I

106TH CONGRESS

2D SESSION H. R. 4992

To guarantee for all Americans quality, affordable, and comprehensive health

insurance coverage.

IN THE HOUSE OF REPRESENTATIVES

JULY 27, 2000

Ms. BALDWIN (for herself and Mr. OBEY) introduced the following bill; which

was referred to the Committee on Commerce, and in addition to the Committee on Ways and Means, 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 concerned

A BILL

To guarantee for all Americans quality, affordable, and

comprehensive health insurance coverage.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Health Security for All Americans Act’’.

6 (b) TABLE OF CONTENTS.—The table of contents of

7 the Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Findings.
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TITLE I—HEALTH SECURITY FOR ALL AMERICANS—EXPANSION

PHASE (PHASE I)

Sec. 101. Expansion phase (phase I) voluntary State universal health insurance

coverage plans.

‘‘TITLE XXII—HEALTH SECURITY FOR ALL AMERICANS

‘‘PART A—EXPANSION PHASE (PHASE I) PLANS

‘‘Sec. 2201. Purpose; voluntary State plans.

‘‘Sec. 2202. Plan requirements.

‘‘Sec. 2203. Coverage requirements for expansion phase (phase I) plans.

‘‘Sec. 2204. Allotments.

‘‘Sec. 2205. Administration.

‘‘Sec. 2206. Definitions.’’.

TITLE II—HEALTH SECURITY FOR ALL AMERICANS—UNIVERSAL

PHASE (PHASE II)

Sec. 201. Universal phase (phase II) State universal health insurance coverage

plans.

‘‘PART B—UNIVERSAL PHASE (PHASE II) PLANS

‘‘Sec. 2211. Purpose; mandatory State plans.

‘‘Sec. 2212. Plan requirements.

‘‘Sec. 2213. Coverage requirements for universal phase (phase II) plans.

‘‘Sec. 2214. Requirements for employers regarding the provision of benefits.

‘‘Sec. 2215. Allotments.

‘‘Sec. 2216. Administration; definitions.’’.

Sec. 202. Consumer protections.

‘‘PART C—CONSUMER PROTECTIONS

‘‘Sec. 2221. Home care standards.

‘‘Sec. 2222. Consumer protection in the event of termination or suspension

of services.

‘‘Sec. 2223. Consumer protection through disclosure of information.

‘‘Sec. 2224. Consumer protection through notice of changes in health care

delivery.’’.

TITLE III—PATIENT PROTECTIONS

Sec. 301. Incorporation of certain protections.

TITLE IV—HEALTH CARE QUALITY, PATIENT SAFETY, AND

WORKFORCE STANDARDS

Sec. 401. Health Care Quality, Patient Safety, and Workforce Standards Institute.

Sec. 402. Health Care Quality, Patient Safety, and Workforce Standards Advisory Committee.

TITLE V—IMPROVING MEDICARE BENEFITS

Sec. 501. Full mental health and substance abuse treatment benefits parity.
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TITLE VI—LONG-TERM AND HOME HEALTH CARE

Sec. 601. Studies and demonstration projects to identify model programs.

TITLE VII—MISCELLANEOUS

Sec. 701. Nonapplication of ERISA.

Sec. 702. Sense of Congress regarding offsets.

1 SEC. 2. FINDINGS.

2 Congress makes the following findings:

3 (1) The health of the American people is the

4 foundation of American strength, productivity, and

5 wealth.

6 (2) The guarantee of health care coverage and

7 access to quality medical care to all Americans is a

8 fundamental right and is essential to the general

9 welfare.

10 (3) 45,000,000 Americans, more than

11 11,000,000 of whom are children, have no health in12 surance, and that number will grow to more than

13 54,000,000 by 2007 even if the economy remains

14 strong.

15 (4) Health insurance coverage is unstable; less

than 1 16 ⁄2 of all adults have been in their current

17 health plan for 3 years.

18 (5) The average American will hold at least 7

19 jobs during their life, risking lack of health coverage

20 every time they change or are between jobs.

21 (6) In 1998, annual health care expenditures in

22 the United States totaled $1,150,000,000,000, or
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1 $4,094 per person. National health expenditures are

2 projected to total $2,200,000,000,000 by 2008.

3 (7) In 1998, health care expenditures rep4 resented 13.5 percent of the gross domestic product

5 in the United States and grew at the rate of 5.6 per6 cent while the gross domestic product grew only at

7 the rate of 4.9 percent. By 2008, health care ex8 penditures are projected to reach 16.2 percent of

9 gross domestic product. Growth in health spending

10 is projected to average 1.8 percentage points above

11 the growth rate of the gross domestic product for

12 the period beginning with 1998 and ending with

13 2008.

14 (8) Although the United States spends consid15 erably more in health care per person than any other

16 nation, it ranks only fifteenth among countries

17 worldwide on an overall index designed to measure

18 a range of health goals according to the World

19 Health Organization.

20 (9) One of 4 adults, about 40,000,000 people,

21 say they have gone without needed medical care be22 cause they couldn’t afford it.

23 (10) Nearly 31,000,000 Americans face collec24 tion agencies annually because they owe money for

25 medical bills.
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1 (11) The average American worker is paying 3

2 times more for family coverage than 10 years ago,

3 and more than 4 times more for employee-only cov4 erage.

5 (12) Because many individuals do not have

6 health insurance coverage, they may incur health

7 care costs which they do not fully reimburse, result8 ing in cost-shifting to others.

9 (13) As a consequence of the piecemeal health

10 care system in the United States, administrative

11 overhead costs approximately $1,000 per person an12 nually, while other Western industrialized nations

13 with universal health care systems spend approxi14 mately $200 per person annually for administrative

15 overhead.

16 (14) The United States should adopt national

17 goals of universal, affordable, comprehensive health

18 insurance coverage and should provide generous

19 matching grants to the States to achieve those goals

20 within 5 years of the date of enactment of this Act.
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1 TITLE I—HEALTH SECURITY FOR

2 ALL AMERICANS—EXPANSION

3 PHASE (PHASE I)

4 SEC. 101. EXPANSION PHASE (PHASE I) VOLUNTARY STATE

5 UNIVERSAL HEALTH INSURANCE COVERAGE

6 PLANS.

7 The Social Security Act (42 U.S.C. 301 et seq.) is

8 amended by adding at the end the following:

9 ‘‘TITLE XXII—HEALTH SECURITY

10 FOR ALL AMERICANS

11 ‘‘PART A—EXPANSION PHASE (PHASE I) PLANS

12 ‘‘SEC. 2201. PURPOSE; VOLUNTARY STATE PLANS.

13 ‘‘(a) PURPOSE.—The purpose of this part is to pro14 vide funds to participating States to enable those States

15 to ensure universal health insurance coverage by estab16 lishing State administered systems.

17 ‘‘(b) EXPANSION PHASE (PHASE I) PLAN RE18 QUIRED.—A State is not eligible for a payment under sec19 tion 2205(a) unless the State has submitted to the Sec20 retary a plan that—

21 ‘‘(1) sets forth how the State intends to use the

22 funds provided under this part to ensure universal,

23 affordable, and comprehensive health insurance cov24 erage to eligible residents of the State consistent

25 with the provisions of this part; and
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1 ‘‘(2) has been approved under section 2202(d).

2 ‘‘SEC. 2202. PLAN REQUIREMENTS.

3 ‘‘(a) IN GENERAL.—Every expansion phase (phase I)

4 plan shall include provisions for the following:

5 ‘‘(1) INFORMATION ON THE LEVEL OF HEALTH

6 INSURANCE COVERAGE.—

7 ‘‘(A) The level of health insurance coverage

8 within the State as determined under sub9 section (b).

10 ‘‘(B) The base coverage gap for the year

11 involved as determined under subsection (b)(4).

