Summary: H.R.5837 — 102nd Congress (1991-1992)All Information (Except Text)

There is one summary for H.R.5837. Bill summaries are authored by CRS.

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Introduced in House (08/12/1992)

American Health Security Plan of 1992 - Title I: Eligibility and Enrollment - Entitles every U.S. resident citizen, national, and lawful resident alien to health care services and long-term care services under this Act. Requires each State program to provide for a mechanism for enrollment and issuance of an identification and processing card. Provides for portability, including mandating use of a uniform claims form.

Title II: Benefits - Subtitle A: Health Care Services - Includes as covered services: (1) inpatient and outpatient hospital care; (2) diagnostic and screening tests; (3) services furnished by health care professionals, including medically necessary dental care; (4) preventive care; (5) prescription drugs, biologicals, and devices; (6) substance abuse services; (7) outpatient mental health services; (8) hospice care; (9) habilitation and rehabilitation; (10) home medical equipment and prosthetic devices; and (11) approved experimental treatment.

Prohibits States from limiting the amount, duration, or scope of services except as provided in this Act. Excludes cosmetic surgery and certain inpatient amenities.

Requires: (1) the Federal Health Board established by this Act to provide, subject to certain requirements, for copayments and out-of-pocket limits; and (2) the Federal Health Priorities Council established by this Act to study: (1) whether out-of-pocket limits should be modified to take into account family size and composition; (2) whether co-payments effectively contain costs and whether they are an administrative burden on providers; (3) the effects of the continuation of duplicative private insurance on the quality, access, and cost of the public insurance program; and (4) whether cost sharing should be different for individuals who engage in practices deemed to increase the likelihood of service use.

Subtitle B: Long-Term Care Services - Requires that the Board set standards for eligibility, long-term care services coverage, income protection, and case management. Requires that long-term care include at least home- and community-based services, nursing home care, hospice care, home medical equipment, and services for individuals with developmental disabilities and mental illness.

Requires the Board to establish an income-related cost sharing schedule. Requires reduction of cost sharing to ensure that the income and assets of the individual using long-term care services under this Act are sufficient to: (1) cover all items needed in addition to those provided by the long-term care facility; (2) maintain the individual's primary residence; and (3) maintain the individual's independence once the individual no longer needs long-term care services. Requires a reduction in cost sharing to ensure that the income of the spouse, dependent, parent, or guardian of the individual using long-term care services is not reduced below certain levels.

Provides for the appointment of a Long-Term Care Services Assessment Commission to make recommendations annually regarding specified aspects of long-term care under this Act. Authorizes appropriations.

Subtitle C: Modification of Services - Requires annual recommendations by the Priorities Council regarding changes in services under this Act. Authorizes the Board to promulgate regulations for implementing the Council's recommendations. Gives the regulations the force of law unless Congress disapproves.

Title III: Federal and State Administration - Subtitle A: Federal Administration - Establishes the Federal Health Board to administer this Act and take other actions, including establishing national minimum quality standards, establishing uniform reporting requirements, developing a uniform claims form, and reviewing and approving interstate consortia minimizing fragmented care, and combating fraud and abuse.

Requires the Board to appoint the Federal Health Advisory Council.

Establishes the Federal Health Priorities Council to conduct hearings and studies and make recommendations on how health care dollars should be allocated in the context of a publicly funded national health insurance plan.

Authorizes appropriations for the Board, the Advisory Council, and the Priorities Council.

Subtitle B: State Administration - Provides for Board review and approval of State programs. Includes in requirements for State programs: (1) financing of services through a designated fund; (2) designation of a single nonprofit State agency to administer the program; (3) establishment of boards to negotiate with hospitals and practitioners; and (4) freedom of individuals to choose providers.

Allows States to contract with fiscal intermediaries, in a process of competitive bidding, to administer the State program.

Provides for waivers for States to: (1) implement alternative and innovative provider reimbursement, cost sharing, and administration; and (2) provide services through a capitation method.

Allows any group of States to establish a regional consortium in lieu of State programs. Provides for congressional disapproval of the consortium agreement.

Mandates grants to and cooperative agreements with States for programs, research, and treatment relating to environmental health and health promotion and disease prevention.

Mandates grants to States or regional consortia for the establishment and initial operation of the State or regional plan. Authorizes appropriations.

Title IV: Financing - Subtitle A: Health Budgets - Requires the Board to establish an annual or biennial budget for Federal and State expenditures under this Act. Requires computation of national average per capita costs, adjustments for risk groups, and adjustments for specified factors in each State. Provides for determination by the Board of the Federal and State shares of expenditures, subject to congressional disapproval. Entitles each State with an approved State program to a Federal contribution of the Federal share plus that State's total projected expenditures for services under this Act.

Prohibits a State, either by intention or as an unstated consequence of budget allocations, from restricting timely access to medically necessary and appropriate services under this Act or permitting queues to form that have the potential to be life threatening.

