S 2888 IS
106th CONGRESS
2d Session
S. 2888
To guarantee for all Americans quality, affordable, and comprehensive
health insurance coverage.
IN THE SENATE OF THE UNITED STATES
July 19, 2000
Mr. WELLSTONE introduced the following bill; which was read twice and
referred to the Committee on Finance
A BILL
To guarantee for all Americans quality, affordable, and comprehensive
health insurance coverage.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE- This Act may be cited as the `Health Security for All
Americans Act'.
(b) TABLE OF CONTENTS- The table of contents of the Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I--HEALTH SECURITY FOR ALL AMERICANS--EXPANSION PHASE (PHASE I)
Sec. 101. Expansion phase (phase I) voluntary State universal health
insurance coverage plans.
`TITLE XXII--HEALTH SECURITY FOR ALL AMERICANS
`Part A--Expansion Phase (Phase I) Plans
`Sec. 2201. Purpose; voluntary State plans.
`Sec. 2202. Plan requirements.
`Sec. 2203. Coverage requirements for expansion phase (phase I)
plans.
`Sec. 2204. Allotments.
`Sec. 2205. Administration.
`Sec. 2206. Definitions.'.
TITLE II--HEALTH SECURITY FOR ALL AMERICANS--UNIVERSAL PHASE (PHASE II)
Sec. 201. Universal phase (phase II) State universal health insurance
coverage plans.
`Part B--Universal Phase (Phase II) Plans
`Sec. 2211. Purpose; mandatory State plans.
`Sec. 2212. Plan requirements.
`Sec. 2213. Coverage requirements for universal phase (phase II)
plans.
`Sec. 2214. Requirements for employers regarding the provision of
benefits.
`Sec. 2215. Allotments.
`Sec. 2216. Administration; definitions.'.
Sec. 202. Consumer protections.
`Part C--Consumer Protections
`Sec. 2221. Home care standards.
`Sec. 2222. Consumer protection in the event of termination or
suspension of services.
`Sec. 2223. Consumer protection through disclosure of
information.'.
`Sec. 2224. Consumer protection through notice of changes in health care
delivery.'.
TITLE III--PATIENT PROTECTIONS
Sec. 301. Incorporation of certain protections.
TITLE IV--HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS
Sec. 401. Health Care Quality, Patient Safety, and Workforce Standards
Institute.
Sec. 402. Health Care Quality, Patient Safety, and Workforce Standards
Advisory Committee.
TITLE V--IMPROVING MEDICARE BENEFITS
Sec. 501. Full mental health and substance abuse treatment benefits
parity.
Sec. 502. Study and report regarding addition of prescription drug
benefit.
TITLE VI--LONG-TERM AND HOME HEALTH CARE
Sec. 601. Studies and demonstration projects to identify model
programs.
TITLE VII--MISCELLANEOUS
Sec. 701. Nonapplication of ERISA.
Sec. 702. Sense of Congress regarding offsets.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) The health of the American people is the foundation of American
strength, productivity, and wealth.
(2) The guarantee of health care coverage and access to quality medical
care to all Americans is a fundamental right and is essential to the general
welfare.
(3) 45,000,000 Americans, more than 11,000,000 of whom are children,
have no health insurance, and that number will grow to more than 54,000,000
by 2007 even if the economy remains strong.
(4) Health insurance coverage is unstable; less than 1/2 of all adults
have been in their current health plan for 3 years.
(5) The average American will hold at least 7 jobs during their life,
risking lack of health coverage every time they change or are between
jobs.
(6) In 1998, annual health care expenditures in the United States
totaled $1,150,000,000,000, or $4,094 per person. National health
expenditures are projected to total $2,200,000,000,000 by 2008.
(7) In 1998, health care expenditures represented 13.5 percent of the
gross domestic product in the United States and grew at the rate of 5.6
percent while the gross domestic product grew only at the rate of 4.9
percent. By 2008, health care expenditures are projected to reach 16.2
percent of gross domestic product. Growth in health spending is projected to
average 1.8 percentage points above the growth rate of the gross domestic
product for the period beginning with 1998 and ending with 2008.
(8) Although the United States spends considerably more in health care
per person than any other nation, it ranks only fifteenth among countries
worldwide on an overall index designed to measure a range of health goals
according to the World Health Organization.
(9) One of 4 adults, about 40,000,000 people, say they have gone without
needed medical care because they couldn't afford it.
(10) Nearly 31,000,000 Americans face collection agencies annually
because they owe money for medical bills.
(11) The average American worker is paying 3 times more for family
coverage than 10 years ago, and more than 4 times more for employee-only
coverage.
(12) Because many individuals do not have health insurance coverage,
they may incur health care costs which they do not fully reimburse,
resulting in cost-shifting to others.
(13) As a consequence of the piecemeal health care system in the United
States, administrative overhead costs approximately $1,000 per person
annually, while other Western industrialized nations with universal health
care systems spend approximately $200 per person annually for administrative
overhead.
(14) The United States should adopt national goals of universal,
affordable, comprehensive health insurance coverage and should provide
generous matching grants to the States to achieve those goals within 5 years
of the date of enactment of this Act.
TITLE I--HEALTH SECURITY FOR ALL AMERICANS--EXPANSION PHASE (PHASE
I)
SEC. 101. EXPANSION PHASE (PHASE I) VOLUNTARY STATE UNIVERSAL HEALTH
INSURANCE COVERAGE PLANS.
The Social Security Act (42 U.S.C. 301 et seq.) is amended by adding at
the end the following:
`TITLE XXII--HEALTH SECURITY FOR ALL AMERICANS
`PART A--EXPANSION PHASE (PHASE I) PLANS
`SEC. 2201. PURPOSE; VOLUNTARY STATE PLANS.
`(a) PURPOSE- The purpose of this part is to provide funds to
participating States to enable those States to ensure universal health
insurance coverage by establishing State administered systems.
`(b) EXPANSION PHASE (PHASE I) PLAN REQUIRED- A State is not eligible for
a payment under section 2205(a) unless the State has submitted to the
Secretary a plan that--
`(1) sets forth how the State intends to use the funds provided under
this part to ensure universal, affordable, and comprehensive health
insurance coverage to eligible residents of the State consistent with the
provisions of this part; and
`(2) has been approved under section 2202(d).
`SEC. 2202. PLAN REQUIREMENTS.
