Summary: H.R.1798 — 104th Congress (1995-1996)All Information (Except Text)

There is one summary for H.R.1798. Bill summaries are authored by CRS.

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Introduced in House (06/08/1995)

TABLE OF CONTENTS:

Title I: Establishment and Operation of the United States

Health Service

Part A: Initial Organization

Part B: Organization of Area Health Boards

Part C: General Provisions Regarding Health Boards

Title II: Delivery of Health Care and Supplemental Services

Part A: Patients' Rights in Health Care Delivery

Part B: Eligibility for, Nature of, and Scope of

Services Provided by the Service

Part C: Health Care Facilities and Delivery of Health

Care Services

Title III: Health Labor Force

Part A: Job Categories and Certification

Part B: Education of Health Workers

Part C: Employment and Labor-Management Relations

Within the Service

Title IV: Other Functions of Health Boards

Part A: Advocacy, Grievance Procedures, and

Trusteeships

Part B: Occupational Safety and Health Programs

Part C: Health and Health Care Delivery Research

Part D: Health Planning, Distribution of Drugs and

Other Medical Supplies, and Miscellaneous Functions

Title V: Financing of the Service

Part A: Health Service Taxes

Part B: Health Service Trust Fund

Part C: Preparation of Plans and Budgets

Part D: Allocation and Distribution of Funds

Part E: General Provisions

Title VI: Miscellaneous Provisions

United States Health Service Act - Title I: Establishment and Operation of the United States Health Service - Part A: Initial Organization - Establishes, as an independent entity within the executive branch, the United States Health Service (Service). Vests authority of the Service in the appropriate National Health Board and area health boards. Grants the Service the power of eminent domain.

Directs the President to appoint individuals to serve as members of the Interim National Health Board of the Service.

Declares that the members of the Interim National Board shall serve until the National Health Board holds its initial meeting in accordance with certain provisions of this Act. Sets forth the duties of the Interim National Board.

Authorizes appropriations.

Part B: Organization of Area Health Boards - Requires the Interim National Board to establish health care delivery regions throughout the United States which meet specified requirements.

Sets forth procedures regarding election and appointment of members and certain officers of: (1) interim national, interim regional, and interim district health boards; and (2) initial and subsequent national, regional, district, and community health boards.

Part C: General Provisions Regarding Health Boards - Sets forth the membership and terms of office of health boards. Provides for recall of board members for specified reasons and for filling vacancies on health boards.

Sets forth procedures for the establishment by the National Board of guidelines and standards required by or in furtherance of the objectives of this Act.

Requires each regional board to provide orientation, education, and technical assistance to district and community boards. Requires the appropriate national board to provide such assistance to regional boards.

Title II: Delivery of Health Care and Supplemental Services - Part A: Patients' Rights in Health Care Delivery - Requires the Service to ensure that every user is given the right to receive high quality care and supplemental services without charge and without discrimination. Sets forth a list of other basic health rights.

Amends the Fair Labor Standards Act of 1973 to entitle certain employees to health leave compensation, subject to specified exceptions which exist in current law as exceptions to minimum wage and maximum hours provisions.

Part B: Eligibility for, Nature of, and Scope of Services Provided by the Service - Declares all individuals, while within the United States, to be eligible to receive health care and supplemental services under this Act. Excludes personal comfort or cosmetic services unless they are necessary for health-related reasons.

Requires the Service to provide in the United States specified services in or through facilities established by the Service. Prohibits the Service from providing such services in a region, district, or community other than under the auspices of a regional, district, or community board established in accordance with this Act.

Requires the Service to provide specified supplemental services in or through health care facilities established by the Service.

Provides for reimbursement by the Service of the cost of emergency health care services under certain circumstances.

Part C: Health Care Facilities and Delivery of Health Care Services - Requires each community board to establish and maintain such health care facilities as are necessary for efficient and effective delivery of comprehensive primary health care services, specialized health care services, special services, and community-oriented health measures which are provided, as much as possible, through a single comprehensive health center.

Requires each district board to establish and maintain in its district a general hospital, such other health care facilities as are necessary, and such health care services of a specialized nature as may be provided most effectively and efficiently at the district level.

Requires each regional board to establish and maintain: (1) a regional medical facility for highly specialized health care services; (2) health care and supplemental services for individuals whose needs cannot be met by community or district boards; and (3) such other facilities as are necessary.

Requires each area health board to: (1) hire health workers; (2) purchase or lease necessary premises; and (3) seek to minimize fragmentation and duplication in delivery of health care. Requires each regional board to provide for affiliation and coordination within its region and with adjacent regions.

