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H.R.676 - United States National Health Care Act or the Expanded and Improved Medicare for All Act
To provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes.
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Mr. CONYERS (for himself, Mr. KUCINICH, Ms. WATSON, Mr. ELLISON, Mr. HINCHEY, Mr. DAVIS of Illinois, Ms. BALDWIN, Ms. LEE of California, Mr. MASSA, Mr. NADLER of New York, Mr. MCDERMOTT, Mr. DOYLE, Mr. GUTIERREZ, Mr. OLVER, Ms. KAPTUR, Ms. JACKSON-LEE of Texas, Mr. ENGEL, Mr. MEEKS of New York, Ms. CLARKE, Mr. FARR, Mrs. NAPOLITANO, Ms. PINGREE of Maine, Mr. TONKO, Ms. EDWARDS of Maryland, Mr. GRIJALVA, Mr. BERMAN, Mr. DELAHUNT, Mr. CLAY, Ms. KILPATRICK of Michigan, Ms. WOOLSEY, and Mr. COHEN) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concernedCommentsClose CommentsPermalink
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
TITLE I--ELIGIBILITY AND BENEFITS
Subtitle A--Budgeting and Payments
TITLE IV--ADDITIONAL PROVISIONS
TITLE V--EFFECTIVE DATE
SEC. 2. DEFINITIONS AND TERMS.
(1) USNHC PROGRAM; PROGRAM- The terms ‘USNHC Program’ and ‘Program’ mean the program of benefits provided under this Act and, unless the context otherwise requires, the Secretary with respect to functions relating to carrying out such program.CommentsClose CommentsPermalink
SEC. 101. ELIGIBILITY AND REGISTRATION.
(a) In General- All individuals residing in the United States (including any territory of the United States) are covered under the USNHC Program entitling them to a universal, best quality standard of care. Each such individual shall receive a card with a unique number in the mail. An individual’s social security number shall not be used for purposes of registration under this section.CommentsClose CommentsPermalink
(b) Registration- Individuals and families shall receive a United States National Health Insurance Card in the mail, after filling out a United States National Health Insurance application form at a health care provider. Such application form shall be no more than 2 pages long.CommentsClose CommentsPermalink
(c) Presumption- Individuals who present themselves for covered services from a participating provider shall be presumed to be eligible for benefits under this Act, but shall complete an application for benefits in order to receive a United States National Health Insurance Card and have payment made for such benefits.CommentsClose CommentsPermalink
(e) Coverage for Visitors- The Secretary shall promulgate a rule regarding visitors from other countries who seek premeditated non-emergency surgical procedures. Such a rule should facilitate the establishment of country-to-country reimbursement arrangements or self pay arrangements between the visitor and the provider of care.CommentsClose CommentsPermalink
SEC. 102. BENEFITS AND PORTABILITY.
SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS.
(1) IN GENERAL- No institution may be a participating provider unless it is a public or not-for-profit institution. Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from being investor owned.CommentsClose CommentsPermalink
(4) 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 status.CommentsClose CommentsPermalink
(5) 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 (3).CommentsClose CommentsPermalink
(6) REQUIREMENTS- The payments to owners of converting for-profit providers shall occur during a 15-year period, through the sale of U.S. Treasury Bonds. Payment for conversions under paragraph (3) shall not be made for loss of business profits.CommentsClose CommentsPermalink
(7) MECHANISM FOR CONVERSION PROCESS- The Secretary shall promulgate a rule to provide a mechanism to further the timely, efficient, and feasible conversion of for-profit providers of care.CommentsClose CommentsPermalink
(1) IN GENERAL- Health care delivery facilities must meet State quality and licensing guidelines as a condition of participation under such program, including guidelines regarding safe staffing and quality of care.CommentsClose CommentsPermalink
(2) LICENSURE REQUIREMENTS- Participating clinicians must be licensed in their State of practice and meet the quality standards for their area of care. No clinician whose license is under suspension or who is under disciplinary action in any State may be a participating provider.CommentsClose CommentsPermalink
(1) 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 202.CommentsClose CommentsPermalink
(2) EXCLUSION OF CERTAIN HEALTH MAINTENANCE ORGANIZATIONS- Other health maintenance organizations, including those which principally contract to pay for services delivered by non-employees, shall be classified as insurance plans. Such organizations shall not be participating providers, and are subject to the regulations promulgated by reason of section 104(a) (relating to prohibition against duplicating coverage).CommentsClose CommentsPermalink
SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE.