`(a) IN GENERAL- Every expansion phase (phase I) plan shall include
provisions for the following:
`(1) INFORMATION ON THE LEVEL OF HEALTH INSURANCE COVERAGE-
`(A) The level of health insurance coverage within the State as
determined under subsection (b).
`(B) The base coverage gap for the year involved as determined under
subsection (b)(4).
`(C) State efforts to provide or obtain health insurance coverage for
uncovered residents of the State, including the steps the State is taking
to identify and enroll all uncovered residents of the State who are
eligible to participate in public or private health insurance
programs.
`(2) DETAILS OF, AND TIMELINES FOR, EXPANSION PHASE (PHASE I)
PLAN-
`(A) USE OF FUNDS; COORDINATION- The activities that the State intends
to carry out using funds received under this part, including how the State
will coordinate efforts under this part with existing State efforts to
increase the health insurance coverage of individuals.
`(B) TIMELINES- Consistent with subsection (c), the manner in which
the State will reduce the base coverage gap for the year involved,
including a timetable with specified targets for reducing the base
coverage gap by--
`(i) 50 percent within 2 years after the date of approval of the
expansion phase (phase I) plan; and
`(ii) 100 percent within 4 years after such date.
`(3) MAINTENANCE OF EFFORT- The manner in which the State will ensure
that--
`(A) employers within the State will continue to provide not less than
the level of financial support toward the health insurance premiums
required for coverage of their employees as such employers provided as of
the date of enactment of this title; and
`(B) the State will continue to provide not less than the level of
State expenditures incurred for State-funded health programs as of such
date.
`(4) STATE OUTREACH PROGRAMS; ACCESS- The manner in which, and a
timetable for when, the State will--
`(A) institute outreach programs; and
`(B) ensure that all eligible residents of the State have access to
the health insurance coverage provided under this part.
`(5) ASSURANCE OF COVERAGE OF ESSENTIAL SERVICES- An assurance that the
State program established under this part will comply with the requirements
of section 1867 (commonly referred to as the `Emergency Medical Treatment
and Active Labor Act').
`(6) REPRESENTATION ON BOARDS AND COMMISSIONS- The manner in which the
State will ensure that all Boards and Commissions that the State establishes
to administer the plan will include, among others, representatives of
providers, consumers, employers, and health worker unions.
`(7) DISCLOSURE OF INFORMATION TO THE PUBLIC- The manner in which the
State will ensure that, with respect to entities and individuals that
provide services for which reimbursement is provided under this part--
`(A) financial arrangements between insurers and providers and between
providers and medical equipment suppliers are disclosed to the public;
and
`(B) ownership interests and health care worker qualifications and
credentials are disclosed to the public.
`(8) CONSUMER PROTECTIONS- The manner in which the State will ensure
compliance with sections 2221, 2222, 2223, and 2224.
`(9) PUBLIC REVIEW- The manner in which the State will provide for the
public review of institutional changes in services provided, markets and
regions covered, withdrawal or movement of services, closures or downsizing,
and other actions that affect the provision of health insurance under the
plan.
`(10) SERVICES IN RURAL AND UNDERSERVED AREAS; CULTURAL COMPETENCY- The
manner in which the State will ensure--
`(A) coverage in rural and underserved areas; and
`(B) that the needs of culturally diverse populations are
met.
`(11) PURCHASING POOLS- The manner in which the State will encourage the
formation of State purchasing pools that provide choice of health plans,
control costs, and reduce adverse risk selection.
`(12) LIMITATION ON ADMINISTRATIVE EXPENDITURES- The manner in which the
State will ensure that all qualified plans in the State expend at least 90
percent (or, during the first 2 years of the plan, 85 percent) of total
income received from premiums on the provision of covered health care
benefits (excluding all costs for marketing, advertising, health plan
administration, profits, or capital accumulation) to individuals.
`(13) SELF-EMPLOYED AND MULTIEMPLOYED- The manner in which the State
will address self-employed individuals and multiwage earner families.
`(14) MEDICAID WRAPAROUND COVERAGE- The manner in which the State will
ensure that individuals who are eligible for medical assistance under title
XIX and who receive benefits under the expansion phase (phase I) plan shall
receive any items or services that are not available under the expansion
phase (phase I) plan but that are available under the State medicaid program
under title XIX through `wraparound coverage' under such program.
`(15) OTHER MATTERS- Any other matter determined appropriate by the
Secretary.
`(b) CURRENT LEVEL OF COVERAGE-
`(1) IN GENERAL- The Secretary shall develop a survey approach that
provides timely and up-to-date data to determine the percentage of the
population of each State that is currently covered by a health insurance
plan or program that provides coverage that meets the requirements of
section 2203(a).
`(2) BIANNUAL SURVEY- The Secretary shall provide for the conduct of the
survey developed under paragraph (1) not less than biannually to make
coverage determinations for purposes of paragraph (1).
`(3) USE OF ALTERNATIVE SYSTEM- The Secretary shall permit a State to
utilize an alternative population-based monitoring system to make
determinations with respect to coverage in the State for purposes of
paragraph (1) if the Secretary determines that such system meets or exceeds
the methodological standards utilized in the survey developed under
paragraph (1).
`(4) BASE COVERAGE GAP- For purposes of subsection (a)(1)(A), the base
coverage gap for a State shall be equal to 100 percent of the eligible
individuals and families in the State for the year involved, less the
current level of coverage for those individuals and families for such year
as determined under paragraph (1) or (3).
`(c) REDUCING THE LEVEL OF UNINSURED INDIVIDUALS-
`(1) IN GENERAL- To be eligible to receive funds under this part, a
State shall agree to administer an expansion phase (phase I) plan with a
goal of providing health insurance coverage for 100 percent of the eligible
residents of the State by not later than 4 years after the date of approval
of the State's expansion phase (phase I) plan.
`(2) PERMISSIBLE ACTIVITIES- A State may use amounts provided under this
part for any activities consistent with this part that are appropriate to
enroll individuals in health plans and health programs to meet the targets
contained in the State plan under subsection (a)(2)(B), including through
the use of direct payments to health plans or, in the case of a single State
plan, directly to providers of services.
`(d) PROCESS FOR SUBMISSION, APPROVAL, AND AMENDMENT OF EXPANSION PHASE
(PHASE I) PLAN- The provisions of section 2106 apply to an expansion phase
(phase I) plan under this part in the same manner as they apply to a State
plan under title XXI, except that no expansion phase (phase I) plan may be
effective earlier than January 1, 2001, and all expansion phase (phase I)
plans must be submitted for approval by not later than December 31, 2002.