Requires the National Board to establish guidelines for distribution and coordination of the delivery of health care services and plan and facilitate the transition to the new distribution of facilities and workers.

Requires regional boards, if a community or district board fails to provide health services, to provide the services.

Requires each health board to establish policies and organizational plans consistent with provisions of this Act. Requires such boards, in establishing, implementing, and modifying such policies and plans, to seek participation of affected workers and users.

Provides for a health board, if it determines that it cannot itself effectively manage the operation of all facilities, to establish a health care facility board or boards.

Specifies elements to be provided for in the policies and organizational plans established by health boards.

Prohibits a health board, on and after three years after the effective date of health services, from permitting its health care facilities to be used for the private delivery of health services. Prohibits individuals employed by a health board from engaging in the private delivery of health services.

Requires each health board to ensure that health facilities it operates which provide outpatient services are open during hours which permit all users to make use of such services.

Sets forth requirements for facilities providing inpatient services for 30 continuous days or longer.

Requires each health board to provide that, at least once each year, the inpatients of facilities providing inpatient services for 30 continuous days or longer shall elect, from among themselves and representatives of certain user associations, a review committee of not less than three members. Provides for recall and proxies with respect to such committees.

Requires various health boards to conduct regular inspections of specified facilities.

Requires area health boards to provide: (1) contraception information and materials; (2) evaluation and treatment for venereal diseases and diseases of the reproductive organs; (3) information and counseling regarding pregnancy, child bearing, and possible genetically induced anomalies; (4) pregnancy testing; (5) prenatal services; (6) abortion services; and (7) counseling by women for specified services and counseling by men for specified services. Requires all such services to be delivered without coercion or harassment, with confidentiality, and without prior approval of individuals other than the individual receiving the services. Requires that individuals be permitted to be accompanied by a person of their choice during the provision of such services, subject to exception.

Sets forth restrictions and requirements for informed consent regarding: (1) treatments or procedures which could affect an individual's reproductive capacity; and (2) mastectomy or other breast cancer treatment.

Requires that women giving birth have the right to choose from a complete range of childbirth options.

Title III: Health Labor Force - Part A: Job Categories and Certification - Declares that, notwithstanding State laws to the contrary, the Service shall be the sole judge of the qualifications of its employees.

Requires each area health board to insure that work is performed by certified health workers.

Requires the National Board to establish guidelines for classification, certification, and employment of health workers. Requires that such guidelines: (1) permit alternative approaches to healing, when such approaches have not been shown to be injurious to health; (2) have both flexibility and uniformity to meet stated objectives; and (3) require that each health worker employed by a community board work part of the time in a facility operated by a district or regional board and each health worker employed by a district or regional board work part of the time in a health care facility operated by a community board.

States that each regional board, for job categories requiring advanced specialty training, shall establish certification standards.

Part B: Education of Health Workers - Requires each regional board, in consultation with community and district boards, to establish a health team school (school) to provide initial and continuing basic education in health care delivery and initial and continuing advanced education in health care specialties and health science specialty fields. Requires that the schools be funded exclusively by the Service, prohibits them from charging or accepting tuition or fees, and requires them to provide each student with an allowance for living expenses, educational supplies, and any child care.

Requires each regional board to establish and implement for the school: (1) admissions policies with certain required elements; (2) curriculum policies with stated elements; (3) faculty hiring procedures which will create a faculty which approximates the population of the region by race, sex, and language; and (4) a governance plan for the management of its school which gives significant decision making powers to staff and students.

Prohibits enrolling any individual unless the individual agrees to perform health care services as an employee of the Service, in a job category for which training is being provided, for a period of time equal to the period of enrollment, but not less than two years, and subject to other terms and conditions.

Entitles the Service, if an individual fails to start or fails to complete such service, to recover damages.

Mandates that each area board periodically assess the ratio of the health workers employed by the board in each job category to the number of residents in the area. Gives priority in hiring individuals obligated to perform service to health worker shortage areas and, as a second level of priority, to the regional, district, or community board for the region, district, or community in which the program was completed.

States that the National Board shall establish a program to match the preferences graduates have for locations with the needs and preferences of various boards.

Requires the National Board to make payments of principal and interest on certain loans incurred by individuals for an educational program in health care delivery, health care specialties, or health science fields which is outstanding on the day that individual begins to work for the Service. Establishes a schedule for such payments.

Part C: Employment and Labor-Management Relations Within the Service - Requires health boards to employ, classify, and fix the salaries and benefits of all employees of the Service.

