,i #aac? ,,congress #a/ ,session ,h4 ,r4 #fgf ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,febru>y #ac1 #bjac ,mr4 ,cony]s 7= himself1 ,mr4 ,nadl]1 ,ms4 ,s*ak[sky1 ,ms4 ,p+ree ( ,ma9e1 ,mr4 ,grijalva1 ,mr4 ,ellison1 ,mr4 ,johnson ( ,georgia1 ,ms4 ,eddie ,b]nice ,johnson ( ,texas1 ,mr4 ,takano1 ,ms4 ,norton1 ,ms4 ,l(gr51 ,mr4 ,rangel1 ,ms4 ,moore1 ,ms4 ,*u1 ,mr4 ,al ,gre5 ( ,texas1 ,mr4 ,f>r1 ,mr4 ,mc,govern1 ,mr4 ,wel*1 ,ms4 ,cl>ke1 ,ms4 ,lee ( ,cali=nia1 ,mr4 ,nolan1 ,mr4 ,pocan1 ,mr4 ,doyle1 ,mr4 ,engel1 ,mr4 ,guti]rez1 ,ms4 ,wilson ( ,florida1 ,mr4 ,coh51 ,ms4 ,edw>ds1 ,mr4 ,mc,dermott1 ,mr4 ,clay1 ,mr4 ,huffman1 ,ms4 ,roybal-,all>d1 ,mr4 ,cumm+s1 ,mr4 ,y>mu?1 ,mr4 ,george ,mill] ( ,cali=nia1 ,mr4 ,honda1 ,mrs4 ,*ri/5s51 & ,mr4 ,ru%7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committees on ,ways & ,means & ,natural ,res\rces1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to provide = compreh5sive heal? insurance cov]age = all ,unit$ ,/ates resid5ts1 improv$ heal? c>e deliv]y1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,exp&$ ,improv$ ,m$ic>e ,= ,all ,act4 7b7 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,sec4 #b4 ,def9itions & t]ms4 ,title ,i--,,eligibility ,,& ,,b5efits ,sec4 #aja4 ,eligibility & regi/ration4 ,sec4 #ajb4 ,b5efits & portability4 ,sec4 #ajc4 ,qualification ( p>ticipat+ provid]s4 ,sec4 #ajd4 ,prohibition aga9/ duplicat+ cov]age4 ,title ,,ii--,,f9ances ,subtitle ,a--,budget+ & ,paym5ts ,sec4 #bja4 ,budget+ process4 ,sec4 #bjb4 ,paym5t ( provid]s & heal? c>e cl9icians4 ,sec4 #bjc4 ,paym5t = long-t]m c>e4 ,sec4 #bjd4 ,m5tal heal? s]vices4 ,sec4 #bje4 ,paym5t = prescription m$ications1 m$ical supplies1 & m$ically necess>y assi/ive equipm5t4 ,sec4 #bjf4 ,consultation 9 e/abli%+ reimbursem5t levels4 ,subtitle ,b--,fund+ ,sec4 #baa4 ,ov]view3 fund+ ! ,m$ic>e ,= ,all ,program4 ,sec4 #bab4 ,appropriations = exi/+ programs4 ,title ,,iii--,,adm9i/ration ,sec4 #cja4 ,public adm9i/ration2 appo9tm5t ( ,director4 ,sec4 #cjb4 ,(fice ( ,quality ,control4 ,sec4 #cjc4 ,regional & ,/ate adm9i/ration2 employm5t ( displac$ cl]ical work]s4 ,sec4 #cjd4 ,confid5tial electronic pati5t record sy/em4 ,sec4 #cje4 ,national ,bo>d ( ,univ]sal ,quality & ,access4 ,title ,,iv--,,additional ,,provisions ,sec4 #dja4 ,treatm5t ( ,,va & ,,ihs heal? programs4 ,sec4 #djb4 ,public heal? & prev5tion4 ,sec4 #djc4 ,r$uction 9 heal? disp>ities4 ,title ,v--,,effective ,,date ,sec4 #eja4 ,effective date4 #b4 ,def9itions & t]ms ,9 ?is ,act3 7#a7 ,m$ic>e ,= ,all ,program2 program ,! t]ms ,m$ic>e ,= ,all ,program & ,program mean ! program ( b5efits provid$ "u ?is ,act &1 unless ! context o!rwise requires1 ! ,secret>y ) respect to functions relat+ to c>ry+ out su* program4 7#b7 ,national bo>d ( univ]sal quality & access ,! t]m ,national ,bo>d ( ,univ]sal ,quality & ,access means su* ,bo>d e/abli%$ "u section #cje4 7#c7 ,regional (fice ,! t]m regional (fice means a regional (fice e/abli%$ "u section #cjc4 7#d7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#e7 ,director ,! t]m ,director means1 9 relation to ! ,program1 ! ,director appo9t$ "u section #cja4 ,i ,,eligibility ,,& ,,b5efits #aja4 ,eligibility & regi/ration 7a7 ,9 g5]al ,all individuals resid+ 9 ! ,unit$ ,/ates 7includ+ any t]ritory ( ! ,unit$ ,/ates7 are cov]$ "u ! ,m$ic>e ,= ,all ,program entitl+ !m to a univ]sal1 be/ quality /&>d ( c>e4 ,ea* su* individual %all