`SEC. 2203. COVERAGE REQUIREMENTS FOR EXPANSION PHASE (PHASE I) PLANS.
`(a) REQUIRED SCOPE OF HEALTH INSURANCE COVERAGE- Health insurance
coverage provided under this part shall consist of at least the benefits
provided under the Federal Employees Health Benefits Program standard Blue
Cross/Blue Shield preferred provider option service benefit plan, described in
and offered under section 8903(1) of part 5, United States Code, including
mental health and substance abuse treatment benefits parity.
`(b) LIMITATIONS ON PREMIUMS AND COST-SHARING-
`(1) DESCRIPTION; GENERAL CONDITIONS- An expansion phase (phase I) plan
shall include a description, consistent with this subsection, of the amount
(if any) of premiums, cost-sharing, or other similar charges imposed. Any
such charges shall be imposed pursuant to a public schedule.
`(2) LIMITATIONS ON PREMIUMS AND COST-SHARING-
`(A) INDIVIDUALS AND FAMILIES WITH INCOME BELOW 150 PERCENT OF POVERTY
LINE- In the case of an individual or family whose income is at or below
150 percent of the poverty line--
`(i) the State plan may not impose a premium; and
`(ii) the total annual aggregate amount of cost-sharing imposed by a
State with respect to all individuals in a family may not exceed 0.5
percent of the family's income for the year involved.
`(B) INDIVIDUALS AND FAMILIES WITH INCOME BETWEEN 150 AND 300 PERCENT
OF POVERTY LINE- In the case of an individual or family whose income
exceeds 150 percent but does not exceed 300 percent of the poverty
line--
`(i) the State plan may not impose a premium that exceeds an amount
that is equal to--
`(I) 20 percent of the average cost of providing benefits to an
individual (or a family) under this part in the year involved;
or
`(II) 3 percent of the family's income for the year involved;
and
`(ii) the total annual aggregate amount of premiums and cost-sharing
(combined) imposed by a State with respect to all individuals in a
family may not exceed 5 percent of the family's income for the year
involved.
`(C) INDIVIDUALS AND FAMILIES WITH INCOME ABOVE 300 PERCENT OF POVERTY
LINE- In the case of an individual or family whose income exceeds 300
percent of the poverty line--
`(i) the State plan may not impose a premium that exceeds 20 percent
of the average cost of providing benefits to an individual (or a family
of the size involved) under this part in the year involved;
and
`(ii) the total annual aggregate amount of premiums and cost-sharing
(combined) imposed by a State with respect to all individuals in a
family may not exceed 7 percent of the family's income for the year
involved.
`(D) SELF-EMPLOYED INDIVIDUALS- The State shall establish rules for
self-employed individuals based on individual and family income.
`(3) COLLECTION- The State shall establish procedures for collecting any
premiums, cost-sharing, or other similar charges imposed under this part.
Such procedures shall provide for annual reconciliations and
adjustments.
`(c) APPLICATION OF CERTAIN REQUIREMENTS-
`(1) RESTRICTION ON APPLICATION OF PREEXISTING CONDITION EXCLUSIONS- The
expansion phase (phase I) plan shall not permit the imposition of any
preexisting condition exclusion for covered benefits under the plan.
`(A) IN GENERAL- Except as provided in subparagraph (B), the expansion
phase (phase I) plan shall offer eligible individuals and families a
choice of qualified plans from which to receive benefits under this part.
At least 1 plan shall be a preferred provider option plan.
`(B) WAIVER- The Secretary--
`(i) may waive the requirement under subparagraph (A) if determined
appropriate; and
`(ii) shall waive such requirement in the case of a State that
establishes a single State plan.
`SEC. 2204. ALLOTMENTS.
`(1) IN GENERAL- With respect to a fiscal year, the Secretary shall
allot to each State with an expansion phase (phase I) plan approved under
this part the amount determined under paragraph (2) for such State for such
fiscal year.
`(2) DETERMINATION OF COST OF COVERAGE- The amount determined under this
paragraph is the amount equal to--
`(i) the Federal participation rate for the State as determined
under subsection (b) or, if applicable, the enhanced Federal
participation rate for the State, as determined under subsection
(c);
`(ii) the estimated cost for the minimum benefits package required
to comply under section 2203, not to exceed the sum of--
`(I) the total annual Government and employee contributions
required for individual or self and family health benefits coverage
under the Federal Employees Health Benefits Program standard Blue
Cross/Blue Shield preferred provider option service benefit plan,
described in and offered under section 8903(1) of title 5, United
States Code (adjusted for age, as the Secretary determines
appropriate); and
`(II) the estimated average cost-sharing expense for an individual
or family; and
`(iii) the estimated number of residents to be enrolled in the
expansion phase (phase I) plan; less
`(i) the individual or family health insurance contribution and
cost-sharing payments to be made in accordance with section 2203(b);
and
`(ii) any applicable employer contribution to such
payments.
`(b) FEDERAL PARTICIPATION RATE- For purposes of subsection (a)(2)(A)(i),
the Federal participation rate for a State shall be equal to the enhanced FMAP
determined for the State under section 2105(b).
`(c) ENHANCED FEDERAL PARTICIPATION RATE-
`(1) IN GENERAL- For purposes of subsection (a)(2)(A)(i), the enhanced
Federal participation rate for a State shall be equal to the Federal
participation rate for such State under subsection (b), as adjusted by the
Secretary based on the decrease in the base coverage gap in the State.
`(2) AMOUNT OF ADJUSTMENT AND APPLICATION-
`(A) AMOUNT OF ADJUSTMENT- The Federal participation rate under
subsection (b) with respect to a State shall be increased by--
`(i) 1 percentage point if the base coverage gap of the State has
decreased by at least 50 percent within 2 years after the date of
approval of the expansion phase (phase I) plan, as determined by the
Secretary; and
`(ii) 3 percentage points if the base coverage gap of the State has
decreased by 100 percent within 4 years after the date of approval of
the expansion phase (phase I) plan, as determined by the
Secretary.
`(B) APPLICATION- The increase described in--
`(i) subparagraph (A)(i) shall only apply to a State for the period
beginning with the month of the determination under such subparagraph
and ending with the month preceding the month of the determination under
subparagraph (A)(ii) (if any), but in no event for more than 24 months;
and
`(ii) subparagraph (A)(ii) shall apply to a State for any year (or
portion thereof) beginning with the month of the determination under
such subparagraph.
