health care and supplemental services in health care facilities under
  its supervision, shall evaluate such data in relation to the health care
  needs of their respective area, and shall transmit such data and evaluation--
  (1) to its respective regional board, in the case of a district or community
  board, and
  (2) to the National Health Board, in the case of a regional board,
and shall make available such data and evaluations to residents of its area.
  (b) Each regional board shall coordinate the planning and administration of
  the delivery of health care services, health worker education, and health
  research in its region, and shall facilitate the planning and administration
  of such programs by district and community boards in its region.
  (c) The National Health Board shall formulate a 1-year and 5-year national
  health plan and budget, taking into account the area plans and budgets
  prepared in accordance with section 522, to provide guidance and direction
  to area health boards.
distribution of drugs and other medical supplies
  SEC. 432. (a)(1) The National Health Board, after consultation with
  the regional boards, shall, not later than the effective date of health
  services, publish and disseminate to area health boards a National Pharmacy
  and Medical Supply Formulary (hereinafter in this section referred to as
  the `Formulary').
  (2) The Formulary shall contain a listing of drugs, therapeutic devices,
  appliances, equipment, and other medical supplies (including eyeglasses,
  other visual aids, hearing aids, and prosthetic devices) (hereinafter
  in this section referred to as `drugs and other medical supplies'). For
  each item on such listing the Formulary shall contain (A) the standards
  of quality for the production of such item, (B) the medical conditions for
  which the item is certified as effective for purposes of the provision of
  health care services under this Act, and (C) such other information on
  such item as the National Health Board determines to be appropriate for
  the effective and efficient delivery of health care services under this Act.
  (3) The National Health Board shall, at regular intervals, update the
  contents of the Formulary and publish a price list for items listed in
  the Formulary, which prices shall reflect the actual costs of manufacture.
  (b)(1) Each regional board shall establish a program, in accordance with this
  subsection and under guidelines established by the National Health Board,
  for the purchase and distribution of drugs and other medical supplies for
  use in health care facilities established by such board or by a community
  or district board within its region.
  (2) Such program shall provide for the purchase of each drug or other
  medical supply item only (A) following competitive bidding on such item or
  (B) based on the price listed for such item in the price list published
  under subsection (a)(3).
  (3) Such program shall provide for the distribution of drugs (and their
  dispensing by community and district boards in its region) under their
  generic names.
  (4) For purposes of paragraph (3), the term `generic names' means the
  established names, as defined in section 502(e)(2) of the Federal Food,
  Drug, and Cosmetic Act (21 U.S.C. 352(e)(2)).
  (c) The National Health Board is authorized to establish and operate drug
  and medical supply manufacturing facilities, if it determines that such
  operation will result in reduced expenditures by the Service.
miscellaneous functions of the national health board
  SEC. 433. (a) The appropriate National Health Board shall publish, not
  later than December 31 of each year, a report presenting and evaluating
  operations of the Service during the fiscal year ending in such year and
  surveying the future health needs of the Nation and plans the Board has
  for the Service to meet such needs.
  (b) The National Health Board shall, not later than the effective date of
  health services, prepare and disseminate to area health boards, for use
  by users, a comprehensive dictionary of terms used in health care records
  and services maintained or provided by the Service. Such dictionary shall
  explain terms related to symptoms, signs, diagnoses, etiologic agents
  and conditions, diagnostic procedures, and the treatment and prevention
  of, and rehabilitation following, illnesses, and shall include extensive
  citations of lay and professional sources which a user might consult for
  additional information on such terms.
TITLE V--FINANCING OF THE SERVICE
Part A--Health Service Taxes
individual and corporate income taxes
  SEC. 501. (a)(1) Subchapter A of chapter 1 of the Internal Revenue Code
  of 1954 (relating to normal taxes and surtaxes) is amended by adding at
  the end thereof the following new part:
`PART VII--HEALTH SERVICE TAXES
`Sec. 59. Tax imposed.
`SEC. 59. TAX IMPOSED.
  `(a) INDIVIDUALS, ESTATES, AND TRUSTS- In addition to other taxes, there
  is hereby imposed for each taxable year on the taxable income of every
  individual and of every estate and trust taxable under section 1(d),
  a tax in an amount equal to 10 percent of the total amount of the normal
  tax and surtax imposed by section 11 for such taxable year.'.
  `(b) CORPORATION- In addition to the other taxes, there is hereby imposed
  for each taxable year on the taxable income of every corporation, a tax
  in an amount equal to 90 percent of the total amount of the normal tax
  and surtax imposed by section 11 for such taxable year.'.
  (2) The table of parts of such subchapter A is amended by adding after
  the item relating to part VI the following new item:
`Part VII. Health service taxes.'.
  (b) Subsection (a) of section 3402 of the Internal Revenue Code of 1954
  (relating to income tax collected at source) is amended by inserting after
  the third sentence thereof the following sentence: `With respect to wages
  paid on and after the effective date of health services under the Health
  Service Act (as established in section 601 of such Act), the Secretary
  shall prescribe new tables which shall be the same as the tables prescribed
  under the previous sentence, except that such tables shall be modified
  to the extent necessary to reflect the amendment made to subchapter A of
  chapter 1 by section 501(a)(1) of the Health Service Act.'.
