,i #aacth ,,congress #ast ,session ,h4 ,r4 #fgf ,,in ,,the ,,house ,,of ,,representatives ,february #ac1 #bjac ,mr4 ,conyers 7for himself1 ,mr4 ,nadler1 ,ms4 ,schakowsky1 ,ms4 ,pingree of ,maine1 ,mr4 ,grijalva1 ,mr4 ,ellison1 ,mr4 ,johnson of ,georgia1 ,ms4 ,eddie ,bernice ,johnson of ,texas1 ,mr4 ,takano1 ,ms4 ,norton1 ,ms4 ,lofgren1 ,mr4 ,rangel1 ,ms4 ,moore1 ,ms4 ,chu1 ,mr4 ,al ,green of ,texas1 ,mr4 ,farr1 ,mr4 ,mc,govern1 ,mr4 ,welch1 ,ms4 ,clarke1 ,ms4 ,lee of ,california1 ,mr4 ,nolan1 ,mr4 ,pocan1 ,mr4 ,doyle1 ,mr4 ,engel1 ,mr4 ,gutierrez1 ,ms4 ,wilson of ,florida1 ,mr4 ,cohen1 ,ms4 ,edwards1 ,mr4 ,mc,dermott1 ,mr4 ,clay1 ,mr4 ,huffman1 ,ms4 ,roybal-,allard1 ,mr4 ,cummings1 ,mr4 ,yarmuth1 ,mr4 ,george ,miller of ,california1 ,mr4 ,honda1 ,mrs4 ,christensen1 and ,mr4 ,rush7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means and ,natural ,resources1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to provide for comprehensive health insurance coverage for all ,united ,states residents1 improved health care delivery1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,expanded ,improved ,medicare ,for ,all ,act4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,definitions and terms4 ,title ,i--,,eligibility ,,and ,,benefits ,sec4 #aja4 ,eligibility and registration4 ,sec4 #ajb4 ,benefits and portability4 ,sec4 #ajc4 ,qualification of participating providers4 ,sec4 #ajd4 ,prohibition against duplicating coverage4 ,title ,,ii--,,finances ,subtitle ,a--,budgeting and ,payments ,sec4 #bja4 ,budgeting process4 ,sec4 #bjb4 ,payment of providers and health care clinicians4 ,sec4 #bjc4 ,payment for long-term care4 ,sec4 #bjd4 ,mental health services4 ,sec4 #bje4 ,payment for prescription medications1 medical supplies1 and medically necessary assistive equipment4 ,sec4 #bjf4 ,consultation in establishing reimbursement levels4 ,subtitle ,b--,funding ,sec4 #baa4 ,overview3 funding the ,medicare ,for ,all ,program4 ,sec4 #bab4 ,appropriations for existing programs4 ,title ,,iii--,,administration ,sec4 #cja4 ,public administration2 appointment of ,director4 ,sec4 #cjb4 ,office of ,quality ,control4 ,sec4 #cjc4 ,regional and ,state administration2 employment of displaced clerical workers4 ,sec4 #cjd4 ,confidential electronic patient record system4 ,sec4 #cje4 ,national ,board of ,universal ,quality and ,access4 ,title ,,iv--,,additional ,,provisions ,sec4 #dja4 ,treatment of ,,va and ,,ihs health programs4 ,sec4 #djb4 ,public health and prevention4 ,sec4 #djc4 ,reduction in health disparities4 ,title ,v--,,effective ,,date ,sec4 #eja4 ,effective date4 #b4 ,definitions and terms ,in this ,act3 7#a7 ,medicare ,for ,all ,program2 program ,the terms ,medicare ,for ,all ,program and ,program mean the program of benefits provided under this ,act and1 unless the context otherwise requires1 the ,secretary with respect to functions relating to carrying out such program4 7#b7 ,national board of universal quality and access ,the term ,national ,board of ,universal ,quality and ,access means such ,board established under section #cje4 7#c7 ,regional office ,the term regional office means a regional office established under section #cjc4 7#d7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#e7 ,director ,the term ,director means1 in relation to the ,program1 the ,director appointed under section #cja4 ,i ,,eligibility ,,and ,,benefits #aja4 ,eligibility and registration 7a7 ,in general ,all individuals residing in the ,united ,states 7including any territory of the ,united ,states7 are covered under the ,medicare ,for ,all ,program entitling them to a universal1 best quality standard of care4 ,each such individual shall receive a card with a unique number in the mail4 ,an individual's ,social ,security number shall not be used for purposes of registration under this section4 7b7 ,registration ,individuals and families shall receive a ,medicare ,for ,all ,program ,card in the mail1 after filling out a ,medicare ,for ,all ,program application form at a health care provider4 ,such application form shall be no more than #b pages long4 7c7 ,presumption ,individuals who present themselves for covered services from a participating provider shall be presumed to be eligible for benefits under this ,act1 but shall complete an application for benefits in order to receive a ,medicare ,for ,all ,program ,card and have payment made for such benefits4 7d7 ,residency criteria ,the ,secretary shall promulgate a rule that provides criteria for determining residency for eligibility purposes under the ,medicare ,for ,all ,program4 7e7 ,coverage for visitors ,the ,secretary shall promulgate a rule regarding visitors from other countries who seek premeditated non-emergency surgical procedures4 ,such a rule should facilitate the establishment of country-to-country reimbursement arrangements or self pay arrangements between the visitor and the provider of care4 #ajb4 ,benefits and portability 7a7 ,in general ,the health care benefits under this ,act cover all medically necessary services1 including at least the following3 7#a7 ,primary care and prevention4 7#b7 ,approved dietary and nutritional therapies4 7#c7 ,inpatient care4 7#d7 ,outpatient care4 7#e7 ,emergency care4 7#f7 ,prescription drugs4 7#g7 ,durable medical equipment4 7#h7 ,long-term care4 7#i7 ,palliative care4 7#aj7 ,mental health services4 7#aa7 ,the full scope of dental services1 services1 including periodontics1 oral surgery1 and endodontics1 but not including cosmetic dentistry4 7#ab7 ,substance abuse treatment services4 7#ac7 ,chiropractic services1 not including electrical stimulation4 7#ad7 ,basic vision care and vision correction 7other than laser vision correction for cosmetic purposes74 7#ae7 ,hearing services1 including coverage of hearing aids4 7#af7 ,podiatric care4 7b7 ,portability ,such benefits are available through any licensed health care clinician anywhere in the ,united ,states that is legally qualified to provide the benefits4 7c7 ,no cost-,sharing ,no deductibles1 copayments1 coinsurance1 or other cost-sharing shall be imposed with respect to covered benefits4 #ajc4 ,qualification of participating providers 7a7 ,requirement ,to be public or non-,profit 7#a7 ,in general ,no institution may be a participating provider unless it is a public or not-for-profit institution4 ,private physicians1 private clinics1 and private health care providers shall continue to operate as private entities1 but are prohibited from being investor owned4 7#b7 ,conversion of investor-owned providers ,for-profit providers of care opting to participate shall be required to convert to not-for-profit status4 7#c7 ,private delivery of care requirement ,for-profit providers of care that convert to non-profit status shall remain privately owned and operated entities4 7#d7 ,compensation for conversion ,the owners of such for-profit providers shall be compensated for reasonable financial losses incurred as a result of the conversion from for-profit to non-profit status4 7#e7 ,funding ,there are authorized to be appropriated from the ,treasury such sums as are necessary to compensate investor-owned providers as provided for under paragraph 7#c74 7#f7 ,requirements ,the payments to owners of converting for-profit providers shall occur during a #ae-year period1 through the sale of ,u4,s4 ,treasury ,bonds4 ,payment for conversions under paragraph 7#c7 shall not be made for loss of business profits4 7#g7 ,mechanism for conversion process ,the ,secretary shall promulgate a rule to provide a mechanism to further the timely1 efficient1 and feasible conversion of for-profit providers of care4 7b7 ,quality standards 7#a7 ,in general ,health care delivery facilities must meet ,state quality and licensing guidelines as a condition of participation under such program1 including guidelines regarding safe staffing and quality of care4 7#b7 ,licensure requirements ,participating clinicians must be licensed in their ,state of practice and meet the quality standards for their area of care4 ,no clinician whose license is under suspension or who is under disciplinary action in any ,state may be a participating provider4 7c7 ,participation of health maintenance organizations 7#a7 ,in general ,non-profit health maintenance organizations that deliver care in their own facilities and employ clinicians on a salaried basis may participate in the program and receive global budgets or capitation payments as specified in section #bjb4 7#b7 ,exclusion of certain health maintenance organizations ,other health maintenance organizations which principally contract to pay for services delivered by non-employees shall be classified as insurance plans4 ,such organizations shall not be participating providers1 and are subject to the regulations promulgated by reason of section #ajd7;a7 7relating to prohibition against duplicating coverage74 