12 ‘‘(C) State efforts to provide or obtain

13 health insurance coverage for uncovered resi14 dents of the State, including the steps the State

15 is taking to identify and enroll all uncovered

16 residents of the State who are eligible to par17 ticipate in public or private health insurance

18 programs.

19 ‘‘(2) DETAILS OF, AND TIMELINES FOR, EXPAN20 SION PHASE (PHASE I) PLAN.—

21 ‘‘(A) USE OF FUNDS; COORDINATION.—

22 The activities that the State intends to carry

23 out using funds received under this part, in24 cluding how the State will coordinate efforts

25 under this part with existing State efforts to in-
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1 crease the health insurance coverage of individ2 uals.

3 ‘‘(B) TIMELINES.—Consistent with sub4 section (c), the manner in which the State will

5 reduce the base coverage gap for the year in6 volved, including a timetable with specified tar7 gets for reducing the base coverage gap by—

8 ‘‘(i) 50 percent within 2 years after

9 the date of approval of the expansion

10 phase (phase I) plan; and

11 ‘‘(ii) 100 percent within 4 years after

12 such date.

13 ‘‘(3) MAINTENANCE OF EFFORT.—The manner

14 in which the State will ensure that—

15 ‘‘(A) employers within the State will con16 tinue to provide not less than the level of finan17 cial support toward the health insurance pre18 miums required for coverage of their employees

19 as such employers provided as of the date of en20 actment of this title; and

21 ‘‘(B) the State will continue to provide not

22 less than the level of State expenditures in23 curred for State-funded health programs as of

24 such date.
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1 ‘‘(4) STATE OUTREACH PROGRAMS; ACCESS.—

2 The manner in which, and a timetable for when, the

3 State will—

4 ‘‘(A) institute outreach programs; and

5 ‘‘(B) ensure that all eligible residents of

6 the State have access to the health insurance

7 coverage provided under this part.

8 ‘‘(5) ASSURANCE OF COVERAGE OF ESSENTIAL

9 SERVICES.—An assurance that the State program

10 established under this part will comply with the re11 quirements of section 1867 (commonly referred to as

12 the ‘Emergency Medical Treatment and Active

13 Labor Act’).

14 ‘‘(6) REPRESENTATION ON BOARDS AND COM15 MISSIONS.—The manner in which the State will en16 sure that all Boards and Commissions that the State

17 establishes to administer the plan will include,

18 among others, representatives of providers, con19 sumers, employers, and health worker unions.

20 ‘‘(7) DISCLOSURE OF INFORMATION TO THE

21 PUBLIC.—The manner in which the State will ensure

22 that, with respect to entities and individuals that

23 provide services for which reimbursement is provided

24 under this part—
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1 ‘‘(A) financial arrangements between in2 surers and providers and between providers and

3 medical equipment suppliers are disclosed to the

4 public; and

5 ‘‘(B) ownership interests and health care

6 worker qualifications and credentials are dis7 closed to the public.

8 ‘‘(8) CONSUMER PROTECTIONS.—The manner

9 in which the State will ensure compliance with sec10 tions 2221, 2222, 2223, and 2224.

11 ‘‘(9) PUBLIC REVIEW.—The manner in which

12 the State will provide for the public review of insti13 tutional changes in services provided, markets and

14 regions covered, withdrawal or movement of services,

15 closures or downsizing, and other actions that affect

16 the provision of health insurance under the plan.

17 ‘‘(10) SERVICES IN RURAL AND UNDERSERVED

18 AREAS; CULTURAL COMPETENCY.—The manner in

19 which the State will ensure—

20 ‘‘(A) coverage in rural and underserved

21 areas; and

22 ‘‘(B) that the needs of culturally diverse

23 populations are met.

24 ‘‘(11) PURCHASING POOLS.—The manner in

25 which the State will encourage the formation of
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1 State purchasing pools that provide choice of health

2 plans, control costs, and reduce adverse risk selec3 tion.

4 ‘‘(12) LIMITATION ON ADMINISTRATIVE EX5 PENDITURES.—The manner in which the State will

6 ensure that all qualified plans in the State expend

7 at least 90 percent (or, during the first 2 years of

8 the plan, 85 percent) of total income received from

9 premiums on the provision of covered health care

10 benefits (excluding all costs for marketing, adver11 tising, health plan administration, profits, or capital

12 accumulation) to individuals.

13 ‘‘(13) SELF-EMPLOYED AND MULTI14 EMPLOYED.—The manner in which the State will

15 address self-employed individuals and multiwage

16 earner families.

17 ‘‘(14) MEDICAID WRAPAROUND COVERAGE.—

18 The manner in which the State will ensure that indi19 viduals who are eligible for medical assistance under

20 title XIX and who receive benefits under the expan21 sion phase (phase I) plan shall receive any items or

22 services that are not available under the expansion

23 phase (phase I) plan but that are available under

24 the State medicaid program under title XIX through

25 ‘wraparound coverage’ under such program.
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1 ‘‘(15) OTHER MATTERS.—Any other matter de2 termined appropriate by the Secretary.

3 ‘‘(b) CURRENT LEVEL OF COVERAGE.—

4 ‘‘(1) IN GENERAL.—The Secretary shall develop

5 a survey approach that provides timely and up-to6 date data to determine the percentage of the popu7 lation of each State that is currently covered by a

8 health insurance plan or program that provides cov9 erage that meets the requirements of section

10 2203(a).

11 ‘‘(2) BIANNUAL SURVEY.—The Secretary shall

12 provide for the conduct of the survey developed

13 under paragraph (1) not less than biannually to

14 make coverage determinations for purposes of para15 graph (1).

16 ‘‘(3) USE OF ALTERNATIVE SYSTEM.—The Sec17 retary shall permit a State to utilize an alternative

18 population-based monitoring system to make deter19 minations with respect to coverage in the State for

20 purposes of paragraph (1) if the Secretary deter21 mines that such system meets or exceeds the meth22 odological standards utilized in the survey developed

23 under paragraph (1).

24 ‘‘(4) BASE COVERAGE GAP.—For purposes of

25 subsection (a)(1)(A), the base coverage gap for a
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1 State shall be equal to 100 percent of the eligible in2 dividuals and families in the State for the year in3 volved, less the current level of coverage for those in4 dividuals and families for such year as determined

5 under paragraph (1) or (3).

6 ‘‘(c) REDUCING THE LEVEL OF UNINSURED INDIVID7 UALS.—

8 ‘‘(1) IN GENERAL.—To be eligible to receive

9 funds under this part, a State shall agree to admin10 ister an expansion phase (phase I) plan with a goal

11 of providing health insurance coverage for 100 per12 cent of the eligible residents of the State by not later

13 than 4 years after the date of approval of the State’s

14 expansion phase (phase I) plan.

15 ‘‘(2) PERMISSIBLE ACTIVITIES.—A State may

16 use amounts provided under this part for any activi17 ties consistent with this part that are appropriate to

18 enroll individuals in health plans and health pro19 grams to meet the targets contained in the State

20 plan under subsection (a)(2)(B), including through

21 the use of direct payments to health plans or, in the

22 case of a single State plan, directly to providers of

23 services.

24 ‘‘(d) PROCESS FOR SUBMISSION, APPROVAL, AND

25 AMENDMENT OF EXPANSION PHASE (PHASE I) PLAN.—
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1 The provisions of section 2106 apply to an expansion

2 phase (phase I) plan under this part in the same manner

3 as they apply to a State plan under title XXI, except that

4 no expansion phase (phase I) plan may be effective earlier

5 than January 1, 2001, and all expansion phase (phase I)

6 plans must be submitted for approval by not later than

7 December 31, 2002.

8 ‘‘SEC. 2203. COVERAGE REQUIREMENTS FOR EXPANSION

9 PHASE (PHASE I) PLANS.

10 ‘‘(a) REQUIRED SCOPE OF HEALTH INSURANCE COV11 ERAGE.—Health insurance coverage provided under this

12 part shall consist of at least the benefits provided under

13 the Federal Employees Health Benefits Program standard

14 Blue Cross/Blue Shield preferred provider option service

15 benefit plan, described in and offered under section

16 8903(1) of part 5, United States Code, including mental

17 health and substance abuse treatment benefits parity.

