Text: H.R.1300 — 102nd Congress (1991-1992)All Information (Except Text)

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HR 1300 SC8
102d CONGRESS
2d Session
 H. R. 1300
Entitled the `Universal Health Care Act of 1991'.
IN THE HOUSE OF REPRESENTATIVES
March 6, 1991
Mr. RUSSO (for himself, Mr. MILLER of California, Mr. MOODY, Mr. DOWNEY,
Ms. PELOSI, Mr. SCHUMER, Mr. RANGEL, Mr. MCDERMOTT, Mr. YATES, Mr. ANNUNZIO,
Mrs. COLLINS of Illinois, Mr. SAVAGE, Mr. LIPINSKI, Mr. EVANS, Mr. HAYES
of Illinois, Mr. SANGMEISTER, Mr. MARKEY, Mr. KLECZKA, Mr. MARTINEZ,
Mr. LAFALCE, Mrs. MINK, and Mr. OBERSTAR) introduced the following bill;
which was referred jointly to the Committees on Energy and Commerce, Ways
and Means, Post Office and Civil Service, Armed Services, and Veterans' Affairs
April 23, 1991
Additional sponsors: Mr. CONYERS, Mr. SERRANO, Mr. LEWIS of Georgia,
Mr. ABERCROMBIE, Ms. NORTON, Mr. TOWNS, Mr. DWYER of New Jersey, Mr. POSHARD,
Mr. SOLARZ, Mr. OWENS of New York, Mr. HOCHBRUECKNER, and Mr. FRANK of
Massachusetts
August 26, 1991
Additional sponsors: Mr. GEJDENSON, Mr. STUDDS, Mr. CLAY, Mr. NOWAK,
Mr. MCNULTY, Mr. COYNE, Mr. BEILENSON, Mrs. BOXER, Mr. OLVER, Mr. RAHALL,
Mr. RAVENEL, Mr. WEISS, Mr. SCHEUER, Mr. SWIFT, Mr. DYMALLY, Mr. MAVROULES,
Mr. MFUME, and Mr. Kildee
November 6, 1991
Additional sponsors: Mr. KENNEDY, Mr. ATKINS, Mr. DICKS, Mr. EDWARDS of
California, Mr. FLAKE, Mr. PAYNE of New Jersey, Mr. BERMAN, Mr. FOGLIETTA,
Mr. VENTO, Mr. FORD of Tennessee, and Mr. Faleomavaega
January 22, 1992
Additional sponsors: Mr. TRAXLER, Mr. KOLTER, and Mr. Feighan
February 24, 1992
Additional sponsors: Mr. BROWN and Mrs. COLLINS of Michigan
March 27, 1992
Deleted sponsors: Mr. CLEMENT (added February 27, 1992; deleted March 18,
1992); Mr. TRAXLER (added November 20, 1991; deleted March 18, 1992).
May 6, 1992
Additional sponsors: Mr. BLACKWELL, Mr. PALLONE, Mr. ENGEL, Mr. BORSKI,
and Mr. Sawyer
Deleted sponsor: Mr. KOLTER (added November 21, 1991; deleted March 31, 1992)
SEPTEMBER 14, 1992
Additional sponsors: Mr. SABO, Mr. SIKORSKI, Mr. ACKERMAN, and Mr. Manton
Deleted sponsors: Mr. RAHALL (added June 25, 1991; deleted September 9, 1992),
Mr. RAVENEL (added June 26, 1991; deleted August 4, 1992), and Mr. KILDEE
(added July 31, 1991; deleted September 10, 1972)
A BILL
Entitled the `Universal Health Care Act of 1991'.
  Be it enacted by the Senate and House of Representatives of the United
  States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
  (a) SHORT TITLE- This Act may be cited as `Universal Health Care Act
  of 1991'.
  (b) Table of Contents-
Sec. 1. Short title; table of contents.
Sec. 2. National Health Insurance Program.
`TITLE XXI--NATIONAL HEALTH INSURANCE PROGRAM
`Part A--Eligibility and Entitlement
`Sec. 2101. Eligibility and entitlement.
`Sec. 2102. Enrollment.
`Part B--Benefits
`Sec. 2111. Scope of benefits.
`Sec. 2112. Exclusions.
`Part C--Payments
`Sec. 2121. Payments for hospital services and nursing facility services.
`Sec. 2122. Payment for other facility-based services.
`Sec. 2123. Payments for physicians' services and other professional services.
`Sec. 2124. Payments for other items and services.
`Sec. 2125. Use of fiscal agents.
`Sec. 2126. Mandatory assignment.
`Sec. 2127. No payments to Federal providers of services.
`Sec. 2128. Reporting systems.
`Part D--Administration
`Sec. 2131. General provisions.
`Sec. 2132. National health budget.
`Sec. 2133. National Health Trust Fund.
`Sec. 2134. State maintenance of effort payments.
`Sec. 2135. National advisory board.
`Sec. 2136. State advisory boards.
Part E--Miscellaneous
`Sec. 2171. Definitions.
`Sec. 2172. Incorporation of miscellaneous medicare-related provisions.
Sec. 3. Financing.
Sec. 4. Termination of other programs.
Sec. 5. Effective date for benefits.
SEC. 2. NATIONAL HEALTH INSURANCE PROGRAM.
  The Social Security Act is amended by adding at the end the following
  new title:
`TITLE XXI--NATIONAL HEALTH INSURANCE PROGRAM
`Part A--Eligibility and Entitlement
`SEC. 2101. ELIGIBILITY AND ENTITLEMENT.
  `(a) IN GENERAL- Every individual who is a resident of the United States
  and is a citizen or national of the United States or lawful resident alien
  (as defined in subsection (c)) is entitled to health insurance benefits
  under this title for each month in which the individual meets such condition.
  `(b) Treatment of Certain Nonimmigrants-
  `(1) IN GENERAL- The Secretary may make eligible to enroll for coverage
  for health benefits under this title such classes of aliens admitted to
  the United States as nonimmigrants as the Secretary may provide.
  `(2) CONSIDERATION- In providing for eligibility under paragraph (1),
  the Secretary shall consider reciprocity in health care benefits offered
  to individuals described in subsection (a) who are nonimmigrants in other
  foreign states, and such other factors as the Secretary deems appropriate.
