I

104TH CONGRESS

1ST SESSION H. R. 1798

To establish a United States Health Service to provide high quality comprehensive health care for all Americans and to overcome the deficiencies

in the present system of health care delivery.

IN THE HOUSE OF REPRESENTATIVES

JUNE 8, 1995

Mr. DELLUMS introduced the following bill; which was referred to the Committee on Commerce, and in addition to the Committees on Ways and

Means, the Judiciary, Government Reform and Oversight, National Security, and Veterans’ Affairs, 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 establish a United States Health Service to provide high

quality comprehensive health care for all Americans and

to overcome the deficiencies in the present system of

health care delivery.

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

3 SHORT TITLE

4 SECTION 1. This Act may be cited as the ‘‘United

5 States Health Service Act’’.

TABLE OF CONTENTS

Sec. 1. Short title.
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Sec. 2. Findings.

Sec. 3. Purposes.

Sec. 4. Definitions.

TITLE I—ESTABLISHMENT AND OPERATION OF THE UNITED

STATES HEALTH SERVICE

PART A—INITIAL ORGANIZATION

Sec. 101. Establishment of the Service.

Sec. 102. Appointment of Interim National Health Board.

Sec. 103. Powers and duties of the Interim National Health Board.

Sec. 104. Authorization.

PART B—ORGANIZATION OF AREA HEALTH BOARDS

Sec. 111. Establishment of health care delivery regions.

Sec. 112. Appointment of interim regional health boards.

Sec. 113. Establishment of health care delivery districts and health care delivery communities.

Sec. 114. Election of community health boards.

Sec. 115. Appointment of district health boards.

Sec. 116. Appointment of regional health boards.

Sec. 117. Appointment of the National Health Board.

Sec. 118. Subsequent election and appointment of members of health boards.

Sec. 119. Modification of the boundaries of health care delivery areas.

PART C—GENERAL PROVISIONS REGARDING HEALTH BOARDS

Sec. 121. Definitions.

Sec. 122. Membership of health boards.

Sec. 123. Meetings and records of health boards.

Sec. 124. Procedures for establishment of national guidelines and standards.

Sec. 125. Assistance to area health board members.

TITLE II—DELIVERY OF HEALTH CARE AND SUPPLEMENTAL

SERVICES

PART A—PATIENTS RIGHTS IN HEALTH CARE DELIVERY

Sec. 201. Basic health rights.

Sec. 202. Right to paid leave to receive health care services.

PART B—ELIGIBILITY FOR, NATURE OF, AND SCOPE OF SERVICES

PROVIDED BY THE SERVICE

Sec. 211. Eligibility for services.

Sec. 212. Entitlement to services.

Sec. 213. Provision of health care and supplemental services.

PART C—HEALTH CARE FACILITIES AND DELIVERY OF HEALTH CARE

SERVICES

Sec. 221. Establishment of health care facilities and distribution of delivery of

health care and other services.

Sec. 222. Operation and inspection of health care facilities.

Sec. 223. Provision of health services relating to reproduction and child-bearing.
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TITLE III—HEALTH LABOR FORCE

PART A—JOB CATEGORIES AND CERTIFICATION

Sec. 301. Effect of State law.

Sec. 302. Qualifications of health workers.

Sec. 303. Establishment of job categories and certification standards.

PART B—EDUCATION OF HEALTH WORKERS

Sec. 311. Health team schools.

Sec. 312. Service requirement.

Sec. 313. Payment for certain educational loans.

PART C—EMPLOYMENT AND LABOR-MANAGEMENT RELATIONS WITHIN THE

SERVICE

Sec. 321. Employment, transfer, promotion, and receipt of fees.

Sec. 322. Applicability of laws relating to Federal employees.

Sec. 323. Applicability of Federal labor-management relations laws.

Sec. 324. Defense of certain malpractice and negligence suits.

TITLE IV—OTHER FUNCTIONS OF HEALTH BOARDS

PART A—ADVOCACY, GRIEVANCE PROCEDURES, AND TRUSTEESHIPS

Sec. 401. Advocacy and legal services program.

Sec. 402. Grievance procedures and trusteeships.

PART B—OCCUPATIONAL SAFETY AND HEALTH PROGRAMS

Sec. 411. Functions of the National Health Board.

Sec. 412. Community occupational safety and health activities.

Sec. 413. Regional occupational safety and health programs.

Sec. 414. Workplace health facilities.

Sec. 415. Employee rights relating to occupational safety and health.

Sec. 416. Definitions.

PART C—HEALTH AND HEALTH CARE DELIVERY RESEARCH

Sec. 421. Principles and guidelines for research.

Sec. 422. Establishment of institutes.

PART D—HEALTH PLANNING, DISTRIBUTION OF DRUGS AND OTHER

MEDICAL SUPPLIES, AND MISCELLANEOUS FUNCTIONS

Sec. 431. Health planning and budgeting.

Sec. 432. Distribution of drugs and other medical supplies.

Sec. 433. Miscellaneous functions of the National Health Board.

TITLE V—FINANCING OF THE SERVICE

PART A—HEALTH SERVICE TAXES

Sec. 501. Individual and corporate income taxes.

Sec. 502. Other changes in the Internal Revenue Code of 1954.

Sec. 503. Existing employer-employee health benefit plans.

Sec. 504. Workers compensation programs.
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PART B—HEALTH SERVICE TRUST FUND

Sec. 511. Establishment of health service trust fund.

Sec. 512. Transfer of funds to the health service trust fund.

Sec. 513. Administration of health service trust fund.

PART C—PREPARATION OF PLANS AND BUDGETS

Sec. 521. Determination of fund availability.

Sec. 522. Preparation of area plans and budgets.

PART D—ALLOCATION AND DISTRIBUTION OF FUNDS

Sec. 531. National budget.

Sec. 532. Regional budgets.

Sec. 533. District budgets.

Sec. 534. Special operating expense fund.

Sec. 535. Distribution of funds.

Sec. 536. Annual statement, records, and audits.

PART E—GENERAL PROVISIONS

Sec. 541. Issuance of obligations.

Sec. 542. Definitions.

TITLE VI—MISCELLANEOUS PROVISIONS

Sec. 601. Effective date of health services.

Sec. 602. Repeal of provisions.

Sec. 603. Transition provisions.

Sec. 604. Amendment to Budget and Accounting Act.

Sec. 605. Separability.

1 FINDINGS

2 SEC. 2. The Congress makes the following findings:

3 (1) The health of the Nation’s people is a foun4 dation of their well-being.

5 (2) High quality health care is a right of all

6 people.

7 (3) Many of the Nation’s people are unable

8 fully to exercise this right because of the inability of

9 the present health care delivery system to make high

10 quality health care available to all individuals re11 gardless of race, sex, age, national origin, income,
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1 marital status, sexual orientation, religion, political

2 belief, place of residence, or previous health status.

3 (4) The present health care system has failed to

4 address the basic deterioration in occupational, envi5 ronmental, and social conditions affecting the health

6 of the people of this Nation.

7 (5) Unnecessary and excessive profits and ad8 ministrative expenses have inflated the cost of health

9 care.

10 (6) The health professions have failed to control

11 the cost of their services and the imbalance in the

12 number of health workers among geographic areas

13 or health care specialties.

14 (7) The present health care system has failed to

15 make full and efficient use of allied health workers.

16 (8) A United States Health Service is the best

17 means to implement the right to high quality health

18 care and to overcome the deficiencies in the present

19 health care delivery system.

20 PURPOSES

21 SEC. 3. The purposes of this Act are:

22 (1) To create a United States Health Service to

23 provide without charge to all residents, regardless of

24 race, sex, age, national origin, income, marital sta25 tus, sexual orientation, religion, political belief, place

26 of residence, or previous health status, comprehen-
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1 sive health care services delivered by salaried health

2 workers and emphasizing the promotion and mainte3 nance of health as well as the treatment of illness.

4 (2) To establish representative and democratic

5 governance of the Service through community boards

6 chosen through community elections, district and re7 gional boards selected by the community and district

8 boards, respectively, and a National Health Board

9 selected by the regional boards, subject to the ap10 proval of the President.

11 (3) To provide health workers in the Service

12 with fair and reasonable compensation, secure em13 ployment, opportunities for full and equal participa14 tion in the governance of health facilities, and oppor15 tunities for advancement without regard to race, sex,

16 age, national origin, sexual orientation, religion, or

17 political belief.

18 (4) To increase the availability and continuity

19 of health care by linking local health care facilities

20 to hospitals and specialized care facilities.

21 (5) To implement local, regional, and national

22 planning for the establishing, equipping, and staffing

23 of health care facilities needed to overcome present

24 shortages and redistribute health resources, espe25 cially for currently deprived inner-city and rural pop-
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1 ulations, minority groups, prisoners, and occupa2 tional groups.

3 (6) To finance the Service through progressive

4 taxation of individuals and employer contributions,

5 and to distribute these revenues on a capitation

6 basis, supplemented by allocations to meet special

7 health care needs.

8 DEFINITIONS

9 SEC. 4. For the purposes of this Act, unless the con10 text implies otherwise:

11 Service

12 (1) The term ‘‘Service’’ means the United

13 States Health Service established in section 101.

14 National Health Board; Interim National Health

15 Board; Appropriate National Health Board

16 (2)(A) The term ‘‘National Health Board’’

17 means the National Health Board of the Service.

18 (B) The term ‘‘Interim National Health Board’’

19 means the Interim National Health Board, ap20 pointed under section 102, of the Service.

21 (C) The term ‘‘appropriate National Health

22 Board’’ means—

23 (i) the Interim National Health Board,

24 prior to the initial meeting of the National

25 Health Board under section 117, and
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1 (ii) the National Health Board, at and

2 after such meeting.

3 Health Board; Area Health Board

4 (3)(A) The term ‘‘health board’’ means the In5 terim National Health Board, National Health

6 Board, an interim regional health board, a regional

7 health board, a district health board, or a commu8 nity health board established under this Act.

9 (B) The term ‘‘area health board’’ means a re10 gional health board, a district health board, or a

11 community health board established under this Act.

12 Community; District; Region; Area

13 (4)(A) The term ‘‘community’’ means a health

14 care delivery community established under title I.

15 (B) The term ‘‘district’’ means a health care

16 delivery district established under title I.

17 (C) The term ‘‘region’’ means a health care de18 livery region established under title I.

19 (D) The term ‘‘area’’ means, with respect to an

20 area health board or an area health care facility—

21 (i) in the case of a community board or a

22 health care facility established by a community

23 board, the community for which such board is

24 established or in which the facility is located;
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1 (ii) in the case of a district board or a

2 health care facility established by a district

3 board, the district for which such board is es4 tablished or in which the facility is located; and

5 (iii) in the case of a regional board or a

6 health care facility established by a regional

7 board, the region for which such board is estab8 lished or in which the facility is located.

9 Interim Regional Board; Regional Board; District

10 Board; Community Board

11 (5)(A) The term ‘‘interim regional board’’

12 means an interim regional health board established

13 in accordance with section 112.

14 (B) The term ‘‘regional board’’ means a re15 gional health board established in accordance with

16 title I.

17 (C) The term ‘‘district board’’ means a district

18 health board established in accordance with title I.

19 (D) The term ‘‘community board’’ means a

20 community health board established in accordance

21 with title I.

22 Respective Regional and District Board

23 (6)(A) The terms ‘‘respective regional board’’

24 and ‘‘respective interim regional board’’ mean, with

25 respect to a community board or a district board,
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1 the regional board or interim regional board, respec2 tively, for the region which contains the community

3 or district for which such community board or dis4 trict board is established.

5 (B) The term ‘‘respective district board’’

6 means, with respect to a community board, the dis7 trict board for the district which contains the com8 munity for which such community board is estab9 lished.

10 User; Registered User; Eligible User;

11 User Member

12 (7)(A) The term ‘‘user’’ means an individual

13 who is eligible under section 211 to receive health

14 care services from the Service under this Act.

15 (B) The term ‘‘registered user’’ means, with re16 spect to an area, a user who resides in the area and

17 is registered to vote in the area in general elections

18 for Federal, State, or local officials.

19 (C) The term ‘‘eligible user’’ means, for pur20 poses of sections 114 through 118, with respect to

21 a community, district, or region, an individual who

22 (i) is 18 years of age or older, (ii) resides in the

23 community, district, or region, respectively, and (iii)

24 is not a health worker (as defined in paragraph

25 (8)(A)), an indirect provider of health care (as de-
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1 fined in subparagraph (E)), or a member of the im2 mediate family of such a worker or indirect provider.

3 (D) The term ‘‘user member’’ means, with re4 spect to a health board, an eligible user elected or

5 appointed by users or user members to the health

6 board under sections 114 through 118.

7 (E) The term ‘‘indirect provider of health care’’

8 means an individual who—

9 (i) receives (either directly or through his

10 or her spouse) more than one-tenth of his or

11 her gross annual income from any one or com12 bination of—

13 (I) fees or other compensation for

14 provision of, research into, or instruction

15 in, the provision of health care,

16 (II) entities engaged in the provision

17 of health care or in such research or in18 struction,

19 (III) producing or supplying drugs or

20 other articles for individuals or entities for

21 use in the provision of or in research into

22 or instruction in the provision of health

23 care, or

24 (IV) entities engaged in producing

25 drugs or such other articles;
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1 (ii) holds a fiduciary position with, or has

2 a fiduciary interest in, any entity described in

3 subclause (II) or (IV) of clause (i); or

4 (iii) is engaged in issuing any policy or

5 contract of individual or group health insurance

6 or hospital or medical service benefits.

7 Health Worker; Authorized Health Worker; Eligible

8 Health Worker; Worker Member

9 (8)(A) The term ‘‘health worker’’ includes—

10 (i) any employee of the Service; and

11 (ii) any individual who for remuneration

12 delivers, administers any program in, provides

13 supporting services for, teaches the subject

14 matter of, or performs research in, health care

15 services.

16 (B) The term ‘‘authorized health worker’’

17 means, with respect to a specified health care serv18 ice, an individual who is an employee of the Service

19 and is authorized by a health board to deliver the

20 service.

21 (C) The term ‘‘eligible area health worker’’

22 means, for purposes of sections 114 through 118

23 with respect to a community, district, or region, a

24 health worker who is employed by the community,

25 district, or regional health board (respectively) or, in
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1 the case of sections 114 through 117, is scheduled

2 to be employed by such board on the effective date

3 of health services.

4 (D) The term ‘‘worker member’’ means, with

5 respect to a health board, an eligible area health

6 worker elected or appointed by health workers or

7 worker members to the health board under sections

8 114 through 118.

9 Health Care Facility; Area Health Care

10 Facility

11 (9)(A) The term ‘‘health care facility’’ means

12 an administrative unit composed of specified staff,

13 equipment, and premises and established by a health

14 board as an appropriate unit of organization for the

15 delivery of specified health care or supplemental

16 services under this Act.

17 (B) The term ‘‘area health care facility’’ means,

18 with respect to an area health board, a health care

19 facility established by the area health board.

20 Health Care Service; Supplemental Services

21 (10)(A) The term ‘‘health care services’’ means

22 the services described in paragraphs (1) through (5)

23 of section 213(a).
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1 (B) The term ‘‘supplemental services’’ means

2 the services described in paragraphs (1), (2), and

3 (3) of section 213(b).

4 Number of Residents

5 (11) The term ‘‘number of residents’’ means

6 the number of residents in a health care delivery

7 area as determined by the most recent decennial na8 tional census.

9 Effective Date of Health Services

10 (12) The term ‘‘effective date of health serv11 ices’’ means the effective date of health services

12 under this Act as specified in section 601.

13 TITLE I—ESTABLISHMENT AND OPERATION OF

14 THE UNITED STATES HEALTH SERVICE

15 PART A—INITIAL ORGANIZATION

16 ESTABLISHMENT OF THE SERVICE

17 SEC. 101. (a) There is established, as an independent

18 establishment of the executive branch of the United

19 States, the United States Health Service.

20 (b)(1) The authority of the Service shall be exercised

21 by the appropriate National Health Board and, in accord22 ance with this Act and guidelines established by such

23 Board, by area health boards.

24 (2) The Service shall have the authority, under the

25 power of eminent domain, to acquire by condemnation
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1 under judicial process real estate for the Service for public

2 purposes whenever it is necessary or advantageous to do

3 so.

4 APPOINTMENT OF INTERIM NATIONAL HEALTH BOARD

5 SEC. 102. (a) The President shall, no later than 30

6 days after the date of enactment of this Act, appoint 21

7 individuals—

8 (1) who are 18 years of age or older,

9 (2) who are concerned about the health care

10 problems of the Nation,

11 (3) who approximate the Nation’s population by

12 race, sex, income, language, and region of residence,

13 and

14 (4) no more than seven of whom are or have

15 been health workers, indirect providers of health

16 care, or members of the immediate family of such

17 workers or indirect providers within 24 months of

18 the date of such nomination.

19 To serve as members of the Interim National Health

20 Board of the Service.

21 (b) The President shall, at the time of such appoint22 ments, designate two nominees to the Interim National

23 Health Board who are not and have not been health work24 ers, indirect providers of health care, or members of the

25 immediate family of such workers or indirect providers
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1 within 24 months of the date of such appointment as

2 chairperson and vice chairperson of such Board.

3 POWERS AND DUTIES OF THE INTERIM NATIONAL

4 HEALTH BOARD

5 SEC. 103. (a) The members of the Interim National

6 Health Board shall serve as the National Health Board

7 of the Service until the National Health Board holds its

8 initial meeting in accordance with section 117(c)(2).

9 (b) The Interim National Health Board shall—

10 (1) establish the boundaries of health care de11 livery regions, in accordance with section 111;

12 (2) select interim regional health boards in ac13 cordance with section 111;

14 (3) assist interim regional health boards in the

15 performance of their functions;

16 (4) coordinate the initial election of community

17 health boards, under section 114; and

18 (5) carry out such duties of the National

19 Health Board as it deems necessary and consistent

20 with the timetable given under this Act and the pur21 poses of the Service, except that no staff member

22 may be appointed and no employee may be hired by

23 the Interim National Health Board for a period ex24 tending beyond 90 days after the appointment of the

25 National Health Board under section 117.
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1 (c) The Interim National Health Board shall operate

2 in a manner consistent with the provisions of part C.

3 (d) The Interim National Health Board shall submit

4 a report to Congress on its performance under this Act

5 no later than 30 days after the appointment of the Na6 tional Health Board under section 117.

7 AUTHORIZATION

8 SEC. 104. There are authorized to be appropriated

9 to the Service $4,000,000,000 to carry out the provisions

10 of this Act with respect to the establishment of the Serv11 ice. Funds appropriated under this section shall remain

12 available until expended.

13 PART B—ORGANIZATION OF AREA HEALTH BOARDS

14 ESTABLISHMENT OF HEALTH CARE DELIVERY REGIONS

15 SEC. 111. (a) No later than 6 months after the ap16 pointment of members of the Interim National Health

17 Board, such Board shall establish, in accordance with this

18 section, health care delivery regions throughout the United

19 States.

20 (b) Each health care delivery region shall meet the

21 following requirements:

22 (1) The region shall be a contiguous geographic

23 area appropriate for the effective governance, plan24 ning, and delivery of all health care and supple25 mental services under this Act for residents of the

26 region.
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1 (2) The region shall have a population of not

2 less than 500,000 and of not more than 3,000,000

3 individuals, except that—

4 (A) the population of a region may be

5 more than 3,000,000 if the region includes a

6 standard metropolitan statistical area (as deter7 mined by the Office of Management and Budg8 et) with a population of more than three mil9 lion; and

10 (B) the population of a region may be less

11 than 500,000 if the Interim National Health

12 Board determines that this is necessary to fa13 cilitate the delivery of health care and supple14 mental services or the effective governance of

15 the health program within such region.

16 (3) The boundaries of each region shall take

17 into account—

18 (A) any economic or geographic barrier to

19 the receipt of health care and supplemental

20 services in nonmetropolitan areas, and

21 (B) the differences in needs between

22 nonmetropolitan and metropolitan areas in the

23 planning, development, and delivery of health

24 care and supplemental services.
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1 (c) At least 60 days prior to the establishment of the

2 boundaries of any region, the Interim National Health

3 Board shall provide for—

4 (1) notice in the area which would be affected

5 by the establishment of such boundaries of the

6 boundaries proposed to be established, and of the

7 date, time, and location of the public hearing on

8 such establishment as provided in paragraph (2);

9 and

10 (2) a public hearing at which individuals can

11 speak or present written statements relating to the

12 establishment of such boundaries.

13 (d) The boundaries of regions shall be modified in

14 accordance with section 119.

15 APPOINTMENT OF INTERIM REGIONAL HEALTH BOARDS

16 SEC. 112. (a) No later than 60 days after the estab17 lishment of health care delivery regions under section 111,

18 the Interim National Health Board shall appoint an in19 terim regional board for each such region.

20 (b) Each interim regional board shall be composed

21 of nine members—

22 (1) who are 18 years of age or older;

23 (2) who are concerned about the health care

24 problems of their region;
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1 (3) who approximate the region’s population by

2 race, sex, income, and language; and

3 (4) no more than three of whom are or have

4 been health workers, indirect providers or health

5 care, or members of the immediate family of such

6 workers or indirect providers within 24 months of

7 the date of such appointment.

8 (c) The Interim National Health Board shall, at the

9 time of appointment of each interim regional board, des10 ignate two members of the board who are not and have

11 not been health workers, indirect providers of health care,

12 or members of the immediate family of such workers or

13 indirect providers within 24 months of the date of such

14 appointment as chairperson and vice chairperson of such

15 board.

16 (d) A vacancy in the membership of an interim re17 gional board shall be filled in the same manner as the

18 original appointment.

19 (e) The members of an interim regional board shall

20 serve until the certification of appointment of a regional

21 board in its region in accordance with section 116.

22 (f) Each interim regional board shall—

23 (1) establish the boundaries of health care de24 livery districts and of health care delivery commu-
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1 nities within its region in accordance with section

2 113;

3 (2) conduct elections for voting members of

4 community boards within its region, in accordance

5 with section 114; and

6 (3) carry out such functions of a regional

7 board, set out under this Act, as the Interim Na8 tional Health Board deems appropriate for the pur9 poses of this Act.

10 (g) Each interim regional board shall operate in a

11 manner in accordance with part C of this title.

12 ESTABLISHMENT OF HEALTH CARE DELIVERY DISTRICTS

13 AND HEALTH CARE DELIVERY COMMUNITIES

14 SEC. 113. (a) No later than 6 months after its ap15 pointment under section 112, each interim regional board

16 shall establish, in accordance with this section, health care

17 delivery districts and health care delivery communities

18 throughout its region.

