H.R.4202 - Health Savings and Security Act of 1994103rd Congress (1993-1994)
|Sponsor:||Rep. McCrery, Jim [R-LA-5] (Introduced 04/13/1994)|
|Committees:||House - Education and Labor; Energy and Commerce; Judiciary; Ways and Means|
|Latest Action:||08/02/1994 See H.R.3600. (All Actions)|
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Summary: H.R.4202 — 103rd Congress (1993-1994)All Bill Information (Except Text)
Introduced in House (04/13/1994)
TABLE OF CONTENTS:
Title I: Insurance Reform
Subtitle A: Insurance Provisions
Subtitle B: Promoting Development of Voluntary Health
Plan Purchasing Cooperatives
Subtitle C: Federal Preemption
Subtitle D: Rules of Construction Regarding Abortion
Title II: Amendments of Internal Revenue Code of 1986
Subtitle A: Limitations on Employer Deduction for Health
Care Coverage for Employees and on Employee
Exclusion for Employer-Provided Health Care
Subtitle B: Credits for Contributions to Medical Savings
Accounts, for Purchase of High Deductible Umbrella
Insurance, and for Routine Preventive Care
Subtitle C: Repeal of Medical Expense Deduction
Subtitle D: Veterans Medical Benefits and Services
Title III: Savings In Medicare and Medicaid Programs
Subtitle A: Medicare Program
Subtitle B: Medicaid Program
Title IV: Containing Health Care Costs
Subtitle A: Medical Malpractice Liability Reform
Subtitle B: Treatment of Certain Activities Under the
Title V: Special Assistance for Frontier, Rural, and
Urban Underserved Areas
Subtitle A: Frontier, Rural, and Urban Underserved Areas
Subtitle B: Primary Care Provider Education
Subtitle C: Programs Relating to Primary and Preventive
Subtitle D: Limitation on Funding for Abortions
Title VI: Administrative Cost Savings
Subtitle A: Standardization of Claims Processing
Subtitle B: Electronic Medical Data Standards
Subtitle C: Development and Distribution of Comparative
Subtitle D: Preemption of State Quill Pen Laws
Title VII: Anti-Fraud and Anti-Rationing
Subtitle A: Criminal Prosecution of Health Care Fraud
Subtitle B: Coordination of Health Care Anti-Fraud and
Subtitle C: Protection Against Rationing of Treatment
Health Savings and Security Act of 1994 - Title I: Insurance Reform - Subtitle A: Insurance Provisions - Part 1: Requirements for Tax-Favored Health Plans - Authorizes a State to establish or operate a managed health care plan.
(Sec. 102) Requires such a plan to provide for all medically necessary acute medical care (including physician services; inpatient, outpatient, and emergency hospital services and appropriate alternatives to hospitalization; and inpatient and outpatient prescription drugs), to not exclude coverage for selected illnesses or selected treatments if consistent with medically accepted practices, and to meet applicable cost-sharing requirements of this Act.
Requires that such plan, in the case of a high deductible umbrella insurance plan, provide a deductible amount for benefits provided in any plan year which is at least $1,500 (but not to exceed $3,000) for items and services furnished to a family (composed of one or more individuals) enrolled under the plan in a year.
Specifies that a health insurance plan may not require the payment of any copayment or coinsurance for an item or service for which coverage is required after an individual or a family has incurred out-of-pocket expenses equal to a specified limit for a plan year.
(Sec. 103) Requires that such a plan provide: (1) for a variation in premium rates only on the basis of age, sex, geography, and family enrollment, individual and group coverage, and in the case of group coverage, on the basis of the number of individuals covered within the group; (2) for a charge of the same premium rates to new applicants and existing policyholders with the same age, sex, geographic characteristics, and family enrollment; and (3) that the highest premium for the plan for a particular class of family enrollment and geographic characteristics may not exceed four times the lowest premium for such plan for the same enrollment and geographic characteristics. Permits incentive discounts of not more than ten percent for participating in an approved program to promote healthy behavior, prevent or delay the onset of illness, or provide for screening or early detection of illness.