  `(c) LAWFUL RESIDENT ALIEN DEFINED- In this section, the term `lawful
  resident alien' means an alien lawfully admitted for permanent residence and
  any other alien lawfully residing permanently in the United States under
  color of law, including an alien granted asylum or with lawful temporary
  resident status under section 210, 210A, or 245A of the Immigration and
  Nationality Act.
`SEC. 2102. ENROLLMENT.
  `(a) IN GENERAL- The Secretary shall provide a mechanism for the enrollment
  of individuals entitled to benefits under this title and, in conjunction
  with such enrollment, the issuance of a national health insurance card
  which may be used for purposes of identification and processing of claims
  for benefits under this title.
  `(b) ENROLLMENT AT BIRTH OR IMMIGRATION- The mechanism under subsection
  (a) shall include a process for the automatic enrollment of individuals
  at the time of birth in the United States or at the time of immigration
  into the United States or other acquisition of lawful resident status in
  the United States. Such mechanism shall also provide for the enrollment
  of eligible individuals as of January 1, 1994.
`Part B--Benefits
`SEC. 2111. SCOPE OF BENEFITS.
  `(a) IN GENERAL- Except as provided in the succeeding provisions of this
  part, the benefits provided to an individual by the program established
  by this title shall consist of entitlement to have payment made on the
  individual's behalf for the following:
  `(1) Inpatient hospital services.
  `(2) Nursing facility services.
  `(3) Home health services.
  `(4) Hospice care.
  `(5) Medical and other health services and professional medical services
  furnished by health care professionals who are authorized to provide such
  services under State law.
  `(6) Prescription drugs and biologicals.
  `(7) Preventive health services, including prenatal and postnatal care
  and preventive care for children.
  `(8) Home and community-based services, but only for individuals--
  `(A) over 18 years of age determined (in a manner specified by the
  Secretary)--
  `(i) to be unable to perform, without the assistance of an individual, at
  least 2 of the following 5 activities of daily living (or who has a similar
  level of disability due to cognitive impairment): bathing, eating, dressing,
  toileting, and transferring in and out of a bed or in and out of a chair, or
  `(ii) due to cognitive or mental impairments, requires supervision because
  the individual behaves in a manner that poses health or safety hazards to
  himself or herself or others; or
  `(B) under 19 years of age determined (in a manner specified by the
  Secretary) to meet such alternative standard of disability for children
  as the Secretary develops.
  `(9) Such other medical or health care items or services as the Secretary
  determines to be appropriate.
  `(b) NO DEDUCTIBLES OR COINSURANCE- There is no coinsurance, deductibles,
  or copayments applicable to covered benefits.
  `(c) Certifications for Certain Services-
  `(1) IN GENERAL- Except as provided with respect to eligible organizations
  under section 2372(a)(10), payment for services furnished an individual
  by a provider of services may be made only to providers of services which
  have entered into a participation agreement and only if the conditions
  described in section 1814(a) or 1835(a) have been met with respect to
  services to which such sections applied.
  `(2) SPECIAL RULES- In applying--
  `(A) section 1814(a)(2)(B) under this subsection, instead of the
  certification described in that section with respect to post-hospital
  extended care services, there must be a certification with respect to
  nursing facility services that the services are or were required to be
  given because the individual needs or needed nursing care or skilled
  rehabilitation services which as a practice matter can only be provided
  in a nursing facility on an inpatient basis; and
  `(B) section 1814(a)(2)(C) under this subsection, the certifications that
  the individual is or was confined to the individual's home and that the
  care be on an intermittent basis shall not apply.
  `(3) CERTIFICATION FOR HOME AND COMMUNITY-BASED SERVICES- With respect to
  home and community-based services, there shall be required a certification
  of the type described in section 1814(a) as to the facts that the individual
  provided the service is described in subsection (a)(8) and, but for the
  provision of such services, is at risk of institutionalization.
  `(d) SCHEDULE FOR PREVENTIVE HEALTH SERVICES- The Secretary, in consultation
  with experts in the field of preventive health and taking into account the
  cost-effectiveness of appropriate preventive health care, shall establish a
  schedule specifying the periodicity under which preventive health benefits
  are covered benefits under this title.
  `(e) Limitation on Certain Inpatient Mental Health Services-
  `(1) INPATIENT HOSPITAL CARE FOR MENTAL DISORDER- The benefits under this
  title for inpatient hospital care for mental disorder shall be limited to
  45 days per year, except that days of inpatient care may be substituted
  for days of partial hospitalization according to a ratio established
  by the Secretary. Such inpatient care shall include reimbursement for
  professional care, provided to an individual while receiving inpatient care,
  provided by a physician or duly licensed or certified clinical psychologist
  operating within the scope of practice of the physician or psychologist,
  as determined under State law.
  `(2) OUTPATIENT PSYCHOTHERAPY AND COUNSELING- The benefits under this
  title for outpatient psychotherapy and counseling for a mental disorder
  shall be limited to 20 visits per year by a provider who is acting within
  the scope of State law and who--
  `(A) is a physician, or
  `(B) meets standards established by the Secretary and is a duly licensed or
  certified clinical psychologist or a duly licensed or certified clinical
  social worker, or a duly licensed or certified equivalent mental health
  professional, or a clinic or center providing duly licensed or certified
  mental health services.
`SEC. 2112. EXCLUSIONS.
  `(a) IN GENERAL- Except as otherwise provided in this section, the provisions
  of section 1862 apply to payments under this title in the same manner as
  they applied to payments under part A or part B of title XVIII.
  `(b) EXCEPTIONS- Under this title, the limitations specified in paragraphs
  (7) and (12) of section 1862(a) and the provisions of section 1862(b)
  shall not apply and the limitations of paragraph (1) of such section shall
  not apply to preventive health services which the Secretary finds to be
  appropriate for the prevention of illness or disease.
`Part C--Payments
`SEC. 2121. PAYMENTS FOR HOSPITAL SERVICES AND NURSING FACILITY SERVICES.