Subtitle B: Payments to Providers - Provides for State payments to hospitals and other health care and long-term care institutions for the areas of operating, capital, and health training expenses. Sets forth principles for guiding State reimbursement negotiation boards in each such area.

Requires the State practitioner reimbursement negotiation board to negotiate with the State organizations representing each of the practitioner disciplines to derive a relative value scale fee schedule fulfilling specified principles. Sets forth principles for negotiating reimbursement rates for nonphysician providers.

Declares payment by a State program to be payment in full.

Subtitle C: Revenues - Requires the Board to develop a mechanism for determining and collecting a premium from individuals and employers.

Requires the Board, subject to congressional disapproval, to collect premiums from individuals and employers according to certain requirements, including that the premiums from: (1) individuals be income-based and progressive; and (2) employers be based on each employer's ability to pay.

Amends the Internal Revenue Code to define "accident or health insurance," for purposes of provisions relating to exclusions from gross income, to mean an approved State program under this Act. Removes provisions relating to amounts paid to highly compensated individuals under a discriminatory self-insured medical expense reimbursement plan.

Prohibits trade or business expense deductions for employer group health plan expenses unless the plan is an approved State plan under this Act.

Removes provisions: (1) limiting deductions for health insurance costs of self-employed individuals to 25 percent of those costs; and (2) terminating, on a specified date, the allowance of any deductions for such costs for self-employed individuals.

Modifies definitions under provisions allowing individual medical expense deductions, including defining "medical care" to mean premiums and cost-sharing under this Act.

Terminates, after 1998, the child health insurance credit.

Establishes in the Treasury the Federal Health Care Trust Fund. Appropriates to the Fund premiums under this Act and additional revenues received as a result of amendments made by this subtitle. Transfers to the Fund all remaining amounts in the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. Authorizes and appropriates: (1) amounts equal to appropriations under title XIX (Medicaid) of the Social Security Act and under provisions of Federal law relating to the Civilian Health and Medical Plan of the Uniformed Services (CHAMPUS) and relating to health insurance for Federal officials and employees; (2) additional sums as required to cover administrative expenses and grants; (3) payments to each State for the Federal share of expenditures under this Act; and (4) sums as determined by the Board to be necessary to cover contingencies.

Declares that the receipts and disbursements of the Fund shall not be included in the totals of the U.S. budget and exempts them from any general budget limitation.

Makes each State responsible for establishing a financing program for the implementation of the State program.

Title V: Congressional Consideration - Sets forth rules, changeable as any other rule of the House of Representatives or the Senate, regarding congressional disapproval resolutions under this Act.

Title VI: Private Options - Declares that this Act does not prohibit private insurance coverage supplementing the services covered under this Act.

Allows private insurance coverage for services covered under this Act, subject to limitations, including: (1) prohibiting private coverage for the cost-sharing requirements for health care services and other non-long-term care services covered under this Act; (2) requiring issuers of private insurance to inform purchasers of any duplication in coverage; and (3) requiring the Comptroller General to review private insurance industry practices and make recommendations to the Congress regarding prevention of fraud and abuse in the sale of duplicative or supplemental private insurance.

Declares that the purchase of any private insurance does not relieve the purchaser of the payment of premiums under this Act.

Title VII: Expansion of Outcomes Research and Delivery of Services in Underserved Areas - Amends provisions of the Social Security Act relating to health care outcomes research to authorize appropriations.

Authorizes appropriations to carry out provisions of the Public Health Service Act relating to the National Health Service Corps.

Amends the Public Health Service Act to authorize grants to local communities for programs to finance the health-related education of residents of such communities, provided such residents agree to practice in a health-related field in that community for at least four years after graduation. Authorizes appropriations.

Mandates grants to expand the availability of comprehensive primary health services in medically underserved areas. Allows community and migrant health centers in existence at enactment of this Act to use any increase in revenue resulting from the increase in the number of insured patients treated for the expansion of the amounts and types of services furnished, to serve additional patients or areas, or to promote the recruitment, training, or retention of personnel. Authorizes appropriations.

Title VIII: Malpractice Reform - Requires the Board to make grants to States for the development and implementation of medical malpractice reforms meeting specified criteria. Authorizes appropriations.

Title IX: Effective Dates; Terminations; Transition; Relation to ERISA - Repeals: (1) titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act; (2) provisions of the Internal Revenue Code relating to hospital insurance; (3) certain provisions of Federal law relating to the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); and (4) specified provisions of Federal law relating to health benefits for Federal officials and employees.

Requires the Board to recommend to the Congress amendment or repeal of any other Federal program inconsistent with or duplicative of the principles of this Act.

Supersedes, to the extent they are inconsistent with this Act, the provisions of the Employee Retirement Income Security Act.