(Sec. 104) Requires that such plan: (1) provide guaranteed issue at standard rates to all applicants; and (2) not exclude from coverage, or limit coverage for, any preexisting condition, with exceptions.
(Sec. 105) Requires that such plan provide the policyholder with a contractual right to renew the coverage which stipulates that the insurer cannot cancel or refuse to renew the coverage except for cases of nonpayment of premiums, or fraud or misrepresentation, by the policyholder.
(Sec. 106) Sets forth restrictions on agent compensation and broker activities.
Part 2: Certification of High Deductible Umbrella Insurance Plans and Managed Care Health Plans - Requires each State to submit to the Secretary of Health and Human Services a report on steps the State is taking to implement and enforce a regulatory program with respect to high deductible umbrella insurance plans and managed care health plans by a specified deadline. Directs the Secretary, upon determining that a State has failed to submit a report by the deadline or that the State has not implemented and provided adequate enforcement of the regulatory program, to give the State 60 days to submit such report or implement and enforce such program. Sets forth procedures for Federal enforcement if such failure has not been corrected.
(Sec. 112) Directs the Secretary to develop State regulatory program standards, in the form of model Acts and model regulations, which include: (1) procedures for certifying that the requirements of part 1 of this subtitle have been met by a health insurance plan applying for certification as a high deductible umbrella insurance plan or a managed care health plan; (2) specified requirements regarding marketing practices and reinsurance or allocation of risk mechanisms with respect to such a plan; (3) requirements regarding solvency standards and guaranty funds for carriers of such plans; and (4) reporting requirements under which carriers report to the Internal Revenue Service regarding the acquisition and termination by individuals of coverage under such plans.
Directs the Secretary to: (1) request the National Association of Insurance Commissioners to develop models for reinsurance or allocation of risk mechanisms for high deductible umbrella insurance plans and managed care health plans made available to individuals for whom an insurer is at risk of incurring high costs under the plan; and (2) review such models to determine if they provide for an effective reinsurance or allocation of risk mechanism.
Requires each State to establish one or more reinsurance or allocation of risk mechanisms consistent with such a model. Permits a State to establish and maintain such a mechanism jointly with other States. Directs the Secretary to establish and maintain a reinsurance or allocation of risk mechanism if a State has failed to establish or maintain such a mechanism.
Amends the Internal Revenue Code to impose a tax on the providing of any high deductible umbrella insurance plan or managed care health plan which covers any individual in a Federal reinsurance State. Directs that the tax imposed equal the applicable percentage of the amount received by the insurer for providing such plan in such Federal reinsurance State. Makes the insurer liable for payment of the tax.
Subtitle B: Promoting Development of Voluntary Health Plan Purchasing Cooperatives - Directs the Secretary to establish standards relating to the establishment of health plan purchasing cooperatives (HPPCs), qualifications for qualified health carriers, and the roles of States under this subtitle. Sets forth provisions regarding deadlines, revision of standards, application of standards through States, the Federal role, and implementation of the standards.
(Sec. 122) Requires each State to establish boundaries for HPPC areas in the State.
(Sec. 123) Authorizes the establishment of one or more State-chartered, nonprofit private corporations to serve as an HPPC for each HPPC area for the benefit of small employers and eligible individuals in the area. Specifies that a carrier may not form, underwrite, or possess a majority vote of an HPPC, but may administer an HPPC.
Sets forth provisions regarding: (1) the establishment by each HPPC of bylaws; (2) the election of members of its board of directors; (3) limitation of liability for good faith actions taken by any member of the board, its employees, or agent in the performance of duties of HPPCs; (4) appointment of officers and an executive director; (5) reporting, recordkeeping, and audit requirements; and (6) general authorities and limits on the authority of HPPCs.
(Sec. 124) Requires each HPPC to: (1) enter into contracts and hold policies with qualified health carriers which elect to offer HPPC plans to members; (2) provide for the enrollment of eligible employees of small employers and eligible individuals in HPPC plans of qualified health carriers offered by the HPPC; (3) provide to its members and eligible employees of small employer members comparison sheets with clear standardized information on each qualified health carrier and each HPPC plan offered by a qualified health carrier; (4) establish requirements for participation of small employers and eligible individuals as HPPC members consistent with any standards established by the Secretary and to maintain eligibility records; and (5) establish dispute resolution procedures to resolve disputes between the HPPC and its members or qualified health carriers.