  `(a) Based on Approved Budget-
  `(1) IN GENERAL- In the case of hospital services and nursing facility
  services, payment under this title shall be based on an annual budget for
  operating expenses of the institution which is submitted to, and approved
  by, the Secretary (or the State in accordance with section 2131(c)) in a
  form and manner specified by the Secretary. Such approved budgets--
  `(A) shall take into account amounts that are reasonable and necessary
  in the efficient provision of necessary hospital services and nursing
  facility services,
  `(B) shall not include amounts properly allocable to services that are
  not hospital services or nursing facility services, respectively,
  `(C) shall be consistent with the national and State health budgets
  established by the Secretary, and
  `(D) shall not include capital-related item and direct medical education.
Payment under such budget shall only be changed to reflect changes in volume
or type of services if such changes are significantly different than the
volume or type of such services assumed in the approval of the budget.
  `(2) PERIODIC PAYMENTS- The provisions of section 1815 (other than subsection
  (e)) shall apply to payments under this title in the same manner as they
  applied to payments under part A of title XVIII.
  `(3) SUBMITTAL TO STATE ADVISORY BOARDS- Each hospital, nursing facility,
  or other institutional provider shall submit the budget for review by the
  State advisory board (appointed under section 2136) for the State in which
  the provider is located prior to approval of that budget by the Secretary
  (or the State under section 2131(c)).
  `(b) BUDGETING FOR CAPITAL AND MEDICAL EDUCATION EXPENDITURES- Items in
  budgets for capital-related items and for direct medical education may
  only be approved if such amounts are consistent with the portion of the
  national and State health budgets established under subsections (c) and
  (d) of section 2132.
  `(c) MODIFICATION OF THE PROSPECTIVE PAYMENT ASSESSMENT COMMISSION-
  The Prospective Payment Assessment Commission, instead of conducting
  activities described in section 1886, shall advise the Secretary concerning
  the approval of budgets under this section and shall annually report to
  the Congress and the Secretary recommendations on how the budget approval
  process should be modified to best meet the objectives of this title and
  on global budgets and fee schedules established under section 2123 for
  the payment of facility-based outpatient services.
`SEC. 2122. PAYMENTS FOR OTHER FACILITY-BASED SERVICES.
  `(a) IN GENERAL- Payment under this title for home health services, hospice
  care, home and community-based services, and facility-based outpatient
  services (other than those described in section 2121) shall be based
  on either--
  `(1) a budget (of the type described in section 2121(a)(1)) for the
  facility which is submitted to, and approved by, the Secretary (or State
  under section 2131(c)) in a form and manner specified by the Secretary, or
  `(2) a fee schedule established by the Secretary,
as selected by the facility for each reimbursement period; except that
the Secretary (or the State under section 2131(c)) may use an alternative
prospective payment method (including capitation) so long as the method is
reviewed by the State advisory board (appointed under section 2136), there is
opportunity for full public comment, and the objectives of this title are met.
  `(b) CONSIDERATION IN ESTABLISHMENT OF FEE SCHEDULES- The fee schedule
  established under subsection (a)(2) for facility-based outpatient services
  shall--
  `(1) take into account the payment amounts established under section 2123
  for any related professional services, and
  `(2) provide an amount for capital-related costs if the costs are consistent
  with the national and State capital budgets established under section
  2132(c), but only in the case of services either--
  `(A) for which title XVIII provided for payment of a facility-related
  component, or
  `(B) for which the Secretary determines that such a component is appropriate
  to assure access to outpatient services in appropriate facilities.
  `(c) LIMIT ON PAYMENT FOR HOME AND COMMUNITY-BASED SERVICES- Payments
  under this title for home and community-based services with respect to any
  individual may not exceed 65 percent of the average amount of payment that
  would have been made for the individual if the individual were a resident
  of a nursing facility in the same area in which the services are provided.
  `(d) LONG-TERM CARE PAYMENT REVIEW COMMISSION--
  `(1) ESTABLISHMENT- The Director of the Congressional Office of Technology
  Assessment shall provide for the appointment of a Long-Term Care Payment
  Review Commission to be composed of individuals with national recognition
  for their expertise in health care economics and related fields for
  nursing facility services, home health services, hospice care, and home and
  community-based services. Appointments shall be made without regard to the
  provisions of title 5, United States Code, governing appointments in the
  competitive service. Members of the Commission shall first be appointed
  no later than January 1, 1993, for a term of 3 years, except that the
  Director may provide initially for such shorter terms as will insure that
  (on a continuing basis) the terms of no more than one-third of the number
  of members expire in any year. Membership on the Commission shall include
  health care economists, representatives of providers and manufacturers of
  such services, and consumers of such services.
  `(2) FUNCTIONS- The Commission shall advise the Secretary concerning the
  payment amounts established under section 2121 and this section for services
  described in paragraph (1) and shall annually report to the Congress and
  the Secretary recommendations on how the global budgets and fee schedules
  should be modified to best meet the objectives of this title.
`SEC. 2123. PAYMENTS FOR PHYSICIANS' SERVICES AND OTHER PROFESSIONAL SERVICES.
  `(a) IN GENERAL- Payment under this title for physicians' services and
  other professional services shall be based on a fee schedule established
  by the Secretary.
  `(b) USE OF NATIONAL RELATIVE VALUE SCALE- Such schedule shall--
  `(1) vary the payment amount among different services based on the relative
  value of the input factors to provide the services,
  `(2) vary among different areas, for the portion of the payment relating
  to based on reasonable differences in the prices for goods and services
  among the different areas, and
  `(3) be consistent with the national health budget established by the
  Secretary.
In establishing such schedule, the Secretary shall take into account the
fee schedules established under section 1848, without regard to the update
factor provided under that section.
  `(c) MODIFICATION OF THE PHYSICIAN PAYMENT REVIEW COMMISSION-
  `(1) REDESIGNATION- The Commission established under section 1845 is renamed
  the `Professional Payment Review Commission' and is continued for purposes
  of carrying out this subsection.
  `(2) ADDITIONAL MEMBERS- The Director of the Office of Technology
  Assessment shall increase the membership of the Commission to such
  number as may be necessary to include representation of nurses and other
  health care professionals whose services are paid for on the basis of
  a relative-value fee schedule established under this section, and shall
  consult with the Physician Payment Review Commission, the General Health
  Care Review Commission, and other appropriate provider organizations.