18 ‘‘(b) LIMITATIONS ON PREMIUMS AND COST-SHAR19 ING.—

20 ‘‘(1) DESCRIPTION; GENERAL CONDITIONS.—An

21 expansion phase (phase I) plan shall include a de22 scription, consistent with this subsection, of the

23 amount (if any) of premiums, cost-sharing, or other

24 similar charges imposed. Any such charges shall be

25 imposed pursuant to a public schedule.
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1 ‘‘(2) LIMITATIONS ON PREMIUMS AND COST2 SHARING.—

3 ‘‘(A) INDIVIDUALS AND FAMILIES WITH IN4 COME BELOW 150 PERCENT OF POVERTY

5 LINE.—In the case of an individual or family

6 whose income is at or below 150 percent of the

7 poverty line—

8 ‘‘(i) the State plan may not impose a

9 premium; and

10 ‘‘(ii) the total annual aggregate

11 amount of cost-sharing imposed by a State

12 with respect to all individuals in a family

13 may not exceed 0.5 percent of the family’s

14 income for the year involved.

15 ‘‘(B) INDIVIDUALS AND FAMILIES WITH

16 INCOME BETWEEN 150 AND 300 PERCENT OF

17 POVERTY LINE.—In the case of an individual or

18 family whose income exceeds 150 percent but

19 does not exceed 300 percent of the poverty

20 line—

21 ‘‘(i) the State plan may not impose a

22 premium that exceeds an amount that is

23 equal to—

24 ‘‘(I) 20 percent of the average

25 cost of providing benefits to an indi-
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1 vidual (or a family) under this part in

2 the year involved; or

3 ‘‘(II) 3 percent of the family’s in4 come for the year involved; and

5 ‘‘(ii) the total annual aggregate

6 amount of premiums and cost-sharing

7 (combined) imposed by a State with re8 spect to all individuals in a family may not

9 exceed 5 percent of the family’s income for

10 the year involved.

11 ‘‘(C) INDIVIDUALS AND FAMILIES WITH IN12 COME ABOVE 300 PERCENT OF POVERTY

13 LINE.—In the case of an individual or family

14 whose income exceeds 300 percent of the pov15 erty line—

16 ‘‘(i) the State plan may not impose a

17 premium that exceeds 20 percent of the

18 average cost of providing benefits to an in19 dividual (or a family of the size involved)

20 under this part in the year involved; and

21 ‘‘(ii) the total annual aggregate

22 amount of premiums and cost-sharing

23 (combined) imposed by a State with re24 spect to all individuals in a family may not
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1 exceed 7 percent of the family’s income for

2 the year involved.

3 ‘‘(D) SELF-EMPLOYED INDIVIDUALS.—The

4 State shall establish rules for self-employed in5 dividuals based on individual and family in6 come.

7 ‘‘(3) COLLECTION.—The State shall establish

8 procedures for collecting any premiums, cost-shar9 ing, or other similar charges imposed under this

10 part. Such procedures shall provide for annual rec11 onciliations and adjustments.

12 ‘‘(c) APPLICATION OF CERTAIN REQUIREMENTS.—

13 ‘‘(1) RESTRICTION ON APPLICATION OF PRE14 EXISTING CONDITION EXCLUSIONS.—The expansion

15 phase (phase I) plan shall not permit the imposition

16 of any preexisting condition exclusion for covered

17 benefits under the plan.

18 ‘‘(2) CHOICE OF PLANS.—

19 ‘‘(A) IN GENERAL.—Except as provided in

20 subparagraph (B), the expansion phase (phase

21 I) plan shall offer eligible individuals and fami22 lies a choice of qualified plans from which to re23 ceive benefits under this part. At least 1 plan

24 shall be a preferred provider option plan.

25 ‘‘(B) WAIVER.—The Secretary—
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1 ‘‘(i) may waive the requirement under

2 subparagraph (A) if determined appro3 priate; and

4 ‘‘(ii) shall waive such requirement in

5 the case of a State that establishes a single

6 State plan.

7 ‘‘SEC. 2204. ALLOTMENTS.

8 ‘‘(a) STATE ALLOTMENTS.—

9 ‘‘(1) IN GENERAL.—With respect to a fiscal

10 year, the Secretary shall allot to each State with an

11 expansion phase (phase I) plan approved under this

12 part the amount determined under paragraph (2) for

13 such State for such fiscal year.

14 ‘‘(2) DETERMINATION OF COST OF COV15 ERAGE.—The amount determined under this para16 graph is the amount equal to—

17 ‘‘(A) the product of—

18 ‘‘(i) the Federal participation rate for

19 the State as determined under subsection

20 (b) or, if applicable, the enhanced Federal

21 participation rate for the State, as deter22 mined under subsection (c);

23 ‘‘(ii) the estimated cost for the min24 imum benefits package required to comply
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1 under section 2203, not to exceed the sum

2 of—

3 ‘‘(I) the total annual Government

4 and employee contributions required

5 for individual or self and family health

6 benefits coverage under the Federal

7 Employees Health Benefits Program

8 standard Blue Cross/Blue Shield pre9 ferred provider option service benefit

10 plan, described in and offered under

11 section 8903(1) of title 5, United

12 States Code (adjusted for age, as the

13 Secretary determines appropriate);

14 and

15 ‘‘(II) the estimated average cost16 sharing expense for an individual or

17 family; and

18 ‘‘(iii) the estimated number of resi19 dents to be enrolled in the expansion phase

20 (phase I) plan; less

21 ‘‘(B) the sum of—

22 ‘‘(i) the individual or family health in23 surance contribution and cost-sharing pay24 ments to be made in accordance with sec25 tion 2203(b); and
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1 ‘‘(ii) any applicable employer contribu2 tion to such payments.

3 ‘‘(b) FEDERAL PARTICIPATION RATE.—For purposes

4 of subsection (a)(2)(A)(i), the Federal participation rate

5 for a State shall be equal to the enhanced FMAP deter6 mined for the State under section 2105(b).

7 ‘‘(c) ENHANCED FEDERAL PARTICIPATION RATE.—

8 ‘‘(1) IN GENERAL.—For purposes of subsection

9 (a)(2)(A)(i), the enhanced Federal participation rate

10 for a State shall be equal to the Federal participa11 tion rate for such State under subsection (b), as ad12 justed by the Secretary based on the decrease in the

13 base coverage gap in the State.

14 ‘‘(2) AMOUNT OF ADJUSTMENT AND APPLICA15 TION.—

16 ‘‘(A) AMOUNT OF ADJUSTMENT.—The

17 Federal participation rate under subsection (b)

18 with respect to a State shall be increased by—

19 ‘‘(i) 1 percentage point if the base

20 coverage gap of the State has decreased by

21 at least 50 percent within 2 years after the

22 date of approval of the expansion phase

23 (phase I) plan, as determined by the Sec24 retary; and
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1 ‘‘(ii) 3 percentage points if the base

2 coverage gap of the State has decreased by

3 100 percent within 4 years after the date

4 of approval of the expansion phase (phase

5 I) plan, as determined by the Secretary.

6 ‘‘(B) APPLICATION.—The increase de7 scribed in—

8 ‘‘(i) subparagraph (A)(i) shall only

9 apply to a State for the period beginning

10 with the month of the determination under

11 such subparagraph and ending with the

12 month preceding the month of the deter13 mination under subparagraph (A)(ii) (if

14 any), but in no event for more than 24

15 months; and

16 ‘‘(ii) subparagraph (A)(ii) shall apply

17 to a State for any year (or portion thereof)

18 beginning with the month of the deter19 mination under such subparagraph.