  (c) The amendments made in this section shall apply to taxable years
  beginning on or after the effective date of health services.
other changes in the internal revenue code of 1954
  SEC. 502. (a) DENIAL OF EXCLUSION FROM GROSS INCOME FOR AMOUNTS PAID BY
  THIRD PARTIES FOR MEDICAL CARE- Section 105 of the Internal Revenue Code
  of 1954 (relating to amounts received under accident and health plans)
  is amended by striking out subsection (b).
  (b) DENIAL OF EXCLUSION FROM GROSS INCOME OF CERTAIN CONTRIBUTIONS BY THE
  EMPLOYER TO HEALTH PLANS- Section 106 of such Code (relating to contributions
  by employer to accident and health plans) is amended to read as follows:
`SEC. 106. CONTRIBUTIONS BY EMPLOYERS TO ACCIDENT AND HEALTH PLANS.
  `Gross income does not include contributions by the employer to accident
  or health plans for compensation (through insurance or otherwise) to
  his employees for personal injuries or sickness to the extent that such
  contributions do not provide for health care and supplemental services
  available to such employees under the Health Service Act.'
  (c) DENIAL OF DEDUCTION OF HEALTH CARE EXPENSES AS TRADE OR BUSINESS
  EXPENSES- Section 162 of such Code (relating to trade or business expenses)
  is amended by redesignating subsection (h) as subsection (i) and by adding
  after subsection (g) the following new subsection:
  `(h) PAYMENTS FOR HEALTH CARE- No deduction shall be allowed under subsection
  (a) for any amount paid for health care services (other than any amount
  of tax imposed by section 59 and paid by the employer on behalf of his
  employees) which an individual was eligible to receive under title II of
  the Health Service Act.'.
  (d) DENIAL OF DEDUCTION FOR CONTRIBUTIONS TO CERTAIN MEDICAL AND HOSPITAL
  FACILITIES- (1) Paragraph (2) of section 170(c) of such Code (relating
  to charitable, etc., contributions and gifts) is amended by inserting
  `(other than an organization described in subsection (b)(1)(A)(iii))'
  after `(2) A corporation, trust, or community chest, fund, or foundation'.
  (2) Subsection (e) of section 501 of such Code (relating to cooperative
  hospital service organizations) is amended by striking out the last sentence.
  (e) DENIAL OF DEDUCTION FOR MEDICAL, DENTAL, ETC., EXPENSES- (1) Section
  213 of such Code (relating to medical, dental, etc., expenses) is repealed.
  (2) The table of sections of part VII of subchapter B of chapter 1 of
  subtitle A of such Code is amended by striking out the item relating to
  section 213.
  (f) HOSPITAL INSURANCE TAX- (1) Subsection (b) of section 1401 of such Code
  (relating to rate of tax on self-employment income) is repealed.
  (2)(A) Subsection (b) of section 3101 of such Code (relating to rate of
  tax on employees under the Federal Insurance Contributions Act) is repealed.
  (B) Section 3201 of such Code (relating to rate of tax imposed on employees
  under the Railroad Retirement Tax Act) is amended by striking out `(a)
  plus the rate imposed by section 3101(b)'.
  (C) Subsection (a) of section 3211 of such Code (relating to rate of tax on
  employee representatives under the Railroad Retirement Tax Act) is amended
  by striking out `3101(a), 3101(b)' and inserting in lieu thereof `3101(a)'.
  (D) Subsection (e) of section 6051 of such Code (relating to railroad
  employees) is repealed.
  (g) The amendments made by this section shall apply to taxable years
  beginning on or after the effective date of health services.
existing employer-employee health benefit plans
  SEC. 503. No contractual or other nonstatutory obligation of any employer to
  pay for or provide any health care and supplemental service to his present
  and former employees and their dependents and survivors, or to any of such
  persons, shall apply on and after the effective date of health services
  to the extent such individuals are eligible to receive such health care
  and supplemental services under this Act.
workers compensation programs
  SEC. 504. No workers compensation program, whether established pursuant to
  Federal or State law or private initiative, shall pay for or provide any
  health care and supplemental services on and after the effective date of
  health services, to the extent such health care and supplemental services
  are available under this Act.
Part B--Health Service Trust Fund
establishment of health service trust fund
  SEC. 511. (a) There is hereby created on the books of the Treasury of the
  United States a trust fund to be known as the Health Service Trust Fund
  (hereinafter in this title referred to as the `Trust Fund'). The Trust
  Fund shall consist of such gifts and bequests as may be made to the Service
  and such amounts as may be deposited in, or appropriated to, such fund as
  provided in this part.
