I

103D CONGRESS

1ST SESSION H. R. 36

To direct the Secretary of Health and Human Services to establish a schedule

of preventive health care services and to provide for coverage of such

services in accordance with such schedule under private health insurance

plans and health benefit programs of the Federal Government, and

for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JANUARY 5, 1993

Mr. GILMAN introduced the following bill; which was referred jointly to the

Committees on Energy and Commerce, Post Office and Civil Service, Veterans’ Affairs, and Ways and Means

MAY 24, 1993

Additional sponsor: Mr. FISH

A BILL

To direct the Secretary of Health and Human Services to

establish a schedule of preventive health care services

and to provide for coverage of such services in accordance with such schedule under private health insurance

plans and health benefit programs of the Federal Government, and for other purposes.

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

2 This Act may be cited as the ‘‘Comprehensive Preven3 tive Health and Promotion Act of 1993’’.

4 SEC. 2. ESTABLISHMENT OF SCHEDULE OF PREVENTIVE

5 HEALTH CARE SERVICES.

6 (a) INITIAL SCHEDULE.—

7 (1) PROPOSED SCHEDULE.—Not later than 6

8 months after the date of the enactment of this Act,

9 the Secretary of Health and Human Services, in

10 consultation with representatives of individuals de11 scribed in subsection (d), shall establish a proposed

12 initial schedule of recommended preventive health

13 care services. In accordance with section 553 of title

14 5, United States Code, the Secretary shall publish

15 such proposed schedule in the Federal Register and

16 provide for a 90-day period for receiving public com17 ment on the schedule.

18 (2) FINAL SCHEDULE.—The proposed schedule

19 of recommended preventive health care services es20 tablished under paragraph (1) shall become effective

21 for the first calendar year that begins 90 or more

22 days after the expiration of the period for receiving

23 public comment described in paragraph (1).

24 (b) ANNUAL ADJUSTMENT.—Not later than October

25 1 of every year (beginning with the first year for which

26 the schedule established under subsection (a) is in effect),
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1 the Secretary, in consultation with representatives of indi2 viduals described in subsection (d) and in accordance with

3 section 553 of title 5, United States Code, may revise the

4 schedule of preventive health care services established

5 under this section for the following calendar year.

6 (c) USE OF SOURCES FOR ESTABLISHING SCHED7 ULE.—In establishing the initial schedule of recommended

8 preventive health care services under subsection (a) and

9 in revising the schedule for subsequent years under sub10 section (b), the Secretary shall take into consideration the

11 recommendations for preventive health care services con12 tained in the Guide to Clinical Preventive Services pre13 sented to the Department of Health and Human Services

14 by the United States Preventive Services Task Force and

15 the Year 2000 Health Objectives of the United States

16 Public Health Service.

17 (d) INDIVIDUALS SERVING AS CONSULTANTS.—The

18 individuals described in this subsection are as follows:

19 (1) Hospital administrators.

20 (2) Administrators of health benefit plans.

21 (3) General practice physicians.

22 (4) Mental health practitioners.

23 (5) Pediatricians.

24 (6) Chiropractors.
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1 (7) Physicians practicing in medical specialty

2 areas.

3 (8) Nutritionists.

4 (9) Nurses.

5 (10) Experts in scientific research.

6 (11) Dentists.

7 (12) Representatives of manufacturers of pre8 scription drugs.

9 (13) Health educators.

10 SEC. 3. APPLICATION TO INDIVIDUALS ENROLLED IN PRI11 VATE HEALTH INSURANCE PLANS.

12 (a) REQUIREMENT FOR CARRIERS AND PLANS.—

13 (1) IN GENERAL.—Each carrier and employer

14 health benefit plan shall include in the services cov15 ered for each individual enrolled with the carrier or

16 plan the preventive health care services applicable to

17 the individual under the schedule of preventive

18 health care services established under section 2.