receive a c>d ) a unique numb] 9 ! mail4 ,an individual's ,social ,security numb] %all n be us$ = purposes ( regi/ration "u ?is section4 7b7 ,regi/ration ,individuals & families %all receive a ,m$ic>e ,= ,all ,program ,c>d 9 ! mail1 aft] fill+ out a ,m$ic>e ,= ,all ,program application =m at a heal? c>e provid]4 ,su* application =m %all be no m ?an #b pages long4 7c7 ,presumption ,individuals :o pres5t !mselves = cov]$ s]vices f a p>ticipat+ provid] %all be presum$ to be eligible = b5efits "u ?is ,act1 b %all complete an application = b5efits 9 ord] to receive a ,m$ic>e ,= ,all ,program ,c>d & h paym5t made = su* b5efits4 7d7 ,resid5cy crit]ia ,! ,secret>y %all promulgate a rule t provides crit]ia = det]m9+ resid5cy = eligibility purposes "u ! ,m$ic>e ,= ,all ,program4 7e7 ,cov]age = visitors ,! ,secret>y %all promulgate a rule reg>d+ visitors f o!r c\ntries :o seek prem$itat$ non-em]g5cy surgical proc$ures4 ,su* a rule %\ld facilitate ! e/abli%m5t ( c\ntry-to-c\ntry reimbursem5t arrangem5ts or self pay arrangem5ts betwe5 ! visitor & ! provid] ( c>e4 #ajb4 ,b5efits & portability 7a7 ,9 g5]al ,! heal? c>e b5efits "u ?is ,act cov] all m$ically necess>y s]vices1 includ+ at lea/ ! foll[+3 7#a7 ,prim>y c>e & prev5tion4 7#b7 ,approv$ diet>y & nutritional !rapies4 7#c7 ,inpati5t c>e4 7#d7 ,outpati5t c>e4 7#e7 ,em]g5cy c>e4 7#f7 ,prescription drugs4 7#g7 ,durable m$ical equipm5t4 7#h7 ,long-t]m c>e4 7#i7 ,palliative c>e4 7#aj7 ,m5tal heal? s]vices4 7#aa7 ,! full scope ( d5tal s]vices1 s]vices1 includ+ p]iodontics1 oral surg]y1 & endodontics1 b n includ+ cosmetic d5ti/ry4 7#ab7 ,sub/ance abuse treatm5t s]vices4 7#ac7 ,*iropractic s]vices1 n includ+ electrical /imulation4 7#ad7 ,basic vision c>e & vision correction 7o!r ?an las] vision correction = cosmetic purposes74 7#ae7 ,he>+ s]vices1 includ+ cov]age ( he>+ aids4 7#af7 ,podiatric c>e4 7b7 ,portability ,su* b5efits are available ?r\gh any lic5s$ heal? c>e cl9ician any:]e 9 ! ,unit$ ,/ates t is legally qualifi$ to provide ! b5efits4 7c7 ,no co/-,%>+ ,no d$uctibles1 copaym5ts1 co9surance1 or o!r co/-%>+ %all be impos$ ) respect to cov]$ b5efits4 #ajc4 ,qualification ( p>ticipat+ provid]s 7a7 ,requirem5t ,to be public or non-,pr(it 7#a7 ,9 g5]al ,no in/itution may be a p>ticipat+ provid] unless x is a public or n-=-pr(it in/itution4 ,private physicians1 private cl9ics1 & private heal? c>e provid]s %all cont9ue to op]ate z private entities1 b are prohibit$ f be+ inve/or own$4 7#b7 ,conv]sion ( inve/or-own$ provid]s ,=-pr(it provid]s ( c>e opt+ to p>ticipate %all be requir$ to conv]t to n-=-pr(it /atus4 7#c7 ,private deliv]y ( c>e requirem5t ,=-pr(it provid]s ( c>e t conv]t to non-pr(it /atus %all rema9 privately own$ & op]at$ entities4 7#d7 ,comp5sation = conv]sion ,! own]s ( su* =-pr(it provid]s %all be comp5sat$ = reasonable f9ancial losses incurr$ z a result ( ! conv]sion f =-pr(it to non-pr(it /atus4 7#e7 ,fund+ ,!re are au?oriz$ to be appropriat$ f ! ,treasury su* sums z are necess>y to comp5sate inve/or-own$ provid]s z provid$ = "u p>agraph 7#c74 7#f7 ,requirem5ts ,! paym5ts to own]s ( conv]t+ =-pr(it provid]s %all occur dur+ a #ae-ye> p]iod1 ?r\gh ! sale ( ,u4,s4 ,treasury ,bonds4 ,paym5t = conv]sions "u p>agraph 7#c7 %all n be made = loss ( bus9ess pr(its4 7#g7 ,me*anism = conv]sion process ,! ,secret>y %all promulgate a rule to provide a me*anism to fur!r ! timely1 effici5t1 & feasible conv]sion ( =-pr(it provid]s ( c>e4 7b7 ,quality /&>ds 7#a7 ,9 g5]al ,heal? c>e deliv]y facilities mu/ meet ,/ate quality & lic5s+ guidel9es z a condition ( p>ticipation "u su* program1 includ+ guidel9es reg>d+ safe /aff+ & quality ( c>e4 7#b7 ,lic5sure requirem5ts ,p>ticipat+ cl9icians mu/ be lic5s$ 9 _! ,/ate ( practice & meet ! quality /&>ds = _! area ( c>e4 ,no cl9ician ^: lic5se is "u susp5sion or :o is "u discipl9>y action 9 any ,/ate may be a p>ticipat+ provid]4 7c7 ,p>ticipation ( heal? ma9t5ance organizations 7#a7 ,9 g5]al ,non-pr(it heal? ma9t5ance organizations t deliv] c>e 9 _! own facilities & employ cl9icians on a sal>i$ basis may p>ticipate 9 ! program & receive global budgets or capitation paym5ts z specifi$ 9 section #bjb4 7#b7 ,exclusion ( c]ta9 heal? ma9t5ance organizations ,o!r heal? ma9t5ance organizations :i* pr9cipally contract to pay = s]vices deliv]$ by non-employees %all be classifi$ z insurance plans4 ,su* organizations %all n be p>ticipat+ provid]s1 & are subject to ! regulations promulgat$ by reason ( section #ajd7;a7 7relat+ to prohibition aga9/ duplicat+ cov]age74 7d7 ,fre$om ( *oice ,pati5ts %all h free *oice ( p>ticipat+ physicians & o!r cl9icians1 hospitals1 & inpati5t c>e facilities4 #ajd4 ,prohibition aga9/ duplicat+ cov]age 7a7 ,9 g5]al ,x is unlawful = a private heal? insur] to sell heal? insurance cov]age t duplicates ! b5efits provid$ "u ?is ,act4 7b7 ,con/ruction ,no?+ 9 ?is ,act %all be con/ru$ z prohibit+ ! sale ( heal? insurance cov]age = any additional b5efits n cov]$ by ?is ,act1 su* z = cosmetic surg]y or o!r s]vices & items t are n m$ically necess>y4 ,,ii ,,f9ances ,a ,budget+ & ,paym5ts #bja4 ,budget+ process 7a7 ,e/abli%m5t ( op]at+ budget & capital exp5ditures budget 7#a7 ,9 g5]al ,to c>ry out ?is ,act !re are e/abli%$ on an annual basis consi/5t ) ?is title-- 7,a7 an op]at+ budget1 includ+ am\nts = optimal physician1 nurse1 & o!r heal? c>e pr(essional /aff+2 7,b7 a capital exp5ditures budget2 7,c7 reimbursem5t levels = provid]s consi/5t ) subtitle ,b2 & 7,d7 a heal? pr(essional education budget1 includ+ am\nts = ! cont9u$ fund+ ( resid5t physician tra9+ programs4 7#b7 ,regional allocation ,aft] ,congress appropriates am\nts = ! annual budget = ! ,m$ic>e ,= ,all ,program1 ! ,director %all provide ! regional (fices ) an annual fund+ allotm5t to cov] ! co/s ( ea* region's exp5ditures4 ,su* allotm5t %all cov] global budgets1 reimbursem5ts to cl9icians1 heal? pr(essional education1 & capital exp5ditures4 ,regional (fices may receive additional funds f ! national program at ! discretion ( ! ,director4 7b7 ,op]at+ budget ,! op]at+ budget %all be us$ =-- 7#a7 paym5t = s]vices r5d]$ by physicians & o!r cl9icians2 7#b7 global budgets = in/itutional provid]s2 7#c7 capitation paym5ts = capitat$ gr\ps2 & 7#d7 adm9i/ration ( ! ,program4 7c7 ,capital exp5ditures budget ,! capital exp5ditures budget %all be us$ = funds ne$$ =-- 7#a7 ! con/ruction or r5ovation ( heal? facilities2 & 7#b7 = major equipm5t pur*ases4 7d7 ,prohibition aga9/ co-,m+l+ op]ations & capital improvem5t funds ,x is prohibit$ to use funds "u ?is ,act t are e>m>k$-- 7#a7 = op]ations = capital exp5ditures2 or 7#b7 = capital exp5ditures = op]ations4 #bjb4 ,paym5t ( provid]s & heal? c>e cl9icians 7a7 ,e/abli%+ global budgets2 mon?ly lump sum 7#a7 ,9 g5]al ,! ,m$ic>e ,= ,all ,program1 ?r\gh its regional (fices1 %all pay ea* in/itutional provid] ( c>e1 