  `(3) ALTERNATIVE FUNCTIONS- The Commission, instead of conducting activities
  described in section 1845, shall advise the Secretary concerning the fee
  schedules established under this section and shall annually report to the
  Congress and the Secretary recommendations on how the fee schedules should
  be modified to best meet the objectives of this title.
`SEC. 2124. PAYMENTS FOR OTHER ITEMS AND SERVICES.
  `(a) IN GENERAL- Payment under this title for items and services not
  described in the previous section shall be made on the basis of fee
  schedules established by the Secretary consistent with the national health
  budget established by the Secretary. In establishing such schedules, the
  Secretary shall consult with the Commission established under subsection (b).
  `(b) General Health Care Payment Review Commission-
  `(1) ESTABLISHMENT- The Director of the Congressional Office of Technology
  Assessment shall provide for the appointment of a General Health Care Payment
  Review Commission, to be composed of individuals with national recognition
  for their expertise in health care economics and related fields for items
  and services for which payment is made under a fee schedule established
  under this section, representatives of providers and manufacturers of
  such items and services, and representatives of consumers of these items
  and services. Appointments shall be made without regard to the provisions
  of title 5, United States Code, governing appointments in the competitive
  service. Members of the Commission shall first be appointed no later than
  January 1, 1993, for a term of 3 years, except that the Director may provide
  initially for such shorter terms as will insure that (on a continuing basis)
  the terms of no more than one-third of the number of members expire in any
  year. Membership on the Commission shall include health care economists,
  representatives of providers and manufacturers of such items and services,
  and representatives of consumers of these items and services.
  `(2) FUNCTIONS- The Commission under this subsection shall advise the
  Secretary concerning the fee schedules established under this section and
  shall annually report to the Congress and the Secretary recommendations
  on how the fee schedules should be modified to best meet the objectives
  of this title.
`SEC. 2125. USE OF FISCAL AGENTS.
  `(a) IN GENERAL- The Secretary (or the State in accordance with section
  2131(c)), using competitive bidding procedures, may enter into such
  contracts with qualified entities, such as voluntary associations, as
  the Secretary determines to be appropriate to process claims under this
  title. The Secretary may provide for a process for entering into separate
  contracts under this section for claims processing under this title,
  but in no case may more than one contract be entered into for any State.
  `(b) FUNCTIONS- Under contracts entered into under this section,
  the qualified entity may carry out such functions provided for fiscal
  intermediaries and carriers under title XVIII as the Secretary determines
  to be appropriate.
  `(c) PAYMENTS- Payments to fiscal agents under contracts under this section
  shall be on a per claim basis.
`SEC. 2126. MANDATORY ASSIGNMENT.
  `(a) IN GENERAL- Payments for benefits under this title shall constitute
  payment in full for such benefits and the entity furnishing an item or
  service for which payment is made under this title shall accept such
  payment as payment in full for the item or service and may not accept
  any payment or impose any charge for any such item or service other than
  accepting payment from the Federal Government in accordance with this title.
  `(b) ENFORCEMENT- If an entity knowingly and willfully bills for an item or
  service or accepts payment in violation of subsection (a), the Secretary may
  apply sanctions against the entity in the same manner as sanctions could have
  been imposed under section 1842(j)(2) for a violation of section 1842(j)(1).
`SEC. 2127. NO PAYMENTS TO MOST FEDERAL PROVIDERS OF SERVICES.
  `No payment may be made under this title to any Federal provider of services
  (other than such a provider of the Indian Health Service and other than
  such a provider of the Department of Veterans Affairs) which the Secretary
  determines is providing services to the public generally as a community
  institution or agency, and no such payment may be made to any provider
  of services for any item or service which such provider is obligated by
  a law of, or a contract with, the United States to render at public expense.
`SEC. 2128. REPORTING SYSTEMS.
  `(a) ESTABLISHMENT OF SYSTEM- The Secretary, by not later than January 1,
  1993, shall establish a system for the reporting, by hospitals and other
  providers of services, of information (including information on patient care)
  sufficient to provide for the review and approval of budgets of hospitals,
  skilled nursing facilities, and other facilities under this part and the
  development of fee shedules for services under this part.
  `(b) BASIS- Such system shall be based on the standardized electronic
  cost reporting format placed into effect under section 1886(f)(1)(B)
  and the uniform reporting standards established under section 4007(c)
  of the Omnibus Budget Reconciliation Act of 1987.
  `(c) REQUIREMENT- Notwithstanding any other provision of this title,
  a hospital or other provider of services that fails to file reports on a
  timely basis in accordance with the system established under this section
  is not eligible for payments under this title.
`Part D--Administration
`SEC. 2131. GENERAL PROVISIONS.
  `(a) THROUGH HCFA- The Secretary, acting through the Administrator of the
  Health Care Financing Administration, shall administer the program under
  this title.
  `(b) USE OF STATE-LEVEL OFFICES- The Secretary shall provide for an office in
  each State to be responsible for administration of this title in that State.
  `(c) USE OF STATES- If a State requests to administer this title in the
  State, the Secretary shall provide for the administration of the provisions
  of this title within each State by each State as the Secretary determines
  will meet the objectives of this title, unless and until the States fails
  to comply with such requirements. Any State administering this title shall
  submit its State budget (including individual institutional budgets) to
  the Secretary to assure compliance with the national health budget and
  this title.
`SEC. 2132. NATIONAL AND STATE HEALTH BUDGETS.
  `(a) IN GENERAL- For each calendar year the Secretary shall establish a
  national health budget and, for each State, a State health budget which
  specifies--
  `(1) the level and application of expenditures to be made under this title
  in the year in the United States and in the State, respectively, and
  `(2) the amount and source of revenues to the National Health Trust Fund
  in the year.
Each State health budget shall take into account the population in the State,
health care costs and needs in the State, and such other factors as the
Secretary determines to be appropriate.
  `(b) EXPENDITURE LEVEL- The total level of expenditures to be specified
  in the national health budget for a year may not exceed the level of
  expenditures for covered benefits under this title made in 1992 increased
  in a compounded manner for each succeeding year (up to the year involved) by
  the annual percentage in the gross national product for the preceding year.