19 (2) DEFINITIONS.—In this section:

20 (A) The term ‘‘carrier’’ means any entity

21 which provides health insurance or health bene22 fits in a State, and includes a licensed insur23 ance company, a prepaid hospital or medical

24 service plan, a health maintenance organization,

25 the plan sponsor of a multiple employer welfare
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1 arrangement or an employee benefit plan (as

2 defined under the Employee Retirement Income

3 Security Act of 1974), or any other entity pro4 viding a plan of health insurance subject to

5 State insurance regulation, but such term does

6 not include for purposes of section 103 an en7 tity that provides health insurance or health

8 benefits under a multiple employer welfare ar9 rangement.

10 (B)(i) Subject to clause (ii), the term ‘‘em11 ployer health benefit plan’’ means a health ben12 efit plan (including an employee welfare benefit

13 plan, as defined in section 3(1) of the Employee

14 Retirement Income Security Act of 1974) which

15 is offered to employees through an employer

16 and for which the employer provides for any

17 contribution to such plan or any premium for

18 such plan are deducted by the employer from

19 compensation to the employee.

20 (ii) A State may provide (for a plan in a

21 State) that the term ‘‘employer health benefit

22 plan’’ does not include an association plan (as

23 defined in clause (iii)).

24 (iii) For purposes of clause (ii), the term

25 ‘‘association plan’’ means a health benefit plan
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1 offered by an organization to its members if the

2 organization was formed other than for pur3 poses of purchasing insurance.

4 (C) The term ‘‘full-time employee’’ means,

5 with respect to an employer, an individual who

6 normally is employed for at least 30 hours per

7 week by the employer.

8 (D) The term ‘‘health benefit plan’’ means

9 any hospital or medical expense incurred policy

10 or certificate, hospital or medical service plan

11 contract, or health maintenance subscriber con12 tract, or a multiple employer welfare arrange13 ment or employee benefit plan (as defined

14 under the Employee Retirement Income Secu15 rity Act of 1974) which provides benefits with

16 respect to health care services, but does not in17 clude—

18 (i) coverage only for accident, dental,

19 vision, disability income, or long-term care

20 insurance, or any combination thereof,

21 (ii) medicare supplemental health in22 surance,

23 (iii) coverage issued as a supplement

24 to liability insurance,
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1 (iv) worker’s compensation or similar

2 insurance, or

3 (v) automobile medical-payment insur4 ance,

5 or any combination thereof.

6 (E) The term ‘‘small employer carrier’’

7 means a carrier with respect to the issuance of

8 an employer health benefit plan which provides

9 coverage to one or more full-time employees of

10 an entity actively engaged in business which, on

11 at least 50 percent of its working days during

12 the preceding year, employed at least 2, but

13 fewer than 36, full-time employees. For pur14 poses of determining if an employer is a small

15 employer, rules similar to the rules of sub16 section (b) and (c) of section 414 of the Inter17 nal Revenue Code of 1986 shall apply.

18 (b) ENFORCEMENT THROUGH EXCISE TAX.—

19 (1) IN GENERAL.—Chapter 43 of the Internal

20 Revenue Code of 1986 (relating to qualified pension,

21 etc., plans) is amended by adding at the end thereof

22 the following new section:
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1 ‘‘SEC. 4980C. FAILURE TO COMPLY WITH EMPLOYER

2 HEALTH BENEFIT PLAN STANDARDS RE3 GARDING PREVENTIVE HEALTH CARE.

4 ‘‘(a) IMPOSITION OF TAX.—

5 ‘‘(1) IN GENERAL.—There is hereby imposed a

6 tax on the failure of a carrier or an employer health

7 benefit plan to comply with section 3(a)(1) of the

8 Comprehensive Preventive Health and Promotion

9 Act of 1993.

10 ‘‘(2) EXCEPTION.—Paragraph (1) shall not

11 apply to a failure by a small employer carrier or

12 plan in a State if the Secretary of Health and

13 Human Services determines that the State has in ef14 fect a regulatory enforcement mechanism that pro15 vides adequate sanctions with respect to such a fail16 ure by such a carrier or of such a plan.