20 ‘‘(3) FULL COVERAGE.—For purposes of this

21 part, a State shall be deemed to have decreased its

22 base coverage gap by 100 percent if the Secretary

23 determines that—

24 ‘‘(A) 98 percent of all eligible residents of

25 the State are provided health insurance cov-
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1 erage under the expansion phase (phase I) plan;

2 and

3 ‘‘(B) the remaining 2 percent of such resi4 dents are served by alternative health care de5 livery systems as demonstrated by the State.

6 ‘‘(d) GRANTS TO INDIAN TRIBES, NATIVE HAWAIIAN

7 ORGANIZATIONS, AND ALASKA NATIVE ORGANIZA8 TIONS.—

9 ‘‘(1) IN GENERAL.—Out of funds appropriated

10 under subsection (e), the Secretary shall reserve an

11 amount, not to exceed 1 percent of the total allot12 ments determined under subsection (a) for a fiscal

13 year, to make grants to Indian tribes, Native Hawai14 ian organizations, and Alaska Native organizations

15 for development and implementation of universal

16 health insurance coverage plans for members of such

17 tribes and organizations.

18 ‘‘(2) PLAN.—To be eligible to receive a grant

19 under paragraph (1), an Indian tribe, Native Hawai20 ian organization, or Alaska Native organization shall

21 submit a universal health insurance coverage plan to

22 the Secretary at such time, in such manner, and

23 containing such information, as the Secretary may

24 require.
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1 ‘‘(3) REGULATIONS.—The Secretary shall issue

2 regulations specifying the requirements of this part

3 that apply to Indian tribes, Native Hawaiian organi4 zations, and Alaska Native organizations receiving

5 grants under paragraph (1).

6 ‘‘(e) APPROPRIATION.—

7 ‘‘(1) IN GENERAL.—Out of any funds in the

8 Treasury not otherwise appropriated, there is appro9 priated to carry out this title such sums as may be

10 necessary for fiscal year 2001 and each fiscal year

11 thereafter.

12 ‘‘(2) BUDGET AUTHORITY.—Paragraph (1) con13 stitutes budget authority in advance of appropria14 tions Acts and represents the obligation of the Fed15 eral Government to provide States, Indian tribes,

16 Native Hawaiian organizations, and Alaska Native

17 organizations with the allotments determined under

18 this section and the grants for administrative and

19 outreach activities under section 2205.

20 ‘‘SEC. 2205. ADMINISTRATION.

21 ‘‘(a) PAYMENTS.—

22 ‘‘(1) IN GENERAL.—

23 ‘‘(A) QUARTERLY.—Subject to subpara24 graph (B) and subsection (b), the Secretary

25 shall make quarterly payments to each State
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1 with an expansion phase (phase I) plan ap2 proved under this part, from its allotment

3 under section 2204.

4 ‘‘(B) FUNDING FOR ADMINISTRATION AND

5 OUTREACH.—

6 ‘‘(i) AUTHORITY TO MAKE GRANTS.—

7 In addition to the allotments determined

8 under section 2204, the Secretary may

9 make grants to States, Indian tribes, Na10 tive Hawaiian organizations, and Alaska

11 Native organizations for expenditures for

12 administrative and outreach activities.

13 ‘‘(ii) AMOUNTS.—

14 ‘‘(I) IN GENERAL.—A grant

15 awarded under this subparagraph

16 shall not exceed the applicable per17 centage (as determined under sub18 clause (II)) of the total amount allot19 ted to the State, Indian tribe, Native

20 Hawaiian organization, or Alaska Na21 tive organization under section 2204.

22 ‘‘(II) APPLICABLE PERCENT23 AGE.—For purposes of subclause (I),

24 the applicable percentage is—
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1 ‘‘(aa) 14 percent during the

2 first 2 years an expansion phase

3 (phase I) plan is in effect and

4 complies with the requirements of

5 this title;

6 ‘‘(bb) 12 percent during the

7 third, fourth, and fifth years that

8 such plan, or a universal phase

9 (phase II) plan added by an ad10 dendum to an expansion phase

11 (phase I) plan, is in effect and

12 complies with the requirements of

13 this title; and

14 ‘‘(cc) 10 percent during any

15 year thereafter such plan (or uni16 versal phase (phase II) plan

17 added by an addendum to such

18 plan) is in effect and complies

19 with the requirements of this

20 title.

21 ‘‘(2) ADVANCE PAYMENT; RETROSPECTIVE AD22 JUSTMENT.—The Secretary may make payments

23 under this part for each quarter on the basis of ad24 vance estimates by the State and such other inves25 tigation as the Secretary may find necessary, and
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1 may reduce or increase the payments as necessary to

2 adjust for any overpayment or underpayment for

3 prior quarters.

4 ‘‘(3) FLEXIBILITY IN SUBMITTAL OF CLAIMS.—

5 Nothing in this subsection shall be construed as pre6 venting a State from claiming as expenditures in the

7 quarter expenditures that were incurred in a pre8 vious quarter.

9 ‘‘(b) AUTHORITY FOR BLENDED RATE FOR HEALTH

10 SECURITY, MEDICAID, AND SCHIP FUNDS.—The Sec11 retary shall establish procedures for blending the pay12 ments that a State is entitled to receive under this title,

13 title XIX, and title XXI into 1 payment rate if—

14 ‘‘(1) the State requests such a blended pay15 ment; and

16 ‘‘(2) the Secretary finds that the State meets

17 maintenance of effort requirements established by

18 the Secretary.

19 ‘‘(c) LIMITATIONS ON FEDERAL PAYMENTS BASED

20 ON COST CONTAINMENT.—

21 ‘‘(1) DETERMINATION OF BASELINE.—Each

22 year (beginning with 2001), the Secretary shall es23 tablish a baseline projection for the national rate of

24 growth in private health insurance premiums for

25 such year.
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1 ‘‘(2) REQUIREMENT.—Beginning with fiscal

2 year 2002 and each fiscal year thereafter, any pay3 ment made to a State under section 2204 shall not

4 exceed the amount paid to the State under such sec5 tion for the preceding fiscal year, adjusted for

6 changes in enrollment and a premium inflation ad7 justment that is 0.5 percent below the baseline pro8 jection determined under paragraph (1) for the year.

9 ‘‘(d) OTHER LIMITATIONS ON USE OF FUNDS.—

10 ‘‘(1) IN GENERAL.—A State participating under

11 part A, and, effective January 1, 2005, all States

12 under part B, shall ensure that any payments re13 ceived by the State under section 2205 or 2116(a)

14 are not used by any individual or entity, including

15 providers or health plans that contract to provide

16 services herein, to finance directly or indirectly, or to

17 otherwise facilitate expenditures to influence health

18 care workers of such individual or entity with re19 spect to issues related to unionization.

20 ‘‘(2) CONSTRUCTION.—Nothing in this sub21 section shall be construed to limit expenditures made

22 for the purpose of good faith collective bargaining or

23 pursuant to the terms of a bona fide collective bar24 gaining agreement.
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1 ‘‘(e) WAIVER OF FEDERAL REQUIREMENTS.—A

2 State may request (and the Secretary may grant) a waiver

3 of any provision of Federal law that the State determines

4 is necessary in order to carry out an approved expansion

5 phase (phase I) plan under this part.

6 ‘‘(f) REPORT.—Not later than January 1, 2002, and

7 each January 1 thereafter, the Secretary, in consultation

8 with the General Accounting Office and the Congressional

9 Budget Office, shall prepare and submit to the appro10 priate committees of Congress a report on the number of

11 States receiving payments under this part for the year for

12 which the report is being prepared as well as the level of

13 insurance coverage attained by each such State.

14 ‘‘SEC. 2206. DEFINITIONS.

15 ‘‘In this title:

16 ‘‘(1) COST-SHARING.—The term ‘cost-sharing’

17 has the meaning given such term under the Federal

18 Employees Health Benefits Program standard Blue

19 Cross/Blue Shield preferred provider option service

20 benefit plan described in and offered under section

21 8903(1) of part 5, United States Code, and includes

22 deductibles, copayments, coinsurance, as such terms

23 are defined for purposes of such plan.

