There is one summary for S.14. Bill summaries are authored by CRS.

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Introduced in Senate (01/04/1973)

Health Maintenance Organization and Resources Development Act - Declares that the purpose of this Act is to assist in improving the system for the delivery of health care through encouragement of and support for the planning, development, and initial operation of health maintenance organizations, health service organizations, and area health education and service centers, particularly with the intent to improve the health of populations in medically underserved areas.

Title I: Health Maintenance Organizations - Part A: Support of Health Maintenance Organizations - Sets forth definitions of terms used in this title.

Authorizes the Secretary of Health, Education, and Welfare to make grants to public or private nonprofit agencies, organizations or institutions to assist in projects for planning or studying the feasibility of developing or expanding health maintenance organizations.

Provides that no project may receive more than $250,000 in such grants. States that the Secretary shall give priority to those applicants that give assurances that at least thirty percent of their total enrollment shall be persons from medically underserved areas.

Authorizes to be appropriated for such grants $25,000,000 for fiscal year 1974, and for each of the next two succeeding fiscal years.

Authorizes the Secretary to make grants to any public or private nonprofit agency, organization, or institution to assist it in meeting the costs of projects to initially develop a health maintenance organization before it begins actual operation.

Provides that no project may receive more than $1,000,000 in such grants. States that priority will be given to those applicants who assure the Secretary that at least thirty percent of their total enrollment will come from medically underserved areas.

Specifies the uses for such grant funds.

Authorizes to be appropriated for such grants $50,000,000 for fiscal year 1974, and for each of the next two succeeding fiscal years.

Authorizes the Secretary to make grants to any public or private nonprofit health maintenance organization or any public or private nonprofit agency, organization, or institution intending to become a health maintenance organization to: (1) assist in meeting construction costs for ambulatory care facilities; and (2) assist in meeting capital investment costs for necessary transportation equipment.

Provides that special consideration will be given to those applicants for grants to acquire or renovate existing facilities.

Provides that no project may receive more than $2,500,000 in construction grants. States that priority will be given to those applicants who assure the Secretary that at least thirty percent of their total enrollment will come from medically underserved areas.

Authorizes to be appropriated for such grants $74,000,000 for fiscal year 1974, and for each of the next two succeeding fiscal years.

Authorizes the Secretary to make grants to public and private nonprofit health maintenance organizations to assist them in meeting operating deficits incurred during their first three years of operation. Provides that such grants may be made only after the Secretary has determined that the applicant has made reasonable attempts to meet his operating expenses.

Authorizes to be appropriated for such grants $59,400,000 for fiscal year 1974, and for each of the next two succeeding fiscal years.

Authorizes the Secretary to make loans to assist any public or private nonprofit health maintenance organization or any public or private nonprofit agency, organization, or institution intending to become a health maintenance organization to assist it in meeting the cost of constructing facilities for ambulatory care and transportation services.

Provides that applications for loans to acquire or renovate existing facilities will be given special consideration. States that a loan for any project under this section may not exceed ninety percent of the costs.

Authorizes to be appropriated for such loans $74,000,000 for fiscal year 1974, and for each of the next two succeeding fiscal years.

Provides that appropriations for such loans, loan repayments, and other receipts in connection with construction loans shall be placed in a revolving fund to be used by the Secretary for such loans and other expenditures.

Authorizes the Secretary to make loans to any public or private nonprofit health maintenance organization to assist it in meeting a portion of its initial operating costs in excess of its gross revenues (as determined by regulation).

Authorizes to be appropriated for such loans $59,400,000 for fiscal year 1974, and for each of the next two succeeding fiscal years.

Part B: Supplemental Health Maintenance Organizations - Directs the Secretary to make grants and loans to supplemental health maintenance organizations from funds appropriated under this Act in amounts not to exceed 17.5 percent of the amounts appropriated for 'regular' health maintenance organizations.