17 ‘‘(b) AMOUNT OF TAX.—

18 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

19 the tax imposed by subsection (a) shall be an

20 amount not to exceed 25 percent of the amounts re21 ceived by the carrier or under the plan for coverage

22 during the period such failure persists.

23 ‘‘(2) LIMITATION IN CASE OF INDIVIDUAL FAIL24 URES.—In the case of a failure that only relates to

25 specified individuals or employers (and not to the

26 plan generally), the amount of the tax imposed by
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1 subsection (a) shall not exceed the aggregate of

2 $100 for each day during which such failure persists

3 for each individual to which such failure relates. A

4 rule similar to the rule of section 4980B(b)(3) shall

5 apply for purposes of this section.

6 ‘‘(c) LIABILITY FOR TAX.—The tax imposed by this

7 section shall be paid by the carrier.

8 ‘‘(d) EXCEPTIONS.—

9 ‘‘(1) CORRECTIONS WITHIN 30 DAYS.—No tax

10 shall be imposed by subsection (a) by reason of any

11 failure if—

12 ‘‘(A) such failure was due to reasonable

13 cause and not to willful neglect, and

14 ‘‘(B) such failure is corrected within the

15 30-day period beginning on earliest date the

16 carrier knew, or exercising reasonable diligence

17 would have known, that such failure existed.

18 ‘‘(2) WAIVER BY SECRETARY.—In the case of a

19 failure which is due to reasonable cause and not to

20 willful neglect, the Secretary may waive part or all

21 of the tax imposed by subsection (a) to the extent

22 that payment of such tax would be excessive relative

23 to the failure involved.

24 ‘‘(e) DEFINITIONS.—For purposes of this section, the

25 terms ‘carrier’, ‘employer health benefit plan’, and ‘small
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1 employer carrier’ have the respective meanings given such

2 terms in section 3(a)(2) of the Comprehensive Preventive

3 Health and Promotion Act of 1993.’’

4 (2) CLERICAL AMENDMENT.—The table of sec5 tions for chapter 43 of such Code is amended by

6 adding at the end thereof the following new items:

‘‘Sec. 4980C. Failure to comply with employer health plan standards regarding preventive health care.’’.

7 (3) EFFECTIVE DATE.—The amendments made

8 by this subsection shall apply to plan years begin9 ning after December 31, 1993.

10 SEC. 4. COVERAGE OF PREVENTIVE HEALTH CARE SERV11 ICES UNDER MEDICARE.

12 (a) IN GENERAL.—Section 1861(s)(2) of the Social

13 Security Act (42 U.S.C. 1395x(s)(2)) is amended—

14 (1) by striking ‘‘and’’ at the end of subpara15 graph (O);

16 (2) by striking the semicolon at the end of sub17 paragraph (P) and inserting ‘‘; and’’; and

18 (3) by adding at the end the following new sub19 paragraph:

20 ‘‘(Q) in the case of an individual, services appli21 cable to the individual under the schedule of preven22 tive health care services established under the Com23 prehensive Preventive Health and Promotion Act of

24 1993 (to the extent such services are not otherwise
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1 covered with respect to the individual under this

2 title);’’.

3 (b) CONFORMING AMENDMENTS.—Section 1862(a)

4 of such Act (42 U.S.C. 1395y(a)) is amended—

5 (1) in paragraph (1)—

6 (A) in subparagraph (E), by striking

7 ‘‘and’’ at the end,

8 (B) in subparagraph (F), by striking the

9 semicolon at the end and inserting ‘‘, and’’, and

10 (C) by adding at the end the following new

11 subparagraph:

12 ‘‘(G) in the case of items or services described

13 in section 1861(s)(2)(Q), which are not provided in

14 accordance with the schedule of preventive health

15 care services established under the Comprehensive

16 Preventive Health and Promotion Act of 1993 ;’’;

17 and

18 (2) in paragraph (7), by striking ‘‘paragraph

19 (1)(B) or under paragraph (1)(F)’’ and inserting

20 ‘‘subparagraphs (B), (F), or (G) of paragraph (1)’’.