  (b) There is hereby appropriated to the Trust Fund for each fiscal year
  beginning in the fiscal year in which the effective date of health services
  (as defined in title VI) falls, and for each fiscal year thereafter,
  out of any moneys in the Treasury not otherwise appropriated, an amount
  equal to 100 percent of expected net receipts from the taxes imposed by
  sections 59 and 3111(b) of the Internal Revenue Code of 1954 (as estimated
  by the Secretary of the Treasury). The amount appropriated by the preceding
  sentence shall be transferred from time to time from the general fund in
  the Treasury to the Trust Fund in such smaller amounts to be determined
  on the basis of estimates by the Secretary of the Treasury of the receipts
  specified in the preceding sentence; and proper adjustments shall be made
  in the amounts subsequently transferred to the extent prior estimates were
  in excess of or were less than the receipts specified in such sentence.
transfer of funds to the health service trust fund
  SEC. 512. (a) On the effective date of health services, there are transferred
  to the Trust Fund all of the assets and liabilities of the Federal Hospital
  Insurance Trust Fund and the Federal Supplementary Medical Insurance
  Trust Fund.
  (b) In addition to the sums appropriated by section 511(b), there is
  appropriated to the Trust Fund for each fiscal year, out of any moneys
  in the Treasury not otherwise appropriated, a governmental contribution
  equal to 40 percent of the sums appropriated by section 511(b) for such
  fiscal year. There shall be deposited in the Trust Fund all recoveries of
  overpayments, and all receipts under loans or other agreements entered into,
  under this Act.
administration of health service trust fund
  SEC. 513. (a) With respect to the Trust Fund, there is hereby created a
  body to be known as the Board of Trustees of the Trust Fund (hereinafter
  in this section referred to as the `Board of Trustees') composed of the
  Secretary of the Treasury, the Secretary of Health and Human Services, and
  the Chairperson of the National Health Board, all ex officio. The Secretary
  of the Treasury shall be the Managing Trustee of the Board of Trustees
  (hereinafter in this section referred to as the `Managing Trustee'). The
  Chairperson of the National Health Board shall serve as the Secretary of the
  Board of Trustees. The Board of Trustees shall meet not less frequently than
  once each calendar year. It shall be the duty of the Board of Trustees to--
  (1) hold the Trust Fund;
  (2) report to the Congress not later than the first day of April of each
  year on the operation and status of the Trust Fund during the preceding
  fiscal year and on its expected operation and status during the current
  fiscal year and the next 2 fiscal years;
  (3) report immediately to the Congress whenever the Board is of the opinion
  that the amount of the Trust Fund is unduly small; and
  (4) review the general policies followed in managing the Trust Fund,
  and recommend changes in such policies, including necessary changes in
  the provisions of law which govern the way in which the Trust Fund is to
  be managed.
The report provided for in paragraph (2) shall include a statement of the
assets of, and the disbursements made from, the Trust Fund during the preceding
fiscal year, an estimate of the expected income to, and disbursements to be
made from, the Trust Fund during the current fiscal year and each of the
next 2 fiscal years, and a statement of the actuarial status of the Trust
Fund. Such report shall be printed as a House document of the session of
the Congress to which the report is made.
  (b) It shall be the duty of the Managing Trustee to invest such portion
  of the Trust Fund as is not, in his judgment, required to meet current
  withdrawals. Such investments may be made only in interest-bearing
  obligations of the United States or in obligations guaranteed as to
  both principal and interest by the United States. For such purpose such
  obligations may be acquired (1) on original issue at the issue price, or (2)
  by purchase of outstanding obligations at the market price. The purposes
  for which obligations of the United States may be issued under the Second
  Liberty Bond Act, as amended, are hereby extended to authorize the issuance
  at par of public-debt obligations for purchase by the Trust Fund.
  (c) Any obligations acquired by the Trust Fund (except public-debt
  obligations issued exclusively to the Trust Fund) may be sold by the
  Managing Trustee at the market price, and such public-debt obligations
  may be redeemed at par plus accrued interest.
  (d) The interest on, and the proceeds from the sale or redemption of,
  any obligations held in the Trust Fund shall be credited to and form a
  part of the Trust Fund.
  (e) The Managing Trustee shall pay from time to time from the Trust Fund
  such amounts as the National Health Board certifies are necessary to carry
  out this Act.
Part C--Preparation of Plans and Budgets
determination of fund availability
  SEC. 521. (a)(1) The National Health Board shall, not later than January 1
  of each year, initially fix the maximum amount of funds which may (except
  as provided in subsection (c)) be obligated during the fiscal year beginning
  on October 1 of such year for expenditure from the Trust Fund.
  (2) Such amount shall not exceed for a fiscal year the lesser of--
  (A) 140 percent of the expected net receipts during the fiscal year (as
  estimated by the Secretary of the Treasury) from the taxes imposed by
  sections 59 and 3111(b) of the Internal Revenue Code of 1954;
  (B) the amount of the aggregate obligations that the National Health Board
  determines were (or will be) incurred by the Service from the Trust Fund
  during the previous fiscal year, adjusted to reflect changes in the cost
  of living, in the number of users, and in the capacity of the Service to
  provide services under this Act, as such changes are reflected in the plans
  and budgets prepared and submitted by area health boards under this part; or
  (C) the amount fixed under subsection (b).
  (3) The National Health Board may at any time refix such amount to reflect
  changes (A) of one percent or more in the expected net tax receipts
  (described in paragraph (2)(A)), or (B) of five percent or more in the
  cost of living, number of users, or the capacity of the Service to provide
  services under this Act. The National Health Board shall promptly report
  to Congress any increase made in such amount and the reasons therefor.