Title II: Support of Health Service Organizations - Declares that it is the purpose of this title to assist in the establishment of health service organizations and area health education centers primarily directed at defined rural population groups which are characterized by a lack of medical care services.

Authorizes the Secretary to make grants to public or private nonprofit agencies, organizations, or institutions to assist them in meeting the costs of projects to plan or study the feasibility of developing or expanding a health service organization. Provides that no project may receive more than $250,000 in such grants. Provides that grant funds awarded shall be available for expenditure by the grantee for no more than two years.

Authorizes to be appropriated for such grants $10,000,000 for fiscal year 1974, and for each of the next two succeeding fiscal years.

Authorizes the Secretary to make grants to any public or private nonprofit entity to assist it in meeting the cost of a project to initially develop a health service organization before it begins actual operation. States that no project may receive more than $1,000,000 in such grants.

Provides that grant funds shall be used to: (1) implement an enrollment campaign; (2) design and arrange for the provision of health services; (3) develop administrative and internal organizational arrangements; (4) recruit personnel and conduct training activities; and (5) pay architects' and engineers' fees.

Authorizes to be appropriated for such grants $20,000,000 for fiscal year 1974, and for each of the next two succeeding fiscal years.

Authorizes the Secretary to make grants to any public or private nonprofit health service organization to: (1) assist in meeting construction costs for those ambulatory care facilities (or portions of such facilities) that will be used to provide health services to its enrollees; and (2) assist in meeting capital investment costs for necessary transportation equipment that will be used to improve access to health services for its enrollees.

States that special consideration will be given to those applicants for grants who acquire or renovate existing facilities. Provides that no project may receive more than $2,500,000 in construction grants under this section.

Authorizes to be appropriated for such grants $25,000,000 for fiscal year 1974, and for each of the next two succeeding fiscal years.

Authorizes the Secretary to make grants to public or private nonprofit health service organizations to assist them in meeting operating deficits incurred during their first three years of operation. States that such grants may be made only after the Secretary has determined that the applicant has made reasonable attempts to obtain funds from other sources.

Authorizes to be appropriated for such grants $20,000,000 for fiscal year 1974, and for each of the next two succeeding fiscal years.

Authorizes the Secretary to make loans to assist any public or private nonprofit health service organization or any public or private nonprofit agency, organization, or institution intending to become a health service organization to meet the costs of constructing facilities for ambulatory care and transportation services. Provides that such facilities must be used by the health service organization to provide health services to its enrollees.

Provides that applications for loans to acquire or renovate existing facilities will be given special consideration. States that a loan for any project under this section may not exceed ninety percent of the costs.

Authorizes to be appropriated for such loans $25,000,000 for fiscal year 1974, and for each of the next two succeeding fiscal years.

Authorizes the Secretary to make loans to any public or private nonprofit health service organization to assist it in meeting a portion of its initial operating costs in excess of its gross revenues (as determined by regulation).

States that such loans (with respect to any project) may not exceed: sixty percent of such excess operating costs for the first year; forty percent of such excess operating costs for the second year; and twenty percent of such excess operating costs for the third year.

Authorizes to be appropriated for such loans $20,000,000 for fiscal year 1974, and for each of the next two succeeding fiscal years.

Title III: Area Health Education and Service Centers and General Requirements - Authorizes the Secretary to make grants to university health centers or to regional medical programs to assist them in meeting the costs of developing area health education and service centers.

Specifies the uses for such grant funds.

Authorizes to be appropriated for such grants: $25,000,000 for fiscal year 1974; $50,000,000 for fiscal year 1975; and $75,000,000 for fiscal year 1976.

Authorizes the Secretary to make grants to university health centers or regional medical programs to assist them in constructing and equipping educational facilities to be used by area health education and service centers. Provides that the Secretary may award such grants only after determining that applicants are unable to receive assistance for such purposes under titles I and II of the Medical Facilities Construction and Modernization Amendments of 1970 (Hill-Burton Act) and title IX of the National Housing Act.

