TABLE OF CONTENTS:

Title I: Expansion of the State Children's Health Insurance

Program

Title II: Expanded Health Services for Disabled Individuals

Title III: Health Care Insurance Coverage

Subtitle A: General Provisions

Subtitle B: Tax Provisions

Title IV: Primary and Preventive Care Services

Title V: Patient's Right to Decline Medical Treatment

Title VI: Primary and Preventive Care Providers

Title VII: Cost Containment

Title VIII: Tax Incentives for Purchase of Qualified

Long-Term Care Insurance

Title IX: National Fund for Health Research

Health Care Assurance Act of 1999 - Title I: Expansion of the State Children's Health Insurance Program - Amends title XX (Block Grants to States for Social Services) of the Social Security Act (SSA) with respect to the definition of a low-income child for the State children's health insurance program, to raise the family income eligibility threshold from a maximum 200 percent to a maximum 235 percent of the poverty line for a family of the size involved.

Title II: Expanded Health Services for Disabled Individuals - Amends SSA title II (Old Age, Survivors and Disability Insurance (OASDI)) to extend to 24 months the period of Medicare coverage after returning to work for recipients of OASDI disability benefits. Provides for such recipients to "buy-into" Medicare at a reduced rate, subject to annual review.

(Sec. 202) Amends SSA title XIX (Medicaid) to require a State to permit an individual entitled to Medicaid for nursing facility services or intermediate care facility services for the mentally retarded to choose to receive medical assistance for qualified community-based attendant services (rather than institutional services), in the most integrated setting appropriate to the individual's needs, so long as the aggregate amount of Federal expenditures for such individuals in a fiscal year does not exceed the total that would have been expended for them to receive institutional services, plus a specified decreasing transitional allotment each fiscal year between FY 2000 and 2005. Allows for reimbursement for such services without regard to the recipient's age or the nature of the disability.

Requires a State to develop a long-term care services transition plan to increase the proportion of such services provided in home and community-based, rather than institutional, settings.

Requires the Secretary of Health and Human Services to: (1) report to Congress on how excessive utilization of medical services can be reduced by using qualified community-based attendant services; (2) develop an instrument to assess the functional needs of an individual for qualified community-based attendant services; and (3) establish a task force to examine appropriate methods of financing long-term care services.

(Sec. 203) Amends SSA title XIX (Medicaid) to authorize a State to: (1) waive the income limitation on Medicaid eligibility for any individual for whom it finds the potential for employment opportunities would be enhanced through the provision of certain medical services; and (2) impose on such an individual a premium based on an income-related sliding scale.

Title III: Health Care Insurance Coverage - Subtitle A: General Provisions - Amends the Employee Retirement Income Security Act of 1974 (ERISA) and the Public Health Service Act (PHSA) to mandate: (1) a set of rules for determining the actuarial value of the coverage offered by a plan or group health insurance coverage; and (2) a target actuarial value. Includes coverage for medical and surgical services, medical equipment, preventive services, and emergency transportation in frontier areas (standard coverage).

(Secs. 301 and 302) Mandates model regulations specifying standards for making qualified group health plans available to small employers. Allows a State to implement more stringent standards, so long as the State standards do not prevent the offering of at least one plan that provides standard coverage.

Requires each group plan offered, and issuer offering group coverage, to a small employer to establish a standard premium in each community rating area. Requires each State to divide the State into one or more community rating areas. Prescribes requirements for premiums. Provides for the treatment of rates negotiated with a small employer purchasing group in a rating area.

Mandates full disclosure of rating practices.

Provides for State certification of small employer purchasing groups. Prescribes requirements for such groups. Provides for payroll deductions for premiums.

Requires each such group to offer eligible employees, eligible individuals, and certain uninsured individuals the opportunity to enroll in any qualified group health plan that has an agreement with the group. Prescribes requirements for premiums.

Requires each such group to market plans to members through the entire community rating area served by the group.

Mandates grants to States and small employer purchasing groups to assist in planning, developing, and operating such groups. Authorizes appropriations.

Authorizes a State to establish a system in all or part of the State under which the groups are the sole mechanism through which coverage for employees of small employers may be purchased or provided.

Requires each small employer (except new and very small employers) to make available to each eligible employee a group health plan providing at least standard coverage, with a specified maximum waiting period allowed. Declares that employer cost contributions are not required. Allows the requirement to be met through a multiemployer plan.

Applies the requirements of this title to a multiemployer plan that is maintained by an organization such as a trade, industry, or professional association, a chamber of commerce, a religious organization, or a public entity association. Requires that a plan be certified by the Secretary. Sets forth special rules for church plans, plans maintained by a health plan sponsor, or plans maintained by a rural electric or rural telephone cooperative.

(Sec. 303) Amends the PHSA to apply the provisions of this title to coverage offered in the individual market.

Subtitle B: Tax Provisions - Amends the Internal Revenue Code to impose taxes on the failure to comply with this title's requirements by a health insurance issuer, any small employer, or a qualified association, church plan, multiemployer plan, or plan maintained by a rural electric or telephone cooperative.

(Sec. 314) Allows self-employed individuals to deduct 100 percent of their health insurance costs in 2001 and thereafter.