  `(c) INSTITUTIONAL CAPITAL BUDGET- Each national health budget shall include
  an amount for total expenditures for capital-related items for hospitals
  and nursing facilities and shall provide for State institutional capital
  budgets. Each national health budget shall specify the general manner in
  which such expenditures for capital-related items are to be distributed
  among the different types of facilities and the different areas of the
  United States to take into account the need for capital expenditures
  throughout the United States.
  `(d) HEALTH TRAINING BUDGET- Each national health budget shall include an
  amount for total expenditures for direct medical education expenses for
  institutions receiving payments under budgets approved under section 2121
  and for facility-based outpatient services for which payments are made
  under section 2122. Each national health budget shall specify the general
  manner in which such expenditures are to be taken into account, shall be
  based on a national plan for training of medical personnel developed by the
  Secretary, and shall provide for State budgets for direct medical education
  expenses. Payments under such budgets for such expenditures shall take
  into account the method for payment for direct medical education expenses
  described in section 1886(h).
`SEC. 2133. NATIONAL HEALTH TRUST FUND.
  `(a) ESTABLISHMENT- There is hereby created on the books of the Treasury of
  the United States a trust fund to be known as the `National Health Trust
  Fund' (in this section referred to as the `Trust Fund'). The Trust Fund
  shall consist of such gifts and bequests as may be made as provided in
  section 201(i)(1) and such amounts as may be deposited in, or appropriate
  to, such fund as provided in this part.
  `(b) Appropriations into Trust Fund-
  `(1) TAXES- There are hereby appropriated to the Trust Fund for each fiscal
  year (beginning with fiscal year 1994), out of any moneys in the Treasury
  not otherwise appropriated, amounts equivalent to 100 percent of--
  `(A) the taxes imposed by sections 3101(b), 3101(c), 3111(b), and 3111(c)
  of the Internal Revenue Code of 1986 with respect to wages reported to the
  Secretary of the Treasury or his delegate pursuant to subtitle F of such
  Code after January 1, 1994, as determined by the Secretary of the Treasury
  by applying the applicable rates of tax under such sections to such wages,
  which wages shall be certified by the Secretary of Health and Human Services
  on the basis of records of wages established and maintained by the Secretary
  of Health and Human Services in accordance with such reports;
  `(B) the taxes imposed by sections 1401(b) and 1401(c) of such Code
  with respect to self-employment income reported to the Secretary of the
  Treasury on tax returns under subtitle F of such Code, as determined by
  the Secretary of the Treasury by applying the applicable rates of tax
  under such sections to such self-employment income, which self-employment
  income shall be certified by the Secretary of Health and Human Services on
  the basis of records of self-employment established and maintained by the
  Secretary of Health and Human Services in accordance with such returns; and
  `(C) the aggregate increase in tax liabilities under chapter 1 of the
  Internal Revenue Code of 1986 which is attributable to the application of
  [specify new sections] of such Code.
The amounts appropriated by the preceding sentence shall be transferred from
time to time (but not less frequently than monthly) from the general fund in
the Treasury to the Trust Fund, such amounts to be determined on the basis
of estimates by the Secretary of the Treasury of the taxes, specified in
the preceding sentence, paid to or deposited into the Treasury; and proper
adjustments shall be made in amounts subsequently transferred to the extent
prior estimates were in excess of or were less than the taxes specified in
such sentence.
  `(2) STATE FUNDS- There are hereby appropriated into the Trust Fund such
  amounts as are paid by States under section 2234.
  `(3) LONG-TERM CARE/HEALTH CARE PREMIUMS- There are also transferred and
  deposited into the Trust Fund long-term care/health care premiums imposed
  under section 3(g) of the Universal Health Care Act of 1991.
  `(c) INCORPORATION OF PROVISIONS- The provisions of subsections (b) through
  (i) of section 1817 shall apply to the Trust Fund under this title in the
  same manner as they applied to the Federal Hospital Insurance Trust Fund
  under part A of title XVIII.
  `(d) INCORPORATION OF OTHER TRUST FUNDS- Any amounts remaining in the Federal
  Hospital Insurance Trust Fund or the Federal Supplementary Medical Insurance
  Trust Fund after the settlement of claims for payments under title XVIII have
  been completed, shall be transferred into the National Health Trust Fund.
`SEC. 2134. STATE MAINTENANCE OF EFFORT PAYMENTS.
  `(a) CONDITION OF COVERAGE- Notwithstanding any other provision of this
  title, no individual who is a resident of a State is eligible for benefits
  under this title for a month in a calendar year, unless the State provides
  (in a manner and at a time specified by the Secretary) for payment to the
  National Health Trust Fund in the month of the sum of--
  `(1) the product of $7.083 and the number of residents who are residents
  of the State and otherwise eligible for benefits under this title in the
  month, and
  `(2) 85 percent of  1/12 th of the amount specified in subsection (b)
  for the year,
or, if less,  1/12 th of the limiting amount specified in subsection (c).
  `(b) MAINTENANCE OF EFFORT AMOUNT- The amount of payment specified in
  this subsection for a State for a year is equal to the amount of payment
  (net of Federal payments) made by a State under its State plan under title
  XIX for 1993, increased to the year involved by the compounded sum of the
  percentage increase in the gross national product of the State for each
  year after 1992 and up to the year before the year involved.
  `(c) LIMITING AMOUNT- For purposes of subsection (a), the limiting amount
  specified in this subsection--
  `(1) for 1994, is the total amount of payment made by a State (net of any
  Federal payments made to the State) for health care in 1993, or
  `(2) for any subsequent year, is the amount specified in this subsection
  for the State for the previous year increased to the year involved by the
  compounded sum of the percentage increase in the gross national product
  of the State for each year after 1992 and up to the year before the year
  involved.
`SEC. 2135. NATIONAL ADVISORY BOARD.
  `(a) IN GENERAL- The Director of the Congressional Office of Technology
  Assessment (in this section referred to as the `Director' and the `Office',
  respectively) shall provide for the appointment of a National Health
  Advisory Board (in this section referred to as the `Board') to advise
  the Secretary respecting the implementation of this title. Members of
  the Board shall first be appointed no later than January 1, 1992, for a
  term of 3 years, except that the Director may provide initially for such
  shorter terms as will insure that (on a continuing basis) the terms of no
  more than 7 members expire in any year.