19 (b) Each region shall be divided into three or more

20 health care delivery districts. Each such district shall meet

21 the following requirements:

22 (1) The district shall be a contiguous geo23 graphic area appropriate for the effective govern24 ance, planning, and delivery of all health care serv-
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1 ices, except for highly specialized health services, for

2 residents of such district.

3 (2) The district shall have a population of not

4 less than 100,000 and of not more than 500,000 in5 dividuals, except that a district may have a popu6 lation of less than 100,000 if the interim regional

7 board or regional board (as appropriate) determines

8 that a lesser population would facilitate the delivery

9 of health care and supplemental services or the ef10 fective governance of the health program within such

11 district or its region.

12 (c) Each district shall be divided into three or more

13 health care delivery communities. Each such community

14 shall meet the following requirements:

15 (1) The community shall be a contiguous geo16 graphic area appropriate for the effective govern17 ance, planning, and delivery of comprehensive pri18 mary health care services, described in section

19 221(a)(2), for residents of such community.

20 (2) The residents of the community shall, to the

21 maximum extent feasible, have a commonality of in22 terest, language, and ethnic and racial composition

23 sufficient to support and maintain a community

24 health program under this Act.
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1 (3) The community shall have a population of

2 not less than 25,000 and of not more than 50,000

3 individuals, except in the case of Indian reservations

4 and, except that a community may have a population

5 of less than 25,000 if the interim regional board or

6 regional board (as appropriate) determines that a

7 lesser population would facilitate the delivery of

8 health care and supplemental services or the effec9 tive governance of the health program within such

10 community or the district in which it is located.

11 (d) At least 60 days prior to the establishment of the

12 boundaries of any district or community within its region,

13 the interim regional board shall provide for—

14 (1) notice in the district or community which

15 would be affected by the establishment of such

16 boundaries of the boundaries proposed to be estab17 lished and of the date, time, and location of the pub18 lic hearing on such establishment as provided in

19 paragraph (2); and

20 (2) a public hearing at which individuals resid21 ing within the region can speak or present written

22 statements relating to the establishment of such

23 boundaries.

24 (e) The boundaries of districts and communities shall

25 be modified in accordance with section 119.
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1 ELECTION OF COMMUNITY HEALTH BOARDS

2 SEC. 114. (a)(1) The Interim National Health Board

3 shall arrange with State and local governments for the ini4 tial elections for user members of each community board

5 to be held on a date not later than 9 months after the

6 appointment of interim regional boards under section 112.

7 (2) Elections for worker members of each community

8 board shall first be held as soon as possible after the selec9 tion of health workers for employment by the user mem10 bers of such community boards. Such elections shall be

11 held, to the extent feasible, in accordance with subsection

12 (c)(2)(B).

13 (b)(1) The number of user members to be elected in

14 an election in a community under subsection (a) shall be

15 six, plus one user member for each 5,000 individuals resid16 ing in such community in excess of 30,000 residents.

17 (2) The number of worker members to be elected in

18 an election in a community under subsection (a) shall be

19 three, plus one member for each 10,000 individuals resid20 ing in such community in excess of 30,000 residents.

21 (c)(1) The Interim National Health Board shall es22 tablish procedures for the nomination and election under

23 this section of user members of community boards and

24 worker members of area health boards. Each interim re25 gional board shall conduct and supervise such nominations
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1 and elections in its region in accordance with such proce2 dures.

3 (2)(A) Such procedures for election of user members

4 shall provide, except as otherwise provided in this part,

5 for—

6 (i) the nomination for election as a user mem7 ber to a community board of any eligible user, upon

8 presentation to the respective interim regional board

9 of a petition or petitions signed by at least one per10 cent of the registered users in the community;

11 (ii) the full disclosure by each nominee, at the

12 time of presentation of a petition or petitions under

13 clause (i), to the respective interim regional board of

14 any financial interest of the nominee and such nomi15 nee’s family in the delivery of health care services,

16 in research on health or health care services, or in

17 the provision of drugs or medical supplies;

18 (iii) the opportunity, regardless of race, sex,

19 language, income level, or health condition, for all

20 registered users in each such community to nomi21 nate eligible users for, and for all eligible users in

22 each such community to run for and to serve as user

23 members of, such users’ community board;

24 (iv) the right of all registered users in each

25 such community, regardless of race, sex, language,
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1 income level, or health condition, to vote in elections

2 for user members of such users’ community board,

3 and the right of registered users who are not phys4 ically or mentally capable of voting themselves to

5 designate other registered users to vote proxies on

6 their behalf;

7 (v) public meetings sponsored by the respective

8 interim regional board in each such community with9 in its region, at which all users nominated for elec10 tion to the community board in the community may

11 present their views;

12 (vi) the preparation and distribution within

13 each such community by the respective interim re14 gional board of literature presenting the qualifica15 tions and views of, and disclosing information de16 scribed in clause (ii) for, each nominee for election

17 as a user member of the community board in the

18 community; and

19 (vii) the election of the nominees receiving the

20 greatest number of votes.

21 (B) Such procedures for election of worker members

22 shall provide for—

23 (i) the nomination for election as a worker

24 member of an area health board of any eligible area

25 health worker, upon presentation to the respective
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1 interim regional board of a petition (or petitions)

2 signed by at least 1 percent of the eligible area

3 health workers, and

4 (ii) the full participation of eligible area health

5 workers of all job categories and skill levels in the

6 nomination and election process.

7 (d)(1) Unless an election is set aside under section

8 402(d)(1) (relating to grievance procedures), individuals

9 who have been elected to a community board for a commu10 nity under this section, including user members until

11 worker members have been elected, shall be certified by

12 the interim regional board as constituting, on the date of

13 such certification, the community board for the commu14 nity.

15 (c) With respect to each group of individuals con16 stituting a community board under paragraph (1), the re17 spective interim regional board shall select a time, date,

18 and location within the community of such community

19 board for the holding of the initial meeting of such com20 munity board, which date shall not be later than 30 days

21 after the date of the election, and shall notify the newly

22 elected and approved members of such board and the resi23 dents of such community of the time, date, and location

24 of such meeting.
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1 APPOINTMENT OF DISTRICT HEALTH BOARDS

2 SEC. 115. (a)(1) Not later than 60 days after the

3 initial meeting of each community board, called pursuant

4 to section 114(d)(2), the user members of each such board

5 shall appoint two eligible users in the community to serve

6 as user members of their respective district board.

7 (2) As soon as feasible, the worker members of each

8 such board shall appoint an eligible community health

9 worker to serve as a worker member of their respective

10 district board.

11 (3) As soon as feasible, the eligible district health

12 workers shall, in accordance with section 114(c)(2)(B),

13 elect an eligible district health worker to serve as a worker

14 member of their respective district board.

15 (4) The user and worker members of each such com16 munity board shall promptly notify their respective interim

17 regional board of appointments under this subsection.

18 (b)(1) Not later than 15 days after the date a major19 ity of the initial community boards within a district have

20 notified their respective interim regional board of the ap21 pointment of user members for their respective district

22 boards under subsection (a)(1), such interim regional

23 board shall certify the users so appointed as constituting,

24 on the date of such certification, the district board for the

25 district.
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1 (2) With respect to each district board certified under

2 paragraph (1), its respective interim regional board shall

3 select a time, date, and location within the district of such

4 district board for the holding of the initial meeting of such

5 district board, which date shall not be later than 15 days

6 after the date of such certification, and shall notify the

7 approved members of such board and the residents of such

8 district of the time, date, and location of such meeting.

9 APPOINTMENT OF REGIONAL HEALTH BOARDS

10 SEC. 116. (a)(1) Not later than 60 days after the

11 initial meeting of each district board, called pursuant to

12 section 115(b)(2), the user members of each such board

13 shall appoint two eligible users in the district to serve as

14 user members of their respective regional board.

15 (2) As soon as feasible, the worker members of each

16 such board shall appoint an eligible district (or commu17 nity, in the district) health worker to serve as a worker

18 member of their respective regional board.

19 (3) As soon as feasible, the eligible regional health

20 workers shall, in accordance with section 114(c)(2)(B),

21 elect an eligible regional health worker to serve as a work22 er member of their respective regional board.

23 (4) The user and worker members of each such dis24 trict board shall promptly notify their respective interim
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1 regional board and the Interim National Health Board of

2 such appointments.

3 (b) Not later than 15 days after the date a majority

4 of the initial certified district boards within a region have

5 notified their respective interim regional board of the ap6 pointment of user members for their respective regional

7 board under subsection (a)(1), such interim regional board

8 shall certify the users so appointed as constituting, on the

9 date of such certification, the regional board for the re10 gion.

11 (2) With respect to each regional board certified

12 under paragraph (1), the interim regional board that cer13 tified such board shall select a time, date, and location

14 within its region for the holding of the initial meeting of

15 such regional board, which date shall not be later than

16 15 days after the date of such certification, and shall no17 tify the appointed and approved members of such board

18 and the residents of its region of the time, date, and loca19 tion of such meeting.

20 APPOINTMENT OF THE NATIONAL HEALTH BOARD

21 SEC. 117. (a) The Interim National Health Board

22 shall, for purposes of appointing members of the National

23 Health Board, assign each region to one of three groups

24 of regions, each group having (to the extent possible) an
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1 equal number and balanced geographic distribution of re2 gions.

3 (b)(1) Not later than 60 days after the initial meeting

4 of each regional board, called pursuant to section

5 116(b)(2), each such board for a region in the first two

6 groups of regions (established under subsection (a)) shall

7 appoint (subject to the approval of the President) an eligi8 ble user in the region to serve as a user member of the

9 National Health Board.

10 (2) As soon as feasible, each such board for any other

11 region shall appoint (subject to approval of the President)

12 an eligible regional (or community or district, in the re13 gion) health worker to serve as a worker member of the

14 National Health Board.

15 (3) Each regional board shall promptly notify the In16 terim National Health Board and the President of each

17 appointment under this subsection. The President shall

18 approve or disapprove the appointment of such a member

19 within the 10-day period beginning on the date of his noti20 fication of the appointment; and the appointment of such

21 a member shall be considered as having been approved by

22 the President unless he disapproves the appointment of

23 the member within such time period.

24 (c)(1) No later than 15 days after the date a majority

25 of the appointments under subsection (b)(1) by initially
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1 certified regional boards have been approved by the Presi2 dent, the Interim National Health Board shall certify the

3 individuals so approved as constituting, on the date of

4 such certification, the National Health Board, and shall

5 promptly notify the President and the Congress of such

6 certification.

7 (2) The Interim National Health Board shall select

8 a time, date, and location for the holding of the initial

9 meeting of the National Health Board, which date shall

10 not be later than 15 days after the date of the certification

11 under paragraph (1), and shall notify appointed and ap12 proved members and the public of the time, date, and loca13 tion of such meeting.

14 SUBSEQUENT ELECTION AND APPOINTMENT OF

15 MEMBERS OF HEALTH BOARDS

16 SEC. 118. (a) Members of health boards elected or

17 appointed in accordance with sections 114 through 117

18 shall serve until their successors are certified in accord19 ance with this section.

20 (b)(1) The National Health Board shall arrange with

21 State and local governments for an election for user mem22 bers of each community board to be held on the date of,

23 and in conjunction with, each election for Members of the

24 United States House of Representatives that occurs after

25 the effective date of health services.
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1 (2) An election for worker members of each commu2 nity board shall be held on or about the date of each elec3 tion specified in paragraph (1) and shall be held, to the

4 extent feasible and consistent with section 114(c)(2)(B),

5 in conjunction with the election under paragraph (1).

6 (3) The provisions of section 114 (other than sub7 section (a) thereof) shall apply to elections of members

8 of community boards under this subsection, except that

9 for purposes of this subsection—

10 (A) the term of each member elected under this

11 subsection shall be 4 years, except that, in the case

12 of the elections first held under this section, the

13 term of half of the user members and of half of the

14 worker members or, in the case of an odd number

15 of user or worker members, the term of half plus

16 one of such members shall be 2 years;

17 (B) the individuals whose term of office does

18 not expire following an election, as well as individ19 uals elected in the election, are deemed to constitute

20 the community board under section 114(d)(1); and

21 (C) any reference to an interim regional board

22 or to the Interim National Health Board in section

23 114 shall be considered as a reference to a regional

24 board or to the National Health Board.
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1 (c)(1) Each regional board shall, for purposes of ap2 pointing worker members of district boards within its re3 gion, assign each community to one of two groups of com4 munities within each district, each group having (to the

5 extent possible) an equal number and balanced geographic

6 distribution of communities.

7 (2) Not later than 60 days after the initial meeting

8 of each community board (newly certified after an election

9 under subsection (b))—

10 (A) in the case of the first new certification of

11 such a board—

12 (i) user members of each such board shall

13 appoint two eligible users in the community,

14 one of whom shall serve a 4-year term as a user

15 member of their respective district board and

16 the other a 2-year term on such board; and

17 (ii) worker members of each such board for

18 a community in the first group of communities

19 (established under paragraph (1)) shall appoint

20 an eligible community health worker to serve a

21 4-year term as a worker member of their re22 spective district board, and worker members of

23 each such board for a community in the second

24 group of communities shall appoint an eligible
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1 community health worker to serve a 2-year

2 term on such board;

3 (B) in the case of a subsequent new certifi4 cation of such a board—

5 (i) user members of each such board shall

6 appoint an eligible user for a 4-year term; and

7 (ii) worker members of each such board for

8 a community in a group of communities that

9 did not appoint a worker member to serve a 4-

10 year term after the previous certification shall

11 appoint an eligible community health worker to

12 serve a 4-year term; and

13 (C) beginning with the first new certification of

14 such a board, and every 4 years thereafter, the eligi15 ble district health workers shall, in accordance with

16 section 114(c)(2)(B), elect an eligible district health

17 worker to serve a 4-year term as a worker member

18 of their respective district board.

19 The user and worker members of each such community

20 board shall promptly notify their respective regional board

21 of such appointments.

22 (3) Not later than 15 days after the date a majority

23 of the newly certified community boards within a district

24 have notified their respective regional board of the ap25 pointment or election of individuals for their respective
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1 district boards under paragraph (2), such regional board

2 shall certify the users and workers whose term of office

3 does not expire at the time of such appointments or elec4 tions, as well as individuals newly appointed or elected,

5 as constituting, on the date of such certification, the dis6 trict board for the district.

7 (4) For each district board certified under paragraph

8 (3), the respective regional board shall select a time, date,

9 and location within the district of such district board for

10 the holding of the initial meeting of such new board, which

11 date shall be not later than 15 days after the date of such

12 certification, and shall notify the members of such board

13 appointed under this subsection and the residents of the

14 district of the time, date, and location of such meeting.

15 (d)(1) The National Health Board shall, for purposes

16 of appointing worker members of regional boards, assign

17 each district to one of two groups of districts within each

18 region, each group having (to the extent possible) an equal

19 number and balanced geographic distribution of districts.

20 (2) Not later than 60 days after the initial meeting

21 of each newly certified district board (held pursuant to

22 subsection (c)(4))—

23 (A) in the case of the first new certification of

24 such a board—
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1 (i) user members of each such board shall

2 appoint two eligible users in the district, one of

3 whom shall serve a 4-year term as a user mem4 ber of their respective regional board and the

5 other a 2-year term on such board; and

6 (ii) worker members of each such board for

7 a district in the first group of districts (estab8 lished under paragraph (1)) shall appoint an el9 igible district (or community, within the dis10 trict) health worker to serve a 4-year term as

11 a worker member of their respective regional

12 board, and worker members of each such board

13 for a district in the second group of districts

14 shall appoint an eligible district (or community,

15 within the district) health worker to serve a 2-

16 year term on such board;

17 (B) in the case of a subsequent new certifi18 cation of such a board—

19 (i) user members of each such board shall

20 appoint an eligible user for a 4-year term; and

21 (ii) worker members of each such board for

22 a district in a group of districts that did not

23 appoint a worker member to serve a 4-year

24 term after the previous certification shall ap25 point an eligible district (or community, within
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1 the district) health worker to serve a 4-year

2 term; and

3 (C) beginning with the first new certification of

4 such a board, and every 4 years thereafter, the eligi5 ble regional health workers shall, in accordance with

6 section 114(c)(2)(B), elect an eligible regional

7 healthworker to serve a 4-year term as a worker

8 member of their respective regional board.

9 The user and worker members of each such district board

10 shall promptly notify the National Health Board of such

11 appointments.

12 (3) Not later than 15 days after the date a majority

13 of the newly certified district boards within a region have

14 notified the National Health Board of the appointment or

15 election of individuals for their respective regional boards

16 under paragraph (2), the National Health Board shall cer17 tify the users and workers whose term of office does not

18 expire at the time of such appointments or elections, as

19 well as individuals newly appointed or elected, as con20 stituting, on the date of such certification, the regional

21 board for the region.

22 (4) For each regional board newly certified under

23 paragraph (3), the previously certified regional board shall

24 select a time, date, and location within the region for the

25 holding of the initial meeting of such new board, which
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1 date shall not be later than 15 days after the date of such

2 certification, and shall notify the members of such board

3 appointed and approved under this subsection and the

4 residents of the region of the time, date, and location of

5 such meeting.

6 (e)(1) Not later than 60 days after the initial meeting

7 of each newly certified regional board, held pursuant to

8 subsection (d)(4)—

9 (A) in the case of the first new certification of

10 such a board—

11 (i) each such board for a region in the first

12 group of regions (established under section

13 117(a)) shall appoint (subject to the approval of

14 the President) an eligible regional (or commu15 nity or district, in the region) health worker,

16 and

17 (ii) each such board for any other region

18 shall appoint (subject to the approval of the

19 President) an eligible user in the region,

20 to serve a 4-year term as a member of the National

21 Health Board; and

22 (B) in the case of a subsequent new certifi23 cation of such a board occurring when the terms of

24 office of members of the National Health Board are

25 expiring—
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1 (i) each such board for a region in a group

2 of regions that has appointed an eligible user to

3 serve as a member of the National Board for

4 the previous two appointments under this sub5 section or section 117(b) shall appoint (subject

6 to the approval of the President) an eligible re7 gional (or community or district, in the region)

8 health worker, and

9 (ii) each such board for any other region

10 shall appoint (subject to the approval of the

11 President) an eligible user in the region,

12 to serve a 4-year term as a member of the National Health

13 Board. Each such board shall promptly notify the Na14 tional Health Board and the President of such appoint15 ment. The President shall approve or disapprove the ap16 pointment of such a member within the 10-day period be17 ginning on the date of his notification of the appointment;

18 and the appointment of such a member shall be considered

19 as having been approved by the President unless he dis20 approves the appointment of the member within such time

21 period.

22 (2) No later than 15 days after the date a majority

23 of the appointments under paragraph (1) by newly cer24 tified regional boards have been approved by the Presi25 dent, the National Health Board shall certify the individ-
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1 uals so approved as constituting, on the date of such cer2 tification, the National Health Board and shall promptly

3 notify the President and Congress of such certification.

4 (3) The previously certified National Health Board

5 shall select a time, date, and location for the holding of

6 the initial meeting of the new National Health Board,

7 which date shall not be later than 15 days after the date

8 of certification of such Board under paragraph (2), and

9 shall notify the members appointed and approved under

10 this subsection and the public of the time, date, and loca11 tion of such meeting.

12 MODIFICATION OF THE BOUNDARIES OF HEALTH CARE

13 DELIVERY AREAS

14 SEC. 119. (a) No later than 2 years after each decen15 nial national census, and at such other times as it deems

16 necessary, the National Health Board shall review the ap17 propriateness of the boundaries of each health care deliv18 ery region and may, in accordance with subsection (b),

19 modify the boundary of any region in which there has been

20 a substantial shift of population justifying such modifica21 tion, if such modification is approved in a referendum of

22 registered users residing in an area whose regional identi23 fication would be changed by making such modification.
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1 (b) At least 60 days before the modification by ref2 erendum of the boundary of any region, the National

3 Health Board shall provide for—

4 (1) notice in the area whose regional identifica5 tion would be changed by the modification of such

6 boundaries—

7 (A) of existing boundaries and of the pro8 posed modification, and

9 (B) of the date, time, and location of the

10 public hearing on such modification, as required

11 in paragraph (2), and

12 (2) a public hearing at which individuals can

13 speak or present written statements relating to the

14 modification of such boundaries.

15 (c)(1) After the establishment of regional health

16 boards under section 116—

17 (A) no later than 2 years after each decennial

18 national census,

19 (B) upon receipt of a petition for modification

20 of a boundary of a district or community within the

21 region of such board, which petition is signed by not

22 less than 15 percent of the registered users residing

23 in an area whose district or community identification

24 would be changed by adoption of such petition, and

25 (C) at such other times as it deems appropriate,
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1 each regional board shall review the appropriateness of the

2 boundaries of districts and communities within its region.

3 (2) Any review conducted under paragraph (1) shall

4 comply with the procedures of subsection (d) (relating to

5 open hearings and public participation).

6 (3) A regional board, after reviewing the boundaries

7 of a district or community within its region under para8 graph (1), may modify the boundary of any such district

9 or community if—

10 (A) there has been a substantial shift of popu11 lation justifying such modification, or

12 (B) such modification would better carry out

13 the purposes of this Act, and

14 if such modification is approved in a referendum, held

15 after notice and a public hearing in accordance with sub16 section (d), of registered users residing in an area whose

17 district or community identification would be changed by

18 adoption of the proposed modification.

19 (d) At least 60 days before the modification by ref20 erendum of the boundary of any district or community,

21 the respective regional board shall provide for—

22 (1) notice in the area whose district or commu23 nity identification would be changed by the modifica24 tion of such boundaries—
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1 (A) of existing boundaries and of the

2 boundaries proposed to be modified, and

3 (B) of the date, time, and location of the

4 public hearing on such modification, as required

5 in paragraph (2), and

6 (2) a public hearing at which individuals can

7 speak or present written statements relating to the

8 modification of such boundaries.

9 PART C—GENERAL PROVISIONS REGARDING HEALTH

10 BOARDS

11 DEFINITIONS

12 SEC. 121. As used in this part, the term ‘‘full mem13 ber’’ means, with respect to a health board, a member of

14 such board other than an associate member described in

15 section 122(a)(4).

