Summary: H.R.1398 — 103rd Congress (1993-1994)All Information (Except Text)

There is one summary for H.R.1398. Bill summaries are authored by CRS.

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Introduced in House (03/18/1993)


Title I: Requiring Employers to Provide Health Insurance

Coverage for Employees and Dependents

Title II: Provision of Health Insurance Through a Public

Health Plan

Title III: Cost Containment

Subtitle A: Health Care Spending Amounts

Subtitle B: Administrative Simplification

Subtitle C: Malpractice Reform

Title IV: Group Health Insurance Reform

Title V: Changes in Medicare Program

Title VI: Financing Provisions

Subtitle A: General Provisions

Subtitle B: Deductibility of Certain Health Insurance


Subtitle C: State Maintenance of Effort

Title VII: Medicaid Provisions

Flexible Medical Access and Cost Containment Act of 1993 - Title I: Requiring Employers to Provide Health Insurance Coverage for Employees and Dependents - (Sec. 101) Amends the Internal Revenue Code (IRC) to impose an excise tax on employers who fail to cover employees and their dependents under a qualified employer health plan.

(Sec. 102) Amends the Social Security Act (SSA) to require employers to enroll their employees and dependents in a qualified employer health plan with a basic benefit package that at least mirrors the benefits provided under the public health plan created below or else pay such tax. Provides that a small employer may meet such requirements by purchasing coverage under the public plan. Allows a qualified employer health plan to be either a private or a self-insured plan, depending upon the employer's size. Allows employers to charge employees towards the cost of the premium for such basic coverage. Outlines additional requirements for qualified employer health plan premiums and cost-sharing and for low-income assistance for plan deductibles. Sets forth standards to certify qualified employer health plans. Requires the Secretary of Health and Human Services to: (1) establish procedures for periodic review and recertification of qualified employer health plans; and (2) terminate certification when the plan no longer meets such standards.

Preempts certain State and Federal requirements concerning benefit and coverage rules.

Applies this title to residents of the 50 States and the District of Columbia, but not Puerto Rico and U.S. territories.

(Sec. 103) Amends IRC, the Employee Retirement Income Security Act of 1974, and the Public Health Service Act (PHSA) to repeal certain health insurance continuation requirements.

Title II: Provision of Health Insurance Through a Public Health Plan - (Sec. 201) Amends SSA to create a public health plan similar to Medicare (SSA title XVIII) under which those U.S. citizens and resident aliens who are not Medicare beneficiaries or enrolled under a qualified employer health plan above, or under a Federal health plan, are eligible to enroll for basic health insurance benefits. Provides that, in order to meet the requirements of title I of this Act, a small or medium-size employer may provide for the enrollment of full-time employees and their dependents in the public health plan, but only under certain conditions.

Makes individuals with income below the Federal poverty level who enroll in the plan on a non-employment basis eligible for assistance to limit or eliminate their cost-sharing oligations under the plan.

Provides that the benefits under the public health plan shall generally be the same as those currently covered under Medicare, with certain exceptions. Requires payments for services under the public health plan to be based on rates established by the Secretary in accordance with specified standards and approved by the Federal Health Care Cost Containment Commission.

Directs the Secretary to establish a global fee schedule for payment of obstetrical services with a disincentive for cesarean sections.

Creates in the Treasury the Public Health Trust Fund to receive the funds generated from the excise taxes imposed under this Act as well as from other revenues dedicated to the support of the plan.

Directs the Secretary to provide for the: (1) submission of claims under the new plans established by this Act using uniform forms; and (2) reporting to the Commission of information on required health services provided under this title.

Requires the Secretary to establish a toll-free telephone number for information on the public health plan.

Authorizes the Secretary to conduct demonstration projects to: (1) improve the delivery and quality of health care services under title I of this Act; and (2) increase the efficiency and effectiveness of the methods for paying for such services.

Authorizes reciprocal coverage of foreign nationals whose home countries provide health benefits to U.S. citizens who reside there.

Applies this title only to residents of the 50 States and the District of Columbia.