7d7 ,freedom of choice ,patients shall have free choice of participating physicians and other clinicians1 hospitals1 and inpatient care facilities4 #ajd4 ,prohibition against duplicating coverage 7a7 ,in general ,it is unlawful for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this ,act4 7b7 ,construction ,nothing in this ,act shall be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by this ,act1 such as for cosmetic surgery or other services and items that are not medically necessary4 ,,ii ,,finances ,a ,budgeting and ,payments #bja4 ,budgeting process 7a7 ,establishment of operating budget and capital expenditures budget 7#a7 ,in general ,to carry out this ,act there are established on an annual basis consistent with this title-- 7,a7 an operating budget1 including amounts for optimal physician1 nurse1 and other health care professional staffing2 7,b7 a capital expenditures budget2 7,c7 reimbursement levels for providers consistent with subtitle ,b2 and 7,d7 a health professional education budget1 including amounts for the continued funding of resident physician training programs4 7#b7 ,regional allocation ,after ,congress appropriates amounts for the annual budget for the ,medicare ,for ,all ,program1 the ,director shall provide the regional offices with an annual funding allotment to cover the costs of each region's expenditures4 ,such allotment shall cover global budgets1 reimbursements to clinicians1 health professional education1 and capital expenditures4 ,regional offices may receive additional funds from the national program at the discretion of the ,director4 7b7 ,operating budget ,the operating budget shall be used for-- 7#a7 payment for services rendered by physicians and other clinicians2 7#b7 global budgets for institutional providers2 7#c7 capitation payments for capitated groups2 and 7#d7 administration of the ,program4 7c7 ,capital expenditures budget ,the capital expenditures budget shall be used for funds needed for-- 7#a7 the construction or renovation of health facilities2 and 7#b7 for major equipment purchases4 7d7 ,prohibition against co-,mingling operations and capital improvement funds ,it is prohibited to use funds under this ,act that are earmarked-- 7#a7 for operations for capital expenditures2 or 7#b7 for capital expenditures for operations4 #bjb4 ,payment of providers and health care clinicians 7a7 ,establishing global budgets2 monthly lump sum 7#a7 ,in general ,the ,medicare ,for ,all ,program1 through its regional offices1 shall pay each institutional provider of care1 including hospitals1 nursing homes1 community or migrant health centers1 home care agencies1 or other institutional providers or pre-paid group practices1 a monthly lump sum to cover all operating expenses under a global budget4 7#b7 ,establishment of global budgets ,the global budget of a provider shall be set through negotiations between providers1 ,state directors1 and regional directors1 but are subject to the approval of the ,director4 ,the budget shall be negotiated annually1 based on past expenditures1 projected changes in levels of services1 wages and input1 costs1 a provider's maximum capacity to provide care1 and proposed new and innovative programs4 7b7 ,three payment options for physicians and certain other health professionals 7#a7 ,in general ,the ,program shall pay physicians1 dentists1 doctors of osteopathy1 pharmacists1 psychologists1 chiropractors1 doctors of optometry1 nurse practitioners1 nurse midwives1 physicians' assistants1 and other advanced practice clinicians as licensed and regulated by the ,states by the following payment methods3 7,a7 ,fee for service payment under paragraph 7#b74 7,b7 ,salaried positions in institutions receiving global budgets under paragraph 7#c74 7,c7 ,salaried positions within group practices or non-profit health maintenance organizations receiving capitation payments under paragraph 7#d74 7#b7 ,fee for service 7,a7 ,in general ,the ,program shall negotiate a simplified fee schedule that is fair and optimal with representatives of physicians and other clinicians1 after close consultation with the ,national ,board of ,universal ,quality and ,access and regional and ,state directors4 ,initially1 the current prevailing fees or reimbursement would be the basis for the fee negotiation for all professional services covered under this ,act4 7,b7 ,considerations ,in establishing such schedule1 the ,director shall