21 (c) EFFECTIVE DATE.—The amendments made by

22 this section shall apply to services furnished on or after

23 January 1, 1994.

24 SEC. 5. COVERAGE UNDER STATE MEDICAID PLANS.

25 (a) IN GENERAL.—
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1 (1) INCLUSION IN MEDICAL ASSISTANCE.—Sec2 tion 1905(a) of the Social Security Act (42 U.S.C.

3 1396d(a)) is amended—

4 (A) by striking ‘‘and’’ at the end of para5 graph (21);

6 (B) in paragraph (24), by striking the

7 comma at the end and inserting a semicolon;

8 (C) by redesignating paragraphs (22),

9 (23), and (24) as paragraphs (25), (22), and

10 (23), respectively, and by transferring and in11 serting paragraph (25) after paragraph (23), as

12 so redesignated; and

13 (D) by inserting after paragraph (23) the

14 following new paragraph:

15 ‘‘(24) services applicable to the individual under

16 the schedule of preventive health care services estab17 lished under the Comprehensive Preventive Health

18 and Promotion Act of 1993 (to the extent such serv19 ices are not otherwise covered with respect to the in20 dividual under the State plan under this title); and’’.

21 (2) COVERAGE MADE MANDATORY.—(A) Sec22 tion 1902(a)(10)(A) of such Act (42 U.S.C.

23 1396a(a)(10)(A)) is amended by striking ‘‘(17) and

24 (21)’’ and inserting ‘‘(17), (21), and (24)’’.
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1 (B) Section 1902(a)(10)(C)(iv) of such Act (42

2 U.S.C. 1396a(a)(10)(C)(iv)) is amended—

3 (i) by striking ‘‘(5) and (17)’’ and insert4 ing ‘‘(5), (17), and (24)’’; and

5 (ii) by striking ‘‘through (21)’’ and insert6 ing ‘‘through (24)’’.

7 (C) Section 1902(j) of such Act (42 U.S.C.

8 1396a(j)) is amended by striking ‘‘through (22)’’

9 and inserting ‘‘through (24)’’.

10 (b) EFFECTIVE DATE.—(1) Except as provided in

11 paragraph (2), the amendments made by subsection (a)

12 shall apply to calendar quarters beginning on or after Jan13 uary 1, 1994, without regard to whether or not final regu14 lations to carry out such amendments have been promul15 gated by such date.

16 (2) In the case of a State plan for medical assistance

17 under title XIX of the Social Security Act which the Sec18 retary of Health and Human Services determines requires

19 State legislation (other than legislation appropriating

20 funds) in order for the plan to meet the additional require21 ments imposed by the amendments made by subsections

22 (a) and (b), the State plan shall not be regarded as failing

23 to comply with the requirements of such title solely on the

24 basis of its failure to meet these additional requirements

25 before the first day of the first calendar quarter beginning
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1 after the close of the first regular session of the State leg2 islature that begins after the date of the enactment of this

3 Act. For purposes of the previous sentence, in the case

4 of a State that has a 2-year legislative session, each year

5 of such session shall be deemed to be a separate regular

6 session of the State legislature.

