legislation: 102-s-3348
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| 102-s-3348 | 102 | s | 3348 | Health Care Access and Affordability Act of 1992 | Health | 1992-10-05 | 1992-10-05 | Read twice and referred to the Committee on Finance. | Senate | Sen. Hatch, Orrin G. [R-UT] | UT | R | H000338 | 4 | Health Care Access and Affordability Act of 1992 - Title I: Social Security Act Provisions - Subtitle A: Small Employer Insurance Reform - Part I: Tax Deductible Health Insurance Costs - Amends the Internal Revenue Code to increase the deductible for health insurance costs for self-employed individuals from 25 percent to 100 percent. Makes such deduction permanent. Part II: Standards and Requirements of Small Employer Health Insurance Reform - Amends the Social Security Act to add a new title XXI, Standards For Small Employer Health Insurance and Certification Of Managed Care Plans. Directs the Secretary of Health and Human Services (HHS) to request that the National Association of Insurance Commissioners (NAIC) develop specific standards to implement specified requirements for health insurance plans issued to small employers that relate to: (1) insurer registration; (2) guaranteed eligibility, availability, and renewability; (3) preexisting conditions; (4) restrictions on rating practices; and (5) benefit package offerings. Provides that if NAIC fails to develop such standards or the Secretary finds that they do not implement such requirements, the Secretary must develop such standards. Provides that if a State has not established a regulatory program that provides for the application and enforcement of such standards, the Secretary must certify the compliance of small employer plans with them. Part III: Tax Penalty on Noncomplying Insurers - Amends the Internal Revenue Code to impose an excise tax on the issuer of a health insurance plan to a small employer if the issuer fails to meet the requirements of title XXI of the Social Security Act (as added by this Act). Establishes such tax as 25 percent of the gross premiums received by the issuer. Makes such tax nondeductible. Subtitle B: Medicare and Medicaid Provisions - Part I: Medicare - Amends title XVIII (Medicare) of the Social Security Act to require the Secretary to establish an experimental program offering certain Medicare beneficiaries a choice among specified types of benefit options. Directs the Secretary to evaluate the experimental program and report to the Congress annually on the program's effectiveness. Provides for combined annual accounting of Medicare part A and B trust funds. Directs the Secretary to provide for the establishment of an Advisory Council on Hospital Reimbursement Procedures to recommend to the Secretary a uniform hospital reimbursement form as the sole form for the Health Care Financing Administration to use in processing claims submitted under Medicare. Specifies form contents. Requires a Council report on electronic billing. Requires the Secretary to develop such a form if the Council fails to make such a recommendation. Directs the Secretary to: (1) provide for demonstration projects to provide for the designation of certain medical procedures which will only be reimbursed if performed at a Medicare center of excellence; (2) develop a Medical Directive and Proxy Designation form and provide for a registry within HHS for such forms; and (3) notify providers and Medicare-eligible individuals of the availability of such form. Part II: Medicaid - Directs the Secretary to: (1) make grants to States for demonstration projects for improving access to Medicaid (SSA title XIX) services in medically underserved areas, providing medical assistance under Medicaid to certain uninsured individuals, providing outreach activites to individuals who may be eligible for certain medical assistance, and reducing infant mortality; and (2) report to the Congress on such projects. Authorizes appropriations. Title II: Public Health Service Act Provisions - Amends the Public Health Service Act to mandate a public education program on disease prevention through behavior change, preventive care, and screening. Authorizes appropriations. Modifies the authorization of appropriations for community health centers, earmarking certain funds for the establishment of new centers. Requires the National Health Service Corps to revise its priorities in assigning members. Specifies new criteria. Authorizes appropriations. Establishes in the National Institute on Aging the Center for the Fostering of Independent Living to conduct and support applied research, both social and scientific. Requires the Center to publish a Guide to Independent Living. Authorizes appropriations. Mandates development of a system to produce comprehensive reports under title IX (Agency for Health Care Policy and Research) of the Public Health Service Act concerning the performance of local and regional health care markets. Title III: Permanent Health Care Reform - Consumer Choice Health Care Reform Act of 1992 - Subtitle A: Tax Treatment of Health Care Expenses - Amends the Internal Revenue Code to allow a credit for premiums paid by a qualified individual (excludes a federally covered individual) on an employer-sponsored health insurance plan. Specifies the limitations on such health expenses credit. Allows employers to make advance payments of such credit to employees with a health care expenses eligibility certificate. Terminates the medical expense deduction and the health insurance credit after December 31, 1994. Allows an individual a deduction for a percentage of employer-provided health insurance premiums and allows such deduction in computing adjusted gross income. Repeals the current income exclusion for employer contributions to accident and health plans. Limits the business deduction for employer-provided health insurance premiums to computations based upon the number of employees and the national average premium. Allows individuals a tax deduction for contributions made to a medical care savings account established for the benefit of an eligible individual. Adjusts such deduction for inflation after 1994. Allows such deduction in arriving at adjusted gross income. Establishes an excise tax for excess contributions to medical care savings accounts and makes such accounts subject to the tax on prohibited transactions. Subtitle B: Health Insurance Requirements - Sets forth requirements for employers for withholding health insurance premiums of employees, notifying employees of tax rights with respect to such premiums, converting non-self-insured plans, and selling, transferring, or reassigning existing self-insured plans. Amends the