16 MEMBERSHIP OF HEALTH BOARDS

17 SEC. 122. (a) Each health board shall be composed

18 of—

19 (1) members elected or appointed and approved

20 in accordance with this part B;

21 (2) one member—

22 (A) in the case of a community board, ap23 pointed by the occupational safety and health

24 action council established under section 412 for

25 such community, and
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1 (B) in the case of a regional board, ap2 pointed by the occupational safety and health

3 action council established under section 413 for

4 such region;

5 (3) such voting user members as the members

6 of the board described in paragraphs (1) and (2)

7 may determine from time to time (in consultation

8 with elements of the population from which the

9 members are being selected) to be necessary in order

10 to ensure that (1) the user members of the board

11 approximate the population within its area by race,

12 sex, income level, and language and (2) segments of

13 the population having special health needs (such as

14 the physically and mentally handicapped and the

15 aged) are appropriately represented; and

16 (4) such nonvoting associate members as the

17 members of such board may determine from time to

18 time to be necessary to provide appropriate rep19 resentation of appropriate units of State, territorial,

20 and local government and of segments of the popu21 lation having special health needs; and in the case

22 of the Interim National Health Board and National

23 Health Board, to carry out the purposes of this Act.

24 (b)(1) Except as provided in paragraph (2), no indi25 vidual may serve as a full member of a health board in
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1 a community, district, or region, or of the National Health

2 Board, for more than four consecutive years, exclusive of

3 any time that might be served as a member by election

4 or appointment (A) before the effective date of health serv5 ices, (B) for a 2-year term under section 118(b)(3)(A),

6 118(c)(2)(A), or 118(d)(2)(A), or (C) by appointment

7 under subsection (d) to fill a vacancy.

8 (2) Full members of a health board shall serve until

9 their successors are certified in accordance with this Act.

10 (c)(1)(A) Within 60 days of the date of the presen11 tation to the appropriate regional board of a petition,

12 signed by at least 15 percent of the number of registered

13 users residing in a community or of eligible area health

14 workers, requesting the recall of a user member or elected

15 worker member, respectively, of a board elected and ap16 proved in accordance with this title, such regional board

17 shall conduct an election on the recall of such member.

18 (B) The provisions of section 114 (except for sub19 section (a) thereof) and procedures established thereunder

20 regarding elections of user and worker members shall

21 apply with respect to recall elections conducted under this

22 paragraph, except that for the purposes of this paragraph,

23 any reference in such section to an interim regional board

24 or to the Interim National Health Board shall be consid-
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1 ered as a reference to a regional board or to the National

2 Health Board, respectively.

3 (2) A member of a district or regional board or an

4 interim regional board appointed in accordance with this

5 title may be recalled from office by the affirmative vote

6 of two-thirds of the members of the health board which

7 appointed such member.

8 (3) A member of the Interim National Health Board

9 or National Health Board may be removed from office by

10 the President for inefficiency, neglect of duty, malfeasance

11 in office, or, in the case of the National Health Board,

12 upon recommendation by the affirmative vote of two-thirds

13 of the members of the regional board which nominated

14 such member.

15 (d)(1) A vacancy caused by the death, resignation,

16 or removal of a member (hereinafter in this subsection re17 ferred to as a ‘‘vacating member’’) of a health board, elect18 ed or appointed in accordance with this title, before the

19 expiration of the term for which such vacating member

20 was elected or appointed, shall be filled not later than 60

21 days after the date of such vacancy—

22 (A) in the case of a member of a community

23 board, by election of an eligible individual, in accord24 ance with section 114 (except for subsection (a)

25 thereof);
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1 (B) in the case of a member of a district or re2 gional board, an interim regional board, or the Na3 tional Health Board, by appointment or election

4 and, in the case of the National Health Board, Pres5 idential approval of an eligible individual by the

6 health board or workers which appointed or elected

7 such vacating member; and

8 (C) in the case of a member of the Interim Na9 tional Health Board, by appointment by the Presi10 dent.

11 (2) Any individual appointed to fill a vacancy under

12 this subsection shall serve only for the unexpired term of

13 office of the vacating member.

14 (3) For the purposes of this subsection, the term ‘‘eli15 gible individual’’ means, with respect to filling the place

16 of a vacating member, an individual who is eligible, under

17 the applicable provisions of this Act, to serve on a health

18 board in the capacity in which the vacating member was

19 elected or appointed.

20 MEETINGS AND RECORDS OF HEALTH BOARDS

21 SEC. 123. (a)(1) Each full member of a health board

22 shall have one vote in meetings of such board.

23 (2) A majority of the full members of each health

24 board shall constitute a quorum for the transaction of the
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1 business of such board, and such board shall act upon the

2 vote of a majority of the full members present and voting.

3 (b)(1) Except as otherwise provided in this Act, the

4 full members of each health board shall, at the first meet5 ing following the certification of such board, elect a chair6 person and vice chairperson from among the full members

7 of such board.

8 (2) The chairperson of each health board shall be re9 sponsible for convening meetings of such board and for

10 such other duties as such board may assign. Upon the

11 written request of two full members of such board, the

12 chairperson shall convene a meeting of such board.

13 (3) The vice chairperson shall perform the duties of

14 the chairperson in the event that the chairperson is unable

15 to perform such functions.

16 (c)(1) Each health board shall provide for the record17 ing of the minutes of each of its meetings and each of

18 the meetings of its committees and advisory groups, and

19 shall make such records available to the public for inspec20 tion and copying.

21 (2) Meetings of each health board and each commit22 tee and advisory group thereof (except meetings that con23 cern an individual user or health worker, and such individ24 ual requests that the meeting be closed) shall be open to

25 the public and shall be held at such times and in such
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1 places as the board determines to be convenient to attend2 ance by the public.

3 (3) Each health board shall establish a principal of4 fice within the area it serves.

5 (d) Each health board shall disseminate within the

6 area it serves full information regarding its activities, in7 cluding the furnishing of health care and supplemental

8 services.

9 (e)(1) Each health board may establish such rules,

10 consistent with this Act, as it finds necessary for the effec11 tive and expeditious transaction of its duties and func12 tions.

13 (2) Each health board may establish such committees

14 and advisory groups, and appoint to them such individuals

15 (including health workers), as it deems necessary to carry

16 out its duties and functions.

17 (f)(1) A full member of the Interim National Health

18 Board or National Health Board may receive compensa19 tion at a rate not to exceed the daily equivalent of the

20 annual rate of basic pay in effect for grade GS–18 of the

21 General Schedule for each day (including traveltime) dur22 ing which the member is engaged in the actual perform23 ance of such member’s duties plus reimbursement for trav24 el, subsistence, and other necessary expenses incurred in

25 the performance of such member’s duties.
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1 (2) A full member of a health board, other than the

2 Interim National Health Board of the National Health

3 Board, may receive such amounts per diem when engaged

4 in the actual performance of such member’s duties, or

5 such annual salary, plus reimbursement for travel, subsist6 ence, and other necessary expenses incurred in the per7 formance of such member’s duties, as the appropriate Na8 tional Health Board may establish.

9 PROCEDURES FOR ESTABLISHMENT OF NATIONAL

10 GUIDELINES AND STANDARDS

11 SEC. 124. (a) In addition to guidelines and standards

12 otherwise required to be established by this Act, the Na13 tional Health Board shall establish such guidelines and

14 standards as will facilitate the implementation of the ob15 jectives of this Act and as will encourage innovation and

16 experimentation in the implementation of these objectives.

17 (b) The National Health Board shall submit, at least

18 90 days before the date of establishment of a guideline

19 or standard under this Act, each such guideline or stand20 ard to regional boards for their review and comments.

21 (c) The National Health Board and the regional

22 boards shall establish programs that provide orientation,

23 education, and technical assistance to members of area

24 health boards in the use and application of guidelines and

25 standards established by the National Health Board.
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1 ASSISTANCE TO AREA HEALTH BOARD MEMBERS

2 SEC. 125. Each regional board shall provide orienta3 tion, education, and technical assistance to members of

4 district and community boards in its region, and the ap5 propriate National Health Board shall provide such sup6 port to members of regional boards, to insure that such

7 members are prepared to perform their duties as members

8 of such boards with maximum effectiveness.

9 TITLE II—DELIVERY OF HEALTH CARE AND

10 SUPPLEMENTAL SERVICES

11 PART A—PATIENTS’ RIGHTS IN HEALTH CARE

12 DELIVERY

13 BASIC HEALTH RIGHTS

14 SEC. 201. The Service, in its delivery of health care

15 services to users, shall ensure that every such individual

16 is given the following basic health rights:

17 (1) The right to receive high quality health care

18 and supplemental services without charge and with19 out discrimination on account of race, sex, age, reli20 gion, language, income, marital status, sexual ori21 entation, dress, or previous health status.

22 (2) The right to humane, respectful, dignified,

23 and comforting health care, and to the reduction of

24 pain and distressful symptoms.
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1 (3) The right to have health care services deliv2 ered in a convenient and timely manner.

3 (4) The right to choose the health workers who

4 shall be responsible for, and the health facilities in

5 which to receive, the individual’s health care serv6 ices.

7 (5) The right of access to all information, in8 cluding the individual’s health records and the medi9 cal dictionary produced under section 433(b), which

10 promotes an understanding of health, except when a

11 review committee (the majority of whose members

12 are users) established by the area health board

13 maintaining the information has determined that the

14 provision of the specific information would be harm15 ful to the individual.

16 (6) The right to have all health care informa17 tion, reports, and educational materials translated

18 into the individual’s primary language.

19 (7) The right to receive, prior to the delivery of

20 any health care service, a careful, prompt, and intel21 ligible—

22 (A) explanation of the indications, diag23 noses, benefits, side-effects, and risks involved

24 in the delivery of such service, and a description
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1 of alternatives to such service (including no

2 treatment);

3 (B) answer to any question relating to

4 such health care service; and

5 (C) explanation of one’s health rights de6 scribed in this part, and

7 the right to have such health care service delivered

8 only with the individual’s prior, voluntary, written

9 consent.

10 (8) The right to refuse the initial or continuing

11 delivery of any health care service whenever such re12 fusal does not directly endanger the public health or,

13 in accordance with State law, of the individual if the

14 individual is dangerous to himself or herself.

15 (9) The right to have all individually identifi16 able information and documents treated confiden17 tially and not disclosed (except for statistical pur18 poses and for the control of communicable diseases,

19 drug abuse, and child abuse) without the individual’s

20 prior, voluntary, and written consent.

21 (10) The right of access at all times to individ22 uals or groups for counseling, health information,

23 and assistance on health matters.

24 (11) The right to be accompanied and visited at

25 any time by a friend, relative, or independent advo-
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1 cate of the individual’s choosing, and the right to

2 have routine services, such as feeding, bathing,

3 dressing, and bedding changes, performed by a

4 friend or relative, if the individual so chooses.

5 (12) The right, in the event of terminal illness,

6 to die with a maximum degree of dignity, to be pro7 vided all necessary symptom relief, to be provided

8 (and for the individual’s family to be provided) coun9 seling and comfort, and to be allowed (if desired) to

10 die at home.

11 (13) The right of access to a complaint and

12 grievance system and to legal assistance to enforce

13 these rights.

14 RIGHT TO PAID LEAVE TO RECEIVE HEALTH CARE

15 SERVICES

16 SEC. 202. (a) The Fair Labor Standards Act of 1938

17 is amended by inserting after section 7 (29 U.S.C. 207)

18 the following new section:

19 ‘‘MINIMUM HEALTH LEAVE COMPENSATION

20 ‘‘SEC. 7A. Each employee of any employer who in any

21 workweek is engaged in commerce or in the production

22 of goods for commerce, or is employed in an enterprise

23 engaged in commerce or in the production of goods for

24 commerce, shall be entitled to receive from the employer,

25 for each 35 hours he is employed by the employer (not
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1 counting more than 35 hours in any workweek), com2 pensation for one hour of employment at the regular rate

3 at which the employee is employed (as that term is used

4 in section 7 of this Act) for an hour (1) during the period

5 of 52 weeks beginning with the workweek with which the

6 entitlement is earned, and (2) during which the employee

7 is unable to work because of the need for the employee

8 (or a dependent of that employee) to receive necessary

9 health care services.’’.

10 (b) The Fair Labor Standards Act of 1938 is further

11 amended—

12 (1) by striking out ‘‘sections 6 and 7’’ in sec13 tion 3(o) and inserting in lieu thereof ‘‘sections 6, 7,

14 and 7A’’;

15 (2)(A) by striking out ‘‘and 7’’ in section 13(a)

16 before paragraph (1) and inserting in lieu thereof ‘‘,

17 7, and 7A’’;

18 (B) by striking out ‘‘sections 6 and 7’’ in sec19 tion 13(a)(3) and inserting in lieu thereof ‘‘sections

20 6, 7, and 7A’’;

21 (C) by inserting ‘‘7A,’’ in subsections (d) and

22 (f) of section 13 after ‘‘7,’’ each place it appears;

23 (3) by striking out ‘‘6 and 7’’ in section 14(d)

24 and inserting in lieu thereof ‘‘6, 7, and 7A’’;
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1 (4) by striking out ‘‘section 6 or section 7’’ in

2 section 15(a) and inserting in lieu thereof ‘‘section

3 6, 7, or 7A’’;

4 (5)(A) by striking out ‘‘section 6 or section 7’’

5 in section 16(b) and inserting in lieu thereof ‘‘sec6 tion 6, 7, or 7A’’;

7 (B) by striking out ‘‘or their unpaid overtime

8 compensation’’ in section 16(b) and inserting in lieu

9 thereof ‘‘their unpaid overtime compensation, or

10 their unpaid health leave compensation’’;

11 (C) by inserting ‘‘or of unpaid health leave com12 pensation’’ in section 16(b) after ‘‘amount of unpaid

13 overtime compensation’’;

14 (D) by striking out ‘‘section 6 or 7’’ in the first

15 sentence of section 16(c) and inserting in lieu there16 of ‘‘section 6, 7, or 7A’’;

17 (E) by striking out ‘‘unpaid overtime compensa18 tion’’ in the first sentence of section 16(c) and in19 serting in lieu thereof ‘‘, unpaid overtime compensa20 tion, or unpaid health leave compensation’’;

21 (F) by striking out ‘‘or overtime compensation’’

22 in the second sentence of section 16(c) and inserting

23 in lieu thereof ‘‘, overtime compensation, or health

24 leave compensation’’;
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1 (G) by striking out ‘‘or unpaid overtime com2 pensation under sections 6 and 7’’ in the third sen3 tence of section 16(c) and inserting in lieu thereof

4 ‘‘, unpaid overtime compensation, or unpaid health

5 leave compensation under sections 6, 7, and 7A’’;

6 (6)(A) by inserting ‘‘or minimum health leave

7 compensation higher than the minimum health leave

8 compensation established under this Act’’ in the first

9 sentence of section 18(a) before ‘‘, and no provi10 sion’’; and

11 (B) by inserting ‘‘, or justify any employer in

12 reducing health leave compensation provided by him

13 which is in excess of the applicable minimum health

14 leave compensation under this Act’’ before the pe15 riod at the end of the second sentence of section

16 18(a).

17 PART B—ELIGIBILITY FOR, NATURE OF, AND SCOPE OF

18 SERVICES PROVIDED BY THE SERVICE

19 ELIGIBILITY FOR SERVICES

20 SEC. 211. (a) All individuals while within the United

21 States are eligible to receive health care and supplemental

22 services under this Act.

23 (b) For purposes of this section, the term ‘‘United

24 States’’ includes Indian reservations, the District of Co-
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1 lumbia, the Commonwealth of Puerto Rico, the Virgin Is2 lands, Guam, Samoa, and the Northern Mariana Islands.

3 ENTITLEMENT TO SERVICES

4 SEC. 212. (a) Except as provided in subsection (b),

5 the Service shall, on and after the effective date of health

6 services, provide users with all health care services and

7 supplemental services described in section 213 which the

8 Service determines, in accordance with this title, to be nec9 essary or appropriate for the promotion and enhancement

10 of health, for the prevention of disease, and for the diag11 nosis and treatment of, and rehabilitation following, in12 jury, disability, or disease.

13 (b) Services provided under this Act shall not include

14 personal comfort or cosmetic services unless the area

15 health board providing the services determines that the

16 services are required for health-related reasons.

17 PROVISION OF HEALTH CARE AND SUPPLEMENTAL

18 SERVICES

19 SEC. 213. (a) The Service shall provide in the United

20 States the following health care services in or through fa21 cilities established by the Service—

22 (1) the promotion of health and well-being

23 through health education programs to be carried out

24 in facilities of the Service as well as in workplaces,

25 schools, and elsewhere utilizing all appropriate

26 media, and by assisting other Government agencies
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1 in taking appropriate actions to promote health and

2 well-being;

3 (2) the prevention of illness, injury, and death

4 through education and advocacy addressed to the so5 cial, occupational, and environmental causes of ill6 health; through the provision of appropriate preven7 tive services including social, medical, occupational,

8 and environmental health services, on both an emer9 gency and sustained basis; through screening and

10 other early detection programs to identify and ame11 liorate the primary causes of ill-health; and, where

12 appropriate, through actions taken on an emergency

13 basis to halt environmental threats to life and

14 health;

15 (3) the diagnosis and treatment of illness and

16 injury, including emergency medical services, com17 prehensive outpatient and inpatient health care serv18 ices, occupational health services, mental health

19 services, dental care, long-term care, and home

20 health services;

21 (4) the rehabilitation of the sick and disabled,

22 including physical, psychological, occupational, and

23 other specialized therapies; and

24 (5) the provision of drugs, therapeutic devices,

25 appliances, equipment, and other medical supplies
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1 (including eyeglasses, other visual aids, dental aids,

2 hearing aids, and prosthetic devices) certified effec3 tive in the National Pharmacy and Medical Supply

4 Formulary (published under section 432(a)) and fur5 nished or prescribed by authorized health workers.

6 The Service may not provide such health care services in

7 a region, district, or community other than under the aus8 pices of a regional, district, or community board estab9 lished in accordance with this Act.

10 (b) The Service shall provide the following services

11 supplemental to the delivery of health care services in or

12 through health care facilities established by the Service—

13 (1) ambulance and other transportation services

14 to insure ready and timely access to necessary health

15 care;

16 (2) child care services for individuals who, dur17 ing the time they receive outpatient health care serv18 ices from the Service or are working in a health care

19 facility of the Service, are responsible for a child’s

20 care; and

21 (3) homemaking and home health services—

22 (A) to enable the provision of inpatient

23 health services at a health care facility of the

24 Service to an individual who has the sole re25 sponsibility for the care (i) of a child under 15
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1 years of age, or (ii) of a physically or mentally

2 handicapped individual who requires the care of

3 another individual, and

4 (B) for the bedfast or severely handicapped

5 individual, when provision of such services

6 eliminates the need for the individual to receive

7 inpatient services; and

8 (4) such counseling and social service assistance

9 as will avoid the unnecessary provision of health care

10 services.

11 (c) The Service shall conduct the functions, especially

12 those related to environmental health and the prevention

13 of illness, currently performed by the departments of

14 health of the States and localities, to the extent consistent

15 with Federal, State, and local law, and shall cooperate

16 with State and local governments in its conduct of such

17 functions.

18 (d) The Service shall provide, at rates established by

19 the National Health Board, for reimbursement of the cost

20 of emergency health care services furnished in facilities

21 not operated by the Service or by health workers not em22 ployed by the Service, when an injury or acute illness re23 quires immediate medical attention under circumstances

24 making it medically impractical for the ill or injured indi-
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1 vidual to receive care in a Service facility or by an em2 ployee of the Service.

3 PART C—HEALTH CARE FACILITIES AND DELIVERY OF

4 HEALTH CARE SERVICES

5 ESTABLISHMENT OF HEALTH CARE FACILITIES AND DIS6 TRIBUTION OF DELIVERY OF HEALTH CARE AND

7 OTHER SERVICES

8 SEC. 221. (a)(1) Each community board shall, not

9 later than the effective date of health services and to the

10 maximum extent feasible, establish and maintain in its

11 community such health care facilities as are necessary for

12 the efficient and effective delivery to individuals residing

13 in its community of comprehensive primary health care

14 services (defined in paragraph (2)), specialized health care

15 services (defined in paragraph (3)), special services (de16 fined in paragraph (4)) and community-oriented health

17 measures (defined in paragraph (5)). Such health care fa18 cilities shall be established and maintained in a manner

19 that, as soon as possible and to the greatest extent fea20 sible, provides services through a single comprehensive

21 health center.

22 (2) As used in paragraph (1), the term ‘‘comprehen23 sive primary health care services’’ means those basic out24 patient health care services typically needed for the pro25 motion of health and the prevention and treatment of com-
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1 mon illnesses and includes the following health care serv2 ices—

3 (A) general primary medical and dental care,

4 including diagnosis and treatment, routine physical

5 examinations, laboratory, and radiologic services,

6 and home visits by health workers, as appropriate;

7 (B) preventive health services, including immu8 nizations, nutrition counseling and consultation, and

9 periodic screening and assessment services;

10 (C) children’s health services, including assess11 ment of growth and development, education and

12 counseling on childrearing and child development,

13 and school and day-care center health services;

14 (D) obstetrical and gynecological services, in15 cluding family planning and contraceptive services,

16 pregnancy (prenatal and postnatal) and abortion

17 counseling and services;

18 (E) comprehensive geriatric services;

19 (F) vision and hearing examinations and provi20 sion of eyeglasses and other visual aids and hearing

21 aids;

22 (G) 24-hour emergency medical services;

23 (H) provision of pharmaceuticals and thera24 peutic devices, and medical appliances and equip25 ment;
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1 (I) mental health services, including psycho2 logical and psychiatric counseling;

3 (J) home health services; and

4 (K) occupational safety and health services, in5 cluding screening, diagnosis, treatment, and edu6 cation.

7 (3) As used in paragraph (1), the term ‘‘specialized

8 health care services’’ means those health care services of

9 a specialized nature (whether delivered in an inpatient or

10 outpatient setting) which, applying guidelines established

11 by the National Health Board and by the respective re12 gional board, may be provided most effectively and

13 efficently in a community setting.

14 (4) As used in paragraph (1), the term ‘‘special serv15 ices’’ means supportive services and the facilities (includ16 ing nursing homes and multiservice centers) in which such

17 services are provided for individuals who are physically or

18 mentally handicapped, mentally ill, infirm, or chronically

19 ill, so as to promote the integration and functioning of

20 such individuals within the community.

21 (5) As used in paragraph (1), the term ‘‘community22 oriented health measures’’ includes efforts to focus orga23 nized community activities upon the promotion of health

24 and the prevention of illness and injury, support for self25 help and mutual aid groups offering health promotion and
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1 rehabilitative support programs; surveillance of potential

2 threats to community health, and prompt action to protect

3 against such threats, and includes outreach efforts to en4 sure that all residents are aware of and able to utilize the

5 health services of the Service, as needed.

6 (b) Each district board shall, not later than the effec7 tive date of health services, establish and maintain in its

8 district—

9 (1) a general hospital for the efficient and ef10 fective delivery of health care services to individuals

11 residing in the district requiring inpatient diagnosis,

12 treatment, care, and rehabilitation for injury or ill13 ness; and

14 (2) such other health care facilities as are nec15 essary, using guidelines established by the National

16 Health Board and by the respective regional board,

17 to promote the efficient and effective delivery of

18 health care services within its district.