Sets forth requirements concerning: (1) contracts with members; (2) contracts with plans; (3) overhead allowance; (4) uniform administrative and accounting procedures; and (5) contracts for administrative services.
(Sec. 125) Requires each State to establish a process whereby a carrier that demonstrates to the satisfaction of the State insurance commissioner that it has the capability to fulfill specified requirements (with regard to licensure, administrative capacity, access, grievance procedures, utilization management procedures, quality, information, and data elements) is designated as a qualified health carrier.
Sets forth the functions of qualified health carriers.
Requires that coverage under an HPPC plan offered by a qualified health carrier be available to any member of the HPPC at the anniversary date of each member's coverage under an HPPC plan, with exceptions and subject to specified conditions.
(Sec. 126) Requires each: (1) HPPC to use efficient and standardized means to notify small employers of the availability of plans through the HPPC and to notify the State insurance commissioner of any marketing practices or materials that it finds contrary to the fair marketing of qualified health carriers and HPPC plans; and (2) State insurance commissioner to monitor compliance with marketing requirements.
(Sec. 127) Requires: (1) each HPPC to submit specified data to the State on a quarterly basis; and (2) the Secretary to establish uniform standards for data that an HPPC collects from qualified health carriers and providers and disseminates.
(Sec. 128) Requires each State to: (1) assure compliance of HPPCs, small employers, and eligible employees and individuals with the requirements of this subtitle and to conduct reviews at least annually on the performance of each HPPC in assuring access to health coverage to small employers and eligible individuals in the HPPC area; (2) receive, review, and act on appeals of unresolved disputes between an HPPC and a member; (3) analyze information collected from qualified health carriers and other sources and report findings that assist consumers, HPPCs, qualified health carriers, or health care providers in improving the delivery or purchase of cost-effective health care; (4) prepare and make available to HPPCs and employers located in the State (and to eligible individuals upon request) information, in comparative form, concerning the HPPC plans in the State and HPPCs operating in the State; (5) report to the Secretary annually on the impact of the reform under this subtitle in expanding the availability and affordability of health coverage to eligible employees and individuals; and (6) supervise HPPCs to ensure that actions that affect market competition accomplish the objectives of this title, so as to provide State and Federal protection to HPPCs and HPPC boards of directors against Federal and State antitrust laws.
Subtitle C: Federal Preemption - Bars applicability of any provision of State or local law that: (1) in the case of a group health plan, requires the coverage of one or more specific benefits, services, or categories of health care, or services of any class or type of provider of health care; and (2) prohibits two or more employers from obtaining coverage under an insured multiple employer health plan.
(Sec. 143) Preempts and makes unenforceable specified State law restrictions with respect to reimbursement rates or selective contracting, differential financial incentives, and utilization review methods.
Directs the Comptroller General to conduct a study of the benefits and cost effectiveness of the use of managed care in the delivery of health services.
(Sec. 144) Specifies that nothing in this subtitle shall be construed to invalidate any State law that has the effect of preventing the denial of lifesaving medical treatment pending transfer to another health care provider.
Subtitle D: Rules of Construction Regarding Abortion Services; Inseverability - Specifies that: (1) nothing in this title or title II may be construed to require any health plan to include any abortion services or to condition tax deductibility on the inclusion of such services; and (2) if such provision is judicially determined to be invalid all the provisions of this title and title II shall be deemed to be invalid.
Title II: Amendments of Internal Revenue Code of 1986 - Subtitle A: Limitations on Employer Deduction for Health Care Coverage for Employees and on Employee Exclusion for Employer-Provided Health Care Coverage - Amends the Internal Revenue Code to allow an employer a deduction: (1) for health care coverage for employees under a high deductible umbrella insurance plan or a managed health care plan; (2) for contribution to a medical savings account for an employee; or (3) for payment of permitted coverage. Prohibits such deduction from exceeding the health care tax benefit limitation imposed on individuals receiving coverage under a tax-qualified health care plan.