Internal Revenue Code to impose a tax on the failure to notify employees of the option to convert a non-self-insured plan to a federally qualified health insurance plan. Imposes a tax on the failure of a carrier offering a health insurance plan to comply with requirements with respect to self-insured plans. Revises provisions covering continuation coverage requirements of group health plans and requires such coverage for a maximum of 60 months. Subtitle C: State Plan Requirements - Requires States, as a condition of receiving Federal funds for health care programs after December 31, 1994, to meet specified requirements concerning: (1) health plans for the uninsured; (2) enrollment; and (3) monitoring. Subtitle D: Federal Preemption - Preempts all State laws in existence on January 1, 1995, in the following areas for five years: (1) mandated insurance laws; (2) anti-managed care laws; (3) mandated cost-sharing laws; and (4) certificate of need laws. Subtitle E: Medicaid Reform - Amends title XIX (Medicaid) of the Social Security Act to: (1) set the Federal medical assistance percentage for any State at 100 percent (excluding long-term care assistance); (2) provide Medicaid coverage for all individuals with income at the poverty level; and (3) authorize the HHS Secretary to award grants to States for the provision of long-term care to Medicaid-eligible individuals. Title IV: Antitrust Provisions - Subtitle A: Modification of the Operation of the Antitrust Laws to Hospitals - Provides that it shall not be unlawful under the antitrust laws for two or more hospitals to engage in conduct solely for the purpose of negotiating a proposed agreement (including the sharing of data) to share expensive medical services or expensive high technology equipment. Authorizes the Secretary of Health and Human Services to issue waivers to exempt such conduct from the operation of the antitrust laws, subject to specified requirements. Provides that, to be eligible to receive such a waiver, two or more hospitals must submit to the Secretary an application that contains a proposed agreement that only: (1) provides that such hospitals shall share the expensive medical services or high technology equipment identified in such agreement; (2) specifies the period of time during which such agreement shall be in effect; and (3) describes the particular medical services or high technology equipment to be shared. Directs the Secretary, in evaluating the application, to consider whether implementation of such agreement will result in enhancement of the quality of hospital or hospital-related care, the preservation of hospital services in geographical proximity to the communities traditionally served by the applicants, improvement in the cost-effectiveness of high-technology services provided by the applicants, improvement in the efficient utilization of hospital resources and capital equipment, the provision of services that would not otherwise be available, or the avoidance of duplication of hospital resources. Sets forth: (1) provisions regarding the issuance and effect, and revocation, of a waiver; and (2) reporting requirements. Subtitle B: Encouraging Enforcement Activities of Medical Self-Regulatory Entities - Prohibits the recovery of damages, interest on damages, costs, or attorney fees under provisions of the Clayton Act relating to suits by persons injured, by the United States, and by State attorneys general, or under similar State laws, from any medical self-regulatory entity as a result of engaging in standard setting or enforcement activities designed to promote the quality of health care provided to patients. Directs any Federal agency engaged in the establishment of medical professional standards to consult with and use appropriate medical self-regulatory entities, if available, in carrying out standard setting and related regulatory activities. Subtitle C: Interagency Committee - Establishes the Interagency Committee of Health Care Reform and Antitrust Policy to coordinate policy regarding health care reform and antitrust policy, and to make recommendations to the Congress regarding achieving both health care cost containment and greater access to quality health care through cooperation among health care providers. Title V: Medical Malpractice Reform - Subtitle A: General Provisions - Sets forth findings and definitions. Subtitle B: Grant Programs - Mandates grants to States for medical malpractice alternative dispute resolution systems. Describes fault-based, defined catastrophic injury compensation, early offer and recovery mechanism, and binding arbitration approaches. Allows other approaches. Requires: (1) grants for basic research on the prevention of and compensation for injuries from health care professional or provider malpractice; (2) grants for the licensing and discipline of health care professionals; (3) technical assistance to States for evaluation of medical practice acts and procedures, malpractice detection, and discipline; and (4) grants for educating the public regarding appropriate use of health care, realistic expectations, the resources and role of licensing and disciplinary boards, and faculty training and curricula. Mandates allotments to States for the grants under this title. Authorizes appropriations. Subtitle C: Health Care Malpractice Dispute Reform - Applies these provisions to all Federal or State medical malpractice actions. Limits lump sum future damages award dollar amounts. Mandates collateral source payment reductions. Limits the dollar amount of noneconomic damages. Sets forth time limitations for initiating actions. Preempts certain types of State laws regarding these requirements. Amends title XVIII (Medicare) of the Social Security Act to require: (1) allocation of all practitioner licensing or certification fees to a disciplinary agency; (2) each service provider and medical liability carrier to have a malpractice risk management program; and (3) review by professional societies of malpractice claims. Amends the Public Health Service Act to mandate a grant to an entity that represents recipients of assistance under provisions relating to migrant and community health centers for development of a business plan and establishment of a nationwide risk retention group. Authorizes appropriations for the grant and for capitalization. Title VI: Miscellaneous Provisions - Establishes in the Department of Health and Human Services the President's Council on Senior Fitness. Directs the Secretary, through the President's Council on Physical Fitness and Sports, to implement programs to promote healthy lifestyle choices. Authorizes appropriations. | 2025-08-26T15:13:37Z |