`(3) FULL COVERAGE- For purposes of this part, a State shall be deemed
to have decreased its base coverage gap by 100 percent if the Secretary
determines that--
`(A) 98 percent of all eligible residents of the State are provided
health insurance coverage under the expansion phase (phase I) plan;
and
`(B) the remaining 2 percent of such residents are served by
alternative health care delivery systems as demonstrated by the
State.
`(d) GRANTS TO INDIAN TRIBES, NATIVE HAWAIIAN ORGANIZATIONS, AND ALASKA
NATIVE ORGANIZATIONS-
`(1) IN GENERAL- Out of funds appropriated under subsection (e), the
Secretary shall reserve an amount, not to exceed 1 percent of the total
allotments determined under subsection (a) for a fiscal year, to make grants
to Indian tribes, Native Hawaiian organizations, and Alaska Native
organizations for development and implementation of universal health
insurance coverage plans for members of such tribes and organizations.
`(2) PLAN- To be eligible to receive a grant under paragraph (1), an
Indian tribe, Native Hawaiian organization, or Alaska Native organization
shall submit a universal health insurance coverage plan to the Secretary at
such time, in such manner, and containing such information, as the Secretary
may require.
`(3) REGULATIONS- The Secretary shall issue regulations specifying the
requirements of this part that apply to Indian tribes, Native Hawaiian
organizations, and Alaska Native organizations receiving grants under
paragraph (1).
`(1) IN GENERAL- Out of any funds in the Treasury not otherwise
appropriated, there is appropriated to carry out this title such sums as may
be necessary for fiscal year 2001 and each fiscal year thereafter.
`(2) BUDGET AUTHORITY- Paragraph (1) constitutes budget authority in
advance of appropriations Acts and represents the obligation of the Federal
Government to provide States, Indian tribes, Native Hawaiian organizations,
and Alaska Native organizations with the allotments determined under this
section and the grants for administrative and outreach activities under
section 2205.
`SEC. 2205. ADMINISTRATION.
`(A) QUARTERLY- Subject to subparagraph (B) and subsection (b), the
Secretary shall make quarterly payments to each State with an expansion
phase (phase I) plan approved under this part, from its allotment under
section 2204.
`(B) FUNDING FOR ADMINISTRATION AND OUTREACH-
`(i) AUTHORITY TO MAKE GRANTS- In addition to the allotments
determined under section 2204, the Secretary may make grants to States,
Indian tribes, Native Hawaiian organizations, and Alaska Native
organizations for expenditures for administrative and outreach
activities.
`(I) IN GENERAL- A grant awarded under this subparagraph shall not
exceed the applicable percentage (as determined under subclause (II))
of the total amount allotted to the State, Indian tribe, Native
Hawaiian organization, or Alaska Native organization under section
2204.
`(II) APPLICABLE PERCENTAGE- For purposes of subclause (I), the
applicable percentage is--
`(aa) 14 percent during the first 2 years an expansion phase (phase
I) plan is in effect and complies with the requirements of this title;
`(bb) 12 percent during the third, fourth, and fifth years that such
plan, or a universal phase (phase II) plan added by an addendum to an expansion
phase (phase I) plan, is in effect and complies with the requirements of this
title; and
`(cc) 10 percent during any year thereafter such plan (or universal
phase (phase II) plan added by an addendum to such plan) is in effect and
complies with the requirements of this title.
`(2) ADVANCE PAYMENT; RETROSPECTIVE ADJUSTMENT- The Secretary may make
payments under this part for each quarter on the basis of advance estimates
by the State and such other investigation as the Secretary may find
necessary, and may reduce or increase the payments as necessary to adjust
for any overpayment or underpayment for prior quarters.
`(3) FLEXIBILITY IN SUBMITTAL OF CLAIMS- Nothing in this subsection
shall be construed as preventing a State from claiming as expenditures in
the quarter expenditures that were incurred in a previous quarter.
`(b) AUTHORITY FOR BLENDED RATE FOR HEALTH SECURITY, MEDICAID, AND SCHIP
FUNDS- The Secretary shall establish procedures for blending the payments that
a State is entitled to receive under this title, title XIX, and title XXI into
1 payment rate if--
`(1) the State requests such a blended payment; and
`(2) the Secretary finds that the State meets maintenance of effort
requirements established by the Secretary.
`(c) LIMITATIONS ON FEDERAL PAYMENTS BASED ON COST CONTAINMENT-
`(1) DETERMINATION OF BASELINE- Each year (beginning with 2001), the
Secretary shall establish a baseline projection for the national rate of
growth in private health insurance premiums for such year.
`(2) REQUIREMENT- Beginning with fiscal year 2002 and each fiscal year
thereafter, any payment made to a State under section 2204 shall not exceed
the amount paid to the State under such section for the preceding fiscal
year, adjusted for changes in enrollment and a premium inflation adjustment
that is 0.5 percent below the baseline projection determined under paragraph
(1) for the year.
`(d) OTHER LIMITATIONS ON USE OF FUNDS-
`(1) IN GENERAL- A State participating under part A, and, effective
January 1, 2005, all States under part B, shall ensure that any payments
received by the State under section 2205 or 2116(a) are not used by any
individual or entity, including providers or health plans that contract to
provide services herein, to finance directly or indirectly, or to otherwise
facilitate expenditures to influence health care workers of such individual
or entity with respect to issues related to unionization.
`(2) CONSTRUCTION- Nothing in this subsection shall be construed to
limit expenditures made for the purpose of good faith collective bargaining
or pursuant to the terms of a bona fide collective bargaining
agreement.
`(e) WAIVER OF FEDERAL REQUIREMENTS- A State may request (and the
Secretary may grant) a waiver of any provision of Federal law that the State
determines is necessary in order to carry out an approved expansion phase
(phase I) plan under this part.
`(f) REPORT- Not later than January 1, 2002, and each January 1
thereafter, the Secretary, in consultation with the General Accounting Office
and the Congressional Budget Office, shall prepare and submit to the
appropriate committees of Congress a report on the number of States receiving
payments under this part for the year for which the report is being prepared
as well as the level of insurance coverage attained by each such State.
`SEC. 2206. DEFINITIONS.