24 ‘‘(2) ELIGIBLE RESIDENTS OF A STATE.—
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1 ‘‘(A) IN GENERAL.—The term ‘eligible

2 residents of a State’ means an individual or

3 family who—

4 ‘‘(i) is (or consists of) a resident of

5 the State involved;

6 ‘‘(ii) except as provided in subpara7 graph (B), has a family income that does

8 not exceed 300 percent of the poverty line;

9 ‘‘(iii) is (or consists of) a citizen of

10 the United States, a legal resident alien, or

11 an individual otherwise residing in the

12 United States under the authority of Fed13 eral law; and

14 ‘‘(iv) in the case of an individual, is

15 not eligible for benefits under the medicare

16 program under title XVIII or for medical

17 assistance under the medicaid program

18 under title XIX (other than under the

19 application of section

20 1902(a)(10)(A)(ii)(XIV)).

21 ‘‘(B) OPTION TO PROVIDE COVERAGE FOR

22 INDIVIDUALS AND FAMILIES WITH HIGHER IN23 COME.—If approved by the Secretary, a State

24 may increase the percentage described in sub25 paragraph (A)(ii), or eliminate all income eligi-
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1 bility criteria in order to provide coverage under

2 this part to more individuals and families.

3 ‘‘(3) EXPANSION PHASE (PHASE I) PLAN.—The

4 term ‘expansion phase (phase I) plan’ means the

5 State universal health insurance coverage plan sub6 mitted under section 2201(b).

7 ‘‘(4) HEALTH CARE SERVICES.—The term

8 ‘health care services’ includes medical, surgical,

9 mental health, and substance abuse services, wheth10 er provided on an in-patient or outpatient basis.

11 ‘‘(5) HEALTH CARE WORKER.—The term

12 ‘health care worker’ means an individual employed

13 by an employer that provides—

14 ‘‘(A) health care services; or

15 ‘‘(B) necessary related services, including

16 administrative, food service, janitorial, or main17 tenance service to an entity that provides such

18 health care services.

19 ‘‘(6) HEALTH PLAN.—The term ‘health plan’

20 includes health insurance coverage, as defined in sec21 tion 2791(b)(1) of the Public Health Service Act (42

22 U.S.C. 300gg–91(b)(1)) and group health plans, as

23 defined in section 2791(a) of such Act (42 U.S.C.

24 300gg91(b)(1)).
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1 ‘‘(7) MENTAL HEALTH AND SUBSTANCE ABUSE

2 TREATMENT BENEFITS PARITY.—

3 ‘‘(A) IN GENERAL.—The term ‘mental

4 health and substance abuse treatment benefits

5 parity’ means the same level of parity for such

6 benefits as is required under the Federal Em7 ployees Health Benefits Program standard Blue

8 Cross/Blue Shield preferred provider option

9 service benefit plan, described in and offered

10 under section 8903(1) of part 5, United States

11 Code, as of January 1, 2001.

12 ‘‘(B) EXCEPTION.—Notwithstanding sub13 paragraph (A), there shall be no limit on parity

14 benefits for patients who do not substantially

15 follow their treatment plans unless such limits

16 also are imposed on all medical and surgical

17 benefits.

18 ‘‘(8) POVERTY LINE.—The term ‘poverty line’

19 has the meaning given such term in section 673(2)

20 of the Community Services Block Grant Act (42

21 U.S.C. 9902(2)), including any revision required by

22 such section.

23 ‘‘(9) PREMIUM.—The term ‘premium’ includes

24 any enrollment fees and other similar charges.
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1 ‘‘(10) QUALIFIED PLAN.—The term ‘qualified

2 plan’ means a health plan that satisfies the coverage

3 requirements described under section 2203 and par4 ticipates in an expansion phase (phase I) plan.’’.

5 TITLE II—HEALTH SECURITY

6 FOR ALL AMERICANS—UNI7 VERSAL PHASE (PHASE II)

8 SEC. 201. UNIVERSAL PHASE (PHASE II) STATE UNIVERSAL

9 HEALTH INSURANCE COVERAGE PLANS.

10 Title XXII of the Social Security Act, as added by

11 section 101, is amended by adding at the end the fol12 lowing:

13 ‘‘PART B—UNIVERSAL PHASE (PHASE II) PLANS

14 ‘‘SEC. 2211. PURPOSE; MANDATORY STATE PLANS.

15 ‘‘(a) PURPOSE.—The purposes of this part are to—

16 ‘‘(1) require States to establish and implement

17 State-administered systems to ensure universal

18 health insurance coverage; and

19 ‘‘(2) provide funds to States for the establish20 ment and implementation of such systems.

21 ‘‘(b) UNIVERSAL PHASE (PHASE II) PLAN RE22 QUIRED.—

23 ‘‘(1) IN GENERAL.—Except as provided in para24 graph (2), not later than January 1, 2004, a State

25 shall submit to the Secretary a plan that sets forth
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1 how the State intends to use the funds provided

2 under this part to ensure universal, affordable, and

3 comprehensive health insurance coverage to eligible

4 residents of the State consistent with the provisions

5 of this part.

6 ‘‘(2) STATES WITH PHASE I PLANS.—

7 ‘‘(A) IN GENERAL.—Not later than Janu8 ary 1, 2004, a State with a phase I State plan

9 shall submit an addendum to such plan that

10 provides assurances to the Secretary that such

11 plan conforms to the requirements of this part.

12 ‘‘(B) CONVERSION TO UNIVERSAL PHASE

13 (PHASE II) PLAN.—If an addendum to an ex14 pansion phase (phase I) plan is approved by the

15 Secretary—

16 ‘‘(i) the plan shall be automatically

17 converted to a universal phase (phase II)

18 plan; and

19 ‘‘(ii) section 2214 and any provision

20 of part A that is inconsistent with this

21 part shall not apply to the plan.

22 ‘‘(3) FAILURE TO SUBMIT PLAN OR ADDEN23 DUM.—If a State fails to submit a plan as required

24 in paragraph (1) (or an addendum as required in

25 paragraph (2)), or fails to have such plan or adden-
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1 dum approved by the Secretary, such State shall be

2 in violation of this part; and any residents of such

3 a State may bring a cause of action against the

4 State in Federal district court to require the State

5 to comply with the provisions of this part.

6 ‘‘SEC. 2212. PLAN REQUIREMENTS.

7 ‘‘(a) IN GENERAL.—A universal phase (phase II)

8 plan shall include a description, consistent with the re9 quirements of this part, of the following:

10 ‘‘(1) DETAILS OF THE UNIVERSAL PHASE

11 (PHASE II) PLAN.—The activities that the State in12 tends to carry out using funds received under this

13 part to ensure that all eligible residents of the State

14 have access to the coverage provided under this part,

15 including how the State will coordinate efforts under

16 the program under this part with existing State ef17 forts to increase to 100 percent the health insurance

18 coverage of eligible residents of the State by Janu19 ary 1, 2006.

20 ‘‘(2) REQUIREMENTS FOR EMPLOYERS.—The

21 manner in which the State will ensure that employ22 ers within the State will comply with the require23 ments of section 2214.

24 ‘‘(3) PART A PROVISIONS.—The following provi25 sions apply to a universal phase (phase II) plan
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1 under this part in the same manner as such provi2 sions apply to an expansion phase (phase I) plan

3 under part A:

4 ‘‘(A) STATE OUTREACH PROGRAMS; AC5 CESS.—Section 2202(a)(4).

6 ‘‘(B) ASSURANCE OF COVERAGE OF ESSEN7 TIAL SERVICES.—Section 2202(a)(5).