  (b) The National Health Board shall fix in a fiscal year an amount,
  which the maximum amount described in subsection (a)(1) may not exceed
  in the fiscal year, which is less than the amount described in subsection
  (a)(2)(A) if the Board determines that--
  (1) restriction of the amount to be made available for obligation will not
  materially impair the adequacy or quality of health care and supplemental
  services provided to users, or
  (2) improvement in the organization, delivery, or utilization of such
  services has lessened their aggregate cost (or increase in such cost).
  (c) The National Health Board may obligate for expenditure from the Trust
  Fund, in addition to the maximum amount which may be obligated in a fiscal
  year under subsection (a), such funds as are necessary to provide health care
  and supplemental services needed because of an epidemic, disaster, or other
  occurrence which was not, and could not have been, reasonably planned for by
  the Board and for which the contingency fund provided in section 534(b)(6)
  is insufficient. The National Health Board shall promptly report to Congress
  any obligation made pursuant to this subsection and the reasons therefor.
  (d) In addition to the maximum amounts which may be obligated pursuant
  to subsection (a), the National Health Board may allocate funds borrowed
  in accordance with section 541 for such purposes as it deems necessary
  and appropriate.
preparation of area plans and budgets
  SEC. 522. (a) Each community board shall, not later than January 1 of
  each year, submit to its respective district board a plan and budget for
  the fiscal year beginning on October 1 of such year. In preparing such
  plan and budget, each community board shall consult with users and health
  workers in the community to assure effective and coordinated planning for
  the efficient use of resources in its community.
  (b) Each district board shall, not later than February 1 of each year,
  submit to its respective regional board a plan and budget for the fiscal
  year beginning on October 1 of such year. In preparing such plan and
  budget, each district board shall consult with the users, health workers,
  and community boards in its district to assure effective and coordinated
  planning for the efficient use of resources in its district.
  (c) Each regional board shall, not later than March 1 of each year, submit
  to the National Health Board a plan and budget for the fiscal year beginning
  on October 1 of such year. In preparing such plan and budget, each regional
  board shall consult with the users, health workers, and district boards in
  its region to assure effective and coordinated planning for the efficient
  use of resources in its region.
  (d) In preparing the budgets required by this section, each area health
  board shall specify its operating, prevention, capital, and research
  expenses anticipated for the fiscal year covered by the budget and for
  the 5-year period beginning with such fiscal year.
Part D--Allocation and Distribution of Funds
national budget
  SEC. 531. (a) The National Health Board shall prepare, taking into
  consideration the budgets submitted under section 522(c), and, as soon after
  April 1 of each year as is practicable, shall transmit to the regional
  boards a national health budget for the fiscal year beginning on October
  1 of such year. Such budget shall divide the total funds available for
  obligation in such year, as determined under section 521, into--
  (1) funds for ordinary operating expenses, which shall be further divided
  into funds for use by the National Health Board, and funds to be allocated
  (in accordance with subsection (b)) to the regional boards for use by the
  regional boards and the district and community boards within their regions;
  (2) funds for preventive health measures, which shall be further divided
  into funds for use by the National Health Board and funds to be allocated
  (in accordance with subsection (b)) to the regional boards for use by the
  regional boards and the district and community boards within their regions;
  (3) funds for capital expenses, which shall be further divided into funds for
  use by the National Health Board and funds to be allocated (in accordance
  with subsection (c)) to the regional boards for use by the regional boards
  and district and community boards within their regions;
  (4) funds for research expenses, which shall be further divided into funds
  for the conduct of research under the supervision of the National Health
  Board and funds to be allocated (in accordance with subsection (b)) to
  the regional boards for the conduct of research under the supervision of
  the regional, district, and community boards; and
  (5) funds for special operating expenses, as described in section 534.
  (b) Funds for ordinary operating expenses, for preventive health measures,
  and for research expenses which are allocated to the regional boards under
  subsection (a) shall be divided among the regions in the proportion which
  the number of residents in each region bears to the total population of
  the Nation.
  (c) Funds for capital expenses which are allocated to the regional boards
  under subsection (a) shall be allocated, to the extent consistent with
  the efficient and equitable use of resources, to the regional boards in
  accordance with the budgets for capital expenses submitted by such boards
  to the National Health Board under section 522(c), except that during the
  first 10 fiscal years following the effective date of health services,
  priority shall be given to regions lacking adequate health care facilities
  on such effective date.
  (d) A budget submitted to the regional boards under subsection (a) shall
  be adopted upon the approval of such budget by a majority of such regional
  boards.
regional budgets
  SEC. 532. (a) Each regional board shall prepare, taking into consideration
  the budgets submitted under section 522 (b), and, as soon as may be
  practicable after the adoption under section 531 of the national health
  budget for any fiscal year, shall transmit a regional budget, covering
  operating, prevention, capital, and research expenses for such fiscal year,
  to each district board in its region. Such regional budget shall be adopted
  upon the approval of such budget by a majority of such district boards.
  (b) Funds for capital expenses shall be allocated, to the extent consistent
  with the efficient and equitable use of resources, to the district boards
  in a region in accordance with the budgets for capital expenses submitted
  by such boards to the regional board under section 522(b), except that
  during the first 10 fiscal years following the effective date of health
  services, priority shall be given to districts lacking adequate health
  care facilities on such effective date.
