legislation: 102-s-3300
Data license: Public Domain (U.S. Government data) · Data source: Federal Register API & Regulations.gov API
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| bill_id | congress | bill_type | bill_number | title | policy_area | introduced_date | latest_action_date | latest_action_text | origin_chamber | sponsor_name | sponsor_state | sponsor_party | sponsor_bioguide_id | cosponsor_count | summary_text | update_date | url |
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| 102-s-3300 | 102 | s | 3300 | 21st Century Health Care Act | Health | 1992-10-01 | 1992-10-01 | Read twice and referred to the Committee on Labor and Human Resources. | Senate | Sen. Bingaman, Jeff [D-NM] | NM | D | B000468 | 0 | 21st Century Health Care Act - Title I: Eligibility and Enrollment - Entitles every U.S. resident who is a citizen, national, or lawful resident alien to health care coverage purchased through a health insurance purchasing cooperative (HIPC) created under this Act in their State of primary residence. Authorizes the National Health Care Board created in this Act to also make eligible for health care services such nonimmigrant aliens and other individuals as the Board considers appropriate. Requires such State to provide a mechanism for the enrollment of individuals entitled to health benefits purchased through a HIPC, as well as the issuance of a State health insurance card for use in identification and claims processing. States that each State HIPC program: (1) shall not impose a minimum residency requirement for entitlement in excess of three months; (2) shall provide continuation of services for individuals moving to another State until a minimum period of residency is established in the latter State; and (3) shall provide for the payment of health care services to individuals temporarily absent from the State. Requires the Board to issue regulations to provide for the transition of the Federal Employees Health Benefits Program to the health benefits program established under this Act. Title II: Managed Competition in Health Plans - Subtitle A: National Health Care Board - Establishes a National Health Care Board to: (1) establish and oversee the various responsibilities for the Health Outcomes Management Standards Board, the Health Benefits Standards Board, the Health Insurance Standards Board, the Medicare Transition Board, and the National Health Data System (all created under this Act); (2) establish a uniform data system to designate qualified HIPCs and carriers; (3) determine and implement a system for the collection of relevant health outcomes data; (4) determine and revise minimum benefit requirements of a qualified health benefits plan; (5) establish a program for low-income assistance, including premium and cost-sharing assistance; (6) establish an assistance program for individuals employed by small businesses; and (7) make written recommendations at least annually to the Secretary of Health and Human Services and the States with respect to the planning, development, and implementation of all components of the National Health Insurance Data System established under this Act. Requires the Board to provide for the initial organization of a Health Outcomes Management Standards Board (Outcomes Board) to make recommendations to the Board concerning: (1) the establishment of a national data system for patient outcomes and other quality measures; (2) the standards for information collection and reporting from Accountable Health Plans (AHPs); and (3) oversight of data centers and data evaluation. Provides funding to the Outcomes Board through establishment of an annual registration fee for AHPs. Requires the Board to provide for the initial organization of a Health Benefits Standards Board (Benefits Board) to make recommendations to the Board concerning: (1) the uniform set of effective benefits; (2) effective services for such benefits; and (3) auditing standards to ensure the accuracy of information collected from AHPs. Provides funding to the Benefits Board through an annual AHP registration fee. Requires the Board to provide for the initial organization of a Health Insurance Standards Board (Insurance Board) to make recommendations to the Board concerning the standards for AHPs and HIPCs, and the treatment of uniform effective health benefits and expenses in excess of accountable health plan costs. Requires the Insurance Board to also ensure the financial viability of AHPs and resolve conflicts between AHPs and consumers in the delivery of the uniform set of effective benefits. Provides funding to the Insurance Board through an annual AHP registration fee. Requires the Board to provide for the initial organization of a Medicare Transition Board (Transition Board) to make recommendations to the Congress concerning the integration of the Medicare health program with the health program established under this Act. Provides funding to the Transition Board through an annual AHP registration fee. Directs the Board to: (1) register AHPs that meet standards provided under this Act; (2) establish rules for the process of risk-adjustment of premiums among AHPs by HIPCs; (3) establish standards for the periodic reporting by AHPs of information on clinical health outcomes, status, well-being, plan satisfaction of enrolled individuals, health care expenditures, and volumes and prices of procedures; (4) analyze all information so reported; (5) provide for the distribution of its analysis on individual AHPs; (6) publish annual reports on collected information; and (7) distribute related information as appropriate. Provides procedural rules governing congressional consideration of Board actions, requiring specific disapproval by joint resolution in order to overturn such actions. Subtitle B: Health Insurance Purchasing Cooperatives - Requires each State to provide for the establishment as a not-for-profit corporation of a health insurance purchasing cooperative (HIPC) to implement a State coordinated buying program under specified procedures. Outlines HIPC requirements. Requires each HIPC to be governed by a Board of Directors to oversee the functioning of all HIPCs within such State, provide expertise, coordinate HIPC activities among districts, and resolve disputes arising in the implementation of this Act. Requires each HIPC to: (1) enter into agreements with AHPs and employers; (2) enroll individuals under AHPs; (3) receive and forward adjusted premiums for plan enrollment; (4) coordinate with other HIPCs; (5) engage in education and outreach efforts to inform the public about the HIPC coordinated buying program; (6) solicit bids and negotiate with AHPs to make available health benefit plans through the coordinated buying program and one or more HIPCs; and (7) prepare and disseminate the documentation required by Federal agencies to certify participation in the coordinated program. Provides similar local district activities of HIPCs. Outlines provisions concerning the agreement entered into