8 ‘‘(C) REPRESENTATION ON BOARDS AND

9 COMMISSIONS.—Section 2202(a)(6).

10 ‘‘(D) DISCLOSURE OF INFORMATION TO

11 THE PUBLIC.—Section 2202(a)(7).

12 ‘‘(E) CONSUMER PROTECTIONS AND WORK13 FORCE STANDARDS.—Section 2202(a)(8).

14 ‘‘(F) PUBLIC REVIEW.—Section

15 2202(a)(9).

16 ‘‘(G) SERVICES IN RURAL AND UNDER17 SERVED AREAS; CULTURAL COMPETENCY.—Sec18 tion 2202(a)(10).

19 ‘‘(H) PURCHASING POOLS.—Section

20 2202(a)(11).

21 ‘‘(I) LIMITATION ON ADMINISTRATIVE EX22 PENDITURES.—Section 2202(a)(12).

23 ‘‘(J) SELF-EMPLOYED AND MULTI24 EMPLOYED.—Section 2202(a)(13).
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1 ‘‘(K) MEDICAID WRAPAROUND COV2 ERAGE.—Section 2202(a)(14).

3 ‘‘(4) OTHER MATTERS.—Any other matter de4 termined appropriate by the Secretary.

5 ‘‘(b) PERMISSIBLE ACTIVITIES.—A State may use

6 amounts provided under this part for any activities con7 sistent with this part that are appropriate to enroll indi8 viduals in health plans to ensure that all eligible residents

9 of the State are provided coverage under this part, includ10 ing through the use of direct payments to health plans

11 or providers of services.

12 ‘‘(c) COST CONTAINMENT; COMPETITIVE BIDDING.—

13 Notwithstanding subsection (b), State purchasing pools

14 shall solicit bids from health plans at least annually.

15 ‘‘(d) PROCESS FOR SUBMISSION, APPROVAL, AND

16 AMENDMENT OF UNIVERSAL PHASE (PHASE II) PLAN.—

17 Section 2106 applies to a universal phase (phase II) plan

18 under this part in the same manner as such section applies

19 to a State plan under title XXI, except that no universal

20 phase (phase II) plan may be effective earlier than Janu21 ary 1, 2005, and all such plans must be submitted for

22 approval by not later than January 1, 2004.
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1 ‘‘SEC. 2213. COVERAGE REQUIREMENTS FOR UNIVERSAL

2 PHASE (PHASE II) PLANS.

3 ‘‘(a) REQUIRED SCOPE OF HEALTH INSURANCE COV4 ERAGE.—Section 2203(a) applies to a universal phase

5 (phase II) plan under this part.

6 ‘‘(b) UNIVERSAL COVERAGE.—All States shall ensure

7 that by January 1, 2006, 100 percent of eligible residents

8 of the State have health insurance coverage that meets

9 the requirements of section 2203(a).

10 ‘‘(c) LIMITATIONS ON PREMIUMS AND COST-SHAR11 ING.—Section 2203(b) applies to a universal phase (phase

12 II) plan under this part.

13 ‘‘(d) APPLICATION OF CERTAIN REQUIREMENTS.—

14 Section 2203(c) applies to a universal phase (phase II)

15 plan under this part.

16 ‘‘SEC. 2214. REQUIREMENTS FOR EMPLOYERS REGARDING

17 THE PROVISION OF BENEFITS.

18 ‘‘(a) REQUIREMENTS.—Subject to subsection

19 (c)(2)(B), an employer in a State shall comply with the

20 following requirements:

21 ‘‘(1) EMPLOYERS WITH LESS THAN 500 EM22 PLOYEES.—

23 ‘‘(A) IN GENERAL.—An employer with less

24 than 500 employees shall enroll each employee

25 in a State-designated purchasing pool.

26 ‘‘(B) CONTRIBUTIONS.—
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1 ‘‘(i) IN GENERAL.—Notwithstanding

2 subparagraph (A) and subject to clause

3 (ii), the employer shall make a contribution

4 on behalf of each employee for health in5 surance coverage that is equal to at least

6 80 percent of the total premiums for such

7 coverage for employees and their families if

8 the employee elects dependent coverage.

9 ‘‘(ii) LIMITATION.—An employer shall

10 not be liable under subparagraph (B) for

11 more than 10 percent of each employee’s

12 annual wages.

13 ‘‘(2) EMPLOYERS WITH AT LEAST 500 EMPLOY14 EES.—

15 ‘‘(A) IN GENERAL.—An employer with at

16 least 500 employees, a majority of whose wages

17 fall below an amount equal to 300 percent of

18 the poverty line applicable to a family of the

19 size involved, shall comply with the require20 ments applicable to an employer under para21 graph (1).

22 ‘‘(B) OTHER EMPLOYERS.—

23 ‘‘(i) IN GENERAL.—An employer with

24 at least 500 employees that is not de-
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1 scribed in subparagraph (A) shall, at the

2 option of the employer, either—

3 ‘‘(I) comply with the require4 ments applicable to an employer

5 under paragraph (1); or

6 ‘‘(II) provide health insurance

7 coverage to all employees and their

8 families (if the employee elects de9 pendent coverage) that meets the re10 quirements of section 2213 and the

11 employer contribution required under

12 paragraph (1)(B).

13 ‘‘(ii) ADDITIONAL EMPLOYER CON14 TRIBUTION.—An employer that elects to

15 comply with clause (i)(I) shall contribute

16 an additional 1 percent of payroll into the

17 State-designated purchasing pool in which

18 it participates.

19 ‘‘(3) RULE OF CONSTRUCTION.—Nothing in

20 this title shall be construed as prohibiting a labor or21 ganization from collectively bargaining for an em22 ployer contribution that is greater than the contribu23 tion that is required under paragraph (1)(B) or, as

24 applicable, for health insurance benefits that are
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1 greater than the coverage required under paragraph

2 section 2203(a).

3 ‘‘(4) PART-TIME EMPLOYEES.—An employer

4 shall be responsible for meeting the requirements

5 under this subsection for all employees of the em6 ployer.

7 ‘‘(5) MULTIEMPLOYER FAMILIES.—In the case

8 of a family with more than 1 employer, the employ9 ers of individuals within the family shall apportion

10 their contributions in accordance with rules estab11 lished by the State.

12 ‘‘(b) NONAPPLICABILITY.—This section shall not

13 apply—

14 ‘‘(1) to any State that establishes a single

15 payor system; or

16 ‘‘(2) to any State that established a universal

17 phase (phase II) plan through an approved adden18 dum to an expansion phase (phase I) plan.

19 ‘‘(c) PRIVATE CAUSE OF ACTION.—

20 ‘‘(1) LIABILITY.—An employer that fails to

21 comply with the requirements of subsection (a) or

22 otherwise takes adverse action against an employee

23 for the purpose of interfering with the attainment of

24 any right to which the employee may be entitled to
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1 under this title, shall be liable to the employee af2 fected.

3 ‘‘(2) AMOUNT.—The amount of the liability de4 scribed in paragraph (1) shall be an amount equal

5 to—

6 ‘‘(A) the contributions that otherwise

7 would have been made by the employer on be8 half of the employee under this section;

9 ‘‘(B) an additional amount as liquidated

10 damages; and

11 ‘‘(C) consequential damages for reasonably

12 foreseeable injuries resulting from such action.

13 ‘‘(3) JURISDICTION; EQUITABLE RELIEF.—

14 ‘‘(A) JURISDICTION.—An action under this

15 subsection may be maintained against any em16 ployer in any Federal or State court of com17 petent jurisdiction by any 1 or more employees.

18 ‘‘(B) EQUITABLE RELIEF.—In addition to

19 the damages described in paragraph (2), a

20 court may enjoin any act or practice that vio21 lates this title.

22 ‘‘(4) ATTORNEY’S FEES.—If a plaintiff or plain23 tiffs prevail in an action brought under this sub24 section, the court shall, in addition to any judgment

25 awarded to the plaintiff or plaintiffs, award the rea-
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1 sonable attorney’s fees and costs associated with the

2 bringing of the action.