Authorizes to be appropriated for such grants: $10,000,000 for fiscal year 1974; $20,000,000 for fiscal year 1975; and $25,000,000 for fiscal year 1976.

Requires any loan made by the Secretary to bear interest at rates comparable to prevailing current interest rates for loans guaranteed under this title.

States that no payment of principal on a loan is required until five years after the loan is made.

Provides that loans may not be made unless the applicant gives the Secretary reasonable satisfaction of his ability to make payments of principal and interest when due and gives reasonable assurances that it will have such additional funds as are necessary to complete the project for which the loan is requested.

Authorizes the Secretary, between January 1, 1974, and June 30, 1976, to: (1) guarantee loans made by non-Federal lenders to health maintenance organizations, health service organizations, and university health centers; and (2) pay interest subsidies on loans made by non-Federal lenders to private nonprofit health maintenance organizations, health service organizations, university health centers, and regional medical centers.

Provides that loan guarantees and interest subsidies may be made to assist health maintenance organizations and health service organizations to carry out construction projects for ambulatory care facilities and necessary transportation equipment; to meet their initial development costs for three years; or to meet their operating costs for three years.

Requires that the term of a loan for which a loan guarantee and interest subsidy is sought shall not exceed twenty-five years (if for construction) or fifteen years (if for operating costs), or such shorter period as the Secretary may prescribe.

Requires an applicant to give assurances that it will keep and afford access to such records as the Secretary may require and make such reports containing such information and in such form as the Secretary may require.

Requires that loan guarantees and interest subsidies be subject to such further terms and conditions that the Secretary determines are necessary.

Authorizes the United States to recover amounts of its payments under a loan guarantee from the applicant unless the Secretary, for good cause, waives such right and upon making any payment the United States shall be subrogated to all the rights of the recipient of payments with respect to which the guarantee was made.

Establishes in the Treasury a Health Maintenance Organization, Health Service Organization and Area Health Education and Service Center Loan Guarantee and Interest Subsidy Fund to enable the Secretary to discharge his responsibilities under loan guarantees and to make payments of interest subsidies.

Authorizes to be appropriated from time to time such sums as may be necessary to provide amounts required by the Fund.

Provides that, if at any time sums in the Fund are insufficient, the Secretary is authorized to issue to the Secretary of the Treasury notes or other obligations in such forms and under such terms as the Secretary may prescribe with the approval of the Secretary of the Treasury.

Requires applications for assistance under this title to be submitted to and approved by the Secretary. States that applications must be submitted in such form and manner, and contain such information as the Secretary may prescribe.

Requires recipients, upon completion of assistance under this title, to make a full and complete report to the Secretary describing the plans, developments, and operations in the areas enumerated in this title.

Requires health maintenance organizations, health service organizations, or university health centers receiving assistance under this title to submit to the Secretary continuing assurances of financial responsibility; development and operation consistent with terms of this title and plans contained in the application; and other matters as prescribed by regulation.

Requires an application for grants, loans, loan guarantees or interest subsidies to contain assurances that the applicant will enroll the maximum number of persons it will be able to serve effectively. Provides that it cannot enroll more than fifty percent of its enrollees from medically underserved areas (except in rural areas) as designated by the Secretary. Provides that such assistance may not be made unless the applicant demonstrates that it will or has met such conditions and that these conditions will be maintained.

Authorizes the Secretary to terminate or cancel (after a hearing) any grant, loan, loan guarantee, or interest subsidy made to a health maintenance organization, health service organization, or university health center that is in substantial non-compliance with the material provisions of this title or after notice from the Commission on Quality Health Care that such organization has had its certificate of compliance suspended or revoked.

Establishes in the Treasury a Health Maintenance Trust Fund to enable the Secretary to make grants or enter into contracts with health maintenance and health service organizations for annual capitation payments authorized under this title.