(Sec. 202) Excludes from the gross income of an employee only coverage under a tax-qualified health care plan, contributions to a medical savings account, or permitted coverage payments.
(Sec. 203) Prohibits the provision of health benefits under cafeteria plans.
Subtitle B: Credits for Contributions to Medical Savings Accounts, for Purchase of High Deduction Umbrella Insurance, and for Routine Preventive Care - Allows individuals a tax credit (with limitation) for a percentage of contributions to a medical savings account. Makes such account tax-exempt and excludes other employer payments from the individual's tax base.
(Sec. 212) Allows individuals a tax credit for a percentage of the amount paid for coverage under a tax-qualified health care plan. Requires the establishment of a program to provide health insurance certificates for low-income individuals eligible for such credit.
(Sec. 213) Allows certain individuals a tax credit for a percentage of the amount paid for routine preventive care for the taxpayer, spouse, and dependents.
Subtitle C: Repeal of Medical Expense Deduction - Repeals the deduction for medical, dental, etc., expenses.
Subtitle D: Veterans Medical Benefits and Services Unaffected - Declares that nothing in this title affects veterans' medical benefits and services.
Title III: Savings in Medicare and Medicaid Programs - Subtitle A: Medicare Program - Amends the Internal Revenue Code to impose an annual tax on the Medicare part B (Supplementary Medical Insurance) premiums of high-income and certain other individuals covered by such part.
(Sec. 302) Amends title XVIII (Medicare) of the Social Security Act (SSA) to: (1) impose a co-payment for clinical diagnostic laboratory tests; (2) eliminate mandatory assignment for test payment and billing; and (3) provide for annual indexing of the part B deductible.
Subtitle B: Medicaid Program - Amends SSA title XIX (Medicaid) to: (1) cap Federal payments for acute medical services; (2) discontinue reimbursement standards for inpatient hospital services; (3) provide for optional enrollment of low-income individuals under high deductible umbrella insurance plans and managed care plans (with reduced payment adjustments for States providing such enrollment); (4) allow States more flexibility in contracting for coordinated care services; and (5) prohibit Medicaid funding of abortions not necessary to prevent the death of the mother.
Title IV: Containing Health Care Costs - Subtitle A: Medical Malpractice Liablity Reform - Part 1: General Provisions - Makes this subtitle applicable with respect to any medical malpractice liability claim and action brought in any State or Federal court, with exceptions (such as a claim or action for damages arising from a vaccine-related injury or death). Sets forth provisions regarding preemption, effect on sovereign immunity and choice of law or venue, and Federal court jurisdiction.
Part 2: Medical Malpractice and Product Liability Reform - Prohibits a medical malpractice liability action from being brought in any: (1) State court during a calendar year unless the medical malpractice liability claim that is the subject of the action has been initially resolved under a State's alternative dispute resolution (ADR) system certified for the year by the Secretary or under the alternative Federal system established by this Act; and (2) Federal court during a calendar year unless such claim that is the subject of the action has been initially resolved under such ADR system in the State whose law applies.
Directs the Attorney General to establish an ADR process for the resolution of medical malpractice liability claims brought against the United States, which shall occur after the completion of the administrative claim process. Prohibits a medical malpractice liability action based on such a claim from being brought in any Federal court unless the claim has been initially resolved under the ADR process established by the Attorney General.
Sets forth provisions regarding: (1) procedures for filing actions; and (2) the legal effect of uncontested ADR decisions.
(Sec. 412) Sets a $250,000 limit on noneconomic damages that may be awarded to a claimant and the members of the claimant's family for losses resulting from the injury which is the subject of a medical malpractice liability action.
Prohibits the award of punitive or exemplary damages in such an action: (1) unless the claimant establishes by clear and convincing evidence that the injury suffered was the direct result of conduct manifesting a malicious, wanton, willful, or excessively reckless disregard of the safety of others; and (2) against the manufacturer of a medical product.
Requires that: (1) any punitive or exemplary damages awarded in a medical malpractice liability action be paid to the State in which the action is brought or, in a case brought in Federal court, in the State in which the health care services that caused the injury that is the subject of the action were provided; and (2) such State use such amounts to carry out activities to assure the safety and quality of health care services provided in the State.
