legislation: 103-s-2296
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| 103-s-2296 | 103 | s | 2296 | Health Security Act | Health | 1994-07-19 | 1994-07-19 | Placed on Senate Legislative Calendar under General Orders. Calendar No. 525. | Senate | Sen. Kennedy, Edward M. [D-MA] | MA | D | K000105 | 0 | TABLE OF CONTENTS: Title I: Health Care Security Subtitle A: Universal Coverage and Individual Responsibility Subtitle B: Benefits Subtitle C: State Responsibilities Subtitle D: Consumer Purchasing Cooperatives Subtitle E: Employer Purchasers Subtitle F: Health Plans Subtitle G: Federal Responsibilities Subtitle H: Miscellaneous Employer Responsibilities Subtitle I: General Definitions; Miscellaneous Provisions Title II: Long-Term Care Title III: Public Health Initiatives Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Additional Provisions Regarding Public Health Subtitle J: Occupational Safety and Health Subtitle K: Full Funding for WIC Subtitle L: Border Health Improvement Title V (sic): Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Information Systems, Privacy, and Administrative Simplification Subtitle C: Remedies and Enforcement Subtitle D: Medical Malpractice Subtitle E: Expanded Efforts to Combat Health Care Fraud and Abuse Subtitle F: Repeal of Exemption Title VI: Premium Caps; Premium-Based Financing; and Plan Payments Subtitle A: Premium Caps Subtitle B: Premium-Related Financings Subtitle C: Payments to Health Plans and Miscellaneous Provisions Title VIII (sic): Health and Health-Related Programs of the Federal Government Subtitle E (sic): Amendments to the Employee Retirement Income Security Act of 1974 Title IX: Aggregate Government Payments Subtitle B (sic): Aggregate Federal Payments to Participating State Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls Title X: Workers Compensation Medical Services Title XI: Transitional Insurance Reform Health Security Act - Title I: Health Care Security - Subtitle A: Universal Coverage and Individual Responsibility - Entitles each eligible individual to: (1) the benefit provided under subtitle B through the applicable health plan in which the individual is enrolled; and (2) a health security card to be issued by the alliance or other entity that offers the applicable health plan in which the individual is enrolled. Entitles a Medicare-eligible individual to benefits under Medicare instead of the provisions of this Act. (Sec. 1002) Requires each eligible individual to enroll in an applicable health plan and pay any required premium. Prohibits disenrollment of an eligible individual until the individual is either enrolled in another plan or becomes Medicare-eligible. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting: (1) an individual from purchasing any health services; (2) an individual from purchasing supplemental insurance; (3) an individual who is not an eligible individual from purchasing health insurance; or (4) employers from providing additional coverage. (Sec. 1004) Prescribes principles applicable to all health plans, including: (1) nondiscrimination based on medical history, pre- existing medical conditions, or genetic predisposition to medical conditions; (2) open enrollment periods; and (3) the provision of services as defined in the benefits package. (Sec. 1005) States that a community-rated health plan is the applicable plan for a family, unless a family member is eligible for an experienced-rated health plan. (Sec. 1006) Prohibits an ineligible alien from enrolling in a health plan under this Act. Subtitle B: Benefits - Includes the following terms and services in the comprehensive benefit package: (1) hospital services; (2) services of health professionals; (3) emergency and ambulatory medical and surgical services; (4) clinical preventive services; (5) mental illness and substance abuse services; (6) family planning services and services for pregnant women; (7) hospice care; (8) home health care; (9) extended care services; (10) ambulance services; (11) outpatient laboratory, radiology, and diagnostic services; (12) outpatient prescription drugs and biologicals; (13) outpatient rehabilitation services; (14) durable medical equipment and prosthetic and orthotic devices; (15) vision care; (16) hearing aids for children; (17) dental care; (18) investigational treatments; and (19) optional services. (Sec. 1131) Requires each health plan to offer to its enrollees only one of the following cost sharing schedules: (1) lower cost sharing; (2) higher cost sharing; or (3) combination cost sharing. Provides that the annual maximum out-of-pocket expenses for an individual in any of the plans shall be $2500 and for a family the annual maximum shall be $3000. (Sec. 1141) Excludes the following items and services: (1) an item or service that is not medically necessary or appropriate; (2) an item or service that the National Health Board may determine is not medically necessary or appropriate; (3) custodial care, except hospice care; (4) surgery performed solely for cosmetic purposes, unless required to correct a congenital anomaly or performed to correct a part of the body altered by either disease or accident; (5) hearing aids; (6) eyeglasses and contact lenses for individuals at least 18 years of age; (7) in vitro fertilization; (8) sex change surgery and related services; (9) private duty nursing; (10) personal comfort items, except in the case of hospice care; and (11) any dental procedures involving orthodontic care, inlays, gold or platinum fillings, bridges, crowns, pin-post retention, dental implants, surgical periodontal procedures, or the preparation of the mouth for the fitting or continued use of dentures, except as specified. (Sec. 