7 SEC. 6. COVERAGE OF PREVENTIVE HEALTH CARE SERV8 ICES FOR VETERANS.

9 (a) IN GENERAL.—Section 1701(6) of title 38, Unit10 ed States Code is amended—

11 (1) by striking ‘‘and’’ at the end of subpara12 graph (A);

13 (2) by striking the period at the end of sub14 paragraph (B) and inserting ‘‘; and’’; and

15 (3) by adding at the end the following new sub16 paragraph:

17 ‘‘(C) with respect to any veteran, any preventive

18 care services applicable under the schedule of pre19 ventive health care services established under the

20 Comprehensive Preventive Health and Promotion

21 Act of 1993, to the extent such services are not oth22 erwise treated as medical services under this para23 graph.’’.

24 (b) PROVIDING SERVICES IN OUTPATIENT SET25 TING.—Section 1712(a)(5)(A) of such title is amended—
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1 (1) in the first sentence, by striking the period

2 at the end and inserting the following: ‘‘, or any

3 other medical services applicable to the veteran

4 under the schedule of preventive health care services

5 established under the Comprehensive Preventive

6 Health and Promotion Act of 1993.’’; and

7 (2) in the second sentence, by inserting after

8 ‘‘admission’’ the following: ‘‘or any services applica9 ble to the veteran under the schedule of preventive

10 health care services established under the Com11 prehensive Preventive Health and Promotion Act of

12 1993 (other than services applicable under such

13 schedule that are reasonably necessary in prepara14 tion for hospital admission)’’.

15 (c) EFFECTIVE DATE.—The amendments made by

16 this section shall apply to services furnished on or after

17 January 1, 1994.

18 SEC. 7. COVERAGE OF PREVENTIVE HEALTH CARE SERV19 ICES UNDER FEDERAL EMPLOYEES HEALTH

20 BENEFIT PLANS.

21 (a) IN GENERAL.—Paragraphs (1) and (2) of section

22 8904(a) of title 5, United States Code, are each amended

23 by adding at the end the following new subparagraph:

24 ‘‘(G) With respect to an individual, any

25 preventive health care services applicable to the
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1 individual under the schedule of preventive

2 health care services established under the Com3 prehensive Preventive Health and Promotion

4 Act of 1993.’’.

5 (b) EFFECTIVE DATE.—The amendments made by

6 subsection (a) shall apply with respect to services fur7 nished on or after January 1, 1994.

8 SEC. 8. COVERAGE OF PREVENTIVE HEALTH CARE SERV9 ICES FOR DEPENDENTS OF MEMBERS OF THE

10 UNIFORMED SERVICES.

11 (a) PREVENTIVE HEALTH CARE SERVICES IN12 CLUDED IN AUTHORIZED CARE.—Section 1077(a) of title

13 10, United States Code, is amended by adding at the end

14 the following new paragraph:

15 ‘‘(13) Any preventive care services applicable

16 under the schedule of preventive health care services

17 established under the Comprehensive Preventive

18 Health and Promotion Act of 1993, to the extent

19 such services are not otherwise authorized as health

20 care services under this subsection.’’.

21 (b) EFFECTIVE DATE.—Paragraph (13) of section

22 1077(a) of title 10, United States Code (as added by sub23 section (a)), shall apply with respect to health care serv24 ices furnished on or after January 1, 1994, to dependents
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1 of members or former members of the uniformed services

2 authorized to receive such services.

3 SEC. 9. PREVENTIVE HEALTH CARE DEMONSTRATION

4 PROJECT.

5 (a) ESTABLISHMENT.—There is hereby established a

6 demonstration project to demonstrate the effectiveness in

7 providing preventive health care services in improving the

8 health of individuals and reducing the aggregate costs of

9 providing health care, under which the Secretary of Health

10 and Human Services shall—

11 (1) make grants over a 5-year period to 50 eli12 gible counties to assist the counties in providing pre13 ventive health care services (in accordance with sub14 section (b)) to individuals who would otherwise be

15 unable to pay (or have payment made on their be16 half) for such services;

17 (2) conduct the study described in subsection

18 (c); and

19 (3) carry out the educational program described

20 in subsection (d).

