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[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3719 Introduced in House (IH)]

103d CONGRESS
  1st Session
                                H. R. 3719

             To establish a wellness program for Americans.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           November 23, 1993

   Mr. Lewis of California introduced the following bill; which was 
            referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL

 
             To establish a wellness program for Americans.

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

SECTION 1. SHORT TITLE.

    This Act may be referred to as ``The Well America Act''.

SEC. 2. WELLNESS TRUST FUND.

    (a) Establishment.--There is hereby created on the books of the 
Treasury of the United States a trust fund to be known as the 
``Wellness Trust Fund''. The Wellness Trust Fund shall consist of such 
gifts and bequests as may be made and such amounts as may be deposited 
in, or appropriated to, such fund.
    (b) There are hereby appropriated to the Trust Fund for each year 4 
percent of all health care premiums, as well as 4 percent of all 
Federal expenditures on health care for populations served outside of 
health care plans.

SEC. 3. WELLNESS PROGRAM.

    (a) Wellness Voucher.--The Secretary shall issue to each enrollee 
satisfying the conditions of paragraph (b) a wellness voucher card 
which may be used for identification, verifying eligibility for 
benefits under this section, and processing of payments under this 
section to participating wellness providers selected by the enrollee. 
The wellness voucher card shall bear an indication of its total value 
as computed under paragraph (g), the portion of its value used and the 
portion remaining at any time. The wellness voucher card function may 
be incorporated into the health security card.
    (b) Eligibility.--Those eligible for wellness benefits are:
            (1) Any enrollee thirty years of age or older;
            (2) Any enrollee under thirty years of age who is certified 
        by his or her primary care provider as in special need of 
        wellness benefits as a result of unusual physical 
        characteristics or conditions; or
            (3) Any enrollee under thirty years of age who uses 
        tobacco, for the purpose of a tobacco-use-cessation program; or 
        whose cholesterol condition is certified by his primary care 
        provider to place him or her at high health risk, for the 
        purpose of a weight-loss, nutrition, or exercise program; or 
        whose body weight is certified by his primary care physician to 
        place him or her at high health risk, for the purpose of a 
        weight-loss, nutrition or exercise program.
    (c) Benefits.--Benefits provided under this section are intended to 
promote greater health and reduced injury and illness through programs 
which increase general health status, or promote healthier lifestyles 
by changing health related behaviors, such as hygiene or nutritional 
education programs. They are not intended to duplicate or substitute 
for therapeutic or rehabilitative services more properly included in 
treatments for illnesses, injuries or conditions covered by medical 
benefits. In addition to the activities specified in paragraph (b)(3), 
States shall periodically determine the range of other services 
eligible for reimbursement from wellness voucher funds. Enrollees 
eligible under paragraph (b)(2) are eligible only for such benefits 
related to the characteristic or condition certified by the primary 
care provider.
    (d) Enrollee Use.--An eligible enrollee obtains benefits under this 
section by presenting the wellness voucher card to a participating 
wellness provider in return for covered benefits up to the total value 
remaining on the card. Covered benefits costing more than the value 
remaining on the card may be purchased, but the enrollee is personally 
responsible for the portion of the cost which exceeds the value 
remaining on the voucher card.
    (e) Participating Providers.--
            (1) Wellness providers must be licensed under any 
        applicable State laws relating to the activities provided. The 
        States may establish standards for minimum solvency and 
        insurance (which may include bonding) for participating 
        providers.
            (2) As a condition of participation in the program 
        established by this section, providers agree to provide a 
        defined course of covered benefits in return for the payment 
        made by the Secretary under this section, to provide covered 
        benefits in return for payment in full by the Secretary from a 
        portion of the value of the wellness voucher, or to provide 
        covered benefits to be paid in part by payment from the 
        Secretary under this section.
            (3) As a condition of participation in the program 
        established by this section, providers must agree to inform the 
        enrollee's primary care physician of the services rendered and 
        consult with the primary care physician if requested on any 
        ongoing course of services.
            (4) Each State shall maintain a list of wellness providers 
        satisfying the requirements of this Act, which it shall make 
        public and shall transmit to the Secretary, and shall promptly 
        notify the Secretary of any additions thereto or deletions 
        therefrom.
    (f) Payment.--The Secretary shall establish a mechanism for paying 
to participating providers from the Wellness Trust Fund the cost of 
covered benefits under this section as they are provided, and as claims 
for same are made. In no event shall the Secretary be liable for so 
much of claims which individually or in the aggregate exceed the value 
of the enrollee's wellness voucher.
    (g) Computation of Wellness Voucher Value.--Prior to the beginning 
of each year, the Secretary shall project the total income to the 
Wellness Trust Fund for the coming year, and shall divide this figure, 
less a contingency reserve not to exceed 2 percent, by the number of 
enrollees whom the Secretary projects will be eligible for benefits 
under this section in that year. The quotient is the value of the 
wellness voucher of each eligible enrollee for that year, except that 
the Secretary may adjust the value of wellness vouchers relative to 
each other to take into consideration differences in the cost of 
services among States or alliance service areas. Such process of 
adjustment shall not increase the total aggregate value of all wellness 
vouchers.

SEC. 4. DEFINITIONS.--

    For purposes of this title:
            (a) ``Enrollee'' means an individual--
                    (i) who is entitled to participate in an alliance 
                or who is provided health benefits through a Federal 
                health care program outside of an alliance, and
                    (ii) who is entitled to receive services under this 
                Act.
            (b) ``Primary care providers'' means a primary care 
        physician with the training and experience to assess and treat 
        the full range of basic health care needs, and properly 
        coordinate and refer to others for specialized treatment, or, 
        if licensed or certified as such under State law, a nurse 
        practitioner with equivalent training and experience.
            (c) ``Provider'' means any person who provides services to 
        enrollees or to other providers for enrollees within the 
        meaning of this Act.
            (d) ``Participating provider'' means providers who have 
        agreed to abide by the conditions and requirements of this Act.
            (e) ``Secretary'' means the Secretary of the Treasury 
        unless otherwise specified.
            (f) ``Services'' includes goods, such as equipment.

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