1151) Gives the National Health Board the authority to promulgate such regulations or establish such guidelines as necessary to assure uniformity in the application of the comprehensive benefit package across all health plans. Permits the Board to expand the benefit package. (Sec. 1162) Permits a health professional or facility to refuse to provide a benefit if the professional or facility objects on the basis of a religious belief or moral conviction. (Sec. 1163) Requires facilities to promptly report incorrect test results to the provider who ordered the test. Subtitle C: State Responsibilities - Requires a State, in order to be approved as a participating State, to submit a document describing the State's health care system. (Sec. 1201) Sets forth general responsibilities for participating States. (Sec. 1207) Requires the establishment of a National Center of Consumer Advocacy to provide technical assistance, adequate training, and support to States and Offices of Consumer Advocacy in each State. (Sec. 1209) Requires a State to designate an agency to coordinate the delivery of medical and social services to children with special health care needs. (Sec. 1221) Permits a State, with the Board's approval, to operate a single-payer system if specified requirements are met. (Sec. 1281) Provides for reductions in cost sharing for certain low-income families enrolled in community-rated health plans. Subtitle D: Consumer Purchasing Cooperatives - Requires a State to certify consumer purchasing cooperatives to: (1) enter into agreements with health plans; (2) enter into agreements with community-rated employers; (3) enroll eligible individuals in health plans; (4) make payments to health plans on behalf of community-rated employers and eligible individuals; (5) provide for coordination with other cooperatives; (6) provide information on health plans; and (7) carry out other functions as provided in this title. (Sec. 1321) Provides for the Federal Employees Health Benefits Program (FEHBP) to serve as a consumer purchasing cooperative in each health care coverage area designated by a State. Subtitle E: Employer Purchasers - Sets forth the responsibilities of employer purchasers of health plans. (Sec. 1411) Directs the Secretary of Labor to develop and publish standards applicable to employer sponsored plans offered by large group purchasers. Subtitle F: Health Plans - Sets forth requirements for the certification of health plans by a State. (Sec. 1531) Sets forth requirements relating to essential community providers. Subtitle G: Federal Responsibilities - Establishes the National Health Board in the Executive Branch. (Sec. 1603) Sets forth the general duties and responsibilities of the Board, including an annual report to the President and the Congress. (Sec. 1611) Requires the Board to approve a State health care system if the system meets the applicable requirements of this Act. Prohibits approval of a State health care system prior to 1996. (Sec. 1621) Provides for the Federal assumption of responsibilities in the absence of a State system. (Sec. 1641) Directs the Board to develop a risk adjustment and reinsurance methodology. Sets forth guidelines for developing such methodology. (Sec. 1651) Directs the Board to establish minimum capital requirements for community-rated health plans. (Sec. 1660) Requires the Board to establish a national annual open enrollment period. (Sec. 1671) Sets forth the responsibilities of the Secretary of Health and Human Services. Directs the Secretary to administer and implement all provisions of this Act, except those duties delegated to the Board, any other executive agency, or to any State. (Sec. 1672) Directs the Secretary to undertake an interdisciplinary medical technology impact study to assess the overall effect on patient outcomes of medical technologies used in treating a list of target diseases and conditions. (Sec. 1681) Provides for the certification of essential community providers. Sets forth the categories of providers automatically certified. (Sec. 1687) Directs the Secretary to perform responsibilities with respect to the development of workplace wellness programs. (Sec. 1691) Sets forth the responsibilities of the Secretary of Labor in administering provisions of this Act and related Acts. (Sec. 1695) Provides for collective bargaining dispute resolution for the transition period to a restructured health care delivery system. Subtitle H: Miscellaneous Employer Responsibilities - Sets forth employer responsibilities including: (1) auditing of records; (2) prohibitions on discrimination based on family status; (3) evasion of obligations; (4) prohibitions on self-funding of cost sharing benefits; and (5) obligations to retirees. Subtitle I: General Definitions; Miscellaneous Provisions - Sets forth the definitions and rules used in this Act. (Sec. 1911) Grants the National Health Board, the Secretary of Health and Human Services, and the Secretary of Labor authority to issue regulations as necessary to permit the timely implementation of this Act. (Sec. 1917) Expresses the sense of the Senate Committee on Labor and Human Resources that when the Health Security Act is enacted it should include specified sources of financing not within the jurisdiction of the Committee. Expresses the sense of such Committee that when health reform legislation is enacted it should include the permanent extension of the research and development tax credit. (Sec. 1918) Expresses the sense of such Committee that provisions encouraging the establishment of medical savings accounts be included in any health reform bill passed by the Senate, in conjunction with a comprehensive benefit package described in subtitle B of this