(b) Construction- Nothing in this Act shall be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by this Act, such as for cosmetic surgery or other services and items that are not medically necessary.CommentsClose CommentsPermalink
SEC. 201. BUDGETING PROCESS.
(2) REGIONAL ALLOCATION- After Congress appropriates amounts for the annual budget for the USNHC Program, the Director shall provide the regional offices with an annual funding allotment to cover the costs of each region’s expenditures. Such allotment shall cover global budgets, reimbursements to clinicians, health professional education, and capital expenditures. Regional offices may receive additional funds from the national program at the discretion of the Director.CommentsClose CommentsPermalink
SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLINICIANS.
(1) IN GENERAL- The USNHC Program, through its regional offices, shall pay each institutional provider of care, including hospitals, nursing homes, community or migrant health centers, home care agencies, or other institutional providers or pre-paid group practices, a monthly lump sum to cover all operating expenses under a global budget.CommentsClose CommentsPermalink
(2) ESTABLISHMENT OF GLOBAL BUDGETS- The global budget of a provider shall be set through negotiations between providers, State directors, and regional directors, but are subject to the approval of the Director. The budget shall be negotiated annually, based on past expenditures, projected changes in levels of services, wages and input, costs, a provider’s maximum capacity to provide care, and proposed new and innovative programs.CommentsClose CommentsPermalink
(1) IN GENERAL- The Program shall pay physicians, dentists, doctors of osteopathy, pharmacists, psychologists, chiropractors, doctors of optometry, nurse practitioners, nurse midwives, physicians’ assistants, and other advanced practice clinicians as licensed and regulated by the States by the following payment methods:CommentsClose CommentsPermalink
(A) IN GENERAL- The Program shall negotiate a simplified fee schedule that is fair and optimal with representatives of physicians and other clinicians, after close consultation with the National Board of Universal Quality and Access and regional and State directors. Initially, the current prevailing fees or reimbursement would be the basis for the fee negotiation for all professional services covered under this Act.CommentsClose CommentsPermalink
(ii) The goal of ensuring that physicians, clinicians, pharmacists, and other medical professionals be compensated at a rate which reflects their expertise and the value of their services, regardless of geographic region and past fee schedules.CommentsClose CommentsPermalink
(C) STATE PHYSICIAN PRACTICE REVIEW BOARDS- The State director for each State, in consultation with representatives of the physician community of that State, shall establish and appoint a physician practice review board to assure quality, cost effectiveness, and fair reimbursements for physician delivered services.CommentsClose CommentsPermalink
(E) BILLING- Under this Act physicians shall submit bills to the regional director on a simple form, or via computer. Interest shall be paid to providers who are not reimbursed within 30 days of submission.CommentsClose CommentsPermalink
(G) UNIFORM COMPUTER ELECTRONIC BILLING SYSTEM- The Director shall create a uniform computerized electronic billing system, including those areas of the United States where electronic billing is not yet established.CommentsClose CommentsPermalink
(A) IN GENERAL- In the case of an institution, such as a hospital, health center, group practice, community and migrant health center, 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 programs, physicians and other clinicians employed by such institutions shall be reimbursed through a salary included as part of such a budget.CommentsClose CommentsPermalink
(A) IN GENERAL- Health maintenance organizations, group practices, and other institutions may elect to be paid capitation payments to cover all outpatient, physician, and medical home care provided to individuals enrolled to receive benefits through the organization or entity.CommentsClose CommentsPermalink
(B) SCOPE- Such capitation may include the costs of services of licensed physicians and other licensed, independent practitioners provided to inpatients. Other costs of inpatient and institutional care shall be excluded from capitation payments, and shall be covered under institutions’ global budgets.CommentsClose CommentsPermalink
(C) PROHIBITION OF SELECTIVE ENROLLMENT- Patients shall be permitted to enroll or disenroll from such organizations or entities without discrimination and with appropriate notice.CommentsClose CommentsPermalink
SEC. 203. PAYMENT FOR LONG-TERM CARE.