between each HIPC and AHP, including agreement termination, offer of enrollment to individuals at applicable premium rates, and payment and receipt of premiums. States that each AHP retains the risk of nonpayment by enrolled individuals. Requires each HIPC to offer eligible individuals the opportunity to enroll in an AHP for the HIPC area in which such individual resides. Outlines provisions concerning the enrollment process, as well as the periods of coverage for the initial, general, and special enrollment periods. Provides for the receipt of premiums by a HIPC and the forwarding of such premiums to the AHP providing the health services, after the taking by the HIPC of a specified percentage to cover overhead expenses. Requires the Board to establish rules for coordination among HIPCs in cases where under an agreement with a HIPC eligible individuals are enrolled by an employer located in one State and the employees reside in a different State. Subtitle C: Accountable Health Plans - Part 1: Requirements for Accountable Health Plans - Requires the Board to provide a process whereby a health plan may be registered with the Board by its sponsor as an accountable health plan (AHP). Requires an AHP, in order to be eligible for registering, to: (1) provide for coverage of the uniform set of effective benefits specified by the Board; (2) provide for the collection and reporting to the Board of information concerning enrollees and the provision of services; (3) not discriminate in enrollment or benefits; (4) establish standard premiums for the uniform set of effective benefits; (5) meet financial solvency requirements; and (6) provide for effective grievance procedures and restrict certain physician incentive plans. Requires each AHP to also provide for the imposition of uniform cost-sharing (deductibles and coinsurance). Requires each AHP to provide at least annually to its HIPC necessary information to evaluate AHP cost and performance in meeting the needs of its enrollees. Prohibits an AHP from denying, limiting, or conditioning the coverage under its plan based on the health status, claims experience, receipt of health care, medical history, or lack of evidence of insurability of an individual. Allows an AHP to exclude coverage for a previous condition, but limits such exclusion to six months. Requires each AHP to establish standard premiums, for individual and family coverage, for the uniform set of effective benefits within each HIPC area in which the plan is offered. Provides with respect to each AHP: (1) financial solvency requirements; (2) grievance procedures; and (3) the acceptance of information electronically from the Board on the eligibility of individuals for low-income and small business assistance. Part 2: Preemption from State Laws for Accountable Health Plans - Preempts any State law which is different from the uniform set of effective benefits established by the Board under this Act, as well as any State law restricting network plans or utilization review programs. Subtitle D: Treatment of Areas of Ineffective Competition - Requires the Board, if it determines that there is ineffective price competition in the provision of health services within the uniform set of effective benefits in an area of a State, to authorize the State HIPC to establish reimbursement benchmarks to be used in the determination of rates to be charged by providers of services in such area until the Board finds that effective price competition exists. Subtitle E: Definitions - Provides definitions. Title III: Uniform Effective Health Benefits - Requires the Board to annually specify the uniform set of effective benefits for the next fiscal year to apply in all States. Requires such benefits to include the full range of legally authorized treatments for conditions, but allows for the exclusion of benefits for services and items that the Board determines have not been shown to reasonably improve or significantly ameliorate a health condition. Requires specific treatments, procedures, and care to be left up to the individual AHP. Provides for the inclusion and exclusion of specified services within the uniform set of effective benefits. Requires the Board to entitle every eligible individual under an AHP to payment for such covered services. Title IV: Application of Antitrust Laws - Exempts from the antitrust laws the action of two or more hospitals negotiating a proposed agreement to share expensive medical services or high technology equipment. Requires, for such exemption, such hospitals to submit an application to the Board describing the particulars of such agreement, Board approval, and Board issuance of a waiver from the antitrust laws for such agreement. Allows the revocation of such waiver in specified circumstances. Title V: Cost Control and Financing - Subtitle A: Health Budgets - Requires the Board to: (1) establish an annual fiscal year budget of expenditures; (2) compute the national average per capita cost for each of the health care services included in the expenditures; (3) designate a series of risk groups, by age, sex, and other factors, for health care services and costs; (4) develop for each State HIPC a factor to adjust the national average per capita costs for each risk group; (5) determine total projected expenditures for each State HIPC for each covered health service; (6) determine the appropriate Federal contribution for each State for total projected expenditures; and (7) make appropriate subsequent calculations to adjust the budgets, estimates, and contributions. Requires each State to raise the revenues necessary to cover its share specified in the national health budget established by the Board. Subtitle B: Funding - Directs the Board to develop a mechanism for determining and collecting revenues to fund Federal contributions, which shall be approved or disapproved under congressional joint resolution procedures. Amends the Public Health Service Act to impose on any employer a civil penalty equal to 34 percent of the excess health plan expenses of such employer. Defines the excess health plan expenses as those not covered under an AHP or paid to a HIPC for coverage under an AHP. Prohibits the amount of employer contribution from varying based on the AHP selected. Outlines employer obligations with respect to the enrollment of eligible individuals in an AHP through a State HIPC. Provides civil penalties for failing to meet such obligations. Establishes the National Health Care Trust Fund and appropriates to the Fund all of the premiums received by the Board for coverage under an AHP, along with any penalties collected. Requires each State to establish a funding program for the implementation of the State HIPC program in that State, requiring each program to include the enrollment and standard premium financing required under this Act. Entitles each State with an HIPC program approved by the Board to its appropriate per capita funding from the Board for implementation of the AHP. | 2025-08-26T15:15:11Z |