3 ‘‘SEC. 2215. ALLOTMENTS.

4 ‘‘(a) STATE ALLOTMENTS.—Subsections (a) and (b)

5 of section 2204 apply to a universal phase (phase II) plan

6 under this part in the same manner as such subsections

7 apply to an expansion phase (phase I) plan under part

8 A.

9 ‘‘(b) SPECIAL RULE FOR EXPANSION PHASE (PHASE

10 I) PLANS.—A State that operated an expansion phase

11 (phase I) plan and converted such plan to a universal

12 phase (phase II) plan pursuant to section 2211(b)(2)(B)

13 shall continue to be eligible for the enhanced Federal par14 ticipation rate determined under section 2204(c).

15 ‘‘(c) GRANTS TO INDIAN TRIBES, NATIVE HAWAIIAN

16 ORGANIZATIONS, AND ALASKA NATIVE ORGANIZA17 TIONS.—Section 2204(d) applies to a universal phase

18 (phase II) plan under this part.

19 ‘‘(d) APPROPRIATION.—

20 ‘‘(1) IN GENERAL.—Out of any funds in the

21 Treasury not otherwise appropriated, there is appro22 priated to carry out this title such sums as may be

23 necessary for fiscal year 2005 and each fiscal year

24 thereafter.
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1 ‘‘(2) BUDGET AUTHORITY.—Paragraph (1) con2 stitutes budget authority in advance of appropria3 tions Acts and represents the obligation of the Fed4 eral Government to provide States, Indian tribes,

5 Native Hawaiian organizations, and Alaska Native

6 organizations with the allotments determined under

7 this section and the grants for administrative and

8 outreach activities under section 2205(a)(1)(B) (as

9 applied to this part under section 2216(a)).

10 ‘‘SEC. 2216. ADMINISTRATION; DEFINITIONS.

11 ‘‘(a) ADMINISTRATION.—The provisions of section

12 2205 (other than subsection (c) of such section) apply to

13 a universal phase (phase II) plan under this part in the

14 same manner as such provisions apply to an expansion

15 phase (phase I) plan under part A.

16 ‘‘(b) DEFINITIONS.—

17 ‘‘(1) APPLICATION OF SECTION 2206.—The defi18 nitions set forth in section 2206 apply to a universal

19 phase (phase II) plan under this part in the same

20 manner as such provisions apply to an expansion

21 phase (phase I) plan under part A except that for

22 purposes of this part, the definition of ‘eligible resi23 dents of a State’ set forth in section 2206(2) shall

24 be applied without regard to subparagraphs (A)(ii)

25 and (B).
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1 ‘‘(2) UNIVERSAL PHASE (PHASE II) PLAN.—In

2 this title, the term ‘universal phase (phase II) plan’

3 means the State universal health insurance coverage

4 plan submitted under section 2211(b).’’.

5 SEC. 202. CONSUMER PROTECTIONS.

6 Title XXII of the Social Security Act, as amended

7 by section 201, is amended by adding at the end the fol8 lowing:

9 ‘‘PART C—CONSUMER PROTECTIONS

10 ‘‘SEC. 2221. HOME CARE STANDARDS.

11 ‘‘In order to ensure that home care services are pro12 vided in a consumer-directed manner, a State partici13 pating under part A, and, effective January 1, 2005, all

14 States under part B, shall satisfy the Secretary that any

15 health plan that provides home care services under this

16 title creates, or contracts with, a viable entity other than

17 the consumer or individual provider to provide effective

18 billing, payments for services, tax withholding, unemploy19 ment insurance, and workers compensation coverage, and

20 to serve as the statutory employer of the home care pro21 vider. Recipients of such services shall retain the right to

22 independently select, hire, terminate, and direct the work

23 of the home care provider.
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1 ‘‘SEC. 2222. CONSUMER PROTECTION IN THE EVENT OF

2 TERMINATION OR SUSPENSION OF SERVICES.

3 ‘‘A State participating under part A, and, effective

4 January 1, 2005, all States under part B, shall satisfy

5 the Secretary that any health plan providing services

6 under this title shall ensure that enrollees will receive con7 tinued health services in the event that the plan’s health

8 care services are terminated or suspended, including as

9 the result of the plan filing for bankruptcy relief under

10 title 11, United States Code, or the failure of the plan

11 to provide payments to providers, lockouts, work stop12 pages, or other labor management problems.

13 ‘‘SEC. 2223. CONSUMER PROTECTION THROUGH DISCLO14 SURE OF INFORMATION.

15 ‘‘(a) IN GENERAL.—A State participating under part

16 A, and, effective January 1, 2005, all States under part

17 B, shall satisfy the Secretary that any health care provider

18 that provides services to individuals under this title shall

19 provide to the State information regarding the identity,

20 employment location, and qualifications of health care

21 workers providing services under—

22 ‘‘(1) the licensure of the provider; or

23 ‘‘(2) a contract between the provider and a

24 health plan or the State.
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1 ‘‘(b) AVAILABILITY TO PUBLIC.—A health care pro2 vider shall make the information described in subsection

3 (a) available to the public.

4 ‘‘SEC. 2224. CONSUMER PROTECTION THROUGH NOTICE OF

5 CHANGES IN HEALTH CARE DELIVERY.

6 ‘‘A State participating under part A, and, effective

7 January 1, 2005, all States under part B, shall describe

8 how the State will provide, at a minimum, the following

9 protections:

10 ‘‘(1) Adequate advance notice to the public, the

11 affected health care workers, and labor organizations

12 representing such workers, of a pending—

13 ‘‘(A) facility or operating unit closure;

14 ‘‘(B) sale, merger, or consolidation of a fa15 cility or operating unit;

16 ‘‘(C) transfer of work from 1 facility or en17 tity to another facility or entity; or

18 ‘‘(D) reduction of services.

19 ‘‘(2) A right of first refusal for similar vacant

20 positions with—

21 ‘‘(A) the resulting entity, in the case of a

22 health care worker whose position was elimi23 nated following a merger of the worker’s origi24 nal employer with a new entity; or
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1 ‘‘(B) the contractor, in the case of a health

2 care worker whose position was eliminated fol3 lowing the contracting out of the work the

4 worker formerly performed.’’.

5 TITLE III—PATIENT

6 PROTECTIONS

7 SEC. 301. INCORPORATION OF CERTAIN PROTECTIONS.

8 (a) INCORPORATION.—The provisions of the following

9 bills are hereby enacted into law:

10 (1) H.R. 2723 of the 106th Congress (other

11 than section 135(b)), as passed the House of Rep12 resentatives on October 7, 1999.

13 (2) H.R. 137 of the 106th Congress, as intro14 duced on January 6, 1999.

15 (b) PUBLICATION.—In publishing this Act in slip

16 form and in the United States Statutes at Large pursuant

17 to section 112, of title 1, United States Code, the Archivist

18 of the United States shall include after the date of ap19 proval at the end appendixes setting forth the texts of the

20 bills referred to in subsection (a) of this section.
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1 TITLE IV—HEALTH CARE QUAL2 ITY, PATIENT SAFETY, AND

3 WORKFORCE STANDARDS

4 SEC. 401. HEALTH CARE QUALITY, PATIENT SAFETY, AND

5 WORKFORCE STANDARDS INSTITUTE.

6 (a) ESTABLISHMENT.—

7 (1) INSTITUTE.—There is established within

8 the Agency for Healthcare Research and Quality, an

9 institute to be known as the Health Care Quality,

10 Patient Safety, and Workforce Standards Institute

11 (in this section referred to as the ‘‘Institute’’).

12 (2) DIRECTOR.—The Secretary of Health and

13 Human Services shall appoint a director of the Insti14 tute. The director shall administer the Institute and

15 carry out the duties of the director under this sec16 tion subject to the authority, direction, and control

17 of the Secretary.