  `(b) COMPOSITION- The national advisory board shall be composed of
  21 individuals, appointed by the Director of the Office of Technology
  Assessment (without regard to the provisions of title 5, United States Code,
  governing appointments in the competitive service). The individuals shall
  include persons with national recognition for their expertise in health and
  related fields, physicians and other health professionals, administrators
  of health care facilities, providers of nonprofessional items and services,
  health care economists, and representatives of consumers of health care.
`SEC. 2136. STATE ADVISORY BOARDS.
  `(a) Appointment-
  `(1) IN GENERAL- For each State, the Secretary (or the Governor, in
  accordance with section 2131(c)) shall provide for appointment of a State
  advisory board to advise the Secretary respecting the implementation of
  this title in the State.
  `(2) BUDGET REVIEW- Each such board shall review, and submit comments to
  the Secretary concerning, budgets of hospitals, nursing facilities, and
  other institutional providers in the State submitted for approval by the
  Secretary. Such review shall take into account the State health budgets
  to be established by the Secretary under section 2132.
  `(b) COMPOSITION- Each State advisory board shall be composed of 15
  individuals, and shall include individuals who have expertise in health
  care as well as representatives of consumers, providers, and the State
  government. Each member shall be appointed for a term of 3 years, except
  that members first appointed to each such board shall be appointed for
  such shorter terms as will assure (on a continuing basis) that the terms
  of no more than 5 members expire in any year.
  `(c) CONSULTATION- Each State advisory board shall conduct its activities
  in consultation with the Governor of the State involved.
`Part E--Miscellaneous
`SEC. 2171. DEFINITIONS.
  `(a) INCORPORATION OF MEDICARE DEFINITIONS- Except as otherwise provided
  in this section, the definitions contained in section 1861 (other than
  subsections (v), (y), and (z)) shall apply for purposes of this title in
  the same manner as they applied for purposes of title XVIII.
  `(b) ADDITIONAL DEFINITIONS- In this title:
  `(1) The term `home and community-based services' means the services
  described in paragraphs (1) through (9) of section 1929(a) provided by an
  entity certified as meeting the applicable standards specified in subsections
  (f), (g), and (h) of section 1929 pursuant to a plan of care.
  `(2) The term `nursing facility services' has the meaning given the term
  extended care services in section 1861(h) if the word `skilled' were
  omitted throughout.
  `(3) The term `nursing facility' has the meaning given such term in section
  1819(a) if paragraph (1) of section 1919(a) were substituted for paragraph
  (1) of that section.
`SEC. 2172. INCORPORATION OF MISCELLANEOUS MEDICARE-RELATED PROVISIONS.
  `(a) PROVISIONS IN TITLE XVIII- The following provisions shall apply to
  this title in the same manner as they applied to title XVIII as of the
  date of the enactment of this Act:
  `(1) Section 1819 (relating to requirements for, and assuring quality of
  care in, skilled nursing facilities), except that--
  `(A) any reference in the section to a `skilled nursing facility' is deemed
  a reference to a `nursing facility', and
  `(B) the term `nursing facility' has the meaning given such term in
  section 1919(a).
  `(2) Section 1846 (relating to intermediate sanctions for providers of
  clinical diagnostic laboratory tests).
  `(3) Sections 1863 through 1865 (relating to consultation with State agencies
  and other organizations to develop conditions of participation for providers
  of services, use of State agencies to determine compliance by providers
  of services with conditions of participation, and effect of accreditation).
  `(4)(A) Subject to subparagraph (B), section 1866 (relating to agreements
  with providers of services).
  `(B)(i) The provisions of section 1866(a)(1)(N) shall not apply.
  `(ii) Under section 1866(a)(2), a provider of services may not impose any
  charge for covered items and services under this title.
  `(iii) In the case of a hospital, the provider agreement under section
  1866 shall prohibit a hospital from denying care to any individual on any
  ground other than the hospital's inability to provide the care required.
  `(5) Section 1867 (relating to examination and treatment for emergency
  medical conditions and women in labor).
  `(6) Section 1869 (relating to determinations and appeals).
  `(7) Section 1870 (relating to overpayment on behalf of individuals and
  settlement of claims for benefits on behalf of deceased individuals).
  `(8) Sections 1871 through 1874 (relating to regulations, application of
  certain provisions of title II, designation of organization or publication
  by name, and administration).
  `(9)(A) Subject to subparagraph (B), section 1876 (relating to payments
  to health maintenance organizations and competitive medical plans) shall
  apply to individuals entitled to benefits under this title in the same
  manner as it applies to individuals entitled to benefits under part A,
  and enrolled under part B, of title XVIII.
  `(B) In applying section 1876 under this title--
  `(i) the provisions of such section relating only to individuals enrolled
  under part B of title XVIII shall not apply;
  `(ii) subject to subparagraph (C), any reference to a Trust Fund established
  under title XVIII and to benefits under such title is deemed a reference
  to the National Health Trust Fund and to benefits under this title;
  `(iii) subject to subparagraph (C), the adjusted average per capita cost
  and adjusted community rate shall be determined on the basis of benefits
  under this title; and
  `(iv) subsection (f) shall not apply.
  `(C) For purposes of subparagraph (B), benefits under this title may, at
  the option of an eligible organization, not include benefits for nursing
  facility services that are not post-hospital extended care services and
  benefits for home and community-based services.
  `(10) Section 1877 (relating to limitation on certain physician referrals).
  `(11) Section 1878 (relating to the provider reimbursement review board),
  except that the hearings pursuant to such section shall be on the approval
  of budgets under section 2121 rather than the determination of payment
  amounts under title XVIII.
  `(12) Section 1891 (relating to conditions of participation for home health
  agencies; home health quality).
  `(13) Section 1892 (relating to offset of payments to individuals to collect
  past-due obligations arising from breach of scholarship and loan contract).