  (c) Funds to be allocated to district boards for ordinary operating expenses,
  preventive health measures, and research expenses shall be allocated to
  each district board in the same proportion as the number of residents in
  such district bears to the number of residents in the respective region.
district budgets
  SEC. 533. (a) Each district board shall prepare, taking into consideration
  the budgets submitted under section 522 (a), and, as soon as may be
  practicable after the adoption under section 532 of the regional health
  budget for any fiscal year for the respective region, shall transmit a
  district budget, covering operating, prevention, capital, and research
  expenses for such fiscal year, to each community board in its district. Such
  district budget shall be adopted upon the approval of such budget by a
  majority of such community boards.
  (b) Funds for capital expenses shall be allocated, to the extent consistent
  with the efficient and equitable use of resources, to the community boards
  in a district in accordance with the budgets for capital expenses submitted
  by such boards to the district board under section 522(a), except that
  during the first 10 fiscal years following the effective date of health
  services, priority shall be given to communities lacking adequate health
  care facilities on such effective date.
  (c) Funds to be allocated to community boards for ordinary operating
  expenses, preventive health measures, and research expenses shall be
  allocated to each community board in the same proportion as the number
  of residents in such community bears to the number of residents in the
  respective district.
special operating expense fund
  SEC. 534. (a) A fund for special operating expenses shall be incorporated
  into each budget prepared by the National Health Board. For the purposes of
  this title, the term `special operating expenses' means operating expenses
  associated with--
  (1) the care and treatment of users 65 years of age or older;
  (2) the care and treatment of persons confined to full-time residential
  care institutions, including nursing homes and facilities for the treatment
  of mental illness;
  (3) the special health care needs of low-income users;
  (4) the special health care needs of residents of rural areas;
  (5) special health care needs arising from environmental or occupational
  health conditions;
  (6) special health care needs arising from unexpected occurrences, including
  epidemics and natural disasters; and
  (7) the conduct of environmental health inspection and monitoring services.
  (b) The special operating expense fund shall be allocated as follows:
  (1) Funds for the additional operating expenses associated with the care
  and treatment of users 65 years of age or older shall be allocated to
  district and community boards and shall consist of uniform basic capitation
  amounts multiplied by the number of residents 65 years of age or older in
  the respective districts and communities. The basic capitation amounts
  for districts and for communities shall be determined by the National
  Health Board, based upon studies of the additional operating expenses
  associated with the care and treatment of such residents in such districts
  and communities.
  (2) Funds for the additional operating expenses associated with the care and
  treatment of persons confined to full-time residential care institutions
  shall be allocated to the district and community boards responsible for
  such institutions and shall consist of a uniform basic capitation amount
  for each kind of institution, multiplied by the number of residents in
  such institutions in the respective districts and communities. The basic
  capitation amounts shall be determined by the National Health Board, based
  upon studies of the additional operating expenses associated with the care
  and treatment of such persons and the maintenance of such institutions.
  (3) Funds shall be allocated to community boards for the additional operating
  expenses associated with the special health care needs of low-income
  persons. Such payments shall be allocated to community boards in proportion
  to the number of residents in their communities having incomes below the
  poverty level (as defined by the Secretary of Commerce). The total funds
  allocated for this purpose shall be no less than 2 percent of the ordinary
  operating expense funds allocated in accordance with section 531(a).
  (4) Funds for the additional operating expenses associated with the special
  health care needs of residents of rural areas shall be allocated to district
  and community boards serving areas of low population density and shall
  consist of basic capitation amounts multiplied by the number of residents
  in the respective districts and communities. The basic capitation amounts
  shall be determined by the National Health Board based upon studies of the
  additional operating expenses associated with the provision of health care
  in areas of low population density.
  (5) Funds for the additional operating expenses associated with special
  regional health care needs arising from environmental and occupational
  health problems shall be allocated to regional boards by the National Health
  Board in accordance with its determination of such special needs. The total
  funds allocated for this purpose shall be no greater than one-half of 1
  percent of the ordinary operating expense funds allocated in accordance
  with section 531(a).
  (6) Funds for the additional operating expenses associated with special
  health care needs arising from unexpected occurrences shall be retained
  by the National Health Board in a contingency fund and shall be allocated
  by the National Health Board in accordance with its determination of such
  needs. The total funds retained for this purpose in any one fiscal year
  shall be no greater than one-half of 1 percent of the ordinary operating
  expense funds allocated in such year in accordance with section 531(a).
  (7) Funds for the additional operating expenses associated with the
  conduct of environmental health inspection and monitoring services shall be
  allocated by the National Health Board to the area health boards providing
  such services.
distribution of funds
  SEC. 535. (a) Funds allocated under the national health budget shall be
  distributed by the National Health Board from the Trust Fund. No health
  board may request or receive funds from any other source.