19 In addition, each district board shall provide such health

20 care services of a specialized nature (whether delivered in

21 an inpatient or outpatient setting) as, taking into account

22 guidelines established by the National Health Board and

23 its respective regional board, may be provided most effec24 tively and efficiently at the district level.
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1 (c) Each regional board shall, not later than the ef2 fective date of health services, establish and maintain in

3 its region—

4 (1) a regional medical facility for the efficient

5 and effective delivery of highly specialized health

6 care services, using guidelines established by the Na7 tional Health Board, to individuals residing in the

8 region requiring highly specialized treatment, care,

9 and rehabilitation for injury or illness;

10 (2) health care and supplemental services for

11 individuals whose health care needs otherwise cannot

12 be met by community or district boards because of

13 occupational or other factors, including individuals

14 residing within the region on a temporary or sea15 sonal basis (including migratory agricultural work16 ers) and individuals confined to prisons and other

17 correctional institutions; and

18 (3) such other health care facilities as are nec19 essary to promote the efficient and effective delivery

20 of health care services within its region.

21 (d) Each area health board, taking into account

22 guidelines established by the National Health Board, shall

23 provide the following through its health care facilities es24 tablished pursuant to this section:
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1 (1) Health promotion through education on per2 sonal health matters, nutrition, the avoidance of ill3 ness, and the effective use of health care services

4 with particular emphasis on the appropriate and safe

5 use (discouraging the overuse) of drugs and medical

6 techniques.

7 (2) Maintenance and appropriate transmission

8 and transferral of personal health records for each

9 user of the services of the board consistent with sec10 tion 201(9).

11 (3) Referral services, including referrals, where

12 appropriate, to health care facilities established by

13 other boards.

14 (4) Supplemental services (described in section

15 213(b)), as appropriate.

16 (5) Assistance to individuals who, because of

17 language or cultural differences or educational or

18 other handicaps, are unable fully to utilize the serv19 ices available from and delivered by the board.

20 (6) Information (A) on the rights ensured

21 under this Act, (B) on the guidelines and standards

22 established by the appropriate National Health

23 Board, and (C) on how the area health board is im24 plementing such rights and applying such guidelines

25 and standards.
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1 (7) Information on the grievance mechanisms

2 established pursuant to part A of title IV and on

3 legal services available to pursue grievances against

4 the board.

5 (8) Environmental health inspection and mon6 itoring services, including investigations relating to

7 the prevention of communicable diseases, in coopera8 tion with State and local authorities in the board’s

9 area.

10 (9) Research and data-gathering on the leading

11 causes of ill-health in the board’s area and on health

12 care delivery, in accordance with section 421.

13 (10) In the case of each inpatient health care

14 facility, discharge planning and followup services (A)

15 to identify patients who will need continuing care

16 after discharge from the facility and (B) to plan,

17 with the patient and the patient’s family, arrange18 ments and referrals to meet such postdischarge

19 needs.

20 (e)(1) Each area health board shall, in establishing

21 health care facilities under this section, hire health work22 ers (including administrative personnel) in sufficient num23 bers and with appropriate qualifications to ensure that

24 such facilities provide the health care and other services

25 described in this section.
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1 (2) In its establishment of health care facilities under

2 this section, each area health board shall purchase or lease

3 such premises as it deems necessary and suitable, utiliz4 ing, where appropriate, existing health facilities, including

5 health centers and clinics, hospitals, nursing homes, and

6 medical laboratories.

7 (3) In its establishment of health care facilities under

8 this section, each area health board shall seek to minimize

9 fragmentation and duplication in delivery of health care

10 and other services so as to promote the effective and effi11 cient delivery of such services.

12 (4) Each regional board, taking into account guide13 lines established by the National Health Board, shall pro14 vide for affiliation and coordination of the operation and

15 staff of the health care facilities in its region with the op16 eration and staff of other appropriate health care facilities

17 established within the region such board serves and within

18 adjacent regions.

19 (f) The National Health Board shall establish guide20 lines for distribution and coordination of the delivery of

21 health care and other services described in this section and

22 shall, before the effective date of health services, plan and

23 facilitate the transition to the new distribution of health

24 care facilities and health workers to be effected on and

25 after that date.
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1 (g) In the case that a community or district board

2 fails, on the effective date of health services, to substan3 tially and materially provide health care and supplemental

4 services in accordance with this section, its respective re5 gional board shall take such steps as it deems necessary,

6 consistent with the provisions of section 402 (relating to

7 grievance proceedings), to provide health care and supple8 mental services to users in the community or district af9 fected. Such steps may include, in addition to appointment

10 of a trustee or trustee committee under section

11 402(d)(3)(D)—

12 (1) requiring that the community or district

13 board in an adjacent community or district provide

14 such services to users residing in the community or

15 district affected, or

16 (2) providing reimbursement for the provision

17 of specified health care services in accordance with

18 procedures and schedules in effect under title XVIII

19 of the Social Security Act immediately before the ef20 fective date of health services (except that only users

21 in the affected community or district shall be consid22 ered as entitled to receive such specified services

23 under such title).

24 Paragraph (2) shall not apply on and after three years

25 after the effective date of health services.
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1 OPERATION AND INSPECTION OF HEALTH CARE

2 FACILITIES

3 SEC. 222. (a)(1) Each health board, with respect to

4 each health care facility it has established, shall establish

5 policies and organizational plans consistent with this sec6 tion and with parts A and C of title III (relating to the

7 health labor force) for the operation of such facility and

8 shall establish procedures to ensure that the facility is op9 erated in accordance with such policies and plans.

10 (2) In establishing, implementing, and modifying

11 such policies and plans, each health board shall seek the

12 fullest possible participation of health workers who are

13 employed in, and users who receive health care services

14 from, health care facilities affected by such policies and

15 plans.

16 (3) If a health board that has established more than

17 one health care facility determines that it cannot itself ef18 fectively manage the operation of all such facilities or if

19 a facility serves principally a population with special

20 health needs which is not appropriately represented on the

21 health board, the health board may provide for the estab22 lishment of a health care facility board or boards, com23 posed of users and health workers (or representatives of

24 users or workers of a facility or facilities) in an appro25 priate number and in a proportion approximating that on
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1 the health board, to assume the duties of the health board

2 with respect to the operation of the facility or facilities

3 involved.

4 (b) Such policies and plans shall provide for—

5 (1) the management of each facility by the

6 workers in such facilities through mechanisms which

7 provide full participation of health workers of all job

8 categories and skill levels employed in such facility;

9 (2) the elimination of dominance by health pro10 fessionals and the encouragement of cooperation and

11 mutual respect among all health workers; and

12 (3) regular accountability of the health workers

13 to the health board which established the facility for

14 the efficient and effective operation of the facility.

15 (c)(1) On and after 3 years after the effective date

16 of health services, a health board may not permit a health

17 care facility it has established to be used for the private

18 delivery of inpatient or outpatient health care services.

19 (2) No individual employed by a health board may

20 engage in the private delivery of health care services.

21 (3) For the purposes of this subsection, the term

22 ‘‘private delivery of health care services’’ means the deliv23 ery of health care services for which an individual, group,

24 or organization receives remuneration from any source
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1 other than the Health Service Trust Fund established in

2 section 511.

3 (d) Each health board shall ensure that any health

4 care facility that it operates which provides health care

5 services on an outpatient basis is open during hours that

6 will permit all users to make use of such services.

7 (e)(1) Each health board shall ensure that any health

8 care facility that it operates which provides (or is designed

9 to provide) substantial health care services on an inpatient

10 basis to individuals over a continuous period of 30 days

11 or longer—

12 (A)(i) provides comfortable living quarters for

13 inpatients that are clean and adequately heated,

14 cooled, and ventilated;

15 (ii) provides adequate staff for its inpatients;

16 (iii) provides nutritional food for its inpatients;

17 (iv) provides inpatients with opportunities for

18 creative activity and recreation;

19 (v) establishes and maintains a review commit20 tee in accordance with paragraph (2); and

21 (vi) informs an inpatient of all decisions involv22 ing the inpatient’s health and well-being and permits

23 the inpatient (and the review committee upon the in24 patient’s request) to participate fully in such deci25 sions;
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1 (B) and does not—

2 (i) censor or harass communication be3 tween an inpatient and others by telephone, let4 ter, or in person;

5 (ii) confiscate personal property of an in6 patient, unless possession of such property

7 would interfere with the provision of health

8 care;

9 (iii) deny an inpatient the social and sexual

10 life of such individual’s preference;

11 (iv) require that an inpatient work;

12 (v) pay an inpatient less than minimum

13 wage for work performed while receiving health

14 care services;

15 (vi) physically restrain an inpatient invol16 untarily for a period exceeding 72 hours with17 out the facility’s review committee (described in

18 paragraph (2)) determining, within 72 hours of

19 its initiation and not less often than every 2

20 weeks during which such restraint is continued,

21 that such restraint is required for the physical

22 safety of the inpatient or of others; or

23 (vii) take punitive or discriminatory action

24 (including transfer between or within facilities,

25 changes in physical comforts and diets, changes
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1 in opportunities for social interaction and com2 munication, or restriction of full participation in

3 recreational and creative activities) without the

4 prior approval, and renewed approval not less

5 often than every week thereafter, of the facili6 ty’s review committee (described in paragraph

7 (2)).

8 (2)(A) Each health board shall provide that at least

9 once each year the inpatients at that time of each health

10 care facility it operates which provides (or is designed to

11 provide) health care services on an inpatient basis to indi12 viduals over a continuous period of 30 days or longer shall

13 elect, from among themselves and any representatives of

14 user associations which have a demonstrated interest in

15 the care of such inpatients, a review committee (herein16 after in this paragraph referred to as the ‘‘committee’’)

17 of not less than 3 members.

18 (B) Any member of the committee may be recalled

19 by a vote of two-thirds of the number of inpatients in the

20 facility.

21 (C) In any election or recall under this paragraph any

22 inpatient who is not able to vote for any reason shall be

23 permitted to appoint another individual to vote as proxy.

24 (f) In order to assure that quality care is provided

25 in health care facilities of the Service—
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1 (1) each area health board shall conduct regu2 lar inspections of health care facilities it has estab3 lished,

4 (2) each regional board shall conduct regular

5 inspections of district and community health care fa6 cilities established in its region, and

7 (3) the National Health Board shall conduct

8 regular inspections of area and national health care

9 facilities,

10 and the results of such inspections of a facility shall be

11 reported to the appropriate area health board and users

12 of the facility and shall be made available to the public.

13 PROVISIONS OF HEALTH SERVICES RELATING TO

14 REPRODUCTION AND CHILDBEARING

15 SEC. 223. (a)(1) Area health boards, as appropriate,

16 shall provide the following services:

17 (A) Complete information on contraception and

18 provision of birth control materials or medication of

19 the individual’s choosing.

20 (B) Complete and effective evaluation and

21 treatment of venereal diseases and diseases of the

22 reproductive organs.

23 (C) Complete information and counseling with

24 respect to pregnancy, childbearing, and possible out25 comes involving genetically induced anomalies.
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1 (2) Area health boards, as appropriate, shall provide

2 the following services:

3 (A) Complete and effective pregnancy testing.

4 (B) Prenatal services, including physical exam5 ination, counseling, and instruction of expectant par6 ents in nutrition, childrearing, and children’s health

7 care services.

8 (C) Safe, comfortable, and convenient abortion

9 services.

10 (D) Counseling by women in conjunction with

11 the provision of all gynecologic, female contraceptive,

12 and abortion services and counseling by men for

13 male fertility-related services.

14 (3) The services described in paragraphs (1) and (2)

15 shall be delivered without coercion or harassment, with

16 complete confidentiality, and without prior approval of in17 dividuals other than the individual receiving the services.

18 (4) An individual shall be permitted to be accom19 panied by a person of the individual’s choice during the

20 provision of the services described in paragraphs (1) and

21 (2) to the extent this would not significantly increase the

22 medical risk to the individual.

23 (b) No area health board may perform upon an

24 individual a treatment or procedure (other than a treat25 ment or procedure required to preserve the life of the indi-
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1 vidual) which could reasonably be expected to affect the

2 individual’s capacity to reproduce children, unless (1) the

3 individual has given voluntary written consent to the treat4 ment or procedure after being given complete information

5 on the effect of the treatment or procedure on the individ6 ual’s reproductive capacity, and on possible alternative

7 treatments and procedures, at least 30 days before begin8 ning the treatment or procedure, and (2) the individual

9 has, after such 30-day waiting period, again given written

10 consent to the performance of the treatment or procedure,

11 except that in the case of a woman who has given initial

12 written consent to a sterilization she may be sterilized in

13 less than 30 days following such consent (but in no case

14 in less than 72 hours) if (A) she had given initial written

15 consent at least 30 days before her anticipated delivery

16 date, she delivers before the anticipated date, and the ster17 ilization is performed at the time of delivery, or (B) she

18 undergoes emergency abdominal surgery within the 30-day

19 waiting period and the sterilization is concurrent with the

20 abdominal surgery.

21 (c) An area health board shall insure that, before a

22 mastectomy or other breast cancer treatment is performed

23 on a woman, the woman shall be provided with complete

24 information on the complete range of medical options

25 available for treatment of her condition and the risks and
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1 side effects of each option and an opportunity to consult

2 individuals of her choice, and shall have given voluntary

3 written consent to such procedure.

4 (d) An area health board shall provide that a woman

5 giving birth to an infant shall have the right to choose

6 from a complete range of childbirth options including—

7 (1) giving birth at home, in a birth center (if

8 available), or in a hospital;

9 (2) the presence during childbirth of a person

10 or persons of her choosing;

11 (3) the position for labor and delivery which she

12 chooses;

13 (4) caring for her infant at her bedside;

14 (5) feeding her infant according to the method

15 and schedule of her choice; and

16 (6) selecting the birth attendant of her own

17 choice.

18 She shall be provided with information on the benefits,

19 risks, and side effects of each option and an opportunity

20 to consult individuals and groups of her choosing for infor21 mation and assistance on these options.
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1 TITLE III—HEALTH LABOR FORCE

2 PART A—JOB CATEGORIES AND CERTIFICATION

3 EFFECT OF STATE LAW

4 SEC. 301. Notwithstanding any law of a State or po5 litical subdivision to the contrary, the Service, acting in

6 accordance with the provisions of this Act, shall be the

7 sole judge of the qualifications of its employees.

8 QUALIFICATIONS OF HEALTH WORKERS

9 SEC. 302. (a) Each area health board shall, taking

10 into account guidelines established by the National Health

11 Board, establish procedures which will ensure that, except

12 in emergency situations, any work which is classified

13 under a job category established under this part is per14 formed by a health worker who at the time of such work

15 was (1) certified (in accordance with this part) as com16 petent to perform the work under such job category, and

17 (2) authorized to perform such work by the area health

18 board which employs such worker.

19 (b) Each area health board that employs health work20 ers who perform work classified under a job category es21 tablished under this part shall provide for the periodic re22 view and assessment of the competency of such workers

23 to perform the work within such job category, and shall

24 provide opportunities for health workers to be assessed
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1 and certified with respect to skills required for advance2 ment to other job categories.

3 (c) In order to assure that health workers provide

4 high quality health care services in the Service—

5 (1) each regional board shall provide for peri6 odic review and assessment of the performance of

7 health workers employed by district and community

8 boards in its region, and

9 (2) the National Health Board shall provide for

10 periodic review and assessment of the performance

11 of health workers employed by regional boards and

12 the National Health Board,

13 and the results of such examinations of health workers

14 shall be reported to the appropriate area health board and

15 the users residing in the areas in which the health workers

16 are employed and shall be made available to the public.

17 ESTABLISHMENT OF JOB CATEGORIES AND

18 CERTIFICATION STANDARDS

19 SEC. 303. (a)(1) The National Health Board shall

20 establish such guidelines for the classification, certifi21 cation, and employment of health workers by job category

22 as it determines to be necessary (A) to ensure that health

23 workers who perform work for the Service which requires

24 specialized skills have demonstrated that they possess such

25 skills, (B) to expand the roles of health workers to enable
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1 them to participate in health care delivery to the maxi2 mum extent consistent with their skills, and (C) to provide

3 for affiliation of health workers with health care facilities

4 at the community, district, and regional levels. These

5 guidelines shall permit alternative approaches to healing,

6 and practitioners skilled in such approaches, when these

7 approaches have not been demonstrated to be injurious

8 to health.

9 (2) In establishing guidelines under paragraph (1),

10 the National Health Board shall provide for (A) sufficient

11 flexibility to permit regional health boards to utilize health

12 workers most effectively to meet the health needs of the

13 region, and (B) sufficient uniformity to permit mobility

14 of health workers among the regions.

15 (3) In establishing guidelines under paragraph

16 (1)(C), and as appropriate to the job responsibilities of

17 the respective health workers, the National Health Board

18 shall require that each health worker employed by a com19 munity board must work part of the time in a health care

20 facility operated by the respective district or regional

21 board, and that each health worker (including the faculty

22 of health team schools) employed by a district or regional

23 board must work part of the time in a health care facility

24 operated by a community board within the district or re25 gion.
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1 (4) The National Health Board shall periodically

2 evaluate the job categories and certification practices es3 tablished by area health boards under this section and

4 shall make such modifications to its guidelines as it deter5 mines will promote the delivery of quality health care serv6 ices.

7 (5) The National Health Board shall assist regional

8 boards in applying the guidelines established under this

9 subsection.

10 (b)(1) For each job category (other than a job cat11 egory determined by the National Health Board to involve

12 highly specialized skills requiring advanced specialty train13 ing), each regional health board shall, taking into account

14 the guidelines established under subsection (a), establish

15 certification standards which shall specify—

16 (A) the functions performed by a healthworker

17 employed in such job category;

18 (B) the skills required in the course of properly

19 performing work under such job category;

20 (C) the initial and continuing training, experi21 ence, and performance which must be undertaken or

22 demonstrated by a health worker to achieve and

23 maintain competency to perform the work within

24 such job category; and
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1 (D) the curriculum which a health worker must

2 follow in studies in a health team school (established

3 under part B) to demonstrate sufficient competence

4 to satisfy the specification of subparagraph (C) for

5 such job category.

6 Each area health board within the region shall apply such

7 standards to all health workers employed by it. In applying

8 such standards, such boards shall recognize health worker

9 training, experience, and performance undertaken or dem10 onstrated before the establishment of health team schools

11 under part B, subject to such periodic review and assess12 ment and to such continuing training, experience, or per13 formance as may be required under this part.

14 (2) For each job category established and determined

15 by the National Health Board to involve highly specialized

16 skills requiring advanced specialty training, the National

17 Health Board shall make the specifications described in

18 subparagraphs (A) through (D) of paragraph (1), and

19 area health boards shall apply such certification standards

20 to all health workers employed by them in such job cat21 egories.

22 (3) A health board which establishes standards for

23 a job category under this subsection shall periodically re24 view such standards and shall supplement, modify, or
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1 eliminate such standards as it determines will facilitate

2 the delivery of quality health care services under this Act.

3 PART B—EDUCATION OF HEALTH WORKERS

4 HEALTH TEAM SCHOOLS

5 SEC. 311. (a)(1) Except as provided in paragraph

6 (2), each regional board, in consultation with the commu7 nity and district boards in its region, shall establish a

8 health team school (hereinafter in this part referred to as

9 a ‘‘school’’) in accordance with this section to provide pro10 grams of initial and continuing basic education in health

11 care delivery for health workers in all job categories, and

12 to provide initial continuing advanced education in health

13 care specialties and health science specialty fields. Each

14 school shall be established and functioning not later than

15 4 years after the effective date of health services unless

16 the National Health Board approves a plan, submitted by

17 the regional board, for the establishment of a school within

18 a reasonable time after such deadline.

19 (2) If a regional board determines, after consultation

20 with the community and district boards in its region, that

21 conducting particular educational programs within a

22 school in its region would be inefficient or otherwise inap23 propriate, it may collaborate with one or more regional

24 boards for adjacent regions conducting joint educational

25 programs. In the case of the establishment of such a joint
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1 program, all further references in this part to a region

2 or a regional board with respect to a school offering a joint

3 program shall refer to the regions included within, and

4 the regional boards offering, the joint program.

5 (3) Schools shall be funded exclusively by the Service,

6 shall not charge nor accept tuition or fees for enrollment,

7 and shall provide each student with an adequate allowance

8 for living expenses, educational supplies, and any child

9 care expenses.

10 (4) The National Health Board shall assist regional

11 boards in the establishment and maintenance of schools.

12 (b) Schools shall be operated and maintained in ac13 cordance with the following principles:

14 (1) The activities of each school shall be de15 signed to meet the health needs of the region, dis16 tricts, and communities which it serves.

17 (2) The number of students enrolled in each

18 educational program in a school shall be based on

19 the regional, district, and community boards’ assess20 ments of the needs for health workers within such

21 region, districts, and communities.

22 (3) Schools shall integrate the education of

23 health workers in the different job categories (estab24 lished under part A) so as to permit health workers
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1 to be educated and certified for successively higher

2 levels of health care work.

3 (4) Each school’s admissions policies, curricu4 lum policies, faculty hiring procedures, and govern5 ance plan shall be established and implemented by

6 the regional board in accordance with subsections (c)

7 through (f), respectively, and with the fullest pos8 sible participation of the community and district

9 boards, health workers, staff, and students in its re10 gion.

11 (5) A school may not use individuals who are

12 from low-income populations or minority groups, or

13 who are women or confined in mental or penal insti14 tutions, as subjects for training or demonstration in

15 numbers that are disproportionate to their numbers

16 in the population of the region, and may not use any

17 individuals as subjects for training or demonstration

18 in a manner beyond that required for the immediate

19 purpose of the training or demonstration.

20 The National Board shall establish, not later than one

21 year after the effective date of health services, guidelines

22 for the application of these principles and for the phased

23 integration of health worker education programs, includ24 ing medical, dental, osteopathic, and nursing school pro-
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1 grams, in existence on the date of enactment of this Act

2 into the schools established under this section.

3 (c) Each regional board shall establish and implement

4 admissions policies for education programs in its school.