States that health boards shall give hiring preference to individuals employed as health workers before enactment of this Act. Requires the National Board to ensure that all such individuals desiring employment in the Service find appropriate employment in the Service.

Places restrictions on hiring relating to the: (1) ratio of health workers to residents; and (2) existence of a health worker shortage area in the same region.

Declares that employees of the Service are covered by specified Federal laws.

Requires compensation, benefits, and other terms and conditions of employment to be the same on the effective date of health services as for Federal Government employees until changed by the Service. Prohibits changes in fringe benefits which result in a program which is less favorable to employees of the Service than fringe benefits for employees of the Federal Government on the effective date of health services.

Declares that the provisions of the National Labor Relations Act shall apply to the Service and its employees, subject to specified exceptions.

Declares that provisions of Federal law relating to participation in a strike shall not apply to employees of the Service.

Amends the Labor-Management Reporting and Disclosure Act of 1959 to include the Service in the definition of the term "employer" under that Act.

Provides that the remedies provided by stated Federal laws regarding jurisdiction and tort claims shall be exclusive of any other civil action or proceeding.

Declares that assault or battery arising out of negligence in various health care functions is not an exception under specified Federal law to tort claims and jurisdiction provisions of Federal law.

Authorizes the National Board to hold harmless or provide liability insurance for any employee of the Service under certain circumstances.

Title IV: Other Functions of Health Boards - Part A: Advocacy, Grievance Procedures, and Trusteeships - Requires each area health board to establish a program of health advocacy with specified elements.

Requires the National Board to establish a health rights legal services program, for users and health workers, providing specified elements.

Requires each appropriate regional board to provide that any user, health worker, user association, or specified health board may commence grievance proceedings before specified health boards with respect to alleged violations of this Act. Provides for review of adverse decisions.

Authorizes, in certain circumstances, the entity before which a grievance proceeding is commenced or reviewed to: (1) set aside an election of a community board and require a new election; and (2) if not involving a community board, require that a new election be conducted or a new appointment be made. Requires such entity to transfer such functions as necessary to the appropriate higher health board until a new election is conducted or a new appointment is made.

Authorizes a health board which receives functions under such a transfer to appoint a trustee or trustee committee to carry out transferred functions.

Part B: Occupational Safety and Health Programs - Requires the National Board to oversee occupational safety and health programs conducted at the regional level and to participate in the establishment and administration of occupational safety and health standards under the Occupational Safety and Health Act of 1970, with the advice and comments of regional occupational safety and health action councils established under this Act.

Amends the Occupational Safety and Health Act of 1970 to substitute references to the National Health Board for references to the Secretary of Health and Human Services throughout such Act, with one specified exception. Adds references to the National Health Board to existing provisions in such Act regarding promulgation, modification, and revocation of safety and health standards.

Requires the National Board to establish guidelines for: (1) its participation in the establishment and administration of safety and health standards; (2) the election of community occupational safety and health action councils; (3) the establishment of regional occupational safety and health programs; (4) the establishment and operation of work place health facilities; and (5) the provision of assistance by various health boards to various safety and health councils, and to work place safety and health committees.

Requires each community board to provide for the operation of a community occupational safety and health action council (COSHAC). Gives a formula for election of the members of COSHACs. Specifies the duties of each COSHAC.

Requires each regional board to establish an occupational health and safety program for its region with specified elements, including staffing and supporting the operation of the regional occupational safety and health action council (ROSHAC). Specifies the responsibilities of each ROSHAC.

Requires the employer in each work place to establish and maintain a health facility in or near the work place to meet occupational and emergency health care needs of employees, to be operated either by the community board or by the employer, and the cost, in either case, to be borne by the employer.

Grants employees in each work place having 25 or more employees the right to establish work place occupational safety and health committees. Grants the members of such committees rights to engage in certain activities relating to inspections without loss of pay or other job rights.

Authorizes employees to monitor conditions and to remove themselves from the site of any hazard without loss of pay or other job rights.

Requires employers to minimize hazards and furnish employees with or reimburse employees for needed equipment or clothing.

Specifies rights of employees regarding: (1) inspection of medical records maintained by their employers; (2) provision to employees of copies of all reports, studies, and data concerning health and safety in that work place; and (3) the seeking, through collective bargaining, of standards more restrictive than those established under the Occupational Safety and Health Act of 1970.

Part C: Health and Health Care Delivery Research - Requires the Service to conduct a program of research concerning health and health care delivery.