Allows health maintenance organizations and health service organizations, as well as organizations and providers that receive Quality Health Care Initiative Awards, to provide health care services in States, regardless of specified restrictive provisions in State laws.

States that any health care provider which is certified by the Commission on Quality Health Care Assurance is eligible to apply for a Quality Health Care Initiative Award.

Authorizes to be appropriated to carry out the provisions of this section $100,000,000 for fiscal year 1974; $300,000,000 for fiscal year 1975; and $500,000,000 for fiscal year 1976.

Authorizes the Secretary to make annual grants to health maintenance or health service organizations that provide health services to those individuals who cannot afford to pay the entire amount of a health maintenance or health service premium. Provides that individuals who cannot meet the entire expense of a health maintenance or health service premium will be expected to contribute a reasonable portion (as determined by the Secretary). States that the amount of such annual grants shall be equal to the difference between the maximum amount (as determined by the Secretary) an enrollee could reasonably be expected to pay toward the health maintenance, supplemental health maintenance or health service organization premium and the premium for membership enrollment in such health maintenance, supplemental health maintenance or health service organization for each person enrolled.

Provides that such grants shall not exceed twenty-five percent of the total premium receipts for such health maintenance, supplemental health maintenance or health service organization for the next preceding year.

Authorizes to be appropriated to make such grants $150,000,000 for fiscal year 1974; $375,000,000 for fiscal year 1975; and $700,000,000 for fiscal year 1976.

Provides that where a health maintenance, supplemental health maintenance, or health service organization proposes an increase in its premium rate and the Secretary determines that such increase is due in whole or in part to fulfillment of the requirement for open enrollment, in that such organization has in its enrolled population a disproportionate number of high-risk enrollees, the Secretary shall make annual grants to such organization equal to an amount that would eliminate the need for that part of the proposed premium increase caused by such disproportionate number of high-risk enrollees in such organization.

Authorizes to be appropriated to carry out the provisions of this section $100,000,000 for fiscal year 1974; $150,000,000 for fiscal year 1975; and $350,000,000 for fiscal year 1976.

Title IV: Commission on Quality Health Care Assurance - Commission on Quality Health Care Assurance Act - Establishes a Commission on Quality Health Care Assurance as an independent agency in the Executive Branch. States that the Commission shall consist of eleven members who because of their experience or education are particularly qualified to serve. Provides that membership shall include representatives of the health care delivery industry, private organizations developing quality health care standards and consumers who are not related to the delivery of health care.

Sets forth the duties and administrative powers of the Commission.

Allows a health care provider covered under the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 to apply for an order to permit it to be temporarily out-of-compliance with a quality health care standard. Authorizes the Commission to grant the order if the applicant: (1) is unable to comply with the standard because personnel or equipment are unavailable, or necessary construction cannot be completed by the standard's effective date; and (2) has an effective program for coming into compliance with the standard as soon as possible.

Requires providers to keep records of their activities which are governed by this Act. States that such records must be made available to the Commission and to the Secretary.

Authorizes the Commission to prescribe rules and regulations for inspecting a provider's records and facilities.

Requires providers to publish descriptions of any health care benefit plan covered under this Act. States that plan descriptions must be published within ninety days after the plan is established or when the plan becomes subject to the provisions of this Act.

Authorizes the Commission to suspend the certificate of approval of any provider that is found, after a hearing, to be out-of-compliance with quality health care standards and suspend a provider's eligibility for assistance under this Act and the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963.

Provides that providers who have had certificates suspended for an unreasonable period of time (as determined by the Commission) shall have their certificates revoked and shall be responsible for repaying part or all of the amounts received under such Acts. Authorizes the Commission to arrange with such providers for reimbursement of such amounts. Provides that persons who make false statements on any document required under this Act, upon conviction, will be punished by a fine of not more than $10,000 or by imprisonment of not more than six months, or both.