includ+ hospitals1 nurs+ homes1 community or migrant heal? c5t]s1 home c>e ag5cies1 or o!r in/itutional provid]s or pre-paid gr\p practices1 a mon?ly lump sum to cov] all op]at+ exp5ses "u a global budget4 7#b7 ,e/abli%m5t ( global budgets ,! global budget ( a provid] %all be set ?r\gh negotiations betwe5 provid]s1 ,/ate directors1 & regional directors1 b are subject to ! approval ( ! ,director4 ,! budget %all be negotiat$ annually1 bas$ on pa/ exp5ditures1 project$ *anges 9 levels ( s]vices1 wages & input1 co/s1 a provid]'s maximum capacity to provide c>e1 & propos$ new & innovative programs4 7b7 ,?ree paym5t options = physicians & c]ta9 o!r heal? pr(essionals 7#a7 ,9 g5]al ,! ,program %all pay physicians1 d5ti/s1 doctors ( o/eopa?y1 ph>maci/s1 psy*ologi/s1 *iropractors1 doctors ( optometry1 nurse practition]s1 nurse midwives1 physicians' assi/ants1 & o!r advanc$ practice cl9icians z lic5s$ & regulat$ by ! ,/ates by ! foll[+ paym5t me?ods3 7,a7 ,fee = s]vice paym5t "u p>agraph 7#b74 7,b7 ,sal>i$ positions 9 in/itutions receiv+ global budgets "u p>agraph 7#c74 7,c7 ,sal>i$ positions )9 gr\p practices or non-pr(it heal? ma9t5ance organizations receiv+ capitation paym5ts "u p>agraph 7#d74 7#b7 ,fee = s]vice 7,a7 ,9 g5]al ,! ,program %all negotiate a simplifi$ fee s*$ule t is fair & optimal ) repres5tatives ( physicians & o!r cl9icians1 aft] close consultation ) ! ,national ,bo>d ( ,univ]sal ,quality & ,access & regional & ,/ate directors4 ,initially1 ! curr5t prevail+ fees or reimbursem5t w\ld be ! basis = ! fee negotiation = all pr(essional s]vices cov]$ "u ?is ,act4 7,b7 ,consid]ations ,9 e/abli%+ su* s*$ule1 ! ,director %all take into consid]ation ! foll[+3 7i7 ,! ne$ = a uni=m national /&>d4 7ii7 ,! goal ( ensur+ t physicians1 cl9icians1 ph>maci/s1 & o!r m$ical pr(essionals be comp5sat$ at a rate :i* reflects _! exp]tise & ! value ( _! s]vices1 reg>dless ( geographic region & pa/ fee s*$ules4 7,c7 ,/ate physician practice review bo>ds ,! ,/ate director = ea* ,/ate1 9 consultation ) repres5tatives ( ! physician community ( t ,/ate1 %all e/abli% & appo9t a physician practice review bo>d to assure quality1 co/ effectiv5ess1 & fair reimbursem5ts = physician deliv]$ s]vices4 7,d7 ,f9al guidel9es ,! ,director %all be responsible = promulgat+ f9al guidel9es to all provid]s4 7,e7 ,bill+ ,"u ?is ,act physicians %all submit bills to ! regional director on a simple =m1 or via comput]4 ,int]e/ %all be paid to provid]s :o are n reimburs$ )9 #cj days ( submission4 7,f7 ,no balance bill+ ,lic5s$ heal? c>e cl9icians :o accept any paym5t f ! ,m$ic>e ,= ,all ,program may n bill any pati5t = any cov]$ s]vice4 7,g7 ,uni=m comput] electronic bill+ sy/em ,! ,director %all create a uni=m comput]iz$ electronic bill+ sy/em1 includ+ ^? areas ( ! ,unit$ ,/ates :]e electronic bill+ is n yet e/abli%$4 7#c7 ,sal>ies )9 in/itutions receiv+ global budgets 7,a7 ,9 g5]al ,9 ! case ( an in/itution1 su* z a hospital1 heal? c5t]1 gr\p practice1 community & migrant heal? c5t]1 or a home c>e ag5cy t elects to be paid a mon?ly global budget = ! deliv]y ( heal? c>e z well z = education & prev5tion programs1 physicians & o!r cl9icians employ$ by su* in/itutions %all be reimburs$ ?r\gh a sal>y includ$ z "p ( su* a budget4 7,b7 ,sal>y ranges ,sal>y ranges = heal? c>e provid]s %all be det]m9$ 9 ! same way z fee s*$ules "u p>agraph 7#b74 7#d7 ,sal>ies )9 capitat$ gr\ps 7,a7 ,9 g5]al ,heal? ma9t5ance organizations1 gr\p practices1 & o!r in/itutions may elect to be paid capitation paym5ts to cov] all outpati5t1 physician1 & m$ical home c>e provid$ to individuals enroll$ to receive b5efits ?r\gh ! organization or entity4 7,b7 ,scope ,su* capitation may include ! co/s ( s]vices ( lic5s$ physicians & o!r lic5s$1 indep5d5t practition]s provid$ to inpati5ts4 ,o!r co/s ( inpati5t & in/itutional c>e %all be exclud$ f capitation paym5ts1 & %all be cov]$ "u in/itutions' global budgets4 7,c7 ,prohibition ( selective enrollm5t ,pati5ts %all be p]mitt$ to enroll or dis5roll f su* organizations or entities )\t discrim9ation & ) appropriate notice4 7,d7 ,heal? ma9t5ance organizations ,"u ?is ,act-- 7i7 heal? ma9t5ance organizations %all be requir$ to reimburse physicians bas$ on a sal>y2 & 7ii7 f9ancial inc5tives betwe5 su* organizations & physicians bas$ on utilization are prohibit$4 #bjc4 ,paym5t = long-t]m c>e 7a7 ,allotm5t = regions ,! ,program %all provide = ea* region a s+le budget>y allotm5t to cov] a full array ( long-t]m c>e s]vices "u ?is ,act4 7b7 ,regional budgets ,ea* region %all provide a global budget to local long-t]m c>e provid]s = ! full range ( ne$$ s]vices1 includ+ 9-home1 nurs+ home1 & community bas$ c>e4 7c7 ,basis = budgets ,budgets = long-t]m c>e s]vices "u ?is section %all be bas$ on pa/ exp5ditures1 f9ancial & cl9ical p]=mance1 utilization1 & project$ *anges 9 s]vice1 wages1 & o!r relat$ factors4 7d7 ,favor+ non-,in/itutional c>e ,all ef=ts %all be made "u ?is ,act to provide long-t]m c>e 9 a home- or community-bas$ sett+1 z oppos$ to in/itutional c>e4 #bjd4 ,m5tal heal? s]vices 7a7 ,9 g5]al ,! ,program %all provide cov]age = all m$ically necess>y m5tal heal? c>e on ! same basis z ! cov]age = o!r conditions4 ,lic5s$ m5tal heal? cl9icians %all be paid 9 ! same mann] z specifi$ = o!r heal? pr(essionals1 z provid$ = 9 section #bjb7;b74 7b7 ,favor+ community-,bas$ c>e ,! ,m$ic>e ,= ,all ,program %all cov] supportive resid5ces1 occupational !rapy1 & ongo+ m5tal heal? & c\nsel+ s]vices outside ! hospital = pati5ts ) s]i\s m5tal illness4 ,9 all cases ! highe/ quality & mo/ effective c>e %all be deliv]$1 &1 = "s individuals1 ?is may mean in/itutional c>e4 #bje4 ,paym5t = prescription m$ications1 m$ical supplies1 & m$ically necess>y assi/ive equipm5t 7a7 ,negotiat$ prices ,! prices to be paid ea* ye> "u ?is ,act = cov]$ ph>maceuticals1 m$ical supplies1 & m$ically necess>y assi/ive equipm5t %all be negotiat$ annually by ! ,program4 7b7 ,prescription drug =mul>y 7#a7 ,9 g5]al ,! ,program %all e/abli% a prescription drug =mul>y sy/em1 :i* %all enc\rage be/-practices 9 prescrib+ & disc\rage ! use ( ineffective1 dang]\s1 or excessively co/ly m$ications :5 bett] alt]natives are available4 7#b7 ,promotion ( use ( g5]ics ,! =mul>y %all promote ! use ( g5]ic m$ications b all[ ! use ( br&-"n & (f-=mul>y m$ications4 7#c7 ,=mul>y updates & petition rights ,! =mul>y %all be updat$ frequ5tly & cl9icians & pati5ts may petition _! region or ! ,director to add new ph>maceuticals or to remove ineffective or dang]\s m$ications f ! =mul>y4 #bjf4 ,consultation 9 e/abli%+ reimbursem5t levels ,reimbursem5t levels "u ?is subtitle %all be set aft] close consultation ) regional & ,/ate ,directors & aft] ! annual meet+ ( ,national ,bo>d ( ,univ]sal ,quality & ,access4 ,b ,fund+ #baa4 ,ov]view3 fund+ ! ,m$ic>e ,= ,all ,program 7a7 ,9 g5]al ,! ,m$ic>e ,= ,all ,program is to be fund$ z provid$ 9 subsection 7c77#a74 7b7 ,m$ic>e ,= ,all ,tru/ ,fund ,!re %all be e/abli%$ a ,m$ic>e ,= ,all ,tru/ ,fund 9 :i* funds provid$ "u ?is section are deposit$ & f :i* exp5ditures "u ?is ,act are made4 7c7 ,fund+ 7#a7 ,9 g5]al ,!re are appropriat$ to ! ,m$ic>e ,= ,all ,tru/ ,fund am\nts suffici5t to c>ry out ?is ,act f ! foll[+ s\rces3 7,a7 ,exi/+ s\rces ( ,f$]al ,gov]nm5t rev5ues = heal? c>e4 7,b7 ,increas+ p]sonal income taxes on ! top #e p]c5t income e>n]s4 7,c7 ,in/itut+ a mode/ & progressive excise tax on payroll & self-employm5t income4 7,d7 ,in/itut+ a mode/ tax on une>n$ income4 7,e7 ,in/itut+ a small tax on /ock & bond transactions4 7#b7 ,sy/em sav+s z a s\rce ( f9anc+ ,fund+ o!rwise requir$ = ! ,program is r$uc$ z a result (-- 7,a7 va/ly r$uc+ pap]work2 7,b7 requir+ a rational bulk procurem5t ( m$ications "u section #bje7;a72 & 7,c7 improv$ access to prev5tive heal? c>e4 7#c7 ,additional annual appropriations to ,m$ic>e ,= ,all ,program ,additional sums are au?oriz$ to be appropriat$ annually z ne$$ to ma9ta9 maximum quality1 effici5cy1 & access "u ! ,program4 #bab4 ,appropriations = exi/+ programs ,not)/&+ any o!r provision ( law1 !re are h]eby transf]r$ & appropriat$ to c>ry out ?is ,act1 am\nts f ! ,treasury equival5t to ! am\nts ! ,secret>y e/imates w\ld h be5 appropriat$ & exp5d$ = ,f$]al public heal? c>e programs1 includ+ funds t w\ld h be5 appropriat$ "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act1 "u ! ,m$icaid program "u title ,,xix ( su* ,act1 & "u ! ,*ildr5's ,heal? ,insurance ,program "u title ,,xxi ( su* ,act4 ,,iii ,,adm9i/ration #cja4 ,public adm9i/ration2 appo9tm5t ( ,director 7a7 ,9 g5]al ,except z o!rwise specifically provid$1 ?is ,act %all be adm9i/]$ by ! ,secret>y ?r\gh a ,director appo9t$ by ! ,secret>y4 7b7 ,long-,t]m c>e ,! ,director %all appo9t a director = long-t]m c>e :o %all be responsible = adm9i/ration ( ?is ,act & ensur+ ! availability & accessibility ( high quality long-t]m c>e s]vices4 7c7 ,m5tal heal? ,! ,director %all appo9t a director = m5tal heal? :o %all be responsible = adm9i/ration ( ?is ,act & ensur+ ! availability & accessibility ( high quality m5tal heal? s]vices4 #cjb4 ,(fice ( ,quality ,control ,! ,director %all appo9t a director = an ,(fice ( ,quality ,control4 ,su* director %all1 aft] consultation ) /ate & regional directors1 provide annual recomm5dations to ,congress1 ! ,presid5t1 ! ,secret>y1 & o!r ,program (ficials on h[ to ensure ! highe/ quality heal? c>e s]vice deliv]y4 ,! director ( ! ,(fice ( ,quality ,control %all conduct an annual review on ! adequacy ( m$ically necess>y s]vices1 & %all make recomm5dations ( any propos$ *anges to ! ,congress1 ! ,presid5t1 ! ,secret>y1 & o!r ,m$ic>e ,= ,all ,program (ficials4 #cjc4 ,regional & ,/ate adm9i/ration2 employm5t ( displac$ cl]ical work]s 7a7 ,e/abli%m5t ( ,m$ic>e ,= ,all ,program regional (fices ,! ,secret>y %all e/abli% & ma9ta9 ,m$ic>e ,= ,all regional (fices = ! purpose ( di/ribut+ funds to provid]s ( c>e4 ,:5ev] possible1 ! ,secret>y %\ld incorporate pre-exi/+ ,m$ic>e infra/ructure = ?is purpose4 7b7 ,appo9tm5t ( ,regional & ,/ate ,directors ,9 ea* su* regional (fice !re %all be-- 7#a7 "o regional director appo9t$ by ! ,director2 & 7#b7 = ea* ,/ate 9 ! region1 a deputy director 79 ?is ,act ref]r$ to z a ,/ate ,director7 appo9t$ by ! gov]nor ( t ,/ate4 7c7 ,regional (fice duties ,regional (fices ( ! ,program %all be responsible =-- 7#a7 coord9at+ fund+ to heal? c>e provid]s & physicians2 & 7#b7 coord9at+ bill+ & reimbursem5ts ) physicians & heal? c>e provid]s ?r\gh a ,/ate-bas$ reimbursem5t sy/em4 7d7 ,/ate ,director's duties ,ea* ,/ate ,director %all be responsible = ! foll[+ duties3 7#a7 ,provid+ an annual /ate heal? c>e ne$s assessm5t report to ! ,national ,bo>d ( ,univ]sal ,quality & ,access1 & ! regional bo>d1 aft] a ?or\gh exam9ation ( heal? ne$s1 9 consultation ) public heal? (ficials1 cl9icians1 pati5ts1 & pati5t advocates4 7#b7 ,heal? plann+1 includ+ ov]sight ( ! placem5t ( new hospitals1 cl9ics1 & o!r heal? c>e deliv]y facilities4 7#c7 ,heal? plann+1 includ+ ov]sight ( ! pur*ase & placem5t ( new heal? equipm5t to ensure timely access to c>e & to avoid duplication4 7#d7 ,submitt+ global budgets to ! regional director4 7#e7 ,recomm5d+ *anges 9 provid] reimbursem5t or paym5t = deliv]y ( heal? s]vices 9 ! ,/ate4 7#f7 ,e/abli%+ a quality assurance me*anism 9 ! ,/ate 9 ord] to m9imize bo? "u utilization & ov] utilization & to assure t all provid]s meet high quality /&>ds4 7#g7 ,review+ program disbursem5ts on a qu>t]ly basis & recomm5d+ ne$$ adju/m5ts 9 fee s*$ules ne$$ to a*ieve budget>y t>gets & assure adequate access to ne$$ c>e4 7e7 ,fir/ priority 9 retra9+ & job placem5t2 #b ye>s ( sal>y p>ity b5efits ,! ,program %all provide t cl]ical1 adm9i/rative1 & bill+ p]sonnel 9 insurance companies1 doctors (fices1 hospitals1 nurs+ facilities1 & o!r facilities ^: jobs are elim9at$ due to r$uc$ adm9i/ration-- 7#a7 %\ld h fir/ priority 9 retra9+ & job placem5t 9 ! new sy/em2 & 7#b7 %all be eligible to receive two ye>s ( ,m$ic>e ,= ,all employm5t transition b5efits ) ea* ye>'s b5efit equal to sal>y e>n$ dur+ ! la/ #ab mon?s ( employm5t1 b %all n exce$ #ajj1jjj p] ye>4 7f7 ,e/abli%m5t ( ,m$ic>e ,= ,all employm5t transition fund ,! ,secret>y %all e/abli% a tru/ fund f :i* exp5ditures %all be made to recipi5ts ( ! b5efits allocat$ 9 subsection 7e74 7g7 ,annual appropriations to ,m$ic>e ,= ,all employm5t transition fund ,sums are au?oriz$ to be appropriat$ annually z ne$$ to fund ! ,m$ic>e ,= ,all ,employm5t ,transition ,b5efits4 7h7 ,ret5tion ( "r to unemploym5t b5efits ,no?+ 9 ?is section %all be int]pret$ z a waiv] ( ,m$ic>e ,= ,all ,employm5t ,transition b5efit recipi5ts' "r to receive ,f$]al & ,/ate unemploym5t b5efits4 #cjd4 ,confid5tial electronic pati5t record sy/em 7a7 ,9 g5]al ,! ,secret>y %all create a /&>diz$1 confid5tial electronic pati5t record sy/em 9 accordance ) laws & regulations to ma9ta9 accurate pati5t records & to simplify ! bill+ process1 !reby r$uc+ m$ical errors & bureaucracy4 7b7 ,pati5t option ,not)/&+ t all bill+ %all be pre=m$ electronically1 pati5ts %all h ! option ( keep+ any portion ( _! m$ical records sep>ate f _! electronic m$ical record4 #cje4 ,national ,bo>d ( ,univ]sal ,quality & ,access 7a7 ,e/abli%m5t 7#a7 ,9 g5]al ,!re is e/abli%$ a ,national ,bo>d ( ,univ]sal ,quality & ,access 79 ?is section ref]r$ to z ! ,bo>d7 consi/+ ( #ae memb]s appo9t$ by ! ,presid5t1 by & ) ! advice & cons5t ( ! ,s5ate4 7#b7 ,qualifications ,! appo9t$ memb]s ( ! ,bo>d %all include at lea/ "o ( ea* ( ! foll[+3 7,a7 ,heal? c>e pr(essionals4 7,b7 ,repres5tatives ( in/itutional provid]s ( heal? c>e4 7,c7 ,repres5tatives ( heal? c>e advocacy gr\ps4 7,d7 ,repres5tatives ( labor unions4 7,e7 ,citiz5 pati5t advocates4 