Transfers the National Institutes of Health from the Department of Health and Human Services to the National Health Board. States that the National Board shall establish five new national institutes: Epidemiology, Evaluative Clinical Research, Health Care Services, Pharmacy and Medical Supply, and Sociology of Health and Health Care. Specifies the duties of each such institute.

Part D: Health Planning, Distribution of Drugs and Other Medical Supplies, and Miscellaneous Functions - Requires each area board to collect data on supply and demand regarding health workers and health care delivery.

Requires each regional board to coordinate the planning and administration of health care delivery, health worker education, and health research in its region.

Requires the National Board to formulate one-year and five-year national plans and budgets.

Requires the National Board, after consultation with regional boards, to publish, and regularly update, a National Pharmacy and Medical Supply Formulary. Specifies the contents of the Formulary.

Requires each regional board to establish a program for the purchase and distribution of drugs and other medical supplies. Authorizes the National Board to establish and operate drug and medical supply manufacturing facilities in certain circumstances.

Title V: Financing of the Service - Part A: Health Service Taxes - Amends the Internal Revenue Code to add a new part imposing on individuals and corporations an additional tax of specified percentages of the normal tax and surtax imposed by a specified section of such code.

Ends the income tax exclusion from gross income of amounts paid by third parties for medical care. Excludes from gross income employer contributions to accident or health plans to the extent that such contributions do not provide for health care available to such employees under the Health Service Act. Prohibits income tax deductions for: (1) health care expenses as a trade or business expense; and (2) contributions to certain medical and hospital facilities.

Repeals provisions of the Internal Revenue Code relating to: (1) medical and dental expenses; (2) hospital insurance tax imposed on employment and self-employment income; and (3) receipts for railroad employees.

Declares that no contractual or other nonstatutory obligation of any employer to pay or provide for health care for present or former employees and their dependents and survivors shall apply on or after the effective date of health services under this Act to the extent such individuals are eligible to receive such services under this Act.

Prohibits Federal, State, or private workers' compensation programs from paying for or providing any health care on or after the effective date of health services under this Act to the extent such care is available under this Act.

Part B: Health Service Trust Fund - Creates in the Treasury the Health Service Trust Fund (Trust Fund).

Appropriates to the Trust Fund amounts equal to 100 percent of the expected net receipts from specified provisions of the Internal Revenue Code. Appropriates to the Trust Fund a Government contribution equal to 40 percent of the amount appropriated under such 100 percent provision.

Transfers to the Trust Fund all assets and liabilities of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund.

Creates the Board of Trustees of the Trust Fund.

Requires the investment of specified portions of the Trust Fund. Extends the purposes for which obligations of the United States may be issued under the Second Liberty Bond Act, to authorize the issuance at par of public debt obligations for purchase by the Trust Fund.

Part C: Preparation of Plans and Budgets - Requires the National Board to annually fix the maximum amount of funds which may be expended from the Trust Fund during the fiscal year. Specifies criteria to be considered in determining such amount's maximum value. Authorizes the National Board to refix such maximum amount in certain circumstances. Authorizes the National Board to exceed such maximum amount as necessary because of epidemic, disaster, or other occurrence which was not and could not have been planned for.

Authorizes the National Board to allocate, in addition to such maximum amount, funds borrowed under specified provisions of this Act.

Requires each community, district, and regional board to annually submit fiscal year and five-year plans and budgets to the next higher level health board.

Part D: Allocation and Distribution of Funds - Requires the National Board to annually transmit to regional boards a national health budget dividing the total funds available into funds for ordinary operating expenses, preventive health measures, capital expenses, research expenses, and special operating expenses.

Requires funds for ordinary operating expenses, preventive health measures, and research expenses to be allocated to the regional boards on the basis of population. Requires funds for capital expenses to be allocated according to stated criteria.

Declares the budget submitted to the regional boards by the National Board to be adopted upon the approval by a majority of the regional boards.

Sets forth requirements, similar to those for the national health budget, for preparation and adoption of regional and district budgets.

Defines "special operating expenses" to mean operating expenses associated with: (1) care and treatment for users 65 years of age and older; (2) care and treatment of persons confined to full-time residential institutions, including nursing homes and facilities for the treatment of mental illness; (3) the special health care needs of low-income users; (4) the special health care needs of rural users; (5) special health care needs arising from environmental or occupational health conditions; (6) special health care needs arising from unexpected occurrences, including epidemics and natural disasters; and (7) the conduct of environmental health inspection and monitoring services. Sets forth rules for allocation of special operating expenses.