Authorizes providers of health care to enter into programs for the handling of malpractice claims which may arise out of the care and treatment of patients. States that such programs shall be based upon agreements between the patients and the providers of health care to submit all disputes, not settled to the satisfaction of both parties, to binding arbitration.

Establishes procedures whereby the Commission may, by rule, promulgate, modify, or revoke any quality health assurance system criterion or norm. Provides that nothing in this Act shall prevent any State agency or court from asserting jurisdiction under State law over any health issue with respect to which no standard criterion, or norm is in effect under this Act.

Requires any State which at any time desires to assume responsibility for the development and enforcement of health standards, criterions, or norms relating to any health issue with respect to which a Federal standard, criterion, or norm has been promulgated to submit to the Commission a State plan for the development of such standards, criterions, or norms and their enforcement. Provides that the Commission shall approve the plan submitted by a State if such plan meets requirements specified in this title. Makes provision for judicial review of an adverse decision by the Commission.

Provides that the United States district courts shall have jurisdiction, upon petition of the Commission, to restrain any conditions or practices by a provider of health care which are such that a danger exists which could reasonably be expected to cause death or serious physical harm immediately or before the imminence of such danger can be eliminated through the enforcement procedures provided by this title.

States that if the Commission arbitrarily or capriciously fails to seek relief under this section, any person, who may be injured by reason of such failure, or the representative of such person may bring an action against the Commission in the United States district court for the district in which the imminent danger is alleged to exist or the provider has its principal office, or for the District of Columbia, for a writ of mandamus to compel the Commission to seek such an order and for such further relief as may be appropriate.

Authorizes to be appropriated for the carrying out of the provisions of this title $75,000,000 for fiscal year 1974; $100,000,000 for fiscal year 1975; and $110,000,000 for fiscal year 1976.

Establishes a Federal Medical Malpractice Insurance Program, to be administered by the Commission on Quality Health Care.

Requires the Commission to make medical malpractice liability reinsurance available to primary insurers of such liability to the extend that such primary insurers are liable for damages resulting from acts of an insured who holds a valid certificate of compliance in accordance with the requirements of this title.

Provides that premium rates established by the Commission shall be: (1) uniform with respect to similar classifications of risks; (2) sufficient to provide adequate proceeds to pay all claims for probable losses over a reasonable period of years; and (3) exclusive of any loading for administrative expenses of the United States under this part.

Authorizes the Commission to establish a Medical Malpractice Reinsurance Fund in the Treasury which shall be available: (1) to repay to the Secretary of the Treasury such sums as may be borrowed from him (together with interest) in accordance with the authority provided in this title; (2) to pay such administrative expenses (or portion of such expenses) of carrying out the reinsurance program as the Commission may deem necessary; and (3) to pay claims and other expenses and costs of the reinsurance program (including any premium equalization payments and reinsurance claims), as the Commission deems necessary.

Title V: National Institute of Health Care Delivery - Establishes in the Department of Health, Education, and Welfare a National Institute of Health Care Delivery. Provides that the Institute shall carry out a multidisciplinary research and development program to improve delivery of health care services and shall be the principal agency in the Department to coordinate and cooperate with the Commission for the improvement of health care in the United States. Provides that the Director and Deputy Director of the Institute shall be appointed by the President, by and with the consent of the Senate. Authorizes the Director to appoint not to exceed four Assistant Directors.

Provides that it shall be the function of the Institute to pursue methods and opportunities to improve and advance the effectiveness, efficiency, and quality of health care delivery in the States, regions, and communities of the United States through initiation and support of studies, research, experimentation, development, demonstration and evaluation of areas and subjects set forth in this title.

Provides that the Institute shall: (1) develop methods for, and support of, training of individuals to plan and conduct research, development, demonstrations, and evaluation of health care delivery and related services; (2) provide technical assistance and development of methods for the transfer of new knowledge, components, and systems to public and private agencies, programs, institutions, and individuals engaged in the improvement of health care delivery; and (3) collaborate with governments and private care institutions and programs in foreign countries for the exchange of information and support of research, experiments, demonstrations, and training in order to advance health care delivery in the United States and cooperating nations.