5 Such policies shall—

6 (1) emphasize previous health-related work ex7 perience, as evaluated by health workers (including

8 peers), by individuals who have received health care

9 services from the applicant, and by faculty members;

10 (2) minimize the use of criteria of academic

11 performance other than such criteria as have been

12 shown to be significantly related to future work per13 formance;

14 (3) give preference to segments of the popu15 lation of the region under-represented among health

16 workers;

17 (4) to the extent consistent with paragraph (3),

18 provide for admission of individuals so that the stu19 dent body approximates the population of the region

20 by race, sex, family income, and language; and

21 (5) require that the applicant agree, if accepted

22 into the school, to perform health care services in ac23 cordance with section 312.
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1 (d) Each regional board shall establish and imple2 ment curriculum policies for educational programs in its

3 school. Such policies shall—

4 (1) give priority in study and field work to the

5 leading causes of illness and death in the region, in6 cluding environmental, biological, and social deter7 minants of mortality and morbidity;

8 (2) give special consideration to studying the

9 social, as well as biological, causation and prevention

10 of illness and disease, and to the differing health

11 care needs of populations facing special health risks

12 and having special cultures and lifestyles within the

13 region;

14 (3) provide that all students shall take a com15 mon, initial sequence of courses and that students

16 preparing for more advanced types of health work

17 shall take studies that are progressively more spe18 cialized and differentiated;

19 (4) emphasize work-study experience in all

20 types of health care facilities in the region, including

21 community and workplace facilities, facilities for the

22 aged, mentally ill, and mentally retarded, health care

23 facilities in prisons and other correctional institu24 tions, alcohol and drug rehabilitation facilities, envi25 ronmental health facilities, and all other health care
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1 facilities of the Service in communities and districts

2 in the region;

3 (5) emphasize the appropriate and safe use,

4 and discourage the overuse, of drugs and medical

5 techniques; and

6 (6) facilitate the development by all health

7 workers of skills in decisionmaking and assessment

8 of patient needs in cooperation with other health

9 workers and with patients.

10 (e) Each regional board shall establish and implement

11 faculty hiring procedures for its school. Such procedures

12 shall, to the maximum extent feasible, create a faculty

13 which approximates the population of the region by race,

14 sex, and language.

15 (f) Each regional board shall establish and implement

16 a governance plan for the management of its school. Such

17 plan shall give significant decisionmaking powers to staff

18 and students of the school.

19 SERVICE REQUIREMENT

20 SEC. 312. (a)(1) No individual may be enrolled by

21 a regional board in a school unless the individual agrees

22 to perform health care services as an employee of the Serv23 ice in the job category for which training is being provided

24 (A) for a period of time equal to the period of such

25 enrollement in the school but not less than 2 years, (B)
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1 beginning not later than 1 year after the date of the indi2 vidual’s graduation from the school, and (C) for an area

3 health board with the highest priority ranking under sub4 section (c) that agrees to employ the individual.

5 (2) An individual’s obligation to perform service

6 under an agreement described in paragraph (1) shall be

7 deferred only for a period during which the individual is

8 physically or mentally incapable of performing such serv9 ice.

10 (3) No health board may employ an individual who

11 has made an agreement described in paragraph (1), other

12 than in accordance with subsection (c), until the individual

13 has completed the period of obligated service in accordance

14 with this section.

15 (4) Except as provided in paragraph (5), if an indi16 vidual breaches an agreement under paragraph (1) by fail17 ing (for any reason) either to begin such individual’s serv18 ice obligation or to complete such service obligation, the

19 Service shall be entitled to recover from the individual an

20 amount determined in accordance with the formula

A=φ + 1¥

s

,

t

.

21 in which ‘‘A’’ is the amount the Service is entitled to re22 cover; ‘‘φ’’ is an amount determined by the National

23 Health Board to be the costs to the Service of the edu-
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1 cation program and allowance received by the individual

2 and the interest on such costs which would be payable if

3 at the time the costs were undertaken they were loans

4 bearing interest at the maximum legal prevailing rate, as

5 determined by the Treasurer of the United States; ‘‘t’’ is

6 the total number of months in the individual’s period of

7 obligated service; and ‘‘s’’ is the number of months of such

8 period served by the individual. Any amount of damages

9 which the Service is entitled to recover under this para10 graph shall, within the 1-year period beginning on the date

11 of the breach of the agreement, be paid to the Service.

12 (5)(A) Any obligation of an individual under this sub13 section for service or payment of damages shall be can14 celed upon the death of the individual.

15 (B) The National Health Board shall provide for the

16 waiver or suspension of any obligation of service or pay17 ment by an individual under this part whenever compli18 ance by the individual is impossible or would involve ex19 treme hardship to the individual and if enforcement of

20 such obligation with respect to any individual would be

21 unconscionable.

22 (C) Any obligation of an individual under this part

23 for payment of damages may be released by a discharge

24 in bankruptcy under title 11 of the United States code

25 only if such discharge is granted after the expiration of
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1 the 5-year period beginning on the first date that payment

2 of such damages is required.

3 (b) Each area health board shall periodically assess

4 the ratio of the number of health workers employed by

5 the board in each job category (established under part A)

6 to the number of residents in the area.

7 (c)(1) With respect to an individual obligated to per8 form service under this section as a result of completion

9 of an educational program for a job category in a school,

10 the priority ranking (referred to in subsection (a)(1)(C))

11 of area health boards for hiring the individual is as fol12 lows:

13 (A) The regional board for the region, or a dis14 trict or community board for a district or commu15 nity in the region, in which the program was com16 pleted, if the region, district, or community is a

17 health worker shortage area (as defined in para18 graph (2)) with respect to the job category for which

19 the individual received training.

20 (B) A regional, district, or community board

21 (other than one described in subparagraph (A)) for

22 a region, district, or community which is a health

23 worker shortage area with respect to the job cat24 egory for which the individual received training.

25 (C) Any other area health board.
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1 (2) For the purposes of paragraph (1), the term

2 ‘‘health worker shortage area’’ means, with respect to a

3 job category for which an individual has received training

4 in a school, a region, district, or community which—

5 (A) has a ratio of the number of health workers

6 in the job category employed by the regional, district

7 or community board, respectively, to the number of

8 residents in the region, district, or community

9 (whichever is applicable) which is less than two10 thirds of the ratio of the total number of health

11 workers in the job category employed by all the re12 gional, district, or community boards, respectively, in

13 the Nation to the number of residents in the Nation,

14 and

15 (B) has plans and a budget which provide for

16 the hiring of an individual in the job category.

17 (3) The National Health board shall establish a pro18 gram to match the locational preferences of graduates of

19 schools with the needs and preferences of regional, dis20 trict, and community boards.

21 PAYMENT FOR CERTAIN EDUCATIONAL LOANS

22 SEC. 313. (a) In the case of any individual who has

23 incurred any educational loan before the fourth year after

24 the effective date of health services and for the individual’s

25 costs for an educational program in health care delivery,
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1 health care specialties, or health science specialty fields,

2 the National Health Board shall make payments, in ac3 cordance with subsection (b), for and on behalf of that

4 individual, on the principal of and interest on any such

5 loan which is outstanding on the date the individual begins

6 to work for the Service.

7 (b) The payments described in subsection (a) shall

8 be made by the National Health Board as follows:

9 (1) Upon completion by the individual for whom

10 the payments are to be made of the first year of em11 ployment with the Service, the National Health

12 Board shall pay 30 percent of the principal of, and

13 the interest on, each loan described in subsection (a)

14 which is outstanding on the date he began such em15 ployment.

16 (2) Upon completion by that individual of the

17 second year of such employment, the National

18 Health Board shall pay another 30 percent of the

19 principal of, and the interest on, each such loan.

20 (3) Upon completion by that individual of a

21 third year of such employment, the National Health

22 Board shall pay another 25 percent of the principal

23 of, and the interest on, each such loan.

24 (4) Upon completion by that individual of a

25 fourth year of such employment, the National
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1 Health Board shall pay the remaining 15 percent of

2 the principal of, and all remaining interest on, each

3 such loan.

4 No payment may be made under this subsection with re5 spect to a loan unless the person on whose behalf the pay6 ment is to be made has submitted to the National Health

7 Board a certified copy of the agreement under which such

8 loan was made.

9 (c) Notwithstanding the requirement of completion of

10 employment specified in subsection (b), the National

11 Health Board shall on or before the due date thereof, pay

12 any loan or loan installment which may fall due within

13 the period of employment for which the borrower may re14 ceive payments under this section, upon the declaration

15 of such borrower, at such times and in such manner as

16 the National Health Board may prescribe (and supported

17 by such other evidence as the National Health Board may

18 reasonably require), that the borrower is then employed

19 as described in subsection (b) and that the borrower will

20 continue to be so engaged for the period required (in the

21 absence of this subsection) to entitle the borrower to have

22 made the payments provided by this section for such pe23 riod, except that not more than 85 percent of the principal

24 of any such loan shall be paid pursuant to this subsection.
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1 PART C—EMPLOYMENT AND LABOR-MANAGEMENT

2 RELATIONS WITHIN THE SERVICE

3 EMPLOYMENT, TRANSFER, PROMOTION, AND RECEIPT OF

4 FEES

5 SEC. 321. (a) Health boards shall, in accordance with

6 this Act and taking into account guidelines and standards

7 established by the appropriate National Health Board,

8 employ, classify, and fix the salaries and benefits of all

9 employees of the Service employed in the Service’s facili10 ties.

11 (b) The appropriate National Health Board, in estab12 lishing guidelines and standards under this part, shall, to

13 the extent feasible and consistent with the provisions of

14 this part, provide for—

15 (1) employment and promotion in the Service in

16 the same manner as is provided for employment and

17 promotion under the Federal civil service system;

18 (2) meaningful opportunities for career ad19 vancement;

20 (3) encouragement of health workers to use up

21 to 10 percent of their work time for continuing edu22 cation under part B without loss of pay or other job

23 rights; and
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1 (4) full protection of employees’ rights by pro2 viding an opportunity for a fair hearing on adverse

3 actions with representation of their own choosing.

4 (c) Health boards, in hiring employees to fill vacan5 cies in newly created positions, shall give preference to in6 dividuals who were employed as health workers, or self7 employed while delivering health services, before the date

8 of enactment of this Act. The National Health Board shall

9 ensure, through such steps as it deems necessary, that all

10 such individuals desiring to be employed within the Service

11 shall find appropriate employment in the Service.

12 (d) Employees of the Service shall be eligible for pro13 motion or transfer to any position in the Service for which

14 they are qualified. Each regional board shall establish and

15 maintain a job placement service to assist health workers

16 in its region in identifying suitable employment opportuni17 ties and in transferring between jobs with different area

18 health boards in the region. The authority given by this

19 subsection shall be used to provide a maximum degree of

20 career opportunities for employees and to ensure contin21 ued improvement of health care services.

22 (e) A community or district board may not hire an

23 individual to fill a job vacancy that is classified under part

24 A in a job category if—
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1 (1) the community or district board, respec2 tively, has a ratio of the number of health workers

3 in the job category employed by such board to the

4 number of residents in the community or district

5 (whichever is applicable) which is greater than four6 thirds of the ratio of the total number of health

7 workers in the job category employed by all the com8 munity or district boards, respectively, in its region

9 to the number of residents in such region; and

10 (2) there is a community or district within its

11 region which is a health worker shortage area (as

12 defined in section 312(c)(2)) with respect to the job

13 category.

14 (f) An employee of the Service may not receive any

15 fee or perquisite on account of duties performed by virtue

16 of such employment, except from a health board estab17 lished under this Act.

18 APPLICABILITY OF LAWS RELATING TO FEDERAL

19 EMPLOYEES

20 SEC. 322. (a) Chapter 75 of title 5, United States

21 Code (relating to adverse actions against employees),

22 apply to employees of the Service (other than employees

23 serving on the personal staff of members of health boards)

24 except to the extent provided—
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1 (1) in a collective-bargaining agreement negoti2 ated on behalf of and applicable to them; or

3 (2) in procedures established by the Service and

4 approved by the Office of Personnel Management.

5 (b) Employees of the Service are covered by sub6 chapter I of chapter 81 of title 5, United States Code (re7 lating to compensation for work injuries).

8 (c)(1) Chapter 83 of title 5, United States Code (re9 lating to civil service retirement), applies to employees of

10 the Service except to the extent provided in a collective11 bargaining agreement negotiated on behalf of and applica12 ble to them.

13 (2) The Service shall withhold from pay and shall pay

14 into the Civil Service Retirement and Disability Fund the

15 amounts specified in chapter 83 of title 5, United States

16 Code, as required under paragraph (1). The Service, upon

17 request of the Office of Personnel Management, but not

18 less frequently than annually, shall pay to the Office the

19 costs reasonably related to the administration of Fund ac20 tivities for employees of the Service.

21 (d) Sick and annual leave and compensatory time of

22 employees of the Service, whether accrued prior to or after

23 the commencement of operations of the Service, shall be

24 obligations of the Service.
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1 (e)(1) Compensation, benefits, and other terms and

2 conditions of employment in effect on the effective date

3 of health services for employees of the Federal Govern4 ment performing functions that are provided under this

5 Act by the Service, shall apply to all employees of the

6 Service performing similar functions until changed by the

7 Service in accordance with this Act. Subject to the provi8 sions of this Act, the provisions of subchapter I of chapter

9 85 and chapter 87 of title 5, United States Code (relating

10 to unemployment compensation and life insurance), apply

11 to employees of the Service unless varied, added to, or sub12 stituted for in accordance with paragraph (2).

13 (2) No variation, addition, or substitution with re14 spect to fringe benefits shall result in a program of fringe

15 benefits which on the whole is less favorable to employees

16 of the Service than fringe benefits in effect for employees

17 of the Federal Government on the effective date of health

18 services. No variation, addition, or substitution with re19 spect to fringe benefits of employees for whom there is

20 a collective-bargaining representative shall be made except

21 by agreement between such representative and the Service.

22 APPLICABILITY OF FEDERAL LABOR-MANAGEMENT

23 RELATIONS LAWS

24 SEC. 323. (a)(1) The provisions of the National

25 Labor Relations Act (42 U.S.C. 141 et seq.) shall apply
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1 to the Service and its employees to the extent, not incon2 sistent with subsection (b), to which such provisions apply

3 to employers (as defined in section 2(2) of such Act), ex4 cept that—

5 (A) the phrase ‘‘or any individual employed as

6 a supervisor’’ in section 2(3) of such Act shall not

7 apply (thereby making such Act apply, for these pur8 poses, to such individuals);

9 (B) section 9(b)(1) of such Act (providing for

10 separate treatment for professional and nonprofes11 sional employees) shall not apply;

12 (C) sections 206 through 210 of such Act (re13 lating to national emergencies) shall, for purposes of

14 this Act, have the phrases ‘‘the President of the

15 United States’’ and ‘‘the President’’, wherever they

16 appear, replaced by the phrase ‘‘the National Health

17 Board (or a committee thereof to which it has dele18 gated such authority)’’ and the phrase ‘‘national

19 health or safety’’ replaced by the phrase ‘‘health or

20 safety of the residents of any region’’; and

21 (D) section 213 (providing for intervention in a

22 strike or lockout by the Director of the Federal Me23 diation and Conciliation Service) shall not apply.

24 (2) Paragraphs (3) and (4) of section 7311 of title

25 5, United States Code (prohibiting participation in a
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1 strike or an organization asserting the right to strike),

2 shall not apply to employees of the Service.

3 (b)(1) Collective-bargaining agreements between area

4 health boards and duly recognized bargaining representa5 tives of employees of the Service may include procedures

6 for resolution by the parties of grievances and adverse ac7 tions arising under the agreement, including procedures

8 culminating in binding third-party arbitration.

9 (2) Area health boards and duly recognized bargain10 ing representatives of employees of the Service may by

11 mutual agreement adopt procedures for the resolution by

12 the parties (A) of grievances and adverse actions arising

13 under collective-bargaining agreements, and (B) of dis14 putes or impasses arising in the negotiation of such agree15 ments.

16 (c) Section 3(e) of the Labor-Management Reporting

17 and Disclosure Act of 1959 (42 U.S.C. 402(e)) is amended

18 by inserting ‘‘the United States Health Service and’’ after

19 ‘‘and includes’’.

20 DEFENSE OF CERTAIN MALPRACTICE AND NEGLIGENCE

21 SUITS

22 SEC. 324. (a) The remedy against the United States

23 provided by sections 1346(b) and 2672 of title 28, United

24 States Code, or by alternative benefits provided by the

25 United States where the availability of such benefits pre-
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1 cludes a remedy under section 1346(b) of such title, for

2 damage for personal injury, including death, resulting

3 from the performance of medical, surgical, dental, or relat4 ed functions, including the conduct of clinical studies or

5 investigations, by any employee of the Service while acting

6 within the scope of the employee’s employment, shall be

7 exclusive of any other civil action or proceeding by reason

8 of the same subject matter against the employee (or the

9 employee’s estate) whose act or omission gave rise to the

10 claim.

11 (b) The Attorney General shall defend any civil action

12 or proceeding brought in any court against any person re13 ferred to in subsection (a) (or the person’s estate) for any

14 such damage or injury. Any such person against whom

15 such civil action or proceeding is brought shall deliver

16 within such time after date of service or knowledge of serv17 ice as determined by the Attorney General, all process

18 served upon the person or an attested true copy thereof

19 to the person’s immediate superior or to whomever was

20 designated by the appropriate National Health Board to

21 receive such papers and such person shall promptly fur22 nish copies of the pleading and process therein to the

23 United States attorney for the district embracing the place

24 wherein the proceeding is brought, to the Attorney Gen25 eral, and to the appropriate National Health Board.
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1 (c)(1) Upon a certification by the Attorney General

2 that the defendant was acting in the scope of employment

3 at the time of the incident out of which the suit arose,

4 any such civil action or proceeding commenced in a State

5 court shall be removed without bond at any time before

6 trial by the Attorney General to the district court of the

7 United States of the district and division embracing the

8 place wherein it is pending and the proceeding deemed a

9 tort action brought against the United States under the

10 provision of title 28, United States Code, and all ref11 erences thereto.

12 (2) If a United States district court determines on

13 a hearing on a motion to remand held before a trial on

14 the merits that the case so removed is one in which a rem15 edy by suit within the meaning of subsection (a) is not

16 available against the United States, the case shall be re17 manded to the State court.

18 (3) Where a remedy by suit within the meaning of

19 subsection (a) is not available because of the availability

20 of a remedy through proceedings for compensation or

21 other benefits from the United States as provided by any

22 other law, the case shall be dismissed, but in the event

23 the running of any limitation of time for commencing, or

24 filing an application or claim in, such proceedings for com25 pensation or other benefits shall be deemed to have been
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1 suspended during the pendency of the civil action or pro2 ceeding under this section.

3 (d) The Attorney General may compromise or settle

4 any claim asserted in such civil action or proceeding in

5 the manner provided in section 2677 of title 28, United

6 States Code, and with the same effect.

7 (e) For purposes of this section, the provisions of sec8 tion 2680(h) of title 28, United States Code, shall not

9 apply to assault or battery arising out of negligence in

10 the performance of medical, surgical, dental, or related

11 functions, including the conduct of clinical studies or in12 vestigations.

13 (f) The appropriate National Health Board may, to

14 the extent it deems appropriate, hold harmless or provide

15 liability insurance for any employee of the Service for

16 damage for personal injury, including death, negligently

17 caused by such employee while acting within the scope of

18 employment and as a result of the performance of medical,

19 surgical, dental, or related functions, including the con20 duct of clinical studies or investigations, if the employee

21 is assigned to a foreign country or detailed to a State or

22 political subdivision thereof or to a nonprofit institution,

23 and if the circumstances are such as are likely to preclude

24 the remedies of third persons against the United States
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1 described in section 2679(b) of title 28, United States

2 Code, for such damage or injury.

3 TITLE IV—OTHER FUNCTIONS OF HEALTH

4 BOARDS

5 PART A—ADVOCACY, GRIEVANCE PROCEDURES, AND

6 TRUSTEESHIPS

7 ADVOCACY AND LEGAL SERVICES PROGRAM

8 SEC. 401. (a) Each area health board shall establish

9 a program of health advocacy to ensure the full realization

10 of the patient rights enumerated in part A of title II. Such

11 a program shall include—

12 (1) the employment of individuals having basic

13 legal knowledge and skills as health advocates;

14 (2) the presence of health advocates (A) in in15 patient health care facilities at all times, and (B) in

16 other health care facilities during the provision of

17 health care services;

18 (3) provision for health advocates to (A) in19 form, on an ongoing basis, users and health workers

20 of such patient rights and (B) report to the area

21 health board any infraction of such rights which is

22 not promptly corrected;

23 (4) provision for regular meetings between

24 health workers and health advocates, users, and any

25 user representatives to discuss ways of ensuring the
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1 fulfillment of such rights through affirmative action

2 of such workers and the area health board; and

3 (5) appropriate action by the area health board

4 to ensure that infractions of such rights are prompt5 ly and sufficiently corrected.

6 (b)(1) The National Health Board shall establish a

7 health rights legal services program and shall provide such

8 program with sufficient legal and administrative person9 nel, funding, and facilities (A) to ensure that users and

10 health workers receive, free of charge, high quality legal

11 services (including representation in grievance proceedings

12 commenced under section 402) for legal problems related

13 to health rights and health care services, and (B) to im14 prove, through litigation and other activities, the health

15 care system and expand the rights of users and health

16 workers.

17 (2) The health rights legal services program shall

18 provide directly, by contract with the Legal Services Cor19 poration, or by contract with members of the private bar,

20 for—

21 (A) establishment of a legal services office in

22 each region to provide representation (other than

23 representation provided under subparagraph (B)) of

24 users, health workers, and voluntary associations
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1 having a demonstrated interest in health care in pro2 ceedings and hearings under section 402; and

3 (B) establishment of legal services offices in

4 such communities and districts as are determined, in

5 accordance with guidelines established by the Na6 tional Health Board, to have inadequate legal serv7 ices to provide the legal services described in para8 graph (1)(A).

9 (3) The National Health Board may carry out the

10 functions described in paragraph (1)(B) directly, by con11 tract, or otherwise.

12 GRIEVANCE PROCEDURES AND TRUSTEESHIPS

13 SEC. 402. (a)(1) Each regional and interim regional

14 board shall provide, in accordance with this section, that

15 any user, health worker, or any user association having

16 a demonstrated interest in health care may commence a

17 grievance proceeding before such board (or a person or

18 committee designated by such board) with respect to an

19 alleged violation of this Act by a district or community

20 board within its region. Each regional and interim re21 gional board may commence a grievance proceeding before

22 itself (or a person or committee designated by such board)

23 with respect to an alleged violation of this Act by a district

24 or community board within its region.
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1 (2) The appropriate National Health Board shall pro2 vide, in accordance with this section, that any user, health

3 worker, or any user association having a demonstrated in4 terest in health care may commence a grievance proceed5 ing before such Board (or a person or committee des6 ignated by such Board) with respect to an alleged violation

7 of this Act by a regional or interim regional board. The

8 appropriate National Health Board may commence a

9 grievance proceeding before itself (or a person or commit10 tee designated by such Board) with respect to an alleged

11 violation of this Act by a regional or interim regional

12 board.