Requires funds allocated under the national health budget to be distributed by the National Board from the Trust Fund. Prohibits health boards from requesting or receiving funds from any other source.

Mandates annual financial statements by area health boards.

Part E: General Provisions - Authorizes the National Board to borrow money and to issue and sell obligations as necessary for this Act, but only in amounts specified in appropriations Acts. Limits the aggregate amount of such obligations outstanding at any one time.

Authorizes the National Board to pledge the assets of the Trust Fund and pledge its revenues and receipts for various purposes related to such obligations. Authorizes the National Board to enter into a variety of covenants as necessary or desirable to enhance the marketability of such obligations.

Declares that such obligations: (1) shall be negotiable or nonnegotiable, bearer or registered; (2) shall contain a recital that they are issued under a specified provision of this Act; (3) shall be lawful investments; (4) shall be exempt from State taxes; and (5) shall not, subject to exception, be obligations of the U.S. Government.

Requires the National Board to advise the Secretary of the Treasury of the proposed sale of obligations. Authorizes such Secretary to elect to purchase the obligations. Authorizes the National Board, if the Secretary elects not to buy such obligations, to issue and sell them to a party or parties other than the Secretary, upon notice to the Secretary and consultation regarding various terms and conditions.

Empowers the National Board to require the Secretary of the Treasury to purchase obligations of the Service. Prohibits any required purchase which would result in a holding by the Secretary in excess of a specified amount.

Makes obligations issued by the Service obligations of the U.S. Government under certain circumstances.

Authorizes the Secretary of the Treasury, for the purpose of any purchase of the obligations of the Service, to use as a public debt transaction the proceeds from the sale of any securities issued under the Second Liberty Bond Act. Extends the purposes of such Act to include any purchases of the obligations of the Service under this part.

Title VI: Miscellaneous Provisions - Repeals, on the effective date of health services, the Public Health Service Act, except for specified provisions relating to: (1) its short title and definitions; (2) licensing, quarantine, and inspections authority; and (3) safety of public water systems. Delays, until four years after the effective date of health services, repeal of portions of the Public Health Service Act regarding provision of assistance to educational institutions and their students, in areas which have not established health team schools under part A of title III of this Act.

Repeals specified provisions of the Social Security Act relating to maternal and child health, Medicare, Medicaid, professional standards review, entitlement to hospital insurance benefits, uniform health reporting systems, limitation on Federal participation for capital expenditures, the program for determining qualification for certain health care personnel, disclosure of ownership and related information, disclosure of certain convictions, and payments to States for health care and supplemental services.

Repeals specified provisions of Federal law relating to health insurance for Federal employees, medical benefits and programs relating to veterans, and the civilian health and medical program of the uniformed services.

Repeals the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970, the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act Amendments of 1974, and a specified provision of the Comprehensive Drug Abuse Prevention and Control Act of 1970 relating to medical treatment of narcotic addiction.

Repeals Federal law relating to hospitals, community hospitals, and other health facilities for Indians.

Repeals the District of Columbia Medical Facilities Construction Act of 1968 and the District of Columbia Medical and Dental Manpower Act of 1970.

Repeals specified provisions of the National Housing Act relating to mortgage insurance for nursing homes, hospitals, and group practice facilities.

Repeals the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963, the Family Planning Services and Population Research Act of 1970, the National Arthritis Act of 1974, and the National Diabetes Mellitus Research and Education Act.

Repeals specified provisions of the Lead-Based Paint Poisoning Prevention Act relating to grant, demonstration, and research programs for lead-based paint poisoning prevention.

Repeals the Act of March 2, 1897, relating to tea importation.

Repeals specified provisions of the Occupational Safety and Health Act of 1970 relating to the National Institute for Occupational Safety and Health.

Requires the President to prepare and submit to the Congress legislation to repeal or amend provisions of laws which are inconsistent with this Act, including the transfers of authority of the Secretary of Health and Human Services, under specified provisions of Federal law, to the Service.

Sets forth various requirements regarding review and reporting to the President and the Congress concerning how the Service is carrying out the purposes of the various programs authorized to be conducted by provisions repealed by this Act.

Transfers to the Health Service Trust Fund amounts appropriated to carry out the purposes of any law repealed by this Act.

Provides transition rules regarding contracts entered into or rights or obligations arising before the effective date of such repeals.

Amends the Budget and Accounting Act, 1921 to require that each budget submitted by the President set forth items relating to the Health Service Trust Fund separately from other operations of the Government.

Declares that, if any provisions of this Act are declared invalid, the remainder of the Act shall not be affected.