take into consideration the following3 7i7 ,the need for a uniform national standard4 7ii7 ,the goal of ensuring that physicians1 clinicians1 pharmacists1 and other medical professionals be compensated at a rate which reflects their expertise and the value of their services1 regardless of geographic region and past fee schedules4 7,c7 ,state physician practice review boards ,the ,state director for each ,state1 in consultation with representatives of the physician community of that ,state1 shall establish and appoint a physician practice review board to assure quality1 cost effectiveness1 and fair reimbursements for physician delivered services4 7,d7 ,final guidelines ,the ,director shall be responsible for promulgating final guidelines to all providers4 7,e7 ,billing ,under this ,act physicians shall submit bills to the regional director on a simple form1 or via computer4 ,interest shall be paid to providers who are not reimbursed within #cj days of submission4 7,f7 ,no balance billing ,licensed health care clinicians who accept any payment from the ,medicare ,for ,all ,program may not bill any patient for any covered service4 7,g7 ,uniform computer electronic billing system ,the ,director shall create a uniform computerized electronic billing system1 including those areas of the ,united ,states where electronic billing is not yet established4 7#c7 ,salaries within institutions receiving global budgets 7,a7 ,in general ,in the case of an institution1 such as a hospital1 health center1 group practice1 community and migrant health center1 or a home care agency that elects to be paid a monthly global budget for the delivery of health care as well as for education and prevention programs1 physicians and other clinicians employed by such institutions shall be reimbursed through a salary included as part of such a budget4 7,b7 ,salary ranges ,salary ranges for health care providers shall be determined in the same way as fee schedules under paragraph 7#b74 7#d7 ,salaries within capitated groups 7,a7 ,in general ,health maintenance organizations1 group practices1 and other institutions may elect to be paid capitation payments to cover all outpatient1 physician1 and medical home care provided to individuals enrolled to receive benefits through the organization or entity4 7,b7 ,scope ,such capitation may include the costs of services of licensed physicians and other licensed1 independent practitioners provided to inpatients4 ,other costs of inpatient and institutional care shall be excluded from capitation payments1 and shall be covered under institutions' global budgets4 7,c7 ,prohibition of selective enrollment ,patients shall be permitted to enroll or disenroll from such organizations or entities without discrimination and with appropriate notice4 7,d7 ,health maintenance organizations ,under this ,act-- 7i7 health maintenance organizations shall be required to reimburse physicians based on a salary2 and 7ii7 financial incentives between such organizations and physicians based on utilization are prohibited4 #bjc4 ,payment for long-term care 7a7 ,allotment for regions ,the ,program shall provide for each region a single budgetary allotment to cover a full array of long-term care services under this ,act4 7b7 ,regional budgets ,each region shall provide a global budget to local long-term care providers for the full range of needed services1 including in-home1 nursing home1 and community based care4 7c7 ,basis for budgets ,budgets for long-term care services under this section shall be based on past expenditures1 financial and clinical performance1 utilization1 and projected changes in service1 wages1 and other related factors4 7d7 ,favoring non-,institutional care ,all efforts shall be made under this ,act to provide long-term care in a home- or community-based setting1 as opposed to institutional care4 #bjd4 ,mental health services 7a7 ,in general ,the ,program shall provide coverage for all medically necessary mental health care on the same basis as the coverage for other conditions4 ,licensed mental health clinicians shall be paid in the same manner as specified for other health professionals1 as provided for in section #bjb7;b74 7b7 ,favoring community-,based care ,the ,medicare ,for ,all ,program shall cover supportive residences1 occupational therapy1 and ongoing mental health and counseling services outside the hospital for patients with serious mental illness4 ,in all