`(1) COST-SHARING- The term `cost-sharing' has the meaning given such
term under the Federal Employees Health Benefits Program standard Blue
Cross/Blue Shield preferred provider option service benefit plan described
in and offered under section 8903(1) of part 5, United States Code, and
includes deductibles, copayments, coinsurance, as such terms are defined for
purposes of such plan.
`(2) ELIGIBLE RESIDENTS OF A STATE-
`(A) IN GENERAL- The term `eligible residents of a State' means an
individual or family who--
`(i) is (or consists of) a resident of the State
involved;
`(ii) except as provided in subparagraph (B), has a family income
that does not exceed 300 percent of the poverty line;
`(iii) is (or consists of) a citizen of the United States, a legal
resident alien, or an individual otherwise residing in the United States
under the authority of Federal law; and
`(iv) in the case of an individual, is not eligible for benefits
under the medicare program under title XVIII or for medical assistance
under the medicaid program under title XIX (other than under the
application of section 1902(a)(10)(A)(ii)(XIV)).
`(B) OPTION TO PROVIDE COVERAGE FOR INDIVIDUALS AND FAMILIES WITH
HIGHER INCOME- If approved by the Secretary, a State may increase the
percentage described in subparagraph (A)(ii), or eliminate all income
eligibility criteria in order to provide coverage under this part to more
individuals and families.
`(3) EXPANSION PHASE (PHASE I) PLAN- The term `expansion phase (phase I)
plan' means the State universal health insurance coverage plan submitted
under section 2201(b).
`(4) HEALTH CARE SERVICES- The term `health care services' includes
medical, surgical, mental health, and substance abuse services, whether
provided on an in-patient or outpatient basis.
`(5) HEALTH CARE WORKER- The term `health care worker' means an
individual employed by an employer that provides--
`(A) health care services; or
`(B) necessary related services, including administrative, food
service, janitorial, or maintenance service to an entity that provides
such health care services.
`(6) HEALTH PLAN- The term `health plan' includes health insurance
coverage, as defined in section 2791(b)(1) of the Public Health Service Act
(42 U.S.C. 300gg-91(b)(1)) and group health plans, as defined in section
2791(a) of such Act (42 U.S.C. 300gg91(b)(1)).
`(7) MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT BENEFITS PARITY-
`(A) IN GENERAL- The term `mental health and substance abuse treatment
benefits parity' means the same level of parity for such benefits as is
required under the Federal Employees Health Benefits Program standard Blue
Cross/Blue Shield preferred provider option service benefit plan,
described in and offered under section 8903(1) of part 5, United States
Code, as of January 1, 2001.
`(B) EXCEPTION- Notwithstanding subparagraph (A), there shall be no
limit on parity benefits for patients who do not substantially follow
their treatment plans unless such limits also are imposed on all medical
and surgical benefits.
`(8) POVERTY LINE- The term `poverty line' has the meaning given such
term in section 673(2) of the Community Services Block Grant Act (42 U.S.C.
9902(2)), including any revision required by such section.
`(9) PREMIUM- The term `premium' includes any enrollment fees and other
similar charges.
`(10) QUALIFIED PLAN- The term `qualified plan' means a health plan that
satisfies the coverage requirements described under section 2203 and
participates in an expansion phase (phase I) plan.'.
TITLE II--HEALTH SECURITY FOR ALL AMERICANS--UNIVERSAL PHASE (PHASE
II)
SEC. 201. UNIVERSAL PHASE (PHASE II) STATE UNIVERSAL HEALTH INSURANCE
COVERAGE PLANS.
Title XXII of the Social Security Act, as added by section 101, is amended
by adding at the end the following:
`PART B--UNIVERSAL PHASE (PHASE II) PLANS
`SEC. 2211. PURPOSE; MANDATORY STATE PLANS.
`(a) PURPOSE- The purposes of this part are to--
`(1) require States to establish and implement State-administered
systems to ensure universal health insurance coverage; and
`(2) provide funds to States for the establishment and implementation of
such systems.
`(b) UNIVERSAL PHASE (PHASE II) PLAN REQUIRED-
`(1) IN GENERAL- Except as provided in paragraph (2), not later than
January 1, 2004, a State shall submit to the Secretary a plan that sets
forth
how the State intends to use the funds provided under this part to ensure
universal, affordable, and comprehensive health insurance coverage to eligible
residents of the State consistent with the provisions of this part.
`(2) STATES WITH PHASE I PLANS-
`(A) IN GENERAL- Not later than January 1, 2004, a State with a phase
I State plan shall submit an addendum to such plan that provides
assurances to the Secretary that such plan conforms to the requirements of
this part.
`(B) CONVERSION TO UNIVERSAL PHASE (PHASE II) PLAN- If an addendum to
an expansion phase (phase I) plan is approved by the Secretary--
`(i) the plan shall be automatically converted to a universal phase
(phase II) plan; and
`(ii) section 2214 and any provision of part A that is inconsistent
with this part shall not apply to the plan.
`(3) FAILURE TO SUBMIT PLAN OR ADDENDUM- If a State fails to submit a
plan as required in paragraph (1) (or an addendum as required in paragraph
(2)), or fails to have such plan or addendum approved by the Secretary, such
State shall be in violation of this part; and any residents of such a State
may bring a cause of action against the State in Federal district court to
require the State to comply with the provisions of this part.
`SEC. 2212. PLAN REQUIREMENTS.
`(a) IN GENERAL- A universal phase (phase II) plan shall include a
description, consistent with the requirements of this part, of the
following:
`(1) DETAILS OF THE UNIVERSAL PHASE (PHASE II) PLAN- The activities that
the State intends to carry out using funds received under this part to
ensure that all eligible residents of the State have access to the coverage
provided under this part, including how the State will coordinate efforts
under the program under this part with existing State efforts to increase to
100 percent the health insurance coverage of eligible residents of the State
by January 1, 2006.
`(2) REQUIREMENTS FOR EMPLOYERS- The manner in which the State will
ensure that employers within the State will comply with the requirements of
section 2214.
`(3) PART A PROVISIONS- The following provisions apply to a universal
phase (phase II) plan under this part in the same manner as such provisions
apply to an expansion phase (phase I) plan under part A:
`(A) STATE OUTREACH PROGRAMS; ACCESS- Section 2202(a)(4).
`(B) ASSURANCE OF COVERAGE OF ESSENTIAL SERVICES- Section
2202(a)(5).
`(C) REPRESENTATION ON BOARDS AND COMMISSIONS- Section
2202(a)(6).