Prohibits a defendant, in any medical malpractice liability action in which the damages awarded for future economic loss exceed $100,000, from being required to pay such damages in a single, lump-sum payment, but permits periodic payments based on when the damages are found likely to occur, as determined by the court. Authorizes a court to waive the application of such provision if it is not in the best interests of the plaintiff to receive periodic payments.
(Sec. 413) Directs the court in a medical malpractice liability action to require the party that contested an ADR ruling with respect to the medical malpractice liability claim that is the subject of the action to: (1) pay attorney fees and other costs, with exceptions; and (2) post a performance bond, subject to waiver by the court upon determining that the posting of such a bond is not necessary to ensure that the party pay the costs incurred by the opposing party under the action.
Sets forth provisions regarding: (1) limits on attorney's fees paid; and (2) recordkeeping requirements.
(Sec. 414) Allows a defendant to be held severally but not jointly liable in a medical malpractice action for noneconomic damages, and only for those damages directly attributable to the person's proportionate share of fault or responsibility for the injury.
(Sec. 415) Establishes a seven-year statute of limitations for medical malpractice liability claims beginning on the date the alleged injury occurred.
(Sec. 416) Prohibits a defendant in a medical malpractice liability action from being found to have acted negligently unless the defendant's conduct at the time of providing the health care services was not reasonable.
(Sec. 417) Prohibits the trier of fact, in the case of a medical malpractice liability claim relating to services provided during labor or the delivery of a baby where the health care professional against whom the claim is brought did not previously treat the individual alleged to have been injured for the pregnancy, from finding that the defendant committed malpractice and assessing damages unless the malpractice is proven by clear and convincing evidence. Specifies that a health care professional shall be considered to have previously treated an individual for a pregnancy if the professional is a member of a group practice whose members previously treated the individual for the pregnancy or is providing services to the individual during labor or the delivery pursuant to an agreement with another health care professional.
Part 3: Requirements for State Alternative Dispute Resolution Systems - Sets requirements for a State's ADR system, including that the system: (1) apply to all medical malpractice liability claims under the jurisdiction of the courts of that State; (2) require that a written opinion resolving the dispute be issued within six months of receipt of notice of the claim by each party against whom the claim is filed; (3) require that individuals who hear and resolve claims under the system meet specified qualifications; (4) be approved by the State or local governments; (5) with respect to a State system consisting of multiple dispute resolution procedures, permit the parties to a dispute to select the procedure to be used (and, if they do not agree, assign a particular procedure); (6) transmit to the State agency responsible for monitoring or disciplining health care professionals and providers any findings that such professional or provider committed malpractice, with exceptions; and (7) transmit to the Administrator for Health Care Policy and Research information on disputes resolved in a manner that assures that the identity of the parties to a dispute shall not be revealed.
Makes the provisions of part 2 (malpractice liability standards) applicable with respect to claims brought under a State or alternative Federal ADR system in the same manner as such provisions apply to medical malpractice liability actions brought in the State.
(Sec. 422) Directs the Secretary to: (1) determine, by October 1 of each year (beginning with 1995), whether a State's ADR system meets the requirements of this part for the following calendar year, and certify such system if it does; and (2) establish an alternative Federal ADR system for the resolution of medical malpractice liability claims during a calendar year in States that do not have in effect an alternative ADR system certified for the year.
Sets forth provisions regarding: (1) requirements for the alternative Federal ADR system; and (2) the treatment of States with the alternative system in effect.
(Sec. 423) Directs the Secretary to submit to the Congress a report describing and evaluating State ADR systems operated pursuant to this part and the alternative Federal system.
Part 4: Other Provisions Relating to Medical Malpractice Liability - Permits a State agency responsible for the conduct of disciplinary actions for a type of health care practitioner to enter into agreements to permit State or county professional societies to participate in the licensing of such practitioner and to review any health care malpractice action, claim, allegation, or other information concerning the practice patterns of any such practitioner.
(Sec. 432) Requires the Secretary to conduct a study analyzing the existence and effectiveness of incentives adopted by State and local governments, insurers, medical societies, and other entities to encourage physicians (whether practicing or retired) to volunteer to provide health care services in medically underserved areas.