13 (b)(1) The appropriate National Health Board shall

14 provide, subject to paragraphs (3) and (4), for its review

15 (or a review by a person or committee designated by the

16 Board), by appeal to the Board by any party to a proceed17 ing described in subsection (a)(1) or on its own initiative,

18 of an adverse decision by a regional or interim regional

19 board in the proceeding.

20 (2) On and after the date a suit with respect to an

21 adverse determination in a grievance proceeding or review

22 proceeding is filed under subsection (e), no review proceed23 ing respecting such proceeding may be commenced by ap24 peal to the Board under paragraph (1), and any such re25 view proceeding which was commenced by appeal to the
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1 Board under such paragraph before the date of filing of

2 such suit and is pending on such date shall promptly be

3 discontinued.

4 (3) No review of an adverse administrative decision

5 may be made by appeal or by initiative under this sub6 section unless the appeal is filed or notice of the initiative

7 is published (as the case may be) not later than 15 days

8 after the publication of the decision.

9 (c)(1) Whenever a grievance proceeding is com10 menced under subsection (a), the entity before which the

11 proceeding is held shall investigate the grievance.

12 (2) An entity before which a proceeding or review

13 proceeding is commenced under subsection (a) or (b)—

14 (A) shall conduct a full and open public hearing

15 on the grievance as part of such proceeding—

16 (i) if the grievance is supported by a peti17 tion signed by a minimal number of residents

18 (as defined in paragraph (4)); or

19 (ii) before the entity (or the body which

20 designated it) may set aside an election or

21 transfer any functions of a health board under

22 subsection (d); and

23 (B) may conduct such a hearing if the entity

24 determines that such hearing is in the public inter25 est.
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1 (3) The entity that conducts a hearing under para2 graph (2) shall provide for timely notice to, and oppor3 tunity to be heard by, any party with a direct interest in

4 the grievance for which the hearing is conducted.

5 (4) As used in paragraph (1), the term ‘‘minimal

6 number of residents’’ means, with respect to a grievance

7 which concerns a health board which is—

8 (A) a community board, 100 individuals,

9 (B) a district board, 300 individuals, and

10 (C) a regional or interim regional board, 1,000

11 individuals,

12 who are 18 years of age or older and who reside in the

13 area served by the board.

14 (d)(1) With respect to a grievance proceeding begun

15 under subsection (a) relating to the conduct of an election

16 of a community board, if the entity before which such pro17 ceeding is commenced under such subsection, or is re18 viewed under subsection (b), determines that the election

19 (A) was not conducted substantially in compliance with

20 this Act or (B) has revealed the systematic failure of the

21 user members of such community board to approximate

22 the population of the community by race, sex, language,

23 and income level, the entity shall set aside the election

24 and, unless such determination is reviewed under sub25 section (b), the entity shall require that another election
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1 for members of the community board be conducted, in ac2 cordance with this Act, not later than 60 days after the

3 date of such determination. If such election is conducted

4 because of a determination under clause (B), the election

5 shall be conducted (and subsequent elections may be con6 ducted) in such a manner, including the use of geographic

7 or other subdivisions for electoral purposes, as will facili8 tate the representation of significant elements of the popu9 lation of a community by race, sex, language, and income

10 level.

11 (2) With respect to a grievance proceeding begun

12 under subsection (a) relating to a grievance other than

13 the conduct of an election of a community board, if the

14 entity before which such proceeding is commenced under

15 such subsection, or is reviewed under subsection (b), deter16 mines that the grievance represents—

17 (A) a failure by a health board to comply sub18 stantially and materially with this Act, the entity

19 shall require that a new election or appointment, in

20 accordance with this Act, of members of the health

21 board be conducted or made within 60 days of the

22 date of such determination; or

23 (B) a failure by a health board to comply, but

24 not substantially and materially, with this Act, the

25 entity may require that a new election or appoint-
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1 ment, in accordance with this Act, of members of

2 the health board be conducted or made if such fail3 ure is not corrected within a reasonable period of

4 time (specified by the entity) of the date of such

5 determination.

6 (3)(A) If an entity determines under paragraph (1)

7 or (2) that a community or district board has failed to

8 comply with this Act, the entity shall transfer to the re9 gional (or interim regional) board for such community or

10 district such functions of the community or district board

11 as it determines necessary to carry out this Act until a

12 new election or appointment is conducted or made.

13 (B) If an entity determines under paragraph (2) that

14 a regional or interim regional board has failed to comply

15 with this Act, the entity shall transfer to the appropriate

16 National Health Board such functions of the regional or

17 interim regional board as it determines necessary to carry

18 out this Act until a new regional or interim regional board

19 is appointed.

20 (C) If a health board is transferred the functions of

21 another health board under this paragraph, until a new

22 election or appointment of the other health board has been

23 certified, (i) the health board shall have the powers of the

24 other health board to conduct such functions, (ii) the

25 health board may appoint a trustee (or trustee committee)
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1 to have such powers and carry out such functions, and

2 (iii) any expenses that are certified by the health board

3 (or by the trustee or trustee committee appointed by it)

4 as having been incurred by it in discharging the functions

5 transferred to it under this paragraph shall be paid from

6 funds allocated to the other health board.

7 (e) Any party to a grievance proceeding or review pro8 ceeding commenced under this section may bring suit in

9 the United States district court for the judicial district

10 in which such proceeding, or review proceeding, was

11 brought, for the review of an adverse determination in

12 such proceeding or review proceeding. Such court shall af13 firm such determination unless it finds that such deter14 mination is not supported by substantial evidence or is ar15 bitrary and capricious.

16 PART B—OCCUPATIONAL SAFETY AND HEALTH

17 PROGRAMS

18 FUNCTIONS OF THE NATIONAL HEALTH BOARD

19 SEC. 411. (a) On and after the effective date of

20 health services, the National Health Board shall oversee

21 occupational safety and health programs conducted at the

22 regional level, and shall participate in the establishment

23 and administration of occupational safety and health

24 standards under the Occupational Safety and Health Act

25 of 1970.
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1 (b) In its participation in the establishment and ad2 ministration of occupational safety and health standards

3 under the Occupational Safety and Health Act of 1970,

4 the National Health Board shall seek the advice and com5 ments of regional occupational safety and health action

6 councils established under section 413.

7 (c)(1) To provide for participation of the National

8 Health Board in the establishment and administration of

9 occupational safety and health standards, the Occupa10 tional Safety and Health Act of 1970 (29 U.S.C. 651 et

11 seq.) is amended—

12 (A) by adding at the end of section 3 the fol13 lowing new paragraph:

14 ‘‘(15) The term ‘National Health Board’ means

15 the National Health Board of the United States

16 Health Services.’’;

17 (B) by striking out ‘‘Secretary of Health and

18 Human Services’’ each place it appears (other than

19 in section 22(b)) and inserting in lieu thereof ‘‘Na20 tional Health Board’’;

21 (C) by inserting ‘‘shall request the National

22 Health Board and’’ in the first sentence of section

23 6(b)(1) before ‘‘may request’’;
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1 (D) by inserting ‘‘the Board and’’ in the second

2 sentence of section 6(b)(1) after ‘‘The Secretary

3 shall provide’’;

4 (E) by striking out ‘‘An’’ in the third sentence

5 of section 6(b)(1) and inserting in lieu thereof ‘‘The

6 Board and an’’;

7 (F) by striking out ‘‘its’’ each place it appears

8 in the third sentence of section 6(b)(1) and inserting

9 in lieu thereof ‘‘their’’;

10 (G) by inserting ‘‘after consultation with the

11 National Health Board and’’ in the fourth sentence

12 of section 6(b)(6)(A) after ‘‘may be granted only’’;

13 (H) by inserting ‘‘after consultation with the

14 National Health Board and’’ in the third sentence of

15 section 6(d) before ‘‘after opportunity for’’;

16 (I) by striking out ‘‘The Secretary’’ and all that

17 follows through ‘‘shall each’’ in section 8(g)(2) and

18 inserting in lieu thereof ‘‘The Secretary shall’’;

19 (J) by striking out ‘‘their’’ in section 8(g)(2)

20 and inserting in lieu thereof ‘‘his’’;

21 (K) by inserting ‘‘after consultation with the

22 National Health Board and’’ in section 16 before

23 ‘‘after notice and opportunity’’;
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1 (L) by inserting ‘‘(after consultation with the

2 National Health Board)’’ in section 18(c) after ‘‘in

3 his judgment’’;

4 (M) by inserting ‘‘and the National Health

5 Board’’ in section 19(d) after ‘‘Secretary’’ each

6 place it appears; and

7 (N) by striking out the first sentence of para8 graph (5) of section 20(a).

9 (2) The amendments made by paragraph (1) shall

10 take effect on the effective date of health services.

11 (f) The National Health Board shall establish guide12 lines—

13 (1) for its participation in the establishment

14 and administration of occupational safety and health

15 standards under the Occupational Safety and Health

16 Act of 1970;

17 (2) for the election of community occupational

18 safety and health action councils under section 412;

19 (3) for the establishment of regional occupa20 tional safety and health programs under section 413;

21 (4) for the establishment and operation of

22 workplace health facilities under section 414; and

23 (5) for the provision of assistance by regional

24 and community boards to regional and community

25 occupational safety and health councils, respectively,
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1 and to workplace safety and health committees es2 tablished under section 415.

3 COMMUNITY OCCUPATIONAL SAFETY AND HEALTH

4 ACTIVITIES

5 SEC. 412. (a)(1) Each community board shall cooper6 ate with the appropriate regional board in the establish7 ment and implementation of an occupational safety and

8 health program for its region.

9 (2) Each community board shall provide for the orga10 nization and operation (including staff and support) in its

11 community of a community occupational safety and health

12 action council (hereinafter in this part referred to as a

13 ‘‘COSHAC’’) in accordance with this section.

14 (b) The members of a COSHAC shall be elected by

15 individuals employed in the community as follows:

16 (1) Employees of each workplace in the commu17 nity which has 500 or more employees shall be enti18 tled to elect one member for each 500 such employ19 ees in such workplace.

20 (2) Employees of workplaces in the community

21 which have fewer than 500 employees shall be enti22 tled to vote in community-wide elections for a num23 ber of members equal to (A) the total number of em24 ployees in such workplaces divided by 500, (B)
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1 rounded (if necessary) to the next highest whole

2 number.

3 The elections of COSHAC members shall be conducted by

4 the community board for such COSHAC under guidelines

5 established by the National Board.

6 (c) Each COSHAC shall—

7 (1) appoint one individual to serve, at its pleas8 ure, as a member of the community board for such

9 COSHAC;

10 (2) appoint one individual to serve, at its pleas11 ure, as a member of the regional occupational safety

12 and health action council for its region;

13 (3) advise the community board on, and over14 see, occupational safety and health programs in the

15 community;

16 (4) promote and assist in the establishment of

17 workplace occupational safety and health committees

18 in workplaces in the community, and advise and fa19 cilitate such committees’ actions relating to safety

20 and health hazards in workplaces in the community;

21 and

22 (5) assist employees in determining methods of,

23 and requirements for, inspections of workplaces in

24 the community for safety and health hazards.
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1 REGIONAL OCCUPATIONAL SAFETY AND HEALTH

2 PROGRAMS

3 SEC. 413. (a)(1) Each regional board shall establish

4 an occupational health and safety program for its region

5 in accordance with this subsection and under guidelines

6 established by the National Health Board.

7 (2) A regional occupational health and safety pro8 gram shall, to the maximum extent feasible, use the facili9 ties and resources of community boards in the region

10 and shall include—

11 (A) training programs to enhance the ability of

12 employees in the region to monitor safety and health

13 conditions in their workplaces and to assist safety

14 and health inspectors in the conduct of workplace

15 inspections;

16 (B) facilitating communication among workers

17 employed in similar industries in the region and the

18 Nation with respect to occupational health and safe19 ty hazards they face in common;

20 (C) baseline and periodic biologic screening of

21 employees in the region;

22 (D) development and maintenance of environ23 mental monitoring programs to identify and isolate

24 hazardous workplaces and work areas in the region;
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1 (E) the analysis of employment-related injuries

2 and illnesses occurring in the region; and

3 (F) staff and support for the operation of the

4 regional occupational safety and health action coun5 cil (hereinafter in this part referred to as the

6 ‘‘ROSHAC’’) established in the region under this

7 section.

8 (b) Each ROSHAC shall—

9 (1) appoint one individual to serve, at its pleas10 ure, as a member of the regional board for such

11 ROSHAC;

12 (2) advise the regional board on, and oversee,

13 occupational safety and health programs in the re14 gion; and

15 (3) advise the National Health Board on the es16 tablishment and administration of occupational safe17 ty and health standards under the Occupational

18 Safety and Health Act of 1970.

19 WORKPLACE HEALTH FACILITIES

20 SEC. 414. (a) The employer in each workplace shall

21 establish and maintain a health facility in or near the

22 workplace to provide occupational and emergency health

23 care services to individuals employed in the workplace in

24 accordance with this section and guidelines and standards
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1 for such facilities established by the National Health

2 Board.

3 (b) Each workplace health facility established pursu4 ant to subsection (a) shall, taking into account guidelines

5 established by the National Health Board—

6 (1) be organized in a manner so as to provide

7 an appropriate number of appropriately skilled

8 health workers to meet occupational and emergency

9 health care needs of employees in the workplace; and

10 (2) be operated by the community board for the

11 community in which the workplace is predominantly

12 located, or, where such board deems appropriate, by

13 the employer, with the cost in either case borne by

14 the employer in each workplace.

15 EMPLOYEE RIGHTS RELATING TO OCCUPATIONAL SAFETY

16 AND HEALTH

17 SEC. 415. (a)(1) Employees in each workplace having

18 25 or more employees shall have the right to establish

19 workplace occupational safety and health committees

20 (hereinafter in this subsection referred to as ‘‘commit21 tees’’) with members of their choosing.

22 (2) Members of committees (composed of the greater

23 of 3 members or one member for each 100 employees in

24 the workplace) shall, without any loss of pay or other job

25 rights—
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1 (A) be permitted to spend eight hours of each

2 month inspecting their workplace and conducting

3 such other functions relating to occupational safety

4 and health as are determined by the employees in

5 the workplace; and

6 (B) be permitted to accompany any safety and

7 health inspectors during inspections of the work8 place.

9 (b) Employees in each workplace shall have the right,

10 without any loss of pay or other job rights—

11 (1) to monitor safety and health conditions in

12 their workplace whenever they reasonably deem it

13 necessary and with whatever reasonable scientific in14 struments and expert assistance they choose; and

15 (2) to remove themselves from the site of any

16 hazard to their safety or health until an authorized

17 inspector has certified that the hazard has been

18 eliminated.

19 (c) Employers shall adopt all feasible engineering

20 measures that will minimize occupational safety and

21 health hazards in the workplace. Where such measures are

22 not adequate to protect employees from such hazards, em23 ployers shall furnish their employees with, or reimburse

24 their employees for the reasonable cost of, equipment and
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1 clothing needed to protect an employee from any residual

2 occupational safety and health hazards in the workplace.

3 (d) Employees or their duly chosen representatives

4 shall have the right to inspect all medical records main5 tained by their employers on the condition of their health,

6 and shall have the right to be assisted during such inspec7 tions by persons of their choosing.

8 (e) Employers shall provide their employees with cop9 ies of all reports, studies, and data concerning conditions

10 affecting the health and safety of employees within their

11 workplaces, with annual reports on the morbidity and

12 mortality experience of present and former employees, and

13 with timely notification of the presence within the work14 place of any materials, agents, or conditions which may

15 have a deleterious effect on the safety and health of their

16 employees, along with relevant information on hazards and

17 precautions, symptoms, remedies, and antidotes.

18 (f) Employees shall have the right to seek, through

19 collective bargaining, occupational safety and health

20 standards, including standards relating to physical and

21 mental stress and speed of work, more restrictive than

22 such standards established under the Occupational Safety

23 and Health Act of 1970.
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1 DEFINITIONS

2 SEC. 416. (a) For purposes of this part, the term

3 ‘‘workplace’’ means the regular location where work is per4 formed by one or more employees of an employer.

5 (b) For the purposes of sections 414 and 415, the

6 terms ‘‘employer’’ and ‘‘employee’’ have the same mean7 ings those terms have in section 3 of the Occupational

8 Safety and Health Act of 1970 (42 U.S.C. 653).

9 PART C—HEALTH AND HEALTH CARE DELIVERY

10 RESEARCH

11 PRINCIPLES AND GUIDELINES FOR RESEARCH

12 SEC. 421. (a) On and after the effective date of

13 health services, the Service shall conduct a program of re14 search concerning health and health care delivery. On and

15 after 2 years after such date, such research program shall

16 conform to the following principles:

17 (1) The research shall, to the maximum extent

18 possible, be performed under the direction of, and in

19 association with, community, district, and regional

20 boards.

21 (2) No research shall be conducted within, or

22 using the resources of, an area health facility until

23 it has been reviewed and approved by the area

24 health board responsible for such facility.
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1 (3) Priority shall be given in health research to

2 the prevention and correction of the leading causes

3 of illness and death, particularly environmental, oc4 cupational, nutritional, social, and economic causes.

5 (4) Priority shall be given in health care deliv6 ery research to improvement of the effectiveness and

7 efficiency of ambulatory and primary health care de8 livery, including research on alternative systems of

9 health care delivery and alternative conceptions of

10 health and health care.

11 (5) No experimentation to evaluate new preven12 tive, diagnostic, or therapeutic methods or agents

13 shall be undertaken upon human subjects until all

14 animal research which may effectively contribute to

15 evaluating such methods or agents has been under16 taken.

17 (6) No research shall be conducted on a human

18 subject without the subject’s informed written con19 sent.

20 (7) No research shall be conducted on a human

21 subject while the subject is involuntarily confined to

22 an institution.

23 (8) Each health board, in planning and con24 ducting research under the program, shall cooperate

25 with appropriate officials conducting related re-
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1 search in the Department of Health and Human

2 Services, the Environmental Protection Agency,

3 other Federal Government agencies, and agencies

4 and departments of State, territorial, and local gov5 ernments.

6 (9) The results of research shall be dissemi7 nated to the public and to area health boards in a

8 manner that will most readily permit the use of such

9 results to improve the health of users and the deliv10 ery of health care services.

11 (b) The National Health Board shall establish guide12 lines for the conduct of research in conformance with the

13 principles described in subsection (a).

14 ESTABLISHMENT OF INSTITUTES

15 SEC. 422. On the effective date of health services, the

16 National Institutes of Health (established under title IV

17 of the Public Health Service Act) are transferred to the

18 National Health Board. In addition, the National Health

19 Board shall establish the following institutes:

20 (1) A National Institute of Epidemiology, which

21 shall—

22 (A) gather and analyze disease-related statistics

23 collected by the Service;

24 (B) plan, conduct, support, and assist in epi25 demiologic research conducted by the Service;
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1 (C) conduct and support research on epidemio2 logic methodology and experimental epidemiology;

3 (D) establish and maintain an early warning

4 system for the detection of new diseases and

5 epidemics; and

6 (E) assist in the formulation of policies to

7 eliminate or reduce the causes of illness and injury

8 and to prevent and curtail epidemics of these condi9 tions.

10 (2) A National Institute of Evaluative Clinical Re11 search, which shall—

12 (A) gather and analyze all evidence collected by

13 the Service dealing with the effectiveness of preven14 tive, diagnostic, and therapeutic measures and the

15 occurrence of iatrogenic illnesses;

16 (B) analyze evidence on newly-discovered or

17 proposed preventive, diagnostic, and therapeutic

18 methods and agents;

19 (C) plan and conduct clinical trials, in conform20 ance with the limitations of part A of title II; and

21 (D) assist the National Health Board, in co22 operation with other bodies, including the National

23 Institute of Pharmacy and Medical Supply, in devel24 oping guidelines and standards for the introduction
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1 of new methods of prevention, diagnosis, and treat2 ment.

3 (3) A National Institute of Health Care Services,

4 which shall—

5 (A) analyze data and statistics on the health

6 care resources and needs of the Nation and on the

7 quality of present services;

8 (B) conduct comparative studies of health care

9 services in the various regions of the Nation, and

10 make recommendations for the improvement of

11 health care services in areas with inferior quality of

12 health care services;

13 (C) plan and conduct research on alternative

14 methods of health care delivery, on the functions,

15 tasks, performance and work relationships of various

16 kinds and categories of health workers, on patterns

17 of organization of health care, and on the effective18 ness and benefits of health care in relation to costs;

19 and

20 (D) assist the National Health Board in formu21 lating national policies to improve the quality of

22 health care services.

23 (4) A National Institute of Pharmacy and Medical

24 Supply, which shall—
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1 (A) recommend to the National Health Board

2 standards regarding the quality, distribution, and

3 price of all drugs, therapeutic devices, appliances

4 and equipment to be used by the Service;

5 (B) certify drugs, therapeutic devices, appli6 ances, and equipment for use in the health facilities

7 of the Service, and for furnishing to users of such

8 health facilities;

9 (C) assist the National Health Board in issuing

10 a National Pharmacy and Medical Supply For11 mulary; and

12 (D) conduct a comprehensive program of phar13 maceutical and medical supply research and utiliza14 tion education using, to the maximum extent pos15 sible, regional facilities operated in association with

16 the respective regional health boards.

17 (5) A National Institute of Sociology of Health and

18 Health Care, which shall—

19 (A) conduct ongoing analyses of the basic epis20 temological assumptions of health and health care;

21 (B) assess critically the effects of scientific

22 medicine and of divisions in institutional and tech23 nical skills in health care;
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1 (C) evaluate the effects of health care measures

2 and policies upon population groups and subgroups

3 in the Nation;

4 (D) identify and analyze the social, occupa5 tional, and environmental factors in modern society

6 affecting health and well-being;

7 (E) analyze alternative, holistic approaches to

8 the human body, health, and causality of ill health

9 and the lack of social and psychological well-being;

10 and

11 (F) assist the National Health Board in formu12 lating national policies relating to the promotion of

13 health and the provision of health care.

14 PART D—HEALTH PLANNING, DISTRIBUTION OF DRUGS

15 AND OTHER MEDICAL SUPPLIES, AND MISCELLANE16 OUS FUNCTIONS

17 HEALTH PLANNING AND BUDGETING

18 SEC. 431. (a) Each area health board shall, under

19 guidelines established by the National Health Board, col20 lect data on the supply of and demand for health workers

21 in facilities under its supervision, and on the delivery of

22 health care and supplemental services in health care facili23 ties under its supervision, shall evaluate such data in rela24 tion to the health care needs of their respective area, and

25 shall transmit such data and evaluation—
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1 (1) to its respective regional board, in the case

2 of a district or community board, and

3 (2) to the National Health Board, in the case

4 of a regional board,

5 and shall make available such data and evaluations to resi6 dents of its area.