(Sec. 315) Amends the Internal Revenue Code, ERISA, and PHSA to: (1) provide for group health plan continuation (COBRA) coverage; (2) modify the requirements regarding the period of continuation coverage; and (3) make a special rule for dependent children, extending COBRA coverage until 36 months after a child ceases to be dependent.

Title IV: Primary and Preventive Care Services - Amends SSA title XVIII (Medicare) to cover: (1) annual pap smears, pelvic exams, and mammography screening for women, with no copayment or Part B deductible; and (2) insulin pumps for the computerized delivery of insulin to certain Type I diabetics in lieu of multiple daily manual insulin injections.

(Sec. 402) Authorizes appropriations to carry out the healthy start program under PHSA relating to research and investigations generally, requiring reservation of specified amounts for model projects.

(Sec. 403) Amends PHSA to authorize appropriations for: (1) preventive health service immunization programs; (2) the prevention and control of sexually transmitted diseases; (3) family planning projects; (4) breast and cervical cancer programs; and (5) preventive health and health services block grants.

Amends title V (Maternal and Child Health Services Block Grants) of the Social Security Act to authorize appropriations.

(Sec. 404) Mandates grants to States to enable them to: (1) make grants to establish, operate, and improve local programs of comprehensive health education and prevention, early health intervention, and health education in elementary and secondary schools; and (2) develop related training, technical assistance, and coordination.

Establishes in the Office of the Secretary of Education the Office of Comprehensive School Health Education. Authorizes appropriations.

(Sec. 405) Mandates a program of grants to agencies conducting Head Start training for training and technical assistance to Head Start teachers and other child care providers. Authorizes appropriations.

(Sec. 406) Amends PHSA to make abstinence information a necessary service of adolescent family life demonstration projects. Requires demonstration project grants, as much as practicable, to ensure adequate urban and rural area representation. Mandates a simplified and expedited application process for applicants seeking less than a specified amount of funds. Authorizes appropriations to carry out adolescent family life demonstration projects.

Title V: Patient's Right to Decline Medical Treatment - Prohibits State restrictions, except to protect a third party, on the right: (1) of a competent adult to consent to or decline medical treatment; or (2) of an incapacitated person to consent to or decline medical treatment through a power of attorney or similar document. Mandates development of national advance directive and durable power of attorney forms and requires all health care providers to honor such forms. Shields providers who act in good faith from criminal or civil liability or professional discipline. Denies Medicare and Medicaid payment for services contrary to the adult's wishes.

Title VI: Primary and Preventive Care Providers - Amends SSA title XVIII (Medicare) to increase from 85 percent to 90 percent of the physicians' services fee schedule a specified portion of the formula for the Medicare reimbursement for physician assistants, nurse practitioners, and clinical nurse specialists.

(Sec. 602) Amends title XIX (Medicaid) of the Social Security Act to include physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists in the definition of "medical assistance" for which payment will be made.

(Sec. 603) Amends PHSA to establish grant programs to: (1) provide medical (including osteopathic) students for programs to interest high school or college students in careers in general medical practice; and (2) develop strategies for recruiting and placing medical students interested in practicing general medicine. Authorizes appropriations.

Title VII: Cost Containment - Authorizes a program of clinical trials regarding promising new drugs and disease treatments. Authorizes appropriations.

(Sec. 702) Authorizes appropriations for the Agency for Health Care Policy Research.

Amends the Internal Revenue Code to impose a tax on health insurance premiums, payable by any person who makes, signs, issues, or sells any of the documents and instruments subject to the tax or for whose use or benefit the same are made, signed, issued, or sold. Establishes, and deposits the resulting tax receipts in, the Trust Fund for Medical Treatment Outcomes Research. Mandates annual Trust Fund distributions for outcomes research.

(Sec. 703) Mandates grants to States that establish health care cost containment and quality information systems. Authorizes appropriations.

Title VIII: Tax Incentives for Purchase of Qualified Long-Term Care Insurance - Allows a credit for a percentage of premiums for a long-term care insurance contract.

(Sec. 802) Makes the currently excluded long-term care insurance a "qualified benefit" for cafeteria plans. Excludes from an employee's gross income (the currently included) employer-provided coverage for long-term care.

(Sec. 803) Excludes from gross income amounts from the whole or partial surrender, cancellation, or exchange of any life insurance contract if the amount is used to pay for any qualified long-term care insurance contract and other requirements are met. Declares that no gain or loss shall be recognized on the exchange of a life insurance or annuity contract for a long-term care contract if certain requirements are met.

(Sec. 804) Makes a home equity conversion sale-leaseback transaction eligible for the one-time exclusion from gain from the sale of a principal residence if a portion of the proceeds is used to purchase a qualified long-term care contract and other requirements are met.

Title IX: National Fund for Health Research - Amends PHSA to establish the National Fund for Health Research, consisting of certain amounts set aside from health plan premiums and interest on those amounts. Requires distribution of all amounts available in the Fund in a fiscal year to the institutes and centers of the National Institutes of Health in certain proportions. Excludes the Fund from any budget enforcement procedure under the Congressional Budget Act of 1974 or the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act).