title. Title II: Long-Term Care - Establishes requirements for State programs for home and community-based services to individuals with disabilities. Requires a State to consult with individuals and groups of individuals with disabilities when developing the plan in order to have the plan approved. (Sec. 2103) Defines individuals with disabilities to mean any individual within one or more of the following four categories: (1) individuals requiring help with the activities of daily living; (2) individuals with severe cognitive or mental impairment; (3) individuals with severe or profound mental retardation; and (4) severely disabled children. (Sec. 2107) Directs the Secretary to establish an advisory group to advise on all aspects of such State programs. (Sec. 2111) Provides financial assistance to States to assist in developing and implementing, or expanding and enhancing, a family- centered, culturally competent, community-centered, comprehensive statewide system of extended services and benefits for children with special health care needs. (Sec. 2201) Long-Term Care Insurance Improvement and Accountability Act - Amends the Public Health Service Act to mandate the establishment of model Federal standards for long-term care insurance. (Sec. 2301) Life Care Act - Amends the Public Health Service Act to establish a voluntary long-term care insurance program for individuals 35 years of age and over to cover the nursing home stays of such individuals. (Sec. 2303) Expresses the sense of the Senate Committee on Labor and Human Services concerning the success of PACE (Program of All- inclusive Care for the Elderly) in providing integrated service delivery. Title III: Public Health Initiatives - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the National Council to designate for each academic year the number of individuals nationwide who are authorized to be enrolled in each specified approved physician training program for each medical specialty. (Sec. 3031) Makes funds available for: (1) qualified entities for the operation of approved physician training programs; (2) eligible medical schools for the direct costs of academic programs; and (3) qualified academic health centers or teaching hospitals. (Sec. 3071) Directs the Secretary to carry out a program with respect to graduate nurse training programs that is equivalent to the program for approved physician training programs. Establishes a National Council on Graduate Nurse Education. (Sec. 3081) Authorizes appropriations to the Secretary of Health and Human Services for the following programs: (1) primary care physician and physician assistant training; (2) training of underrepresented minorities and disadvantaged persons; (3) expanding rural health career opportunities and retention efforts; and (4) nurse training. Directs the Secretary to establish a National Advisory Board on Health Care Workforce Development to make recommendations on health care worker matters. Amends the Public Health Service Act to authorize appropriations for grants to improve the training of health care workers in assisting the needs of mentally retarded individuals and others with developmental disabilities. (Sec. 3082) Authorizes appropriations to the Secretary of Labor for a retraining program, a demonstration program for advanced career positions, and a workforce adjustment program. Subtitle B: Academic Health Centers - Authorizes appropriations for grants for: (1) rural information and referral systems; and (2) community- and provider-based health plans to provide services of eligible centers to residents of rural or urban communities. Subtitle C: Health Research Initiatives - Amends the Public Health Service Act to ensure that the National Institutes of Health conducts and supports biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions. Provides for health services research. Authorizes appropriations for such research. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriations for the core functions of public health programs and national initiatives regarding health promotion and disease prevention. Subtitle E: Health Services for Medically Underserved Populations - Authorizes appropriations for: (1) grants and contracts for the development of qualified community health plans and networks; (2) loans and grants for the capital costs of developing qualified community health groups; and (3) grants and contracts for enabling and supplemental services. (Sec. 3471) Authorizes appropriations for: (1) the National Health Service Corps; and (2) such amounts as are necessary to ensure that a specified percentage of participants in the Scholarship Program or the Loan Repayment Program of the Corps are nurses. (Sec. 3481) Entitles a hospital with a low-income utilization rate to specified payments. (Sec. 3491) Expresses the sense of the Senate Committee on Labor and Human Resources on the appropriate recognition of the success of community and migrant health centers. Subtitle F: Mental Health; Substance Abuse - Authorizes appropriations for grants to States for the development and operation of comprehensive managed mental health and substance abuse programs that are integrated with the health delivery system established under this Act. Subtitle G: Comprehensive School Health Education; School- Related Health Services - Authorizes appropriations for: (1) the development and implementation of comprehensive age appropriate health education programs in public schools for children and youth kindergarten through grade 12; and (2) increase access to preventive and primary health care services for children and youth through school-based or school-linked health service sites. Subtitle H: Public Health Service