cases the highest quality and most effective care shall be delivered1 and1 for some individuals1 this may mean institutional care4 #bje4 ,payment for prescription medications1 medical supplies1 and medically necessary assistive equipment 7a7 ,negotiated prices ,the prices to be paid each year under this ,act for covered pharmaceuticals1 medical supplies1 and medically necessary assistive equipment shall be negotiated annually by the ,program4 7b7 ,prescription drug formulary 7#a7 ,in general ,the ,program shall establish a prescription drug formulary system1 which shall encourage best-practices in prescribing and discourage the use of ineffective1 dangerous1 or excessively costly medications when better alternatives are available4 7#b7 ,promotion of use of generics ,the formulary shall promote the use of generic medications but allow the use of brand-name and off-formulary medications4 7#c7 ,formulary updates and petition rights ,the formulary shall be updated frequently and clinicians and patients may petition their region or the ,director to add new pharmaceuticals or to remove ineffective or dangerous medications from the formulary4 #bjf4 ,consultation in establishing reimbursement levels ,reimbursement levels under this subtitle shall be set after close consultation with regional and ,state ,directors and after the annual meeting of ,national ,board of ,universal ,quality and ,access4 ,b ,funding #baa4 ,overview3 funding the ,medicare ,for ,all ,program 7a7 ,in general ,the ,medicare ,for ,all ,program is to be funded as provided in subsection 7c77#a74 7b7 ,medicare ,for ,all ,trust ,fund ,there shall be established a ,medicare ,for ,all ,trust ,fund in which funds provided under this section are deposited and from which expenditures under this ,act are made4 7c7 ,funding 7#a7 ,in general ,there are appropriated to the ,medicare ,for ,all ,trust ,fund amounts sufficient to carry out this ,act from the following sources3 7,a7 ,existing sources of ,federal ,government revenues for health care4 7,b7 ,increasing personal income taxes on the top #e percent income earners4 7,c7 ,instituting a modest and progressive excise tax on payroll and self-employment income4 7,d7 ,instituting a modest tax on unearned income4 7,e7 ,instituting a small tax on stock and bond transactions4 7#b7 ,system savings as a source of financing ,funding otherwise required for the ,program is reduced as a result of-- 7,a7 vastly reducing paperwork2 7,b7 requiring a rational bulk procurement of medications under section #bje7;a72 and 7,c7 improved access to preventive health care4 7#c7 ,additional annual appropriations to ,medicare ,for ,all ,program ,additional sums are authorized to be appropriated annually as needed to maintain maximum quality1 efficiency1 and access under the ,program4 #bab4 ,appropriations for existing programs ,notwithstanding any other provision of law1 there are hereby transferred and appropriated to carry out this ,act1 amounts from the ,treasury equivalent to the amounts the ,secretary estimates would have been appropriated and expended for ,federal public health care programs1 including funds that would have been appropriated under the ,medicare program under title ,,xviii of the ,social ,security ,act1 under the ,medicaid program under title ,,xix of such ,act1 and under the ,children's ,health ,insurance ,program under title ,,xxi of such ,act4 ,,iii ,,administration #cja4 ,public administration2 appointment of ,director 7a7 ,in general ,except as otherwise specifically provided1 this ,act shall be administered by the ,secretary through a ,director appointed by the ,secretary4 7b7 ,long-,term care ,the ,director shall appoint a director for long-term care who shall be responsible for administration of this ,act and ensuring the availability and accessibility of high quality long-term care services4 7c7 ,mental health ,the ,director shall appoint a director for mental health who shall be responsible for administration of this ,act and ensuring the availability and accessibility of high quality mental health services4 #cjb4 ,office of ,quality ,control ,the ,director shall appoint a director for an ,office of ,quality ,control4 ,such director shall1 after consultation with state and regional directors1 provide annual recommendations to ,congress1 the ,president1 the ,secretary1 and other ,program officials on how to ensure the highest quality health care service