Title III: Cost Containment - (Sec. 301) Sets national annual limits on the health expenditures of the public health plan and qualified employer health plans for services covered, adjusted each year as specified.

(Sec. 302) Establishes the Federal Health Care Cost Containment Commission (Commission) to: (1) apportion overall health care spending among the States; (2) monitor State compliance with such apportionment; (3) approve payment rates in certain States; and (4) establish an appeals process for payment rates.

(Secs. 303 and 304) Requires each State to establish a State Health Commission to: (1) allocate its health care spending apportionment among the health services furnished by different classes of providers; and (2) establish, and revise at the direction of the Commission, payment rates for such services which meet specified standards for approval by the Commission.

(Sec. 305) Provides that payment rates approved under this title shall apply under Medicare and the public health plan.

(Sec. 321) Details requirements for uniform health claims cards, systems to verify entitlement to plan benefits, uniform claims submission, electronic medical data reporting, uniform hospital cost reporting, and a study by the Physician Payment Review Commission on malpractice reform.

Title IV: Group Health Insurance Reforms - (Secs. 401 and 402) Amends SSA and IRC, respectively, to: (1) require the Secretary to develop standards for employment-related group health insurance plans; and (2) impose an excise tax on group plan issuers failing to meet such standards, with specified exceptions.

Directs the Secretary to provide for a toll-free telephone information and complaint system for the receipt and disposition of consumer complaints or inquiries about health plan compliance with this title and information to small employers about carriers that offer small employer health plans.

Provides that under such standards, no group plans may discriminate on the basis of an individual's health status, claims experience, receipt of health care, medical history, or lack of evidence of insurability. Provides for the same treatment of pre-existing condition exclusions under such group plans as provided under qualified employer health plans.

Requires the Secretary to publish the names of issuers of insured employment-related small employer health plans that comply with this title.

Requires any health insurance carrier offering small employer health plans to register with the Secretary. Requires such carriers to offer the same plan to all small employers within their community on a continuous, year-round basis. Allows a carrier to terminate or refuse to issue or renew, a plan only for nonpayment of premiums and fraud or misrepresentation. Prohibits a carrier from offering to, or issuing with respect to, a small employer a small employer health plan with a term of less than 12 months.

Requires a plan to provide for benefits for all required health services. Prohibits a plan, however, from imposing cost-sharing with respect to basic benefits in excess of the deductibles and co-payments permitted. Requires premiums to be community-rated for a given geographic area.

Prohibits a small employer carrier from varying the remuneration paid to a broker for the sale or renewal of any small employer health plan based on the claims experience associated with the group to which the plan was sold.

Sets forth requirements relating to health maintenance organization enrollment of small employer employees.

Title V: Changes in Medicare Program - (Secs. 501 through 504) Amends Medicare to add as Medicare benefits annual screenings for colorectal cancer for individuals over age 50 and for breast cancer for women over 64, vaccinations for influenza and tetanus-diphtheria, and well-child care services.

(Sec. 505) Directs the Secretary to provide for demonstration projects providing for Medicare coverage of other specified preventive services to determine whether to cover such services under Medicare part B (Supplementary Medical Insurance). Authorizes appropriations.

(Sec. 506) Directs the Director of the Office of Technology Assessment (OTA) to conduct a study to develop a process to review Medicare coverage of preventive services.

Title VI: Financing Provisions - (Sec. 601) Amends IRC to remove limitations on the contribution base for the hospital insurance tax.

(Secs. 611 and 612) Allows self-employed individuals to deduct the full amount paid for health insurance costs (currently, such deduction is limited to 25 percent of such costs). Repeals the termination date for such deduction, extending it indefinitely. Applies special rules for such individuals and personal corporations before employer health plan requirements take effect.

(Sec. 613) Allows small employers (those employing fewer than 100 employees) a deduction of 20 percent of the insurance premiums paid for qualified employee coverage.

Title VII: Medicaid Provisions - (Sec. 701) Amends SSA title XIX (Medicaid) to: (1) limit Federal financial participation for covered public health plan services; and (2) provide for continuation of Medicaid benefits not covered under the public health plan and nonduplication of benefits with such plan.