(b) Regional Budgets- Each region shall provide a global budget to local long-term care providers for the full range of needed services, including in-home, nursing home, and community based care.CommentsClose CommentsPermalink
(c) Basis for Budgets- Budgets for long-term care services under this section shall be based on past expenditures, financial and clinical performance, utilization, and projected changes in service, wages, and other related factors.CommentsClose CommentsPermalink
(d) Favoring Non-Institutional Care- All efforts shall be made under this Act to provide long-term care in a home- or community-based setting, as opposed to institutional care.CommentsClose CommentsPermalink
SEC. 204. MENTAL HEALTH SERVICES.
(a) In General- The Program shall provide coverage for all medically necessary mental health care on the same basis as the coverage for other conditions. Licensed mental health clinicians shall be paid in the same manner as specified for other health professionals, as provided for in section 202(b).CommentsClose CommentsPermalink
(b) Favoring Community-Based Care- The USNHC Program shall cover supportive residences, occupational therapy, and ongoing mental health and counseling services outside the hospital for patients with serious mental illness. In all cases the highest quality and most effective care shall be delivered, and, for some individuals, this may mean institutional care.CommentsClose CommentsPermalink
SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS, MEDICAL SUPPLIES, AND MEDICALLY NECESSARY ASSISTIVE EQUIPMENT.
(a) Negotiated Prices- The prices to be paid each year under this Act for covered pharmaceuticals, medical supplies, and medically necessary assistive equipment shall be negotiated annually by the Program.CommentsClose CommentsPermalink
(1) IN GENERAL- The Program shall establish a prescription drug formulary system, which shall encourage best-practices in prescribing and discourage the use of ineffective, dangerous, or excessively costly medications when better alternatives are available.CommentsClose CommentsPermalink
(3) 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 formulary.CommentsClose CommentsPermalink
SEC. 206. 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 Access.CommentsClose CommentsPermalink
SEC. 211. OVERVIEW: FUNDING THE USNHC PROGRAM.
(b) USNHC Trust Fund- There shall be established a USNHC Trust Fund in which funds provided under this section are deposited and from which expenditures under this Act are made.CommentsClose CommentsPermalink
(3) ADDITIONAL ANNUAL APPROPRIATIONS TO USNHC PROGRAM- Additional sums are authorized to be appropriated annually as needed to maintain maximum quality, efficiency, and access under the Program.CommentsClose CommentsPermalink
SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS.
Notwithstanding any other provision of law, there are hereby transferred and appropriated to carry out this Act, amounts from the Treasury equivalent to the amounts the Secretary estimates would have been appropriated and expended for Federal public health care programs, including funds that would have been appropriated under the Medicare program under title XVIII of the Social Security Act, under the Medicaid program under title XIX of such Act, and under the Children’s Health Insurance Program under title XXI of such Act.CommentsClose CommentsPermalink
SEC. 301. PUBLIC ADMINISTRATION; APPOINTMENT OF DIRECTOR.
(b) 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 services.CommentsClose CommentsPermalink
(c) 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 services.CommentsClose CommentsPermalink
SEC. 302. OFFICE OF QUALITY CONTROL.
The Director shall appoint a director for an Office of Quality Control. Such director shall, after consultation with state and regional directors, provide annual recommendations to Congress, the President, the Secretary, and other Program officials on how to ensure the highest quality health care service delivery. The director of the Office of Quality Control shall conduct an annual review on the adequacy of medically necessary services, and shall make recommendations of any proposed changes to the Congress, the President, the Secretary, and other USNHC Program officials.CommentsClose CommentsPermalink
SEC. 303. REGIONAL AND STATE ADMINISTRATION; EMPLOYMENT OF DISPLACED CLERICAL WORKERS.