delivery4 ,the director of the ,office of ,quality ,control shall conduct an annual review on the adequacy of medically necessary services1 and shall make recommendations of any proposed changes to the ,congress1 the ,president1 the ,secretary1 and other ,medicare ,for ,all ,program officials4 #cjc4 ,regional and ,state administration2 employment of displaced clerical workers 7a7 ,establishment of ,medicare ,for ,all ,program regional offices ,the ,secretary shall establish and maintain ,medicare ,for ,all regional offices for the purpose of distributing funds to providers of care4 ,whenever possible1 the ,secretary should incorporate pre-existing ,medicare infrastructure for this purpose4 7b7 ,appointment of ,regional and ,state ,directors ,in each such regional office there shall be-- 7#a7 one regional director appointed by the ,director2 and 7#b7 for each ,state in the region1 a deputy director 7in this ,act referred to as a ,state ,director7 appointed by the governor of that ,state4 7c7 ,regional office duties ,regional offices of the ,program shall be responsible for-- 7#a7 coordinating funding to health care providers and physicians2 and 7#b7 coordinating billing and reimbursements with physicians and health care providers through a ,state-based reimbursement system4 7d7 ,state ,director's duties ,each ,state ,director shall be responsible for the following duties3 7#a7 ,providing an annual state health care needs assessment report to the ,national ,board of ,universal ,quality and ,access1 and the regional board1 after a thorough examination of health needs1 in consultation with public health officials1 clinicians1 patients1 and patient advocates4 7#b7 ,health planning1 including oversight of the placement of new hospitals1 clinics1 and other health care delivery facilities4 7#c7 ,health planning1 including oversight of the purchase and placement of new health equipment to ensure timely access to care and to avoid duplication4 7#d7 ,submitting global budgets to the regional director4 7#e7 ,recommending changes in provider reimbursement or payment for delivery of health services in the ,state4 7#f7 ,establishing a quality assurance mechanism in the ,state in order to minimize both under utilization and over utilization and to assure that all providers meet high quality standards4 7#g7 ,reviewing program disbursements on a quarterly basis and recommending needed adjustments in fee schedules needed to achieve budgetary targets and assure adequate access to needed care4 7e7 ,first priority in retraining and job placement2 #b years of salary parity benefits ,the ,program shall provide that clerical1 administrative1 and billing personnel in insurance companies1 doctors offices1 hospitals1 nursing facilities1 and other facilities whose jobs are eliminated due to reduced administration-- 7#a7 should have first priority in retraining and job placement in the new system2 and 7#b7 shall be eligible to receive two years of ,medicare ,for ,all employment transition benefits with each year's benefit equal to salary earned during the last #ab months of employment1 but shall not exceed #ajj1jjj per year4 7f7 ,establishment of ,medicare ,for ,all employment transition fund ,the ,secretary shall establish a trust fund from which expenditures shall be made to recipients of the benefits allocated in subsection 7e74 7g7 ,annual appropriations to ,medicare ,for ,all employment transition fund ,sums are authorized to be appropriated annually as needed to fund the ,medicare ,for ,all ,employment ,transition ,benefits4 7h7 ,retention of right to unemployment benefits ,nothing in this section shall be interpreted as a waiver of ,medicare ,for ,all ,employment ,transition benefit recipients' right to receive ,federal and ,state unemployment benefits4 #cjd4 ,confidential electronic patient record system 7a7 ,in general ,the ,secretary shall create a standardized1 confidential electronic patient record system in accordance with laws and regulations to maintain accurate patient records and to simplify the billing process1 thereby reducing medical errors and bureaucracy4 7b7 ,patient option ,notwithstanding that all billing shall be preformed electronically1 patients shall have the option of keeping any portion of their medical records separate from their electronic medical record4 #cje4 ,national ,board of ,universal ,quality and ,access 7a7 ,establishment 7#a7 ,in general ,there is established