7 (b) Each regional board shall coordinate the planning

8 and administration of the delivery of health care services,

9 health worker education, and health research in its region,

10 and shall facilitate the planning and administration of

11 such programs by district and community boards in its

12 region.

13 (c) The National Health Board shall formulate a 1-

14 year and 5-year national health plan and budget, taking

15 into account the area plans and budgets prepared in ac16 cordance with section 522, to provide guidance and direc17 tion to area health boards.

18 DISTRIBUTION OF DRUGS AND OTHER MEDICAL SUPPLIES

19 SEC. 432. (a)(1) The National Health Board, after

20 consultation with the regional boards, shall, not later than

21 the effective date of health services, publish and dissemi22 nate to area health boards a National Pharmacy and Med23 ical Supply Formulary (hereinafter in this section referred

24 to as the ‘‘Formulary’’).
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1 (2) The Formulary shall contain a listing of drugs,

2 therapeutic devices, appliances, equipment, and other

3 medical supplies (including eyeglasses, other visual aids,

4 hearing aids, and prosthetic devices) (hereinafter in this

5 section referred to as ‘‘drugs and other medical supplies’’).

6 For each item on such listing the Formulary shall contain

7 (A) the standards of quality for the production of such

8 item, (B) the medical conditions for which the item is cer9 tified as effective for purposes of the provision of health

10 care services under this Act, and (C) such other informa11 tion on such item as the National Health Board deter12 mines to be appropriate for the effective and efficient de13 livery of health care services under this Act.

14 (3) The National Health Board shall, at regular in15 tervals, update the contents of the Formulary and publish

16 a price list for items listed in the Formulary, which prices

17 shall reflect the actual costs of manufacture.

18 (b)(1) Each regional board shall establish a program,

19 in accordance with this subsection and under guidelines

20 established by the National Health Board, for the pur21 chase and distribution of drugs and other medical supplies

22 for use in health care facilities established by such board

23 or by a community or district board within its region.

24 (2) Such program shall provide for the purchase of

25 each drug or other medical supply item only (A) following
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1 competitive bidding on such item or (B) based on the price

2 listed for such item in the price list published under sub3 section (a)(3).

4 (3) Such program shall provide for the distribution

5 of drugs (and their dispensing by community and district

6 boards in its region) under their generic names.

7 (4) For purposes of paragraph (3), the term ‘‘generic

8 names’’ means the established names, as defined in section

9 502(e)(2) of the Federal Food, Drug, and Cosmetic Act

10 (21 U.S.C. 352(e)(2)).

11 (c) The National Health Board is authorized to es12 tablish and operate drug and medical supply manufactur13 ing facilities, if it determines that such operation will re14 sult in reduced expenditures by the Service.

15 MISCELLANEOUS FUNCTIONS OF THE NATIONAL HEALTH

16 BOARD

17 SEC. 433. (a) The appropriate National Health

18 Board shall publish, not later than December 31 of each

19 year, a report presenting and evaluating operations of the

20 Service during the fiscal year ending in such year and sur21 veying the future health needs of the Nation and plans

22 the Board has for the Service to meet such needs.

23 (b) The National Health Board shall, not later than

24 the effective date of health services, prepare and dissemi25 nate to area health boards, for use by users, a comprehen-
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1 sive dictionary of terms used in health care records and

2 services maintained or provided by the Service. Such dic3 tionary shall explain terms related to symptoms, signs, di4 agnoses, etiologic agents and conditions, diagnostic proce5 dures, and the treatment and prevention of, and rehabili6 tation following, illnesses, and shall include extensive cita7 tions of lay and professional sources which a user might

8 consult for additional information on such terms.

9 TITLE V—FINANCING OF THE SERVICE

10 PART A—HEALTH SERVICE TAXES

11 INDIVIDUAL AND CORPORATE INCOME TAXES

12 SEC. 501. (a)(1) Subchapter A of chapter 1 of the

13 Internal Revenue Code of 1954 (relating to normal taxes

14 and surtaxes) is amended by adding at the end thereof

15 the following new part:

16 ‘‘PART VII—HEALTH SERVICE TAXES

‘‘Sec. 59. Tax imposed.

17 ‘‘SEC. 59. TAX IMPOSED.

18 ‘‘(a) INDIVIDUALS, ESTATES, AND TRUSTS.—In ad19 dition to other taxes, there is hereby imposed for each tax20 able year on the taxable income of every individual and

21 of every estate and trust taxable under section 1(d), a tax

22 in an amount equal to 10 percent of the total amount of

23 the normal tax and surtax imposed by section 11 for such

24 taxable year.’’.
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1 ‘‘(b) CORPORATION.—In addition to the other taxes,

2 there is hereby imposed for each taxable year on the tax3 able income of every corporation, a tax in an amount equal

4 to 90 percent of the total amount of the normal tax and

5 surtax imposed by section 11 for such taxable year.’’.

6 (2) The table of parts of such subchapter A is amend7 ed by adding after the item relating to part VI the follow8 ing new item:

‘‘Part VII. Health service taxes.’’.

9 (b) Subsection (a) of section 3402 of the Internal

10 Revenue Code of 1954 (relating to income tax collected

11 at source) is amended by inserting after the third sentence

12 thereof the following sentence: ‘‘With respect to wages

13 paid on and after the effective date of health services

14 under the Health Service Act (as established in section

15 601 of such Act), the Secretary shall prescribe new tables

16 which shall be the same as the tables prescribed under

17 the previous sentence, except that such tables shall be

18 modified to the extent necessary to reflect the amendment

19 made to subchapter A of chapter 1 by section 501(a)(1)

20 of the Health Service Act.’’.

21 (c) The amendments made in this section shall apply

22 to taxable years beginning on or after the effective date

23 of health services.
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1 OTHER CHANGES IN THE INTERNAL REVENUE CODE OF

2 1954

3 SEC. 502. (a) DENIAL OF EXCLUSION FROM GROSS

4 INCOME FOR AMOUNTS PAID BY THIRD PARTIES FOR

5 MEDICAL CARE.—Section 105 of the Internal Revenue

6 Code of 1954 (relating to amounts received under accident

7 and health plans) is amended by striking out subsection

8 (b).

9 (b) DENIAL OF EXCLUSION FROM GROSS INCOME OF

10 CERTAIN CONTRIBUTIONS BY THE EMPLOYER TO

11 HEALTH PLANS.—Section 106 of such Code (relating to

12 contributions by employer to accident and health plans)

13 is amended to read as follows:

14 ‘‘SEC. 106. CONTRIBUTIONS BY EMPLOYERS TO ACCIDENT

15 AND HEALTH PLANS.

16 ‘‘Gross income does not include contributions by the

17 employer to accident or health plans for compensation

18 (through insurance or otherwise) to his employees for per19 sonal injuries or sickness to the extent that such contribu20 tions do not provide for health care and supplemental serv21 ices available to such employees under the Health Service

22 Act.’’

23 (c) DENIAL OF DEDUCTION OF HEALTH CARE EX24 PENSES AS TRADE OR BUSINESS EXPENSES.—Section

25 162 of such Code (relating to trade or business expenses)
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1 is amended by redesignating subsection (h) as subsection

2 (i) and by adding after subsection (g) the following new

3 subsection:

4 ‘‘(h) PAYMENTS FOR HEALTH CARE.—No deduction

5 shall be allowed under subsection (a) for any amount paid

6 for health care services (other than any amount of tax im7 posed by section 59 and paid by the employer on behalf

8 of his employees) which an individual was eligible to re9 ceive under title II of the Health Service Act.’’.

10 (d) DENIAL OF DEDUCTION FOR CONTRIBUTIONS TO

11 CERTAIN MEDICAL AND HOSPITAL FACILITIES.—(1)

12 Paragraph (2) of section 170(c) of such Code (relating

13 to charitable, etc., contributions and gifts) is amended by

14 inserting ‘‘(other than an organization described in sub15 section (b)(1)(A)(iii))’’ after ‘‘(2) A corporation, trust, or

16 community chest, fund, or foundation’’.

17 (2) Subsection (e) of section 501 of such Code (relat18 ing to cooperative hospital service organizations) is

19 amended by striking out the last sentence.

20 (e) DENIAL OF DEDUCTION FOR MEDICAL, DENTAL,

21 ETC., EXPENSES.—(1) Section 213 of such Code (relating

22 to medical, dental, etc., expenses) is repealed.

23 (2) The table of sections of part VII of subchapter

24 B of chapter 1 of subtitle A of such Code is amended by

25 striking out the item relating to section 213.
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1 (f) HOSPITAL INSURANCE TAX.—(1) Subsection (b)

2 of section 1401 of such Code (relating to rate of tax on

3 self-employment income) is repealed.

4 (2)(A) Subsection (b) of section 3101 of such Code

5 (relating to rate of tax on employees under the Federal

6 Insurance Contributions Act) is repealed.

7 (B) Section 3201 of such Code (relating to rate of

8 tax imposed on employees under the Railroad Retirement

9 Tax Act) is amended by striking out ‘‘(a) plus the rate

10 imposed by section 3101(b)’’.

11 (C) Subsection (a) of section 3211 of such Code (re12 lating to rate of tax on employee representatives under

13 the Railroad Retirement Tax Act) is amended by striking

14 out ‘‘3101(a), 3101(b)’’ and inserting in lieu thereof

15 ‘‘3101(a)’’.

16 (D) Subsection (e) of section 6051 of such Code (re17 lating to railroad employees) is repealed.

18 (g) The amendments made by this section shall apply

19 to taxable years beginning on or after the effective date

20 of health services.

21 EXISTING EMPLOYER-EMPLOYEE HEALTH BENEFIT

22 PLANS

23 SEC. 503. No contractual or other nonstatutory obli24 gation of any employer to pay for or provide any health

25 care and supplemental service to his present and former
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1 employees and their dependents and survivors, or to any

2 of such persons, shall apply on and after the effective date

3 of health services to the extent such individuals are eligible

4 to receive such health care and supplemental services

5 under this Act.

6 WORKERS COMPENSATION PROGRAMS

7 SEC. 504. No workers compensation program, wheth8 er established pursuant to Federal or State law or private

9 initiative, shall pay for or provide any health care and sup10 plemental services on and after the effective date of health

11 services, to the extent such health care and supplemental

12 services are available under this Act.

13 PART B—HEALTH SERVICE TRUST FUND

14 ESTABLISHMENT OF HEALTH SERVICE TRUST FUND

15 SEC. 511. (a) There is hereby created on the books

16 of the Treasury of the United States a trust fund to be

17 known as the Health Service Trust Fund (hereinafter in

18 this title referred to as the ‘‘Trust Fund’’). The Trust

19 Fund shall consist of such gifts and bequests as may be

20 made to the Service and such amounts as may be depos21 ited in, or appropriated to, such fund as provided in this

22 part.

23 (b) There is hereby appropriated to the Trust Fund

24 for each fiscal year beginning in the fiscal year in which

25 the effective date of health services (as defined in title VI)
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1 falls, and for each fiscal year thereafter, out of any moneys

2 in the Treasury not otherwise appropriated, an amount

3 equal to 100 percent of expected net receipts from the

4 taxes imposed by sections 59 and 3111(b) of the Internal

5 Revenue Code of 1954 (as estimated by the Secretary of

6 the Treasury). The amount appropriated by the preceding

7 sentence shall be transferred from time to time from the

8 general fund in the Treasury to the Trust Fund in such

9 smaller amounts to be determined on the basis of esti10 mates by the Secretary of the Treasury of the receipts

11 specified in the preceding sentence; and proper adjust12 ments shall be made in the amounts subsequently trans13 ferred to the extent prior estimates were in excess of or

14 were less than the receipts specified in such sentence.

15 TRANSFER OF FUNDS TO THE HEALTH SERVICE TRUST

16 FUND

17 SEC. 512. (a) On the effective date of health services,

18 there are transferred to the Trust Fund all of the assets

19 and liabilities of the Federal Hospital Insurance Trust

20 Fund and the Federal Supplementary Medical Insurance

21 Trust Fund.

22 (b) In addition to the sums appropriated by section

23 511(b), there is appropriated to the Trust Fund for each

24 fiscal year, out of any moneys in the Treasury not other25 wise appropriated, a governmental contribution equal to
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1 40 percent of the sums appropriated by section 511(b) for

2 such fiscal year. There shall be deposited in the Trust

3 Fund all recoveries of overpayments, and all receipts

4 under loans or other agreements entered into, under this

5 Act.

6 ADMINISTRATION OF HEALTH SERVICE TRUST FUND

7 SEC. 513. (a) With respect to the Trust Fund, there

8 is hereby created a body to be known as the Board of

9 Trustees of the Trust Fund (hereinafter in this section

10 referred to as the ‘‘Board of Trustees’’) composed of the

11 Secretary of the Treasury, the Secretary of Health and

12 Human Services, and the Chairperson of the National

13 Health Board, all ex officio. The Secretary of the Treasury

14 shall be the Managing Trustee of the Board of Trustees

15 (hereinafter in this section referred to as the ‘‘Managing

16 Trustee’’). The Chairperson of the National Health Board

17 shall serve as the Secretary of the Board of Trustees. The

18 Board of Trustees shall meet not less frequently than once

19 each calendar year. It shall be the duty of the Board of

20 Trustees to—

21 (1) hold the Trust Fund;

22 (2) report to the Congress not later than the

23 first day of April of each year on the operation and

24 status of the Trust Fund during the preceding fiscal
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1 year and on its expected operation and status during

2 the current fiscal year and the next 2 fiscal years;

3 (3) report immediately to the Congress when4 ever the Board is of the opinion that the amount of

5 the Trust Fund is unduly small; and

6 (4) review the general policies followed in man7 aging the Trust Fund, and recommend changes in

8 such policies, including necessary changes in the

9 provisions of law which govern the way in which the

10 Trust Fund is to be managed.

11 The report provided for in paragraph (2) shall include a

12 statement of the assets of, and the disbursements made

13 from, the Trust Fund during the preceding fiscal year,

14 an estimate of the expected income to, and disbursements

15 to be made from, the Trust Fund during the current fiscal

16 year and each of the next 2 fiscal years, and a statement

17 of the actuarial status of the Trust Fund. Such report

18 shall be printed as a House document of the session of

19 the Congress to which the report is made.

20 (b) It shall be the duty of the Managing Trustee to

21 invest such portion of the Trust Fund as is not, in his

22 judgment, required to meet current withdrawals. Such in23 vestments may be made only in interest-bearing obliga24 tions of the United States or in obligations guaranteed as

25 to both principal and interest by the United States. For
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1 such purpose such obligations may be acquired (1) on

2 original issue at the issue price, or (2) by purchase of out3 standing obligations at the market price. The purposes for

4 which obligations of the United States may be issued

5 under the Second Liberty Bond Act, as amended, are

6 hereby extended to authorize the issuance at par of public7 debt obligations for purchase by the Trust Fund.

8 (c) Any obligations acquired by the Trust Fund (ex9 cept public-debt obligations issued exclusively to the Trust

10 Fund) may be sold by the Managing Trustee at the mar11 ket price, and such public-debt obligations may be re12 deemed at par plus accrued interest.

13 (d) The interest on, and the proceeds from the sale

14 or redemption of, any obligations held in the Trust Fund

15 shall be credited to and form a part of the Trust Fund.

16 (e) The Managing Trustee shall pay from time to

17 time from the Trust Fund such amounts as the National

18 Health Board certifies are necessary to carry out this Act.

19 PART C—PREPARATION OF PLANS AND BUDGETS

20 DETERMINATION OF FUND AVAILABILITY

21 SEC. 521. (a)(1) The National Health Board shall,

22 not later than January 1 of each year, initially fix the

23 maximum amount of funds which may (except as provided

24 in subsection (c)) be obligated during the fiscal year begin-
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1 ning on October 1 of such year for expenditure from the

2 Trust Fund.

3 (2) Such amount shall not exceed for a fiscal year

4 the lesser of—

5 (A) 140 percent of the expected net receipts

6 during the fiscal year (as estimated by the Secretary

7 of the Treasury) from the taxes imposed by sections

8 59 and 3111(b) of the Internal Revenue Code of

9 1954;

10 (B) the amount of the aggregate obligations

11 that the National Health Board determines were (or

12 will be) incurred by the Service from the Trust Fund

13 during the previous fiscal year, adjusted to reflect

14 changes in the cost of living, in the number of users,

15 and in the capacity of the Service to provide services

16 under this Act, as such changes are reflected in the

17 plans and budgets prepared and submitted by area

18 health boards under this part; or

19 (C) the amount fixed under subsection (b).

20 (3) The National Health Board may at any time refix

21 such amount to reflect changes (A) of one percent or more

22 in the expected net tax receipts (described in paragraph

23 (2)(A)), or (B) of five percent or more in the cost of living,

24 number of users, or the capacity of the Service to provide

25 services under this Act. The National Health Board shall
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1 promptly report to Congress any increase made in such

2 amount and the reasons therefor.

3 (b) The National Health Board shall fix in a fiscal

4 year an amount, which the maximum amount described

5 in subsection (a)(1) may not exceed in the fiscal year,

6 which is less than the amount described in subsection

7 (a)(2)(A) if the Board determines that—

8 (1) restriction of the amount to be made avail9 able for obligation will not materially impair the ade10 quacy or quality of health care and supplemental

11 services provided to users, or

12 (2) improvement in the organization, delivery,

13 or utilization of such services has lessened their ag14 gregate cost (or increase in such cost).

15 (c) The National Health Board may obligate for ex16 penditure from the Trust Fund, in addition to the maxi17 mum amount which may be obligated in a fiscal year

18 under subsection (a), such funds as are necessary to pro19 vide health care and supplemental services needed because

20 of an epidemic, disaster, or other occurrence which was

21 not, and could not have been, reasonably planned for by

22 the Board and for which the contingency fund provided

23 in section 534(b)(6) is insufficient. The National Health

24 Board shall promptly report to Congress any obligation

25 made pursuant to this subsection and the reasons therefor.
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1 (d) In addition to the maximum amounts which may

2 be obligated pursuant to subsection (a), the National

3 Health Board may allocate funds borrowed in accordance

4 with section 541 for such purposes as it deems necessary

5 and appropriate.

6 PREPARATION OF AREA PLANS AND BUDGETS

7 SEC. 522. (a) Each community board shall, not later

8 than January 1 of each year, submit to its respective dis9 trict board a plan and budget for the fiscal year beginning

10 on October 1 of such year. In preparing such plan and

11 budget, each community board shall consult with users

12 and health workers in the community to assure effective

13 and coordinated planning for the efficient use of resources

14 in its community.

15 (b) Each district board shall, not later than February

16 1 of each year, submit to its respective regional board a

17 plan and budget for the fiscal year beginning on October

18 1 of such year. In preparing such plan and budget, each

19 district board shall consult with the users, health workers,

20 and community boards in its district to assure effective

21 and coordinated planning for the efficient use of resources

22 in its district.

23 (c) Each regional board shall, not later than March

24 1 of each year, submit to the National Health Board a

25 plan and budget for the fiscal year beginning on October
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1 1 of such year. In preparing such plan and budget, each

2 regional board shall consult with the users, health work3 ers, and district boards in its region to assure effective

4 and coordinated planning for the efficient use of resources

5 in its region.

6 (d) In preparing the budgets required by this section,

7 each area health board shall specify its operating, preven8 tion, capital, and research expenses anticipated for the fis9 cal year covered by the budget and for the 5-year period

10 beginning with such fiscal year.

11 PART D—ALLOCATION AND DISTRIBUTION OF FUNDS

12 NATIONAL BUDGET

13 SEC. 531. (a) The National Health Board shall pre14 pare, taking into consideration the budgets submitted

15 under section 522(c), and, as soon after April 1 of each

16 year as is practicable, shall transmit to the regional boards

17 a national health budget for the fiscal year beginning on

18 October 1 of such year. Such budget shall divide the total

19 funds available for obligation in such year, as determined

20 under section 521, into—

21 (1) funds for ordinary operating expenses,

22 which shall be further divided into funds for use by

23 the National Health Board, and funds to be allo24 cated (in accordance with subsection (b)) to the re-
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1 gional boards for use by the regional boards and the

2 district and community boards within their regions;

3 (2) funds for preventive health measures, which

4 shall be further divided into funds for use by the

5 National Health Board and funds to be allocated (in

6 accordance with subsection (b)) to the regional

7 boards for use by the regional boards and the dis8 trict and community boards within their regions;

9 (3) funds for capital expenses, which shall be

10 further divided into funds for use by the National

11 Health Board and funds to be allocated (in accord12 ance with subsection (c)) to the regional boards for

13 use by the regional boards and district and commu14 nity boards within their regions;

15 (4) funds for research expenses, which shall be

16 further divided into funds for the conduct of re17 search under the supervision of the National Health

18 Board and funds to be allocated (in accordance with

19 subsection (b)) to the regional boards for the con20 duct of research under the supervision of the re21 gional, district, and community boards; and

22 (5) funds for special operating expenses, as de23 scribed in section 534.

24 (b) Funds for ordinary operating expenses, for pre25 ventive health measures, and for research expenses which
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1 are allocated to the regional boards under subsection (a)

2 shall be divided among the regions in the proportion which

3 the number of residents in each region bears to the total

4 population of the Nation.

5 (c) Funds for capital expenses which are allocated to

6 the regional boards under subsection (a) shall be allocated,

7 to the extent consistent with the efficient and equitable

8 use of resources, to the regional boards in accordance with

9 the budgets for capital expenses submitted by such boards

10 to the National Health Board under section 522(c), except

11 that during the first 10 fiscal years following the effective

12 date of health services, priority shall be given to regions

13 lacking adequate health care facilities on such effective

14 date.

15 (d) A budget submitted to the regional boards under

16 subsection (a) shall be adopted upon the approval of such

17 budget by a majority of such regional boards.

18 REGIONAL BUDGETS

19 SEC. 532. (a) Each regional board shall prepare, tak20 ing into consideration the budgets submitted under section

21 522 (b), and, as soon as may be practicable after the adop22 tion under section 531 of the national health budget for

23 any fiscal year, shall transmit a regional budget, covering

24 operating, prevention, capital, and research expenses for

25 such fiscal year, to each district board in its region. Such
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1 regional budget shall be adopted upon the approval of such

2 budget by a majority of such district boards.