(Sec. 433) Directs each State to require each: (1) health care professional and provider in the State to participate in a risk management program to prevent, and provide early warning of, practices which may injure or otherwise endanger a patient; and (2) entity which provides health care professional or provider liability insurance in the State to establish risk management programs based on available data or sanction such programs provided by other entities and to require each such professional or provider, as a condition of maintaining insurance, to participate in at least one such program every three years.
(Sec. 434) Requires the Secretary to make grants: (1) for basic research in the prevention of, and compensation for, injuries resulting from health care professional or provider malpractice and for research of the outcomes of health care procedures; (2) to assist States in improving their ability to license and discipline health care professionals; and (3) to States and local governments, private nonprofit organizations, and health professional schools for educating the public about the appropriate use of health care and realistic expectations of medical intervention and about the resources and role of health care professional licensing and disciplinary boards in investigating claims of incompetence or malpractice, and for developing programs of faculty training and curricula for educating health are professionals in quality assurance, risk management, and medical injury prevention. Authorizes appropriations.
Subtitle B: Treatment of Certain Activities Under the Antitrust Laws - Exempts from the antitrust laws specified "safe harbor" activities listed in, or designated by the Attorney General pursuant to, this subtitle. Sets forth provisions regarding the award of attorney's fees and costs of suit to the prevailing party in an action based on a claim involving activity found to be exempt.
(Sec. 452) Lists as safe harbors specified: (1) activities relating to health care services of combinations of health care providers with market share below a specified threshold; (2) activities of medical self-regulatory entities relating to standard setting or enforcement activities not conducted for purposes of financial gain; (3) participation of a health care provider in a written survey of the prices of services, reimbursement levels, or the compensation and benefits of employees and personnel; (4) activities relating to health care joint ventures for high technology and costly equipment and services; (5) activities relating to hospital mergers; (6) joint purchasing arrangements; and (7) negotiations.
(Sec. 453) Directs the Attorney General to publish a notice in the Federal Register soliciting proposals for additional safe harbors and to review and report on proposed safe harbors.
Sets forth criteria in establishing safe harbors, including: (1) the extent to which a competitive or collaborative activity will accomplish an increase in health care access and quality, the establishment of cost efficiencies, and increased ability of health care facilities to provide services in medically underserved areas or to underserved populations; and (2) whether designation as a safe harbor will result in specified desirable outcomes.
(Sec. 454) Directs the Attorney General to issue certificates of review for providers of health care services and to assist persons in applying for such certificates. Sets forth procedures regarding applications for, revocation of, and review of determinations regarding, such certificates. Limits the disclosure of information.
(Sec. 455) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures.
(Sec. 456) Directs the Attorney General to periodically review the safe harbors and certificates of review.
(Sec. 458) Establishes within the Department of Health and Human Services an Office of Health Care Competition Policy.
Title V: Special Assistance for Frontier, Rural, and Urban Underserved Areas - Subtitle A: Frontier, Rural, and Urban Underserved Areas - Amends the Public Health Service Act to direct the Secretary to establish and administer a program to provide allotments to enable States to provide grants for the creation or enhancement of community-based primary health care entities that provide services to low-income or medically underserved populations.
Directs the Secretary to award grants to Federally Qualified Health Centers (FQHCs) and other entities and organizations for the purpose of providing access to services for medically underserved populations or in high impact areas not currently being served by an FQHC.
Directs the Secretary to provide for a study to examine the relationship and interaction between community health centers and hospitals in providing services to individuals residing in medically underserved areas, ensuring that the National Rural Research Centers participate in such study.
(Sec. 502) Amends the Internal Revenue Code to allow a qualified primary health services provider (physician, physician assistant, or nurse practitioner who provides full time primary health services in a health professional shortage area, subject to specified requirements) a credit against tax for a period of 60 consecutive calendar months from the time the taxpayer becomes a qualified provider. Sets forth rules regarding the recapture of credit and the expensing of medical equipment. Excludes National Health Service Corps loan repayments from gross income. Provides a deduction for student loan payments by medical professionals practicing in rural areas.