21 (b) GRANTS TO COUNTIES.—

22 (1) SERVICES DESCRIBED.—A county receiving

23 a grant under subsection (a)(1) shall provide preven24 tive health care services to individuals at clinics in

25 accordance with the schedule of preventive health
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1 care services established under the Comprehensive

2 Preventive Health and Promotion Act of 1993, ex3 cept that—

4 (A) the county may furnish services to in5 dividuals residing in rural areas at locations

6 other than clinics if no clinics that are able to

7 provide such services are located in the area;

8 and

9 (B) the Secretary may revise the schedule

10 of services otherwise required to be provided to

11 take into account the special needs of a partici12 pating county.

13 (2) ELIGIBILITY OF COUNTIES.—A county is el14 igible to receive a grant under subsection (a)(1) if

15 it submits to the Secretary, at such time and in such

16 form as the Secretary may require, an application

17 containing such information and assurances as the

18 Secretary may require.

19 (3) GEOGRAPHIC BALANCE AMONG COUNTIES

20 SELECTED.—In selecting counties to receive grants

21 under subsection (a)(1), the Secretary shall consider

22 the need to select counties representing urban, rural,

23 and suburban areas and counties representing var24 ious geographic regions of the United States.
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1 (c) STUDY OF STATE PREVENTIVE CARE REQUIRE2 MENTS.—

3 (1) STUDY.—The Secretary shall conduct a

4 study of the requirements regarding preventive

5 health care services that are imposed by each State

6 on health benefit plans offered to individuals resid7 ing in the State.

8 (2) REPORT.—Not later than 1 year after the

9 date of the enactment of this Act, the Secretary

10 shall submit a report to Congress on the study con11 ducted under paragraph (1).

12 (d) DISSEMINATION OF INFORMATION ON PREVEN13 TIVE HEALTH CARE.—Not later than 2 years after the

14 date of the enactment of this Act, the Secretary, in con15 sultation with experts in preventive medicine and rep16 resentatives of providers of health care services, shall pub17 lish and disseminate information on the benefits of prac18 ticing preventive health care, the importance of under19 going periodic health examinations, and the need to estab20 lish and maintain a family medical history to businesses,

21 providers of health care services, and other appropriate

22 groups and individuals.

23 (e) STATE DEFINED.—In this section, the term

24 ‘‘State’’ means each of the 50 States and the District of

25 Columbia.
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1 SEC. 10. PROGRAMS TO ESTABLISH ON-SITE WORKSHOPS

2 ON HEALTH PROMOTION.

3 (a) GRANTS TO BUSINESSES.—

4 (1) IN GENERAL.—The Secretary of Health and

5 Human Services shall establish a program under

6 which the Secretary shall make grants over a 5-year

7 period to 30 eligible employers to establish and con8 duct on-site workshops on health care promotion for

9 employees.

10 (2) ELIGIBILITY.—An employer is eligible to re11 ceive a grant under paragraph (1) if the employer

12 submits an application (at such time and in such

13 form as the Secretary may require) containing such

14 information and assurances as the Secretary may re15 quire, including assurances that the employer shall

16 use funds received under the grant only to provide

17 services that the employer does not otherwise pro18 vide (either directly or through a carrier) to its em19 ployees.

20 (3) INFORMATION AND SERVICES PROVIDED.—

21 On-site workshops on health care promotion con22 ducted with grants received under paragraph (1)

23 shall include the presentation of such information

24 and the provision of such services as the Secretary

25 considers appropriate, including counseling on nutri26 tion and weight management, clinical sessions on
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1 avoiding back injury, programs on smoking ces2 sation, and information on stress management.

3 (b) ESTABLISHMENT OF PROGRAMS FOR FEDERAL

4 EMPLOYEES.—The Secretary of Labor shall establish a

5 program under which the Secretary shall conduct on-site

6 workshops on health care promotion for employees of the

7 Federal Government, and shall include in such workshops

8 the presentation of such information and the provision of

9 such services as the Secretary (in consultation with the

10 Secretary of Health and Human Services) considers ap11 propriate, including counseling on nutrition and weight

12 management, clinical sessions on avoiding back injury,

13 programs on smoking cessation, and information on stress

14 management.

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