3 (b) Funds for capital expenses shall be allocated, to

4 the extent consistent with the efficient and equitable use

5 of resources, to the district boards in a region in accord6 ance with the budgets for capital expenses submitted by

7 such boards to the regional board under section 522(b),

8 except that during the first 10 fiscal years following the

9 effective date of health services, priority shall be given to

10 districts lacking adequate health care facilities on such ef11 fective date.

12 (c) Funds to be allocated to district boards for ordi13 nary operating expenses, preventive health measures, and

14 research expenses shall be allocated to each district board

15 in the same proportion as the number of residents in such

16 district bears to the number of residents in the respective

17 region.

18 DISTRICT BUDGETS

19 SEC. 533. (a) Each district board shall prepare, tak20 ing into consideration the budgets submitted under section

21 522 (a), and, as soon as may be practicable after the adop22 tion under section 532 of the regional health budget for

23 any fiscal year for the respective region, shall transmit a

24 district budget, covering operating, prevention, capital,

25 and research expenses for such fiscal year, to each commu-
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1 nity board in its district. Such district budget shall be

2 adopted upon the approval of such budget by a majority

3 of such community boards.

4 (b) Funds for capital expenses shall be allocated, to

5 the extent consistent with the efficient and equitable use

6 of resources, to the community boards in a district in ac7 cordance with the budgets for capital expenses submitted

8 by such boards to the district board under section 522(a),

9 except that during the first 10 fiscal years following the

10 effective date of health services, priority shall be given to

11 communities lacking adequate health care facilities on

12 such effective date.

13 (c) Funds to be allocated to community boards for

14 ordinary operating expenses, preventive health measures,

15 and research expenses shall be allocated to each commu16 nity board in the same proportion as the number of resi17 dents in such community bears to the number of residents

18 in the respective district.

19 SPECIAL OPERATING EXPENSE FUND

20 SEC. 534. (a) A fund for special operating expenses

21 shall be incorporated into each budget prepared by the Na22 tional Health Board. For the purposes of this title, the

23 term ‘‘special operating expenses’’ means operating ex24 penses associated with—
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1 (1) the care and treatment of users 65 years of

2 age or older;

3 (2) the care and treatment of persons confined

4 to full-time residential care institutions, including

5 nursing homes and facilities for the treatment of

6 mental illness;

7 (3) the special health care needs of low-income

8 users;

9 (4) the special health care needs of residents of

10 rural areas;

11 (5) special health care needs arising from envi12 ronmental or occupational health conditions;

13 (6) special health care needs arising from unex14 pected occurrences, including epidemics and natural

15 disasters; and

16 (7) the conduct of environmental health inspec17 tion and monitoring services.

18 (b) The special operating expense fund shall be allo19 cated as follows:

20 (1) Funds for the additional operating expenses

21 associated with the care and treatment of users 65

22 years of age or older shall be allocated to district

23 and community boards and shall consist of uniform

24 basic capitation amounts multiplied by the number

25 of residents 65 years of age or older in the respec-
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1 tive districts and communities. The basic capitation

2 amounts for districts and for communities shall be

3 determined by the National Health Board, based

4 upon studies of the additional operating expenses as5 sociated with the care and treatment of such resi6 dents in such districts and communities.

7 (2) Funds for the additional operating expenses

8 associated with the care and treatment of persons

9 confined to full-time residential care institutions

10 shall be allocated to the district and community

11 boards responsible for such institutions and shall

12 consist of a uniform basic capitation amount for

13 each kind of institution, multiplied by the number of

14 residents in such institutions in the respective dis15 tricts and communities. The basic capitation

16 amounts shall be determined by the National Health

17 Board, based upon studies of the additional operat18 ing expenses associated with the care and treatment

19 of such persons and the maintenance of such institu20 tions.

21 (3) Funds shall be allocated to community

22 boards for the additional operating expenses associ23 ated with the special health care needs of low-income

24 persons. Such payments shall be allocated to com25 munity boards in proportion to the number of resi-
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1 dents in their communities having incomes below the

2 poverty level (as defined by the Secretary of Com3 merce). The total funds allocated for this purpose

4 shall be no less than 2 percent of the ordinary oper5 ating expense funds allocated in accordance with

6 section 531(a).

7 (4) Funds for the additional operating expenses

8 associated with the special health care needs of resi9 dents of rural areas shall be allocated to district and

10 community boards serving areas of low population

11 density and shall consist of basic capitation amounts

12 multiplied by the number of residents in the respec13 tive districts and communities. The basic capitation

14 amounts shall be determined by the National Health

15 Board based upon studies of the additional operat16 ing expenses associated with the provision of health

17 care in areas of low population density.

18 (5) Funds for the additional operating expenses

19 associated with special regional health care needs

20 arising from environmental and occupational health

21 problems shall be allocated to regional boards by the

22 National Health Board in accordance with its deter23 mination of such special needs. The total funds allo24 cated for this purpose shall be no greater than one-
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1 half of 1 percent of the ordinary operating expense

2 funds allocated in accordance with section 531(a).

3 (6) Funds for the additional operating expenses

4 associated with special health care needs arising

5 from unexpected occurrences shall be retained by the

6 National Health Board in a contingency fund and

7 shall be allocated by the National Health Board in

8 accordance with its determination of such needs.

9 The total funds retained for this purpose in any one

10 fiscal year shall be no greater than one-half of 1 per11 cent of the ordinary operating expense funds allo12 cated in such year in accordance with section

13 531(a).

14 (7) Funds for the additional operating expenses

15 associated with the conduct of environmental health

16 inspection and monitoring services shall be allocated

17 by the National Health Board to the area health

18 boards providing such services.

19 DISTRIBUTION OF FUNDS

20 SEC. 535. (a) Funds allocated under the national

21 health budget shall be distributed by the National Health

22 Board from the Trust Fund. No health board may request

23 or receive funds from any other source.

24 (b) All payments shall be made to area health boards,

25 and shall be expended by such boards, in accordance with
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1 the budgets adopted under sections 531 through 533. If

2 the budget for any area health board for a fiscal year is

3 not adopted before the beginning of the fiscal year, until

4 such budget is adopted such area health board shall con5 tinue to receive ordinary operating expense funds, preven6 tion expense funds, and research expense funds at the rate

7 at which it was receiving such funds during the preceding

8 fiscal year, and it shall receive special operating expense

9 funds in accordance with section 534.

10 (c) Each area health board shall maintain separate

11 accounts for—

12 (1) funds for operating expenses, including or13 dinary operating expenses and special operating ex14 penses;

15 (2) funds for preventive health measures;

16 (3) funds for capital expenses; and

17 (4) funds for research expenses.

18 Funds in a capital expense account shall be expended only

19 for capital expenses. Funds in a research expense account

20 shall be expended only for operations, equipment, and fa21 cilities for health and health care delivery research con22 ducted in accordance with part C of title IV. Separate ac23 counts shall not be required for funds for ordinary operat24 ing expenses and for special operating expenses.
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1 (d) Area health boards shall be paid at such time or

2 times as the National Health Board finds appropriate.

3 (e) Before and during any fiscal year, supplementary

4 funds may be allocated to any area health board if the

5 National Health Board finds that such funds are required

6 by events occurring or information acquired after the ini7 tial allocations to such health board were made.

8 (f) Area health boards may retain funds received

9 from the National Health Board for 2 years following the

10 receipt of such funds. Any funds which are unexpended

11 after such time shall be returned to the National Health

12 Board for deposit in the Trust Fund.

13 ANNUAL STATEMENT, RECORDS, AND AUDITS

14 SEC. 536. (a) Each area health board shall prepare

15 annually and transmit to the National Health Board a

16 statement which shall accurately show the financial oper17 ations of such board and the facilities supervised by it for

18 the year for which such statement is prepared.

19 (b) Each area health board shall keep such records

20 as the National Health Board determines to be necessary

21 for the purposes of this Act, including for the facilitation

22 of audits.

23 (c) The National Health Board and the Comptroller

24 General of the United States, or their duly authorized rep25 resentatives, shall, for the purpose of audits, have access
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1 to any books, documents, papers, and records which in

2 their opinion are related or pertinent to the operation of

3 the Service.

4 PART E—GENERAL PROVISIONS

5 ISSUANCE OF OBLIGATIONS

6 SEC. 541. (a) The National Health Board is author7 ized to borrow money and to issue and sell such obliga8 tions as it determines necessary to carry out the purposes

9 of this Act, but only in such amounts as may be specified

10 from time to time in appropriation Acts. The aggregate

11 amount of any such obligations outstanding at any one

12 time shall not exceed $10,000,000,000.

13 (b) The National Health Board may pledge the assets

14 of the Trust Fund and pledge and use its revenues and

15 receipts for the payment of the principal of or interest on

16 such obligations, for the purchase or redemption thereof,

17 and for other purposes incidental thereto. The National

18 Health Board is authorized to enter into binding cov19 enants with the holders of such obligations, and with the

20 trustee, if any, under any agreement entered into in con21 nection with the issuance thereof with respect to the estab22 lishment of reserve, sinking, and other funds, stipulations

23 concerning the issuance of obligations or the execution of

24 leases or lease purchases relating to properties of the Serv25 ice and such other matters as the National Health Board
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1 deems necessary or desirable to enhance the marketability

2 of such obligations.

3 (c) Obligations issued by the Service under this sec4 tion—

5 (1) shall be in such forms and denominations;

6 (2) shall be sold at such times and in such

7 amounts;

8 (3) shall mature at such time or times;

9 (4) shall be sold at such prices;

10 (5) shall bear such rates of interest;

11 (6) may be redeemable before maturity in such

12 manner, at such times, and at such redemption pre13 miums;

14 (7) may be entitled to such relative priorities of

15 claim on the assets of the Service with respect to

16 principal and interest payments; and

17 (8) shall be subject to other terms and condi18 tions, as the National Health Board determines.

19 (d) Obligations issued by the Service under this sec20 tion shall—

21 (1) be negotiable or nonnegotiable and bearer

22 or registered instruments, as specified therein and in

23 any indenture or covenant relating thereto;

24 (2) contain a recital that they are issued under

25 this section, and such recital shall be conclusive evi-
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1 dence of the regularity of the issuance and sale of

2 such obligations and of their validity;

3 (3) be lawful investments and may be accepted

4 as security for all fiduciary, trust, and public funds,

5 the investment or deposit of which shall be under

6 the authority or control of any officer or agency of

7 the Government of the United States, and the Sec8 retary of the Treasury or any other officer or agency

9 having authority over or control of any such fidu10 ciary, trust, or public funds, may at any time sell

11 any of the obligations of the Service acquired under

12 this section;

13 (4) be exempt both as to principal and interest

14 from all taxation now or hereafter imposed by any

15 State or local taxing authority except estate, inherit16 ance, and gift taxes; and

17 (5) not be obligations of, nor shall payment of

18 the principal thereof or interest thereon be guaran19 teed by, the Government of the United States, ex20 cept as provided in subsection (g).

21 (e) At least 15 days before selling any issue of obliga22 tions, the National Health Board shall advise the Sec23 retary of the Treasury of the amount, proposed date of

24 sale, maturities, terms and conditions, and expected maxi25 mum rates of interest of the proposed issue in appropriate
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1 detail and shall consult with him or his designee thereon.

2 The Secretary may elect to purchase such obligations

3 under such terms, including rates of interest, as he and

4 the National Health Board may agree, but at a rate of

5 yield no less than the prevailing yield on outstanding mar6 ketable Treasury securities of comparable maturity, as de7 termined by the Secretary. If the Secretary does not pur8 chase such obligations, the National Health Board may

9 proceed to issue and sell them to a party or parties other

10 than the Secretary upon notice to the Secretary and upon

11 consultation as to the date of issuance, maximum rates

12 of interest, and other terms and conditions.

13 (f) Subject to the conditions of subsection (e), the

14 National Health Board may require the Secretary of the

15 Treasury to purchase obligations of the Service in such

16 amounts as will not cause the holding by the Secretary

17 of the Treasury resulting from such required purchases

18 to exceed $2,000,000,000 at any one time. This subsection

19 shall not be construed as limiting the authority of the Sec20 retary to purchase obligations of the Service in excess of

21 such amount.

22 (g) Notwithstanding subsection (d)(5), obligations is23 sued by the Service shall be obligations of the Government

24 of the United States, and payment of principal and inter25 est thereon shall be fully guaranteed by the Government
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1 of the United States, such guaranty being expressed on

2 the face thereof, if and to the extent that—

3 (1) the National Health Board requests the

4 Secretary of the Treasury to pledge the full faith

5 and credit of the Government of the United States

6 for the payment of principal and interest thereon;

7 and

8 (2) the Secretary, in his discretion, determines

9 that it would be in the public interest to do so.

10 (h) For the purpose of any purchase of the obliga11 tions of the Service, the Secretary of the Treasury is au12 thorized to use as a public debt transaction the proceeds

13 from the sale of any securities issued under the Second

14 Liberty Bond Act, as now or hereafter in force, and the

15 purposes for which securities may be issued under the Sec16 ond Liberty Bond Act, as now or hereafter in force, are

17 extended to include any purchases of the obligations of

18 the Service under this part. The Secretary of the Treasury

19 may, at any time, sell any of the obligations of the Service

20 acquired by him under this chapter. All redemptions, pur21 chases, and sales by the Secretary of the obligations of

22 the Service shall be treated as public debt transactions of

23 the United States.

24 DEFINITIONS

25 SEC. 542. For purposes of this title:
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1 (1) The term ‘‘operating expenses’’ means the

2 cost of providing, planning, operating, and maintain3 ing services, facilities, programs, and boards (other

4 than those associated with research) established or

5 furnished under this Act, and of capital buildings

6 and equipment (other than those associated with re7 search) costing less than $100,000, except for funds

8 associated with the conduct of preventive health

9 measures and research.

10 (2) The term ‘‘capital expenses’’ means ex11 penses which under generally accepted accounting

12 principles are not properly chargeable as expenses of

13 operation and maintenance, which exceed $100,000,

14 and which are not associated primarily with the con15 duct of research.

16 TITLE VI—MISCELLANEOUS PROVISIONS

17 EFFECTIVE DATE OF HEALTH SERVICES

18 SEC. 601. The effective date of health services under

19 this Act is January 1 of the fourth calendar year after

20 the year in which this Act is enacted.

21 REPEAL OF PROVISIONS

22 SEC. 602. (a) Effective on the effective date of health

23 services, the following provisions of law are repealed:

24 (1) The Public Health Service Act, except for—
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1 (A) title I (relating to short title and defini2 tions), parts F and G of title III (relating to licens3 ing and quarantine authority), and title XIV (relat4 ing to safety of public water systems); and

5 (B) titles VII and VIII, which shall remain ef6 fective, during the period beginning on such effective

7 date and ending on the date occurring 4 years after

8 such effective date, with respect to the provision of

9 assistance to educational institutions, and students

10 thereof, in areas which have not established health

11 team schools under part A of title III of this Act.

12 (2) Titles V, XVIII, and XIX of the Social Security

13 Act (relating to the maternal and child health and crippled

14 children’s services, Medicare, and Medicaid); part B of

15 title XI of such Act (relating to professional standards re16 view); sections 226, 1121 through 1124, and 1126 of such

17 Act (relating to entitlement to hospital insurance benefits,

18 uniform health reporting systems, limitation on Federal

19 participation for capital expenditures, program for deter20 mining qualification for certain health care personnel, dis21 closure of ownership and related information, and disclo22 sure of certain convictions); and so much of title XX of

23 such Act (relating to grants to States for services) as pro24 vides for payments to States for health care and supple25 mental services.
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1 (3) Chapter 89 of title 5, United States Code (relat2 ing to health insurance for Federal employees).

3 (4) Chapters 17, 73, and 81 and section 1506 of title

4 38, United States Code (relating to medical benefits and

5 programs relating to veterans).

6 (5) Sections 1079 through 1083 and section 1086 of

7 title 10, United States Code (relating to the civilian health

8 and medical program of the uniformed services).

9 (6) The Comprehensive Alcohol Abuse and Alcohol10 ism Prevention, Treatment, and Rehabilitation Act of

11 1970; the Comprehensive Alcohol Abuse and Alcoholism

12 Prevention, Treatment, and Rehabilitation Act Amend13 ments of 1974; and section 4 of the Comprehensive Drug

14 Abuse Prevention and Control Act of 1970 (relating to

15 medical treatment of narcotic addiction).

16 (7) Public Law 83–568 (42 U.S.C. 2001–2004b) (re17 lating to hospital and other health facilities for Indians)

18 and Public Law 85–151 (42 U.S.C. 2005–2005f) (relating

19 to community hospitals for Indians).

20 (8) The District of Columbia Medical Facilities Con21 struction Act of 1968 and the District of Columbia Medi22 cal and Dental Manpower Act of 1970.

23 (9) Sections 232 and 242 and title XI of the National

24 Housing Act (relating to mortgage insurance for nursing

25 homes, hospitals, and group practice facilities).
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1 (10) The Mental Retardation Facilities and Commu2 nity Mental Health Centers Construction Act of 1963.

3 (11) The Family Planning Services and Population

4 Research Act of 1970.

5 (12) The National Arthritis Act of 1974 and the Na6 tional Diabetes Mellitus Research and Education Act.

7 (13) Titles I and II and section 301 of the Lead8 Based Paint Poisoning Prevention Act (42 U.S.C. 4801,

9 4811, 4821) (relating to grant programs for lead-based

10 paint poisoning prevention).

11 (14) The Act of March 2, 1897 (21 U.S.C. 41–50)

12 (relating to tea importation).

13 (15) Subsection (e) of section 20 and section 22 of

14 the Occupational Safety and Health Act of 1970 (relating

15 to the National Institute for Occupational Safety and

16 Health).

17 (b)(1) Not later than three years after the date of

18 enactment of this Act, the President shall prepare, in con19 sultation with the appropriate National Health Board, and

20 transmit to Congress legislation (A) to repeal or amend

21 such provisions of law as are inconsistent with the pur22 poses of this Act or the provision of health care and sup23 plemental services by the Service under this Act, and (B)

24 to make such conforming and technical amendments in

25 provisions of law as may be necessary to properly effect
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1 the repeal of provisions described in subsection (a) and

2 the repeal or amendment of provisions described in clause

3 (A) of this paragraph.

4 (2) Such legislation shall include the transfers of such

5 authority of the Secretary of Health and Human Services

6 under the provisions of—

7 (A) the Controlled Substances Act;

8 (B) chapter 175 of title 28, United States Code

9 (relating to civil commitment and rehabilitation of

10 narcotics addicts);

11 (C) chapter 314 of title 18, United States Code

12 (relating to sentencing of narcotic addicts to com13 mitment for treatment);

14 (D) the Narcotic Addict Rehabilitation Act of

15 1966;

16 (E) the Drug Abuse Office and Treatment Act

17 of 1972;

18 (F) the Occupational Safety and Health Act of

19 1970;

20 (G) the Lead-Based Paint Poisoning Prevention

21 Act;

22 (H) the Federal Cigarette Labeling and Adver23 tising Act;

24 (I) the Federal Food, Drug, and Cosmetic Act;

25 (J) the Fair Packaging and Labeling Act;
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1 (K) the Act of March 4, 1923 (21 U.S.C. 61–

2 64) (relating to filled milk);

3 (L) the Act of February 15, 1927 (21 U.S.C.

4 141–149) (relating to milk importation);

5 (M) the Federal Caustic Poison Act;

6 (N) the Federal Coal Mine Health and Safety

7 Act of 1969 (other than title IV thereof); and

8 (O) the Solid Waste Disposal Act,

9 to the Service as the President determines, after consulta10 tion with the National Health Board, to be appropriate.

11 (c)(1) The National Health Board shall, immediately

12 upon its initial appointment, and in consultation with the

13 Secretary of Health and Human Services, review the pro14 grams conducted under the specified provisions of the

15 Public Health Service Act and the other Acts described

16 in section 602(a) and shall determine how the Service shall

17 carry out the purposes of such programs.

18 (2) Not later than one year after the effective date

19 of health services, the National Health Board shall report

20 to the President and to the Congress on how the Service

21 is carrying out the purposes of the programs authorized

22 to be conducted under provisions of law which are repealed

23 by subsection (a) (other than paragraph (1)(B) thereof).

24 (3) Not later than 5 years after the effective date

25 of health services, the National Health Board shall report
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1 to the President and to the Congress on how the Service

2 is carrying out the purposes of programs described in sub3 section (a)(1)(B).

4 (d) Not later than 2 years after the effective date of

5 health services, the National Health Board shall transmit

6 to Congress a proposed codification of all the provisions

7 of law which contain functions that are transferred or re8 late to the Service.

9 TRANSITION PROVISIONS

10 SEC. 603. (a) Amounts appropriated to carry out the

11 purposes of any provisions of law repealed by this Act and

12 available on the effective date of such repeal shall be

13 transferred on such date to the Health Service Trust Fund

14 (established under section 511 of this Act).

15 (b) The President is authorized to transfer so much

16 of the positions, personnel, assets, liabilities, contracts,

17 property, and records employed, held, used, arising from,

18 available to or made available in connection with the func19 tions or programs repealed by this Act to the Service as

20 may be agreed upon by the President and the National

21 Health Board.

22 (c) In the case where the authority for the establish23 ment of any office or agency, or all the functions of such

24 office or agency, are repealed under section 602, such of25 fice or agency shall lapse.
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1 (d) The amendments made by section 602—

2 (1) shall not apply with respect to any contract

3 entered into before the effective date of such amend4 ments, and

5 (2) shall not affect (A) any right or obligation

6 arising out of any matter occurring before the effec7 tive date of such amendments, or (B) any adminis8 trative or judicial proceeding (whether or not initi9 ated before that date) for the adjudication or en10 forcement of any such right or obligation.

11 AMENDMENT TO BUDGET AND ACCOUNTING ACT

12 SEC. 604. (a) Section 201 of the Budget and Ac13 counting Act, 1921 (31 U.S.C. 11) is amended by insert14 ing after subsection (j) the following new subsection:

15 ‘‘(k) The Budget transmitted pursuant to subsection

16 (a) shall set forth the items enumerated in paragraphs (4)

17 through (9) and (12) of subsection (a) with respect to ex18 penditures from and appropriations to the Health Service

19 Trust Fund (established under section 511 of the Health

20 Service Act) separately from such items with respect to

21 expenditures and appropriations relating to other oper22 ations of the Government.’’.

23 (b) The amendment made by subsection (a) shall

24 apply with respect to fiscal years beginning more than 1

25 year after the date of enactment of this Act.
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1 SEPARABILITY

2 SEC. 605. If any provision of this Act, or the applica3 tion of such provision to any person or circumstance, shall

4 be held invalid, the remainder of this Act, or the applica5 tion of such provision to persons or circumstances other

6 than those as to which it is held invalid, shall not be af7 fected thereby.

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