(Sec. 503) Amends the SSA to include rural emergency access care hospital services among the benefits provided under the Supplementary Medical Insurance Program for the Aged and Disabled.
(Sec. 504) Amends the Public Health Service Act to direct the Secretary to make grants to assist States in the creation or enhancement of air medical transport systems that provide victims of medical emergencies in rural areas with access to treatments.
(Sec. 505) Authorizes the Secretary to: (1) conduct a demonstration project under which public and private entities may apply for waivers of provisions of the SSA in order to operate rural health networks which improve the access of Medicare and Medicaid beneficiaries to, and the quality and outcomes of, health care services; and (2) grant waivers to operate rural health networks under the demonstration project to a number of public and private entities.
Directs the Secretary to award grants to public and private entities which have received a waiver for planning, developing, and operation of rural health networks. Authorizes appropriations.
Subtitle B: Primary Care Provider Education - Amends the Public Health Service Act to direct the Secretary to provide for the establishment of demonstration projects: (1) in up to seven States for the purpose of testing and evaluating mechanisms to increase the number and percentage of medical students entering primary care practice through the use of funds otherwise available for direct graduate medical education costs under the SSA; and (2) for up to seven health care training consortia for such purpose.
Directs the Secretary to award grants to such consortia for developing and evaluating such projects. Authorizes appropriations.
(Sec. 512) Amends the SSA to count residency training time in nonhospital-owned facilities in determining full-time equivalent residents for direct graduate medical education payments, and for certain indirect medical education payments, under Medicare.
(Sec. 513) Amends the Public Health Service Act to increase: (1) National Health Service Corps funding; and (2) health professions funding for primary care physicians, nurse practitioners, and physician assistants.
Authorizes the Secretary to award grants to enable public and nonprofit private entities to meet the cost of providing traineeships for individuals in baccalaureate and advanced-degree programs to educate such individuals to serve in and prepare for practice as physician assistants. Authorizes appropriations.
(Sec. 516) Directs the Secretary to award grants to States or nonprofit entities to fund not less than ten demonstration projects to enable such States or entities to evaluate: (1) State mechanisms, including changes in the scope of practice laws, to enhance the delivery of primary care by nurse practitioners or physician assistants; (2) the feasibility of and most effective means of training subspecialists to deliver primary care as primary care providers; and (3) State mechanisms to increase the supply or improve the distribution of primary care providers. Authorizes appropriations.
Subtitle C: Programs Relating to Primary and Preventive Care Services - Authorizes the Secretary to award grants to enable States to plan and implement coordinated, multidisciplinary, and comprehensive primary health care and social service programs targeted to pregnant women and infants. Authorizes appropriations.
(Sec. 522) Authorizes frontier States (including Alaska, Wyoming, and Montana) to: (1) implement proposals to offer preventive services, including mobile preventive health centers, which may be located on aircraft, watercraft, or other forms of transportation; and (2) participate in demonstration projects to improve recruitment, retention, and training of rural providers, including nurse partitioners and physician assistants.
Subtitle D: Limitation on Funding for Abortions - Specifies that: (1) nothing in this title shall be construed to authorize funding for any abortion, except to prevent the death of the mother; and (2) the provision of abortion services by a State or other entity shall not be regarded as a condition for participation in any grant or benefit authorized in this title.
Title VI: Administrative Cost Savings - Subtitle A: Standardization of Claims Processing - Directs the Secretary to adopt standards relating to: (1) data elements for use in paper and electronic claims processing under health insurance plans, as well as for use in utilization review and management of care; (2) uniform claims forms; and (3) uniform electronic transmission of the data elements.
Directs the Secretary, in adopting such standards, to take into account the recommendations of current task forces, consult with the National Association of Insurance Commissioners, and seek to make the standards consistent with any uniform clinical data sets which have been adopted and are widely recognized.
Sets forth provisions regarding: (1) deadlines for promulgation; and (2) application of the standards.
(Sec. 603) Directs the Secretary to provide for the periodic review and revision of such standards.