  (b) All payments shall be made to area health boards, and shall be expended
  by such boards, in accordance with the budgets adopted under sections 531
  through 533. If the budget for any area health board for a fiscal year is
  not adopted before the beginning of the fiscal year, until such budget is
  adopted such area health board shall continue to receive ordinary operating
  expense funds, prevention expense funds, and research expense funds at the
  rate at which it was receiving such funds during the preceding fiscal year,
  and it shall receive special operating expense funds in accordance with
  section 534.
  (c) Each area health board shall maintain separate accounts for--
  (1) funds for operating expenses, including ordinary operating expenses
  and special operating expenses;
  (2) funds for preventive health measures;
  (3) funds for capital expenses; and
  (4) funds for research expenses.
Funds in a capital expense account shall be expended only for capital
expenses. Funds in a research expense account shall be expended only for
operations, equipment, and facilities for health and health care delivery
research conducted in accordance with part C of title IV. Separate accounts
shall not be required for funds for ordinary operating expenses and for
special operating expenses.
  (d) Area health boards shall be paid at such time or times as the National
  Health Board finds appropriate.
  (e) Before and during any fiscal year, supplementary funds may be allocated
  to any area health board if the National Health Board finds that such
  funds are required by events occurring or information acquired after the
  initial allocations to such health board were made.
  (f) Area health boards may retain funds received from the National Health
  Board for 2 years following the receipt of such funds. Any funds which
  are unexpended after such time shall be returned to the National Health
  Board for deposit in the Trust Fund.
annual statement, records, and audits
  SEC. 536. (a) Each area health board shall prepare annually and transmit
  to the National Health Board a statement which shall accurately show the
  financial operations of such board and the facilities supervised by it
  for the year for which such statement is prepared.
  (b) Each area health board shall keep such records as the National Health
  Board determines to be necessary for the purposes of this Act, including
  for the facilitation of audits.
  (c) The National Health Board and the Comptroller General of the United
  States, or their duly authorized representatives, shall, for the purpose
  of audits, have access to any books, documents, papers, and records which
  in their opinion are related or pertinent to the operation of the Service.
Part E--General Provisions
issuance of obligations
  SEC. 541. (a) The National Health Board is authorized to borrow money and
  to issue and sell such obligations as it determines necessary to carry
  out the purposes of this Act, but only in such amounts as may be specified
  from time to time in appropriation Acts. The aggregate amount of any such
  obligations outstanding at any one time shall not exceed $10,000,000,000.
  (b) The National Health Board may pledge the assets of the Trust Fund and
  pledge and use its revenues and receipts for the payment of the principal of
  or interest on such obligations, for the purchase or redemption thereof,
  and for other purposes incidental thereto. The National Health Board
  is authorized to enter into binding covenants with the holders of such
  obligations, and with the trustee, if any, under any agreement entered into
  in connection with the issuance thereof with respect to the establishment
  of reserve, sinking, and other funds, stipulations concerning the issuance
  of obligations or the execution of leases or lease purchases relating to
  properties of the Service and such other matters as the National Health
  Board deems necessary or desirable to enhance the marketability of such
  obligations.
  (c) Obligations issued by the Service under this section--
  (1) shall be in such forms and denominations;
  (2) shall be sold at such times and in such amounts;
  (3) shall mature at such time or times;
  (4) shall be sold at such prices;
  (5) shall bear such rates of interest;
  (6) may be redeemable before maturity in such manner, at such times,
  and at such redemption premiums;
  (7) may be entitled to such relative priorities of claim on the assets of
  the Service with respect to principal and interest payments; and
  (8) shall be subject to other terms and conditions, as the National Health
  Board determines.
  (d) Obligations issued by the Service under this section shall--
  (1) be negotiable or nonnegotiable and bearer or registered instruments,
  as specified therein and in any indenture or covenant relating thereto;
  (2) contain a recital that they are issued under this section, and such
  recital shall be conclusive evidence of the regularity of the issuance
  and sale of such obligations and of their validity;
  (3) be lawful investments and may be accepted as security for all fiduciary,
  trust, and public funds, the investment or deposit of which shall be under
  the authority or control of any officer or agency of the Government of the
  United States, and the Secretary of the Treasury or any other officer or
  agency having authority over or control of any such fiduciary, trust, or
  public funds, may at any time sell any of the obligations of the Service
  acquired under this section;
  (4) be exempt both as to principal and interest from all taxation now or
  hereafter imposed by any State or local taxing authority except estate,
  inheritance, and gift taxes; and
  (5) not be obligations of, nor shall payment of the principal thereof or
  interest thereon be guaranteed by, the Government of the United States,
  except as provided in subsection (g).
  (e) At least 15 days before selling any issue of obligations, the National
  Health Board shall advise the Secretary of the Treasury of the amount,
  proposed date of sale, maturities, terms and conditions, and expected
  maximum rates of interest of the proposed issue in appropriate detail and
  shall consult with him or his designee thereon. The Secretary may elect to
  purchase such obligations under such terms, including rates of interest,
  as he and the National Health Board may agree, but at a rate of yield no
  less than the prevailing yield on outstanding marketable Treasury securities
  of comparable maturity, as determined by the Secretary. If the Secretary
  does not purchase such obligations, the National Health Board may proceed
  to issue and sell them to a party or parties other than the Secretary upon
  notice to the Secretary and upon consultation as to the date of issuance,
  maximum rates of interest, and other terms and conditions.