Initiative - Specifies the initiatives under this Act to be funded through funds not otherwise appropriated. Subtitle I: Additional Provisions Regarding Public Health - Requires the Secretary to reserve allocated appropriations for curriculum development and implementation regarding domestic violence and women's health needs. Subtitle J: Occupational Safety and Health - Directs the Secretary of Health and Human Services and the Secretary of Labor to work together to develop and implement a comprehensive program to expand and coordinate initiatives to prevent occupational injuries and illnesses. Subtitle K: Full Funding for WIC - Amends the Child Nutrition Act of 1966 to authorize appropriations for the special supplemental food program. Subtitle L: Border Health Improvement - Authorizes the President to conclude an agreement with Mexico to establish a binational commission to be known as the United States-Mexico Border Health Commission. Title V (sic): Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Requires the National Health Board to establish and oversee a performance-based program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of health care services and access to such services which will be called the National Quality Council. (Sec. 5002) Specifies the duties of such Council. Subtitle B: Information Systems, Privacy, and Administrative Simplification - Directs the National Health Board to develop standards under which health care providers and health plans collect information for a national health care data network. (Sec. 5135) Authorizes the Board to make grants for demonstration projects to promote the development and use of electronically integrated community-based clinical information systems and computerized patient medical records. (Sec. 5160) Health Care Privacy Protection Act - Amends Federal criminal law to prescribe penalties for the wrongful disclosure of protected health information and the misuse of health security cards. (Sec. 5163) Provides limitations on the disclosure of protected health information. (Sec. 5195) Requires the Board to publish standard benefit forms. Subtitle C: Remedies and Enforcement - Sets forth provisions with respect to the review of benefit determinations for enrolled individuals, including provisions: (1) regulating the time limits for notice of disposition of a claim; (2) governing a plan's duty to review claim denials; (3) concerning urgent requests for preauthorization; and (4) concerning other time limits with respect to time limits and notice. (Sec. 5202) Requires each State to establish a complaint review office to permit aggrieved individuals to file complaints. (Sec. 5205) Provides for a Federal Health Plan Review Board to review the decisions of complaint review office hearing officers. (Sec. 5206) Sets monetary penalties for a plan which unreasonably denies or delays payment or provision of benefits. (Sec. 5211) Directs each State to establish and maintain an Early Resolution Program in each complaint review office. Requires a program to include: (1) forums for mediation of disputes; and (2) other forums of alternative dispute resolution as may be prescribed. (Sec. 5231) Sets forth additional remedies and enforcement provisions. Subtitle D: Medical Malpractice - Requires States to adopt an alternative dispute resolution system mechanism under which the parties must participate prior to the commencement of a medical malpractice action. Subtitle E: Expanded Efforts to Combat Health Care Fraud and Abuse - Requires the Secretary of Health and Human Services and the Attorney General to establish a joint program for health care fraud and abuse control. (Sec. 5421) Amends Federal criminal law to impose penalties for health care fraud, theft or embezzlement in connection with health care, false statements relating to health care matters, and bribery and graft relating to health care. Subtitle F: Repeal of Exemption - Amends specified Acts to repeal the exemption for health insurance. Title VI: Premium Caps; Premium-Based Financing; and Plan Payments - Subtitle A: Premium Caps - Sets forth provisions which provide for the computation of factors that limit the growth of premiums for the comprehensive benefit package in community-rated health plans. (Sec. 6002) Directs the Board to determine: (1) a national per capita baseline premium target; and (2) the health care coverage area per capita premium target. (Sec. 6006) Directs the chair of the Board to establish an advisory commission on regional variations in health expenditures. Requires the commission to examine methods of eliminating variation in health care coverage area per capita premium targets due to variation in practice patterns. (Sec. 6011) Subjects each noncomplying community-rated health plan for a year to a reduction in plan payment as specified, in order to assure that payments to community-rated health plans are consistent. (Sec. 6021) Directs the Board to develop a methodology for calculating an annual per capita expenditure equivalent for amounts paid for coverage for the comprehensive benefit package within a large group purchaser. (Sec. 6031) Sets forth special rules for a single-payer State. (Sec. 6041) Directs the Secretary to establish a program to monitor prices and expenditures in the U.S. health care system. Subtitle B: Premium-Related Financings - Makes each family enrolled in a community-rated health plan or an experienced-rated health plan in a class of family enrollment responsible for payment of the family share of premium. Provides for income-related discounts and specified credits. (Sec. 6116) Exempts certain employers from coverage obligations. (Sec. 6121) Specifies premium payments for community-rated