  `(c) TITLE XI PROVISIONS- The following provisions shall apply to this
  title in the same manner as they applied to title XVIII:
  `(1) Sections 1124, 1126, and 1128 through 1128B (relating to fraud
  and abuse).
  `(2) Section 1134 (relating to nonprofit hospital philanthropy).
  `(3) Section 1138 (relating to hospital protocols for organ procurement
  and standards for organ procurement agencies).
  `(4) Section 1142 (relating to research on outcomes of health care services
  and procedures), except that any reference in such section to a Trust Fund
  is deemed a reference to the National Health Trust Fund.
  `(5) Part B of title XI (relating to peer review of the utilization and
  quality of health care services).
  `(d) OTHER PROVISIONS- The provisions of subsections (g) and (i) of section
  201 shall apply to this title and the National Health Trust Fund in the same
  manner as they applied to title XVIII and the Federal Hospital Insurance
  Trust Fund.'.
SEC. 3. FINANCING.
  (a) Increase in Top Corporate Income Tax Rate-
  (1) IN GENERAL- subparagraph (C) of section 1(b)(1) of the Internal Revenue
  Code of 1986 (relating to tax imposed on corporations) is amended by striking
  `34 percent' and inserting `38 percent'.
  (2) EFFECTIVE DATE- The amendment made by this subsection shall apply to
  taxable years beginning after December 31, 1995.
  (b) Increase in Individual Income Taxes-
  (1) IN GENERAL- Section 1 of such Code (relating to tax imposed) as amended
  by striking subsections (a) through (e) and inserting the following:
  `(a) MARRIED INDIVIDUALS FILING JOINT RETURNS AND SURVIVING SPOUSES-
  There is hereby imposed on the taxable income of--
  `(1) every married individual (as defined in section 7703) who makes a
  single return jointly with his spouse under section 6013, and
  `(2) every surviving spouse (as defined in section 2(a)), a tax determined
  in accordance with the following table:
`If taxable income is:
The tax is:
Not over $32,450
15% of taxable income.
Over $32,450 but not over $78,400
$4,867.50, plus 30% of the excess over $32,450.
Over $78,400 but not over $200,000
$18,652.50, plus 34% of the excess over $78,400.
Over $200,000
$59,996.50 plus 38% of the excess over $200,000.
  `(b) HEADS OF HOUSEHOLDS- There is hereby imposed on the taxable income
  of every head of a household (as defined in section 2(b)) a tax determined
  in accordance with the following table:
`If taxable income is:
The tax is:
Not over $26,050
15% of taxable income.
Over $26,050 but not over $67,200
$3,907.50, plus 30% of the excess over $26,500.
Over $67,200 but not over $171,500
$16,252.50, plus 34% of the excess over $67,200.
Over 171,500
$51,714.50, plus 38% of the excess over $171,500.
  `(c) UNMARRIED INDIVIDUALS (OTHER THAN SURVIVING SPOUSES AND HEADS OF
  HOUSEHOLDS)- There is hereby imposed on the taxable income of every
  individual (other than a surviving spouse as defined in section 2(a) or
  the head of a household as defined in section 2(b)) who is not a married
  individual (as defined in section 770) a tax determined in accordance with
  the following table:
`If taxable income is:
The tax is:
Not over $19,450
15% of taxable income.
Over $19,450 but not over $47,050
$2,917.50, plus 30% of the excess over $19,450.
Over $47,050 but not over $120,000
$11,197.50, plus 34% of the excess over $47,050.
Over $120,000
$36,000.50, plus 38% of the excess over $120,000.
  `(d) MARRIED INDIVIDUALS FILING SEPARATE RETURNS- There is hereby imposed
  on the taxable income of every married individual (as defined in section
  7703) who does not make a single return jointly with his spouse under
  section 6013, a tax determined in accordance with the following table:
`If taxable income is:
The tax is:
Not over $16,225
15% of taxable income.
Over $16,225 but not over $39,200
$2,433.75, plus 30% of the excess over $16,225.
Over $39,200 but not over $100,000
$9,326.25, plus 34% of the excess over $39,200.
Over $100,000
$29,998.25, plus 38% of the excess over $100,000.
  `(e) ESTATES AND TRUSTS- There is hereby imposed on the taxable income of--
  `(1) every estate, and
  `(2) every trust,
taxable under this subsection a tax determined in accordance with the
following table:
`If taxable income is:
The tax is:
Not over $5,450
15% of taxable income.
Over $5,450 but not over $14,150
$817.50, plus 30% of the excess over $5,450.
Over $14,150 but not over $25,000
$3,427.50, plus 34% of the excess over $14,150.
Over $25,000
$7,116.50, plus 38% of the excess over $25,000.'
  (2) EFFECTIVE DATE- The amendment made by this subsection shall apply to
  taxable years beginning after December 31, 1995.
  (c) INCREASE IN EMPLOYER HOSPITAL INSURANCE TAX; REPEAL OF DOLLAR LIMITATION
  ON AMOUNT OF WAGES SUBJECT TO EMPLOYEE AND EMPLOYER HOSPITAL INSURANCE TAXES-
  (1) EMPLOYEE TAX- Subsection (b) of section 3101 of such Code is amended
  by striking `equal to' and all that follows and inserting `equal to 1.45
  percent of the wages (as defined in section 3121(a) without regard to
  paragraph (1) thereof) received by him with respect to employment (as
  defined in section 3121(b))'.
  (2) EMPLOYER TAX- Subsection (b) of section 3111 of such Code is amended
  by striking `equal to' and all that follows and inserting `equal to 7.5
  percent of the wages (as defined in section 3121(a) without regard to
  paragraph (1) thereof) paid by him with respect to employment (as defined
  in section 3121(b))'.
  (3) SELF-EMPLOYMENT TAX- Subsection (b) of section 1401 of such Code is
  amended by striking `a tax as follows:' and all that follows and inserting
  `a tax equal to 7.5 percent of the amount of the self-employment income
  (as defined in section 1402(b) without regard to paragraph (1) thereof)
  for such taxable year'.