(a) Establishment of USNHC Program Regional Offices- The Secretary shall establish and maintain USNHC regional offices for the purpose of distributing funds to providers of care. Whenever possible, the Secretary should incorporate pre-existing Medicare infrastructure for this purpose.CommentsClose CommentsPermalink
(1) Providing an annual state health care needs assessment report to the National Board of Universal Quality and Access, and the regional board, after a thorough examination of health needs, in consultation with public health officials, clinicians, patients, and patient advocates.CommentsClose CommentsPermalink
(6) 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 standards.CommentsClose CommentsPermalink
(7) 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 care.CommentsClose CommentsPermalink
(e) First Priority in Retraining and Job Placement; 2 Years of Salary Parity Benefits- The Program shall provide that clerical, administrative, and billing personnel in insurance companies, doctors offices, hospitals, nursing facilities, and other facilities whose jobs are eliminated due to reduced administration--CommentsClose CommentsPermalink
(2) shall be eligible to receive two years of USNHC employment transition benefits with each year’s benefit equal to salary earned during the last 12 months of employment, but shall not exceed $100,000 per year.CommentsClose CommentsPermalink
(f) Establishment of USNHC Employment Transition Fund- The Secretary shall establish a trust fund from which expenditures shall be made to recipients of the benefits allocated in subsection (e).CommentsClose CommentsPermalink
(g) Annual Appropriations to USNHC Employment Transition Fund- Sums are authorized to be appropriated annually as needed to fund the USNHC Employment Transition Benefits.CommentsClose CommentsPermalink
(h) Retention of Right to Unemployment Benefits- Nothing in this section shall be interpreted as a waiver of USNHC Employment Transition benefit recipients’ right to receive Federal and State unemployment benefits.CommentsClose CommentsPermalink
SEC. 304. CONFIDENTIAL ELECTRONIC PATIENT RECORD SYSTEM.
(a) In General- The Secretary shall create a standardized, confidential electronic patient record system in accordance with laws and regulations to maintain accurate patient records and to simplify the billing process, thereby reducing medical errors and bureaucracy.CommentsClose CommentsPermalink
(b) Patient Option- Notwithstanding that all billing shall be preformed electronically, patients shall have the option of keeping any portion of their medical records separate from their electronic medical record.CommentsClose CommentsPermalink
SEC. 305. NATIONAL BOARD OF UNIVERSAL QUALITY AND ACCESS.
(1) IN GENERAL- There is established a National Board of Universal Quality and Access (in this section referred to as the ‘Board’) consisting of 15 members appointed by the President, by and with the advice and consent of the Senate.CommentsClose CommentsPermalink
(3) TERMS- Each member shall be appointed for a term of 6 years, except that the President shall stagger the terms of members initially appointed so that the term of no more than 3 members expires in any year.CommentsClose CommentsPermalink
(1) 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 quality, access, and affordability.CommentsClose CommentsPermalink
(c) Compensation, etc- The following provisions of section 1805 of the Social Security Act shall apply to the Board in the same manner as they apply to the Medicare Payment Assessment Commission (except that any reference to the Commission or the Comptroller General shall be treated as references to the Board and the Secretary, respectively):CommentsClose CommentsPermalink
SEC. 401. TREATMENT OF VA AND IHS HEALTH PROGRAMS.
(a) VA Health Programs- This Act provides for health programs of the Department of Veterans’ Affairs to initially remain independent for the 10-year period that begins on the date of the establishment of the USNHC Program. After such 10-year period, the Congress shall reevaluate whether such programs shall remain independent or be integrated into the USNHC Program.CommentsClose CommentsPermalink
(b) Indian Health Service Programs- This Act provides for health programs of the Indian Health Service to initially remain independent for the 5-year period that begins on the date of the establishment of the USNHC Program, after which such programs shall be integrated into the USNHC Program.CommentsClose CommentsPermalink
SEC. 402. PUBLIC HEALTH AND PREVENTION.
SEC. 403. REDUCTION IN HEALTH DISPARITIES.
It is the intent of this Act to reduce health disparities by race, ethnicity, income and geographic region, and to provide high quality, cost-effective, culturally appropriate care to all individuals regardless of race, ethnicity, sexual orientation, or language.CommentsClose CommentsPermalink
SEC. 501. EFFECTIVE DATE.
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