`(D) DISCLOSURE OF INFORMATION TO THE PUBLIC- Section
2202(a)(7).
`(E) CONSUMER PROTECTIONS AND WORKFORCE STANDARDS- Section
2202(a)(8).
`(F) PUBLIC REVIEW- Section 2202(a)(9).
`(G) SERVICES IN RURAL AND UNDERSERVED AREAS; CULTURAL COMPETENCY-
Section 2202(a)(10).
`(H) PURCHASING POOLS- Section 2202(a)(11).
`(I) LIMITATION ON ADMINISTRATIVE EXPENDITURES- Section
2202(a)(12).
`(J) SELF-EMPLOYED AND MULTIEMPLOYED- Section 2202(a)(13).
`(K) MEDICAID WRAPAROUND COVERAGE- Section 2202(a)(14).
`(4) OTHER MATTERS- Any other matter determined appropriate by the
Secretary.
`(b) PERMISSIBLE ACTIVITIES- A State may use amounts provided under this
part for any activities consistent with this part that are appropriate to
enroll individuals in health plans to ensure that all eligible residents of
the State are provided coverage under this part, including through the use of
direct payments to health plans or providers of services.
`(c) COST CONTAINMENT; COMPETITIVE BIDDING- Notwithstanding subsection
(b), State purchasing pools shall solicit bids from health plans at least
annually.
`(d) PROCESS FOR SUBMISSION, APPROVAL, AND AMENDMENT OF UNIVERSAL PHASE
(PHASE II) PLAN- Section 2106 applies to a universal phase (phase II) plan
under this part in the same manner as such section applies to a State plan
under title XXI, except that no universal phase (phase II) plan may be
effective earlier than January 1, 2005, and all such plans must be submitted
for approval by not later than January 1, 2004.
`SEC. 2213. COVERAGE REQUIREMENTS FOR UNIVERSAL PHASE (PHASE II) PLANS.
`(a) REQUIRED SCOPE OF HEALTH INSURANCE COVERAGE- Section 2203(a) applies
to a universal phase (phase II) plan under this part.
`(b) UNIVERSAL COVERAGE- All States shall ensure that by January 1, 2006,
100 percent of eligible residents of the State have health insurance coverage
that meets the requirements of section 2203(a).
`(c) LIMITATIONS ON PREMIUMS AND COST-SHARING- Section 2203(b) applies to
a universal phase (phase II) plan under this part.
`(d) APPLICATION OF CERTAIN REQUIREMENTS- Section 2203(c) applies to a
universal phase (phase II) plan under this part.
`SEC. 2214. REQUIREMENTS FOR EMPLOYERS REGARDING THE PROVISION OF
BENEFITS.
`(a) REQUIREMENTS- Subject to subsection (c)(2)(B), an employer in a State
shall comply with the following requirements:
`(1) EMPLOYERS WITH LESS THAN 500 EMPLOYEES-
`(A) IN GENERAL- An employer with less than 500 employees shall enroll
each employee in a State-designated purchasing pool.
`(i) IN GENERAL- Notwithstanding subparagraph (A) and subject to
clause (ii), the employer shall make a contribution on behalf of each
employee for health insurance coverage that is equal to at least 80
percent of the total premiums for such coverage for employees and their
families if the employee elects dependent coverage.
`(ii) LIMITATION- An employer shall not be liable under subparagraph
(B) for more than 10 percent of each employee's annual
wages.
`(2) EMPLOYERS WITH AT LEAST 500 EMPLOYEES-
`(A) IN GENERAL- An employer with at least 500 employees, a majority
of whose wages fall below an amount equal to 300 percent of the poverty
line applicable to a family of the size involved, shall comply with the
requirements applicable to an employer under paragraph (1).
`(i) IN GENERAL- An employer with at least 500 employees that is not
described in subparagraph (A) shall, at the option of the employer,
either--
`(I) comply with the requirements applicable to an employer under
paragraph (1); or
`(II) provide health insurance coverage to all employees and their
families (if the employee elects dependent coverage) that meets the
requirements of section 2213 and the employer contribution required
under paragraph (1)(B).
`(ii) ADDITIONAL EMPLOYER CONTRIBUTION- An employer that elects to
comply with clause (i)(I) shall contribute an additional 1 percent of
payroll into the State-designated purchasing pool in which it
participates.
`(3) RULE OF CONSTRUCTION- Nothing in this title shall be construed as
prohibiting a labor organization from collectively bargaining for an
employer contribution that is greater than the contribution that is required
under paragraph (1)(B) or, as applicable, for health insurance benefits that
are greater than the coverage required under paragraph section
2203(a).
`(4) PART-TIME EMPLOYEES- An employer shall be responsible for meeting
the requirements under this subsection for all employees of the
employer.
`(5) MULTIEMPLOYER FAMILIES- In the case of a family with more than 1
employer, the employers of individuals within the family shall apportion
their contributions in accordance with rules established by the State.
`(b) NONAPPLICABILITY- This section shall not apply--
`(1) to any State that establishes a single payor system; or
`(2) to any State that established a universal phase (phase II) plan
through an approved addendum to an expansion phase (phase I) plan.
`(c) PRIVATE CAUSE OF ACTION-
`(1) LIABILITY- An employer that fails to comply with the requirements
of subsection (a) or otherwise takes adverse action against an employee for
the purpose of interfering with the attainment of any right to which the
employee may be entitled to under this title, shall be liable to the
employee affected.
`(2) AMOUNT- The amount of the liability described in paragraph (1)
shall be an amount equal to--
`(A) the contributions that otherwise would have been made by the
employer on behalf of the employee under this section;
`(B) an additional amount as liquidated damages; and
`(C) consequential damages for reasonably foreseeable injuries
resulting from such action.
`(3) JURISDICTION; EQUITABLE RELIEF-
`(A) JURISDICTION- An action under this subsection may be maintained
against any employer in any Federal or State court of competent
jurisdiction by any 1 or more employees.
`(B) EQUITABLE RELIEF- In addition to the damages described in
paragraph (2), a court may enjoin any act or practice that violates this
title.
`(4) ATTORNEY'S FEES- If a plaintiff or plaintiffs prevail in an action
brought under this subsection, the court shall, in addition to any judgment
awarded to the plaintiff or plaintiffs, award the reasonable attorney's fees
and costs associated with the bringing of the action.
`SEC. 2215. ALLOTMENTS.