  (4) RAILROAD RETIREMENT TAXES- Subparagraph (A) of section 3231(e)(2) of
  such Code is amended by adding at the end thereof the following new clause:
  `(iii) LIMITATION NOT TO APPLY TO TAXES EQUIVALENT TO HOSPITAL INSURANCE
  TAXES- Clause (i) shall not apply to--
  `(I) so much of the rate applicable under section 3201(a) or 3221(a)
  (as the case may be) as does not exceed the rate of tax in effect under
  section 3101(b), and
  `(II) so much of the rate of tax applicable under section 3211(a)(1)
  as does not exceed the rate of tax in effect under section 1401(b).'
  (5) Technical amendments-
  (A) Subsection (b) of section 1402 of such Code is amended by striking
  `the applicable contribution base (as determined under subsection (k))'
  and inserting `the contribution and benefit base (as determined under
  section 230 of the Social Security Act)'.
  (B) Section 1402 of such Code is amended by striking subsection (k).
  (C) Paragraph (1) of section 3121(a) of such Code is amended--
  (i) by striking `applicable contribution base (as determined under subsection
  (x))' each place it appears and inserting `contribution and benefit base
  (as determined under section 230 of the Social Security Act)', and
  (ii) by striking `such applicable contribution base' and inserting `such
  contribution and benefit base'.
  (D) Section 3121 of such Code is amended by striking subsection (x).
  (E) Clause (i) of section 3231(e)(2)(B) of such Code is amended to read
  as follows:
  `(i) TIER 1 TAXES- Except as provided in clause (ii), the term `applicable
  base' means for any calendar year the contribution and benefit base
  determined under section 230 of the Social Security Act for such calendar
  year.'
  (F) Paragraph (3) of section 6413(c) of such Code is amended to read
  as follows:
  `(3) SEPARATE APPLICATION FOR HOSPITAL INSURANCE TAXES- Paragraphs (1)
  and (2) shall not apply to--
  `(A) the tax imposed by section 3101(b) (or any amount equivalent to such
  tax), and
  `(B) so much of the tax imposed by section 3201 as is determined at a rate
  not greater than the rate in effect under section 3101(b).'
  (G) Sections 3122 and 3125 of such Code are each amended--
  (i) by striking `section 3111' each place it appears and inserting `section
  3111(a)', and
  (ii) by striking `applicable contribution base limitation' and inserting
  `contribution and benefit base limitation'.
  (6) EFFECTIVE DATE- The amendments made by this subsection shall apply to
  1996 and later calendar years.
  (d) Additional State and Local Employees Subject To Hospital Insurance Tax-
  (1) IN GENERAL- Paragraph (2) of section 3121(u) of such Code is amended
  by striking subparagraphs (C) and (D).
  (2) EFFECTIVE DATE- The amendment made by this subsection shall apply to
  remuneration paid after December 31, 1995.
  (e) Increase in Income Taxes on Social Security Benefits-
  (1) INCREASE IN AMOUNT OF BENEFITS TAKEN INTO ACCOUNT- Subsections (a)
  and (b) of section 86 of such Code is amended by striking `one-half'
  each place it appears and inserting `85 percent'.
  (2) EFFECTIVE DATE- The amendment made by this subsection shall apply to
  taxable years beginning after December 31, 1995.
  (f) SECTION 15 NOT TO APPLY- No amendment made by this section shall be
  treated as a change in a rate of tax for purposes of section 15 of the
  Internal Revenue Code of 1986.
  (g) Long-Term Care/Health Care Premium for the Elderly-
  (1) IN GENERAL- Except as provided in paragraph (2), each individual who
  at any time in a month is 65 years of age or older and is eligible for
  benefits under title XXI of the Social Security Act in the month shall
  pay a long-term care/health care premium for the month of $55.
  (2) EXCEPTION FOR LOW-INCOME ELDERLY- The Secretary of Health and Human
  Services shall provide a process whereby individuals with an adjusted
  gross income which does not exceed $8,500 (or $10,700 in the case of joint
  adjusted gross income in the case of a married individual) are not liable
  for the premium imposed under paragraph (1).
  (3) COLLECTION OF PREMIUM- The premium imposed under this subsection shall
  be collected in the same manner (including deduction from Social Security
  checks) as the premium imposed under part B of title XVIII of the Social
  Security Act was collected under section 1840 of such Act as of the date
  of the enactment of this Act.
  (4) DEPOSIT INTO NATIONAL HEALTH TRUST FUND- Premiums collected under this
  subsection shall be transferred to and deposited into the National Health
  Trust Fund in the same manner as premiums collected under section 1840 of
  the Social Security Act were transferred and deposited into the Federal
  Supplementary Medical Insurance Trust Fund.
  (h) ADDITIONAL REVENUES TO BE SPECIFIED- The Committee on Ways and Means
  of the House of Representatives, shall include in this bill as reported
  such additional provisions reforming the internal revenue laws as are
  necessary to fund over time the expenditure provisions included in this bill.
SEC. 4. TERMINATION OF OTHER PROGRAMS.
  (a) Medicare-
  (1) IN GENERAL- Notwithstanding any other provision of law, no benefits
  shall be available under title XVIII of the Social Security Act for any
  item or service furnished after December 31, 1994.
  (2) TRANSITION- In the case of inpatient hospital services and extended care
  services during a continuous period of stay which began before January 1,
  1995, and which had not ended as of such date, the Secretary of Health
  and Human Services shall provide for continuation of benefits under title
  XVIII of the Social Security Act until the end of the period of stay.
  (b) MEDICAID- No payments shall be made to a State under section 1903(a)
  of the Social Security Act with respect to medical assistance for items
  or services furnished after December 31, 1994.
  (c) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM- No benefits shall be made
  available under chapter 89 of title 5, United States Code, for any part
  of a coverage period occurring after December 31, 1994.
  (d) CHAMPUS- No benefits shall be made available under sections 1079 and
  1086 of title 10, United States Code, for items or services furnished
  after December 31, 1994.
  (e) VETERANS' BENEFITS- No benefits shall be available under chapter 17
  of title 38, United States Code, for items or services furnished after
  December 31, 1994, to the extent that benefits with respect to such items
  or services are available under title XXI of the Social Security Act.
SEC. 5. EFFECTIVE DATE FOR BENEFITS.
  Title XXI of the Social Security Act shall apply to items and services
  furnished on or after January 1, 1995.

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