Sets forth the administrative powers of the Director under this title.

Provides that where funds are advanced for a single project under this Act by more than one Federal agency the Director may act for all in administering the funds advanced and a single non-Federal share requirement may be established according to the proportion of the funds advanced by each Federal agency. Provides for the transfer of research funds from other Government departments and agencies, with the approval of the head of the department or agency involved, for such use as is consistent for the purposes for which the funds were provided.

Transfers the National Center for Health Services Research and Development from the Health Services and Mental Health Administration to the Institute. Authorizes the President, for a period of two years after the date of enactment of this title, to transfer to the Institute any functions of the Department of Health, Education, and Welfare which relate primarily to the functions, powers and duties of the Director, as described by this title.

Establishes a National Advisory Council on Health Care Delivery to be composed of twenty-one members. States that the Council shall consist of the Secretary of Health, Education, and Welfare, the Chief Medical Officer of the Veterans' Administration, a medical officer designated by the Secretary of Defense, the Administrator of the Health Services and Mental Health Administration, the Director of the National Institutes of Health and the Director of the National Institute of Health Care Delivery, who shall be ex officio members, and fifteen members, who are not otherwise full-time employees of the United States, to be appointed by the President. Provides that the appointed members shall be: (1) leaders in the field of medical science, or in the organization, delivery or financing of health care; (2) leaders in the management sciences; and (3) representatives of the consumers of health care.

Provides that the Council shall: (1) review programs, policies, and priorities of the Institute and centers established under this Act and advise the Director on the development and conduct of the programs of the Institute and centers; (2) examine and coordinate health care delivery efforts in cooperation and coordination with the Commission within the Department of Health, Education, and Welfare and other Federal departments and agencies so as to avoid duplication; and (3) assure that significant research and development findings of the Institute and centers are being disseminated to the health care system, and evaluate the extent such findings are making an impact on the health care delivery system.

Provides that the Director shall, within one year after the date of his appointment and prior to February 1 of each year thereafter, prepare and submit a written report to the Secretary for his transmittal to the President and the Congress.

Authorizes to be appropriated for the purpose of carrying out the provisions of this title (except for the provisions dealing with regional and special emphasis centers) the sums of $125,000,000 for fiscal year 1974; $150,000,000 for fiscal year 1975; and $200,000,000 for fiscal year 1976. Provides that any unexpended sums may be carried over without fiscal year limitation.

Authorizes the Director to enter into cooperative arrangements with public or private nonprofit agencies or institutions to pay all or part of the cost of planning, establishing, and providing operating support for: (1) not to exceed eight regional centers to carry out multidisciplinary research and development in health care delivery; (2) the Health Care Technology Center which shall focus on all forms of technology and its application in health care delivery; and (3) the Health Care Management Center which shall focus on the improvement of management and organization in the health field, the training and retraining of administrators, and the development of leaders, planners and policy analysts in such field. Provides that Federal support shall not exceed $2,000,000 per year per center, except for the Health Care Technology Center, and such support may be funded for an initial period of not to exceed three years.

Authorizes to be appropriated for the purpose of providing such support $30,000,000 for fiscal year 1974; $35,000,000 for fiscal 1975; and $40,000,000 for fiscal year 1976. Provides that any unexpended sums may be carried over without fiscal year limitation.

Authorizes the Director to provide funds to be used to increase the Federal contribution to research and demonstration projects, which have been designated by the National Advisory Council as essential, above the maximum level of Federal contributions otherwise authorized by any applicable law. Provides that the increased Federal contribution shall not exceed eighty precent of the cost of such projects. Provides that not to exceed ten percent of the funds authorized by this title shall be available for such grants.