7#c7 ,t]ms ,ea* memb] %all be appo9t$ = a t]m ( #f ye>s1 except t ! ,presid5t %all /agg] ! t]ms ( memb]s initially appo9t$ s t ! t]m ( no m ?an #c memb]s expires 9 any ye>4 7#d7 ,prohibition on conflicts ( int]e/ ,no memb] ( ! ,bo>d %all h a f9ancial conflict ( int]e/ ) ! duties be=e ! ,bo>d4 7b7 ,duties 7#a7 ,9 g5]al ,! ,bo>d %all meet at lea/ twice p] ye> & %all advise ! ,secret>y & ! ,director on a regul> basis to ensure quality1 access1 & af=dability4 7#b7 ,specific issues ,! ,bo>d %all specifically address ! foll[+ issues3 7,a7 ,access to c>e4 7,b7 ,quality improvem5t4 7,c7 ,effici5cy ( adm9i/ration4 7,d7 ,adequacy ( budget & fund+4 7,e7 ,appropriat5ess ( reimbursem5t levels ( physicians & o!r provid]s4 7,f7 ,capital exp5diture ne$s4 7,g7 ,long-t]m c>e4 7,h7 ,m5tal heal? & sub/ance abuse s]vices4 7,i7 ,/aff+ levels & work+ conditions 9 heal? c>e deliv]y facilities4 7#c7 ,e/abli%m5t ( univ]sal1 be/ quality /&>d ( c>e ,! ,bo>d %all specifically e/abli% a univ]sal1 be/ quality ( /&>d ( c>e ) respect to-- 7,a7 appropriate /aff+ levels2 7,b7 appropriate m$ical te*nology2 7,c7 design & scope ( "w 9 ! heal? workplace2 7,d7 be/ practices2 & 7,e7 sal>y level & work+ conditions ( physicians1 cl9icians1 nurses1 o!r m$ical pr(essionals1 & appropriate support /aff4 7#d7 ,twice-a-ye> report ,! ,bo>d %all report its recomm5dations twice ea* ye> to ! ,secret>y1 ! ,director1 ,congress1 & ! ,presid5t4 7c7 ,comp5sation1 etc ,! foll[+ provisions ( section #ahje ( ! ,social ,security ,act %all apply to ! ,bo>d 9 ! same mann] z !y apply to ! ,m$ic>e ,paym5t ,assessm5t ,commission 7except t any ref]5ce to ! ,commission or ! ,comptroll] ,g5]al %all be treat$ z ref]5ces to ! ,bo>d & ! ,secret>y1 respectively73 7#a7 ,subsection 7c77#d7 7relat+ to comp5sation ( ,bo>d memb]s74 7#b7 ,subsection 7c77#e7 7relat+ to *airman & vice *airman74 7#c7 ,subsection 7c77#f7 7relat+ to meet+s74 7#d7 ,subsection 7d7 7relat+ to director & /aff2 exp]ts & consultants74 7#e7 ,subsection 7e7 7relat+ to p[]s74 ,,iv ,,additional ,,provisions #dja4 ,treatm5t ( ,,va & ,,ihs heal? programs 7a7 ,,va heal? programs ,?is ,act provides = heal? programs ( ! ,dep>tm5t ( ,vet]ans' ,affairs to initially rema9 indep5d5t = ! #aj-ye> p]iod t beg9s on ! date ( ! e/abli%m5t ( ! ,m$ic>e ,= ,all ,program4 ,aft] su* #aj-ye> p]iod1 ! ,congress %all reevaluate :e!r su* programs %all rema9 indep5d5t or be integrat$ into ! ,m$ic>e ,= ,all ,program4 7b7 ,indian ,heal? ,s]vice programs ,?is ,act provides = heal? programs ( ! ,indian ,heal? ,s]vice to initially rema9 indep5d5t = ! #e-ye> p]iod t beg9s on ! date ( ! e/abli%m5t ( ! ,m$ic>e ,= ,all ,program1 aft] :i* su* programs %all be integrat$ into ! ,m$ic>e ,= ,all ,program4 #djb4 ,public heal? & prev5tion ,x is ! int5t ( ?is ,act t ! ,program at all times /ress ! importance ( good public heal? ?r\gh ! prev5tion ( diseases4 #djc4 ,r$uction 9 heal? disp>ities ,x is ! int5t ( ?is ,act to r$uce heal? disp>ities by race1 e?nicity1 income & geographic region1 & to provide high quality1 co/-effective1 culturally appropriate c>e to all individuals reg>dless ( race1 e?nicity1 sexual ori5tation1 or language4 ,v ,,effective ,,date #eja4 ,effective date ,except z o!rwise specifically provid$1 ?is ,act %all take effect on ! fir/ day ( ! fir/ ye> t beg9s m ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 & %all apply to items & s]vices furni%$ on or aft] su* date4