`(a) STATE ALLOTMENTS- Subsections (a) and (b) of section 2204 apply to a
universal phase (phase II) plan under this part in the same manner as such
subsections apply to an expansion phase (phase I) plan under part A.
`(b) SPECIAL RULE FOR EXPANSION PHASE (PHASE I) PLANS- A State that
operated an expansion phase (phase I) plan and converted such plan to a
universal phase (phase II) plan pursuant to section 2211(b)(2)(B) shall
continue to be eligible for the enhanced Federal participation rate determined
under section 2204(c).
`(c) GRANTS TO INDIAN TRIBES, NATIVE HAWAIIAN ORGANIZATIONS, AND ALASKA
NATIVE ORGANIZATIONS- Section 2204(d) applies to a universal phase (phase II)
plan under this part.
`(1) IN GENERAL- Out of any funds in the Treasury not otherwise
appropriated, there is appropriated to carry out this title such sums as may
be necessary for fiscal year 2005 and each fiscal year thereafter.
`(2) BUDGET AUTHORITY- Paragraph (1) constitutes budget authority in
advance of appropriations Acts and represents the obligation of the Federal
Government to provide States, Indian tribes, Native Hawaiian organizations,
and Alaska Native organizations with the allotments determined under this
section and the grants for administrative and outreach activities under
section 2205(a)(1)(B) (as applied to this part under section 2216(a)).
`SEC. 2216. ADMINISTRATION; DEFINITIONS.
`(a) ADMINISTRATION- The provisions of section 2205 (other than subsection
(c) of such section) apply to a universal phase (phase II) plan under this
part in the same manner as such provisions apply to an expansion phase (phase
I) plan under part A.
`(1) APPLICATION OF SECTION 2206- The definitions set forth in section
2206 apply to a universal phase (phase II) plan under this part in the same
manner as such provisions apply to an expansion phase (phase I) plan under
part A except that for purposes of this part, the definition of `eligible
residents of a State' set forth in section 2206(2) shall be applied without
regard to subparagraphs (A)(ii) and (B).
`(2) UNIVERSAL PHASE (PHASE II ) PLAN- In this title, the term
`universal phase (phase II) plan' means the State universal health insurance
coverage plan submitted under section 2211(b).'.
SEC. 202. CONSUMER PROTECTIONS.
Title XXII of the Social Security Act, as amended by section 201, is
amended by adding at the end the following:
`PART C--CONSUMER PROTECTIONS
`SEC. 2221. HOME CARE STANDARDS.
`In order to ensure that home care services are provided in a
consumer-directed manner, a State participating under part A, and, effective
January 1, 2005, all States under part B, shall satisfy the Secretary that any
health plan that provides home care services under this title creates, or
contracts with, a viable entity other than the consumer or individual provider
to provide effective billing, payments for services, tax withholding,
unemployment insurance, and workers compensation coverage, and to serve as the
statutory employer of the home care provider. Recipients of such services
shall retain the right to independently select, hire, terminate, and direct
the work of the home care provider.
`SEC. 2222. CONSUMER PROTECTION IN THE EVENT OF TERMINATION OR SUSPENSION OF
SERVICES.
`A State participating under part A, and, effective January 1, 2005, all
States under part B, shall satisfy the Secretary that any health plan
providing services under this title shall ensure that enrollees will receive
continued health services in the event that the plan's health care services
are terminated or suspended, including as the result of the plan filing for
bankruptcy relief under title 11, United States Code, or the failure of the
plan to provide payments to providers, lockouts, work stoppages, or other
labor management problems.
`SEC. 2223. CONSUMER PROTECTION THROUGH DISCLOSURE OF INFORMATION.
`(a) IN GENERAL- A State participating under part A, and, effective
January 1, 2005, all States under part B, shall satisfy the Secretary that any
health care provider that provides services to individuals under this title
shall provide to the State information regarding the identity, employment
location, and qualifications of health care workers providing services
under--
`(1) the licensure of the provider; or
`(2) a contract between the provider and a health plan or the
State.
`(b) AVAILABILITY TO PUBLIC- A health care provider shall make the
information described in subsection (a) available to the public.'.
`SEC. 2224. CONSUMER PROTECTION THROUGH NOTICE OF CHANGES IN HEALTH CARE
DELIVERY.
`A State participating under part A, and, effective January 1, 2005, all
States under part B, shall describe how the State will provide, at a minimum,
the following protections:
`(1) Adequate advance notice to the public, the affected health care
workers, and labor organizations representing such workers, of a
pending--
`(A) facility or operating unit closure;
`(B) sale, merger, or consolidation of a facility or operating
unit;
`(C) transfer of work from 1 facility or entity to another facility or
entity; or
`(D) reduction of services.
`(2) A right of first refusal for similar vacant positions with--
`(A) the resulting entity, in the case of a health care worker whose
position was eliminated following a merger of the worker's original
employer with a new entity; or
`(B) the contractor, in the case of a health care worker whose
position was eliminated following the contracting out of the work the
worker formerly performed.'.
TITLE III--PATIENT PROTECTIONS
SEC. 301. INCORPORATION OF CERTAIN PROTECTIONS.
(a) INCORPORATION- The provisions of the following bills are hereby
enacted into law:
(1) H.R. 2723 of the 106th Congress (other than section 135(b)), as
introduced on August 5, 1999.
(2) H.R. 137 of the 106th Congress, as introduced on January 6,
1999.
(b) PUBLICATION- In publishing this Act in slip form and in the United
States Statutes at Large pursuant to section 112, of title 1, United States
Code, the Archivist of the United States shall include after the date of
approval at the end appendixes setting forth the texts of the bills referred
to in subsection (a) of this section.
TITLE IV--HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE
STANDARDS
SEC. 401. HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS
INSTITUTE.
(1) INSTITUTE- There is established within the Agency for Healthcare
Research and Quality, an institute to be known as the Health Care Quality,
Patient Safety, and Workforce Standards Institute (in this section referred
to as the `Institute').
(2) DIRECTOR- The Secretary of Health and Human Services shall appoint a
director of the Institute. The director shall administer the Institute and
carry out the duties of the director under this section subject to the
authority, direction, and control of the Secretary.
(b) MISSION- The mission of the Institute is to--
(1) demonstrate how patient safety issues and workplace conditions are
linked to quality patient care and the reduction of the incidence of medical
errors; and
(2) reduce the incidence of medical errors and improve patient safety
and quality of care.