18 (b) MISSION.—The mission of the Institute is to—

19 (1) demonstrate how patient safety issues and

20 workplace conditions are linked to quality patient

21 care and the reduction of the incidence of medical

22 errors; and

23 (2) reduce the incidence of medical errors and

24 improve patient safety and quality of care.
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1 (c) DUTIES.—In carrying out the mission of the In2 stitute, the director of the Institute shall—

3 (1) work closely with the director of the Agency

4 for Healthcare Research and Quality to ensure that

5 issues related to workplace conditions are reflected

6 in the activities conducted by such agency in order

7 to reduce the incidence of medical errors and im8 prove patient safety and quality of care, including—

9 (A) the establishment of national goals;

10 (B) the development and implementation

11 of a research agenda;

12 (C) the development and promotion of best

13 practices;

14 (D) the development of performance and

15 staffing standards in consultation with the

16 Health Care Financing Administration and

17 other Federal agencies, as appropriate; and

18 (E) the development and dissemination of

19 information, educational and training materials,

20 and other criteria as it relates to the delivery of

21 quality care;

22 (2) provide recommendations to the Secretary

23 of Health and Human Services and other Federal

24 agencies with responsibility for health care quality

25 and the development of standards that impact on
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1 the delivery of quality patient care on standards re2 lated to workplace conditions and patient safety;

3 (3) support the activities of the Health Care Fi4 nancing Administration related to the development

5 of new or revised conditions of participation under

6 the medicare and medicaid programs and subsequent

7 rulemaking on issues related to workplace condi8 tions, medical errors, and patient safety and quality

9 of care; and

10 (4) conduct other activities determined appro11 priate by the director of the Institute.

12 (d) WORKPLACE CONDITIONS.—For purposes of this

13 section, the term ‘‘workplace conditions’’ shall include

14 issues related to—

15 (1) health care worker staffing;

16 (2) hours of work;

17 (3) confidentiality and whistleblower protec18 tions;

19 (4) employee participation in decisionmaking

20 roles that contribute to improved quality of care and

21 the reduction of the incidence of medical errors;

22 (5) workforce training; and

23 (6) the impact of health care delivery restruc24 turing on communities and health care workers.

25 (e) DEFINITION OF HEALTH CARE WORKER.—
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1 (1) IN GENERAL.—In this section, the term

2 ‘‘health care worker’’ means an individual employed

3 by an employer that provides—

4 (A) health care services; or

5 (B) necessary related services, including

6 administrative, food service, janitorial, or main7 tenance service to an entity that provides such

8 health care services.

9 (2) HEALTH CARE SERVICES.—In paragraph

10 (1), the term ‘‘health care services’’ includes med11 ical, surgical, mental health, and substance abuse

12 services, whether provided on an in-patient or out13 patient basis.

14 (f) AUTHORIZATION OF APPROPRIATIONS.—There

15 are authorized to be appropriated to the Institute such

16 sums as may be necessary to carry out the purposes of

17 this section.

18 SEC. 402. HEALTH CARE QUALITY, PATIENT SAFETY, AND

19 WORKFORCE STANDARDS ADVISORY COM20 MITTEE.

21 (a) ESTABLISHMENT OF COMMITTEE.—There is es22 tablished a Health Care Quality, Patient Safety, and

23 Workforce Standards Committee (in this section referred

24 to as the ‘‘Committee’’).

25 (b) FUNCTIONS OF COMMITTEE.—
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1 (1) ADVICE TO INSTITUTE.—The Committee

2 shall provide advice to the Director of the Health

3 Care Quality, Patient Safety, and Workforce Stand4 ards Institute established under section 401 on

5 issues related to the duties of the Director.

6 (2) INITIAL REPORT.—Not later than December

7 31, 2001, the Committee shall submit an initial re8 port to the Secretary that contains—

9 (A) recommendations regarding minimal

10 workforce standards that are critical for im11 proved health care quality and patient safety;

12 and

13 (B) recommendations regarding additional

14 ways to reduce the incidence of medical errors

15 and to improve patient safety and quality of

16 care.

17 (3) FINAL REPORT.—Not later than December

18 31, 2002, the Committee shall submit a final report

19 to the Secretary of Health and Human Services re20 garding the recommendations contained in the initial

21 report required under paragraph (2), including any

22 modifications of such recommendations.

23 (c) STRUCTURE AND MEMBERSHIP OF THE COM24 MITTEE.—
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1 (1) STRUCTURE.—The Committee shall be com2 posed of the Director of the Health Care Quality,

3 Patient Safety, and Workforce Standards Institute

4 established under section 401 and 15 additional

5 members who shall be appointed by the Secretary of

6 Health and Human Services.

7 (2) MEMBERSHIP.—

8 (A) IN GENERAL.—The members of the

9 Committee shall be chosen on the basis of their

10 integrity, impartiality, and good judgment, and

11 shall be individuals who are, by reason of their

12 education, experience, and attainments, excep13 tionally qualified to perform the duties of mem14 bers of the Committee.

15 (B) SPECIFIC MEMBERS.—In making ap16 pointments under paragraph (1), the Secretary

17 of Health and Human Services shall ensure

18 that the following groups are represented:

19 (i) Health care providers and health

20 care workers, including labor unions rep21 resenting health care workers.

22 (ii) Consumer organizations.

23 (iii) Health care institutions.

24 (iv) Health education organizations.
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1 (d) CHAIRMAN.—The Director of the Health Care

2 Quality, Patient Safety, and Workforce Standards Insti3 tute established under section 401 shall chair the Com4 mittee.

5 TITLE V—IMPROVING MEDICARE

6 BENEFITS

7 SEC. 501. FULL MENTAL HEALTH AND SUBSTANCE ABUSE

8 TREATMENT BENEFITS PARITY.

9 Notwithstanding any provision of title XVIII of the

10 Social Security Act (42 U.S.C. 1395 et seq.), beginning

11 January 1, 2001, each individual who is entitled to bene12 fits under part A or enrolled under part B of the medicare

13 program, including an individual enrolled in a

14 Medicare+Choice plan offered by a Medicare+Choice or15 ganization under part C of such program, shall be pro16 vided full mental health and substance abuse treatment

17 parity under the medicare program established under such

18 title of such Act consistent with title XXII of the Social

19 Security Act (as added by this Act).

20 TITLE VI—LONG-TERM AND

21 HOME HEALTH CARE

22 SEC. 601. STUDIES AND DEMONSTRATION PROJECTS TO

23 IDENTIFY MODEL PROGRAMS.

24 The Secretary of Health of Human Services shall—
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1 (1) conduct studies and demonstration projects,

2 through grant, contract, or interagency agreement,

3 that are designed to identify model programs for the

4 provision of long-term and home health care serv5 ices;

6 (2) report regularly to Congress on the results

7 of such studies and demonstration projects; and

8 (3) include in such report any recommendations

9 for legislation to expand or continue such studies

10 and projects.

11 TITLE VII—MISCELLANEOUS

12 SEC. 701. NONAPPLICATION OF ERISA.

13 The provisions of section 514 of the Employee Retire14 ment Income Security Act of 1974 (29 U.S.C. 1144) shall

15 not apply with respect to health benefits provided under

16 a group health plan (as defined in section 733(a) of that

17 Act (29 U.S.C. 1191b(a))) qualified to offer such benefits

18 under an expansion phase (phase I) plan under title XXII

19 of the Social Security Act (as added by this Act) or under

20 a universal phase (phase II) plan under such title.

21 SEC. 702. SENSE OF CONGRESS REGARDING OFFSETS.

22 It is the sense of Congress that any sums necessary

23 for the implementation of this Act, and the amendments

24 made by this Act, should be offset by—
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1 (1) general revenues available as a result of an

2 on-budget surplus for a fiscal year;

3 (2) direct savings in health care expenditures

4 resulting from the implementation of this Act; and

5 (3) reductions in unnecessary Federal tax bene6 fits available only to individuals and large corpora7 tions that are in the maximum tax brackets.

Æ