a ,national ,board of ,universal ,quality and ,access 7in this section referred to as the ,board7 consisting of #ae members appointed by the ,president1 by and with the advice and consent of the ,senate4 7#b7 ,qualifications ,the appointed members of the ,board shall include at least one of each of the following3 7,a7 ,health care professionals4 7,b7 ,representatives of institutional providers of health care4 7,c7 ,representatives of health care advocacy groups4 7,d7 ,representatives of labor unions4 7,e7 ,citizen patient advocates4 7#c7 ,terms ,each member shall be appointed for a term of #f years1 except that the ,president shall stagger the terms of members initially appointed so that the term of no more than #c members expires in any year4 7#d7 ,prohibition on conflicts of interest ,no member of the ,board shall have a financial conflict of interest with the duties before the ,board4 7b7 ,duties 7#a7 ,in general ,the ,board shall meet at least twice per year and shall advise the ,secretary and the ,director on a regular basis to ensure quality1 access1 and affordability4 7#b7 ,specific issues ,the ,board shall specifically address the following issues3 7,a7 ,access to care4 7,b7 ,quality improvement4 7,c7 ,efficiency of administration4 7,d7 ,adequacy of budget and funding4 7,e7 ,appropriateness of reimbursement levels of physicians and other providers4 7,f7 ,capital expenditure needs4 7,g7 ,long-term care4 7,h7 ,mental health and substance abuse services4 7,i7 ,staffing levels and working conditions in health care delivery facilities4 7#c7 ,establishment of universal1 best quality standard of care ,the ,board shall specifically establish a universal1 best quality of standard of care with respect to-- 7,a7 appropriate staffing levels2 7,b7 appropriate medical technology2 7,c7 design and scope of work in the health workplace2 7,d7 best practices2 and 7,e7 salary level and working conditions of physicians1 clinicians1 nurses1 other medical professionals1 and appropriate support staff4 7#d7 ,twice-a-year report ,the ,board shall report its recommendations twice each year to the ,secretary1 the ,director1 ,congress1 and the ,president4 7c7 ,compensation1 etc ,the following provisions of section #ahje of the ,social ,security ,act shall apply to the ,board in the same manner as they apply to the ,medicare ,payment ,assessment ,commission 7except that any reference to the ,commission or the ,comptroller ,general shall be treated as references to the ,board and the ,secretary1 respectively73 7#a7 ,subsection 7c77#d7 7relating to compensation of ,board members74 7#b7 ,subsection 7c77#e7 7relating to chairman and vice chairman74 7#c7 ,subsection 7c77#f7 7relating to meetings74 7#d7 ,subsection 7d7 7relating to director and staff2 experts and consultants74 7#e7 ,subsection 7e7 7relating to powers74 ,,iv ,,additional ,,provisions #dja4 ,treatment of ,,va and ,,ihs health programs 7a7 ,,va health programs ,this ,act provides for health programs of the ,department of ,veterans' ,affairs to initially remain independent for the #aj-year period that begins on the date of the establishment of the ,medicare ,for ,all ,program4 ,after such #aj-year period1 the ,congress shall reevaluate whether such programs shall remain independent or be integrated into the ,medicare ,for ,all ,program4 7b7 ,indian ,health ,service programs ,this ,act provides for health programs of the ,indian ,health ,service to initially remain independent for the #e-year period that begins on the date of the establishment of the ,medicare ,for ,all ,program1 after which such programs shall be integrated into the ,medicare ,for ,all ,program4 #djb4 ,public health and prevention ,it is the intent of this ,act that the ,program at all times stress the importance of good public health through the prevention of diseases4 #djc4 ,reduction in health disparities ,it is the intent of this ,act to reduce health disparities by race1 ethnicity1 income and geographic region1 and to provide high quality1 cost-effective1 culturally appropriate care to all individuals regardless of race1 ethnicity1 sexual orientation1 or language4 ,v ,,effective ,,date #eja4 ,effective date ,except as otherwise specifically provided1 this ,act shall take effect on the first day of the first year that begins more than #a year after the date of the enactment of this ,act1 and shall apply to items and services furnished on or after such date4