Subtitle B: Electronic Medical Data Standards - Directs the Secretary to promulgate standards for hospitals concerning electronic medical data, including confidentiality standards. Authorizes the Secretary to periodically revise the standards and to promulgate (and periodically revise) standards for providers that are not hospitals.
(Sec. 612) Requires each hospital, as of January 1, 1996 to: (1) maintain clinical data included in the set of comprehensive data elements in electronic form on all inpatients; (2) upon request of the Secretary or a utilization and quality control peer review organization, transmit electronically the data set; and (3) upon request of the Secretary or a fiscal intermediary or carrier, transmit electronically any data with respect to a claim from such data set in accordance with specified standards. Grants the Secretary waiver authority under specified circumstances.
Directs the Secretary of Veterans Affairs to provide that each hospital of the Department of Veterans Affairs shall comply with requirements of this subtitle as if it were participating in the Medicare program. Grants such Secretary waiver authority under specified circumstances.
(Sec. 613) Authorizes, effective January 1, 2000, a Federal agency to require a provider to transmit required data elements electronically in accordance with applicable presentation or transmission standards.
(Sec. 614) Prohibits a health insurance plan, if standards for data elements are promulgated with respect to a class of provider, from requiring for the purpose of utilization review or as a condition of providing benefits under the plan that a provider in the class: (1) provide any data element not in the set of comprehensive data elements specified under such standards; or (2) transmit or present any such data element in a manner inconsistent with the applicable transmission or presentation standards.
Authorizes the Secretary to impose a civil monetary penalty on any health insurance plan (with exceptions) that fails to comply with such provision.
(Sec. 615) Directs the Secretary to establish an advisory commission in collection and use of data and operation of data systems to monitor and advise the Secretary concerning the standards established under this subtitle and operational concerns about the implementation of such standards. Authorizes appropriations.
Subtitle C: Development and Distribution of Comparative Value Information - Directs the Secretary to determine whether each State is developing and implementing a health care value information program (to assure the availability of comparative value information to purchasers of health care in each State) that meets specified criteria.
Authorizes the Secretary to make grants to enable each State to plan the development of, and initiate the implementation of its health care value information program. Authorizes appropriations.
(Sec. 622) Directs the Secretary, if a State has failed to develop or implement such program, to implement a comparable program in the State.
(Sec. 623) Requires the head of each Federal agency with responsibility for the provision of health insurance or health care services to promptly develop and make available to States and to providers and consumers of health care services relevant to health care value information.
Subtitle D: Preemption of State Quill Pen Laws - Provides that, effective January 1, 1996, no effect shall be given to any State law provision that requires medical or health insurance records (including billing information) to be maintained in written rather than electronic form.
Title VII: Anti-Fraud and Anti-Rationing - Subtitle A: Criminal Prosecution of Health Care Fraud - Amends the Federal criminal code to set penalties for health care fraud.
(Sec. 702) Authorizes the Attorney General, in special circumstances, to make payments of up to $10,000 to a person who furnishes information unknown to the Government relating to a possible prosecution for health care fraud, subject to specified limitations.
Subtitle B: Coordination of Health Care Anti-Fraud and Abuse Activities - Amends the SSA to apply Federal health anti-fraud and abuse sanctions to all fraud and abuse against any health insurance plan.
Directs the Secretary to: (1) identify opportunities for the satisfaction of community service obligations that a court may impose upon the conviction of a criminal ofense involving Medicare or State health care programs; and (2) make information concerning such opportunities available to Federal and State law enforcement officers and State and local health care officials.
Subtitle C: Protection Against Rationing of Treatment - Prohibits a health care provider or health insurance plan from denying medical treatment or insurance coverage that a patient is otherwise qualified to receive against the wishes of a patient (or if the patient is incompetent, against the wishes of the patient's guardian) on the basis of the patient's present or predicted age, disability, degree of medical need, or quality of life.
(Sec. 722) Makes specified remedies and procedures under the Civil Rights Act of 1964 applicable to any person who is denied medical treatment or insurance coverage, or who has reasonable grounds for believing that such person is about to be subjected to such denial, in violation of this subtitle. Permits an individual subjected to such denial (or a person who would be entitled to bring a cause of action for the individual's wrongful death) to obtain damages.