  (f) Subject to the conditions of subsection (e), the National Health Board
  may require the Secretary of the Treasury to purchase obligations of the
  Service in such amounts as will not cause the holding by the Secretary of
  the Treasury resulting from such required purchases to exceed $2,000,000,000
  at any one time. This subsection shall not be construed as limiting the
  authority of the Secretary to purchase obligations of the Service in excess
  of such amount.
  (g) Notwithstanding subsection (d)(5), obligations issued by the Service
  shall be obligations of the Government of the United States, and payment of
  principal and interest thereon shall be fully guaranteed by the Government
  of the United States, such guaranty being expressed on the face thereof,
  if and to the extent that--
  (1) the National Health Board requests the Secretary of the Treasury to
  pledge the full faith and credit of the Government of the United States
  for the payment of principal and interest thereon; and
  (2) the Secretary, in his discretion, determines that it would be in the
  public interest to do so.
  (h) For the purpose of any purchase of the obligations of the Service,
  the Secretary of the Treasury is authorized to use as a public debt
  transaction the proceeds from the sale of any securities issued under the
  Second Liberty Bond Act, as now or hereafter in force, and the purposes
  for which securities may be issued under the Second Liberty Bond Act, as
  now or hereafter in force, are extended to include any purchases of the
  obligations of the Service under this part. The Secretary of the Treasury
  may, at any time, sell any of the obligations of the Service acquired
  by him under this chapter. All redemptions, purchases, and sales by the
  Secretary of the obligations of the Service shall be treated as public
  debt transactions of the United States.
definitions
  SEC. 542. For purposes of this title:
  (1) The term `operating expenses' means the cost of providing, planning,
  operating, and maintaining services, facilities, programs, and boards
  (other than those associated with research) established or furnished
  under this Act, and of capital buildings and equipment (other than those
  associated with research) costing less than $100,000, except for funds
  associated with the conduct of preventive health measures and research.
  (2) The term `capital expenses' means expenses which under generally
  accepted accounting principles are not properly chargeable as expenses
  of operation and maintenance, which exceed $100,000, and which are not
  associated primarily with the conduct of research.
TITLE VI--MISCELLANEOUS PROVISIONS
effective date of health services
  SEC. 601. The effective date of health services under this Act is January
  1 of the fourth calendar year after the year in which this Act is enacted.
repeal of provisions
  SEC. 602. (a) Effective on the effective date of health services, the
  following provisions of law are repealed:
  (1) The Public Health Service Act, except for--
  (A) title I (relating to short title and definitions), parts F and G of
  title III (relating to licensing and quarantine authority), and title XIV
  (relating to safety of public water systems); and
  (B) titles VII and VIII, which shall remain effective, during the period
  beginning on such effective date and ending on the date occurring 4 years
  after such effective date, with respect to the provision of assistance to
  educational institutions, and students thereof, in areas which have not
  established health team schools under part A of title III of this Act.
  (2) Titles V, XVIII, and XIX of the Social Security Act (relating to the
  maternal and child health and crippled children's services, Medicare, and
  Medicaid); part B of title XI of such Act (relating to professional standards
  review); sections 226, 1121 through 1124, and 1126 of such Act (relating
  to entitlement to hospital insurance benefits, uniform health reporting
  systems, limitation on Federal participation for capital expenditures,
  program for determining qualification for certain health care personnel,
  disclosure of ownership and related information, and disclosure of certain
  convictions); and so much of title XX of such Act (relating to grants to
  States for services) as provides for payments to States for health care
  and supplemental services.
  (3) Chapter 89 of title 5, United States Code (relating to health insurance
  for Federal employees).
  (4) Chapters 17, 73, and 81 and section 1506 of title 38, United States Code
  (relating to medical benefits and programs relating to veterans).
  (5) Sections 1079 through 1083 and section 1086 of title 10, United States
  Code (relating to the civilian health and medical program of the uniformed
  services).
  (6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment,
  and Rehabilitation Act of 1970; the Comprehensive Alcohol Abuse and
  Alcoholism Prevention, Treatment, and Rehabilitation Act Amendments of 1974;
  and section 4 of the Comprehensive Drug Abuse Prevention and Control Act
  of 1970 (relating to medical treatment of narcotic addiction).
  (7) Public Law 83-568 (42 U.S.C. 2001-2004b) (relating to hospital and other
  health facilities for Indians) and Public Law 85-151 (42 U.S.C. 2005-2005f)
  (relating to community hospitals for Indians).
  (8) The District of Columbia Medical Facilities Construction Act of 1968
  and the District of Columbia Medical and Dental Manpower Act of 1970.
  (9) Sections 232 and 242 and title XI of the National Housing Act (relating
  to mortgage insurance for nursing homes, hospitals, and group practice
  facilities).
  (10) The Mental Retardation Facilities and Community Mental Health Centers
  Construction Act of 1963.
  (11) The Family Planning Services and Population Research Act of 1970.
  (12) The National Arthritis Act of 1974 and the National Diabetes Mellitus
  Research and Education Act.