(c) DUTIES- In carrying out the mission of the Institute, the director of
the Institute shall--
(1) work closely with the director of the Agency for Healthcare Research
and Quality to ensure that issues related to workplace conditions are
reflected in the activities conducted by such agency in order to reduce the
incidence of medical errors and improve patient safety and quality of care,
including--
(A) the establishment of national goals;
(B) the development and implementation of a research agenda;
(C) the development and promotion of best practices;
(D) the development of performance and staffing standards in
consultation with the Health Care Financing Administration and other
Federal agencies, as appropriate; and
(E) the development and dissemination of information, educational and
training materials, and other criteria as it relates to the delivery of
quality care;
(2) provide recommendations to the Secretary of Health and Human
Services and other Federal agencies with responsibility for health care
quality and the development of standards that impact on
the delivery of quality patient care on standards related to workplace
conditions and patient safety;
(3) support the activities of the Health Care Financing Administration
related to the development of new or revised conditions of participation
under the medicare and medicaid programs and subsequent rulemaking on issues
related to workplace conditions, medical errors, and patient safety and
quality of care; and
(4) conduct other activities determined appropriate by the director of
the Institute.
(d) WORKPLACE CONDITIONS- For purposes of this section, the term
`workplace conditions' shall include issues related to--
(1) health care worker staffing;
(3) confidentiality and whistleblower protections;
(4) employee participation in decisionmaking roles that contribute to
improved quality of care and the reduction of the incidence of medical
errors;
(5) workforce training; and
(6) the impact of health care delivery restructuring on communities and
health care workers.
(e) DEFINITION OF HEALTH CARE WORKER-
(1) IN GENERAL- In this section, the term `health care worker' means an
individual employed by an employer that provides--
(A) health care services; or
(B) necessary related services, including administrative, food
service, janitorial, or maintenance service to an entity that provides
such health care services.
(2) HEALTH CARE SERVICES- In paragraph (1), the term `health care
services' includes medical, surgical, mental health, and substance abuse
services, whether provided on an in-patient or outpatient basis.
(f) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be
appropriated to the Institute such sums as may be necessary to carry out the
purposes of this section.
SEC. 402. HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS
ADVISORY COMMITTEE.
(a) ESTABLISHMENT OF COMMITTEE- There is established a Health Care
Quality, Patient Safety, and Workforce Standards Committee (in this section
referred to as the `Committee').
(b) FUNCTIONS OF COMMITTEE-
(1) ADVICE TO INSTITUTE- The Committee shall provide advice to the
Director of the Health Care Quality, Patient Safety, and Workforce Standards
Institute established under section 401 on issues related to the duties of
the Director.
(2) INITIAL REPORT- Not later than December 31, 2001, the Committee
shall submit an initial report to the Secretary that contains--
(A) recommendations regarding minimal workforce standards that are
critical for improved health care quality and patient safety; and
(B) recommendations regarding additional ways to reduce the incidence
of medical errors and to improve patient safety and quality of
care.
(3) FINAL REPORT- Not later than December 31, 2002, the Committee shall
submit a final report to the Secretary of Health and Human Services
regarding the recommendations contained in the initial report required under
paragraph (2), including any modifications of such recommendations.
(c) STRUCTURE AND MEMBERSHIP OF THE COMMITTEE-
(1) STRUCTURE- The Committee shall be composed of the Director of the
Health Care Quality, Patient Safety, and Workforce Standards Institute
established under section 401 and 15 additional members who shall be
appointed by the Secretary of Health and Human Services.
(A) IN GENERAL- The members of the Committee shall be chosen on the
basis of their integrity, impartiality, and good judgment, and shall be
individuals who are, by reason of their education, experience, and
attainments, exceptionally qualified to perform the duties of members of
the Committee.
(B) SPECIFIC MEMBERS- In making appointments under paragraph (1), the
Secretary of Health and Human Services shall ensure that the following
groups are represented:
(i) Health care providers and health care workers, including labor
unions representing health care workers.
(ii) Consumer organizations.
(iii) Health care institutions.
(iv) Health education organizations.
(d) CHAIRMAN- The Director of the Health Care Quality, Patient Safety, and
Workforce Standards Institute established under section 401 shall chair the
Committee.
TITLE V--IMPROVING MEDICARE BENEFITS
SEC. 501. FULL MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT BENEFITS
PARITY.
Notwithstanding any provision of title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.), beginning January 1, 2001, each individual who is
entitled to benefits under part A or enrolled under part B of the medicare
program, including an individual enrolled in a Medicare+Choice plan offered by
a Medicare+Choice organization under part C of such program, shall be provided
full mental health and substance abuse treatment parity under the medicare
program established under such title of such Act consistent with title XXII of
the Social Security Act (as added by this Act).
SEC. 502. STUDY AND REPORT REGARDING ADDITION OF PRESCRIPTION DRUG
BENEFIT.
Not later than January 1, 2003, the Director of the Institute of Medicine
shall study and report to Congress and the President legislative
recommendations for adding a comprehensive, accessible, and affordable
prescription drug benefit to the medicare program established under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
TITLE VI--LONG-TERM AND HOME HEALTH CARE
SEC. 601. STUDIES AND DEMONSTRATION PROJECTS TO IDENTIFY MODEL
PROGRAMS.
The Secretary of Health of Human Services shall--
(1) conduct studies and demonstration projects, through grant, contract,
or interagency agreement, that are designed to identify model programs for
the provision of long-term and home health care services;
(2) report regularly to Congress on the results of such studies and
demonstration projects; and
(3) include in such report any recommendations for legislation to expand
or continue such studies and projects.
TITLE VII--MISCELLANEOUS
SEC. 701. NONAPPLICATION OF ERISA.
The provisions of section 514 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1144) shall not apply with respect to health benefits
provided under a group health plan (as defined in section 733(a) of that Act
(29 U.S.C. 1191b(a))) qualified to offer such benefits under an expansion
phase (phase I) plan under title XXII of the Social Security Act (as added by
this Act) or under a universal phase (phase II) plan under such title.
SEC. 702. SENSE OF CONGRESS REGARDING OFFSETS.
It is the sense of Congress that any sums necessary for the implementation
of this Act, and the amendments made by this Act, should be offset by--
(1) general revenues available as a result of an on-budget surplus for a
fiscal year;
(2) direct savings in health care expenditures resulting from the
implementation of this Act; and
(3) reductions in unnecessary Federal tax benefits available only to
individuals and large corporations that are in the maximum tax
brackets.
END