employers, including premium discounts. (Sec. 6131) Specifies premium payments for large group purchasers. Subtitle C: Payments to Health Plans and Miscellaneous Provisions - Makes States responsible for assisting health plans and cooperatives in the collection of premium payments. Sets forth other duties and responsibilities of States and health plans with respect to payments and other administrative matters. Title VIII (sic): Health and Health-Related Programs of the Federal Government - Subtitle E (sic): Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to define group health plan. (Sec. 8402) Sets limitations on coverage of group health plans under title I (Protection of Employee Benefit Rights) of ERISA. Authorizes the Secretary of Labor to provide special rules for group health plan reporting and disclosure. Makes provisions relating to interference with protected rights and coercive interference applicable to enrollees in large group purchaser health plans. (Sec. 8403) Revises certain continuation coverage requirements (from COBRA - the Consolidated Omnibus Budget Reconciliation Act) under ERISA with respect to group health plans. Repeals ERISA provisions for continuation coverage under group health plans upon full implementation of universal coverage under this Act. Amends the Public Health Service Act with respect to period of coverage under a qualified health plan. Repeals such coverage provisions upon full implementation of universal coverage under this Act. (Sec. 8404) Ends certain ERISA provisions' applicability with respect to: (1) cases of adoption, to the extent otherwise provided in regulations of the National Health Board under this Act; and (2) coverage of pediatric vaccines under group health plans, upon the plan's becoming a large group purchaser health plan under this Act. (Sec. 8405) Requires group health plans covered by specified ERISA provisions to comply with the requirements of this Act for health plan claims procedures. (Sec. 8406) Exempts the Hawaii Prepaid Health care Act from certain ERISA preemption provisions, under specified conditions. Title IX: Aggregate Government Payments - Subtitle B (sic): Aggregate Federal Payments to Participating State - Directs the Secretary of Health and Human Services (HHS) to pay a capped Federal entitlement payment amount to each participating State in each calendar quarter. Sets forth formulas and rules for capped entitlement payments. Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls - Directs the Secretary of HHS to make available loans to States to cover any period of temporary cash-flow shortfall attributable to an estimation discrepancy, an administrative error, or relative timing during the year in which amounts are received and payments are required to be made. (Sec. 9201) Requires each State to provide that any surplus of funds resulting from an estimation discrepancy, up to a reasonable amount specified by the Secretary of HHS, shall be held in a State contingency fund for any future shortfalls from such a discrepancy. Title X: Workers Compensation Medical Services - Makes specified provisions under this Act (HSA) relating to use of standard forms and health care information applicable to a health plan or health care provider's provision of workers compensation medical services. Requires plans and providers that render such services to: (1) provide relevant health care information necessary to assist the worker in the safe and timely return to work; and (2) comply with legal duties and reporting requirements under State workers compensation laws and other Federal and State laws, including those regarding reporting of occupational injuries and diseases. Directs the Secretary of Labor to promulgate rules to clarify such plan and provider information responsibilities. (Sec. 10001) Requires health plans to provide care in disputed workers compensation cases, until an adjudicated determination is made that the claim is compensable as workers compensation. Requires the workers compensation carrier (or the self-insured employer) to reimburse the health plan and the worker if such determination is made. (Sec. 10002) Directs the Secretaries of HHS and Labor to conduct demonstration projects in one or more States with respect to treatment of work-related injuries and illnesses. Requires project development of: (1) protocols for treatment of work-related conditions; and (2) model methods of workers compensation carriers capitated payment on a per case basis to health plans for treatment of specified work-related injuries and illnesses. (Sec. 10003) Establishes a Commission on Workers Compensation Medical Services. Directs the Commission to study the relationship of workers compensation medical services to the new health system under this Act in terms of impact on the cost of such services, access to appropriate care for injured workers, and quality of medical care and its impact on functional and vocational outcomes for injured workers, considering specified issues. Requires the Commission's final report to the President and specified congressional committees to include a recommendation as to whether a transfer of financial responsibility for some or all medical benefits to health plans should be effected, along with a detailed implementation plan if such transfer is recommended. Title XI: Transitional Insurance Reform - Sets forth transitional provisions concerning: (1) enforcement; (2) preservation of current coverage; (3) restrictions on premium increases during transition; (4)portability requirements; (5) restrictions limiting benefit reductions; and (6) the establishment of the National Transitional Health Insurance Risk Pool. | 2025-08-26T13:51:14Z |