  (13) Titles I and II and section 301 of the Lead-Based Paint Poisoning
  Prevention Act (42 U.S.C. 4801, 4811, 4821) (relating to grant programs
  for lead-based paint poisoning prevention).
  (14) The Act of March 2, 1897 (21 U.S.C. 41-50) (relating to tea
  importation).
  (15) Subsection (e) of section 20 and section 22 of the Occupational Safety
  and Health Act of 1970 (relating to the National Institute for Occupational
  Safety and Health).
  (b)(1) Not later than three years after the date of enactment of this Act,
  the President shall prepare, in consultation with the appropriate National
  Health Board, and transmit to Congress legislation (A) to repeal or amend
  such provisions of law as are inconsistent with the purposes of this Act
  or the provision of health care and supplemental services by the Service
  under this Act, and (B) to make such conforming and technical amendments
  in provisions of law as may be necessary to properly effect the repeal
  of provisions described in subsection (a) and the repeal or amendment of
  provisions described in clause (A) of this paragraph.
  (2) Such legislation shall include the transfers of such authority of the
  Secretary of Health and Human Services under the provisions of--
  (A) the Controlled Substances Act;
  (B) chapter 175 of title 28, United States Code (relating to civil commitment
  and rehabilitation of narcotics addicts);
  (C) chapter 314 of title 18, United States Code (relating to sentencing
  of narcotic addicts to commitment for treatment);
  (D) the Narcotic Addict Rehabilitation Act of 1966;
  (E) the Drug Abuse Office and Treatment Act of 1972;
  (F) the Occupational Safety and Health Act of 1970;
  (G) the Lead-Based Paint Poisoning Prevention Act;
  (H) the Federal Cigarette Labeling and Advertising Act;
  (I) the Federal Food, Drug, and Cosmetic Act;
  (J) the Fair Packaging and Labeling Act;
  (K) the Act of March 4, 1923 (21 U.S.C. 61-64) (relating to filled milk);
  (L) the Act of February 15, 1927 (21 U.S.C. 141-149) (relating to milk
  importation);
  (M) the Federal Caustic Poison Act;
  (N) the Federal Coal Mine Health and Safety Act of 1969 (other than title
  IV thereof); and
  (O) the Solid Waste Disposal Act,
to the Service as the President determines, after consultation with the
National Health Board, to be appropriate.
  (c)(1) The National Health Board shall, immediately upon its initial
  appointment, and in consultation with the Secretary of Health and Human
  Services, review the programs conducted under the specified provisions
  of the Public Health Service Act and the other Acts described in section
  602(a) and shall determine how the Service shall carry out the purposes
  of such programs.
  (2) Not later than one year after the effective date of health services,
  the National Health Board shall report to the President and to the Congress
  on how the Service is carrying out the purposes of the programs authorized
  to be conducted under provisions of law which are repealed by subsection
  (a) (other than paragraph (1)(B) thereof).
  (3) Not later than 5 years after the effective date of health services,
  the National Health Board shall report to the President and to the Congress
  on how the Service is carrying out the purposes of programs described in
  subsection (a)(1)(B).
  (d) Not later than 2 years after the effective date of health services, the
  National Health Board shall transmit to Congress a proposed codification
  of all the provisions of law which contain functions that are transferred
  or relate to the Service.
transition provisions
  SEC. 603. (a) Amounts appropriated to carry out the purposes of any
  provisions of law repealed by this Act and available on the effective date
  of such repeal shall be transferred on such date to the Health Service
  Trust Fund (established under section 511 of this Act).
  (b) The President is authorized to transfer so much of the positions,
  personnel, assets, liabilities, contracts, property, and records employed,
  held, used, arising from, available to or made available in connection
  with the functions or programs repealed by this Act to the Service as may
  be agreed upon by the President and the National Health Board.
  (c) In the case where the authority for the establishment of any office
  or agency, or all the functions of such office or agency, are repealed
  under section 602, such office or agency shall lapse.
  (d) The amendments made by section 602--
  (1) shall not apply with respect to any contract entered into before the
  effective date of such amendments, and
  (2) shall not affect (A) any right or obligation arising out of any
  matter occurring before the effective date of such amendments, or (B) any
  administrative or judicial proceeding (whether or not initiated before that
  date) for the adjudication or enforcement of any such right or obligation.
amendment to budget and accounting act
  SEC. 604. (a) Section 201 of the Budget and Accounting Act, 1921 (31
  U.S.C. 11) is amended by inserting after subsection (j) the following
  new subsection:
  `(k) The Budget transmitted pursuant to subsection (a) shall set forth
  the items enumerated in paragraphs (4) through (9) and (12) of subsection
  (a) with respect to expenditures from and appropriations to the Health
  Service Trust Fund (established under section 511 of the Health Service Act)
  separately from such items with respect to expenditures and appropriations
  relating to other operations of the Government.'.
  (b) The amendment made by subsection (a) shall apply with respect to fiscal
  years beginning more than 1 year after the date of enactment of this Act.
separability
  SEC. 605. If any provision of this Act, or the application of such provision
  to any person or circumstance, shall be held invalid, the remainder of this
  Act, or the application of such provision to persons or circumstances other
  than those as to which it is held invalid, shall not be affected thereby.