I

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.

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

3 SECTION 1. SHORT TITLE.

4 This Act may be referred to as ‘‘The Well America

5 Act’’.

6 SEC. 2. WELLNESS TRUST FUND.

7 (a) ESTABLISHMENT.—There is hereby created on

8 the books of the Treasury of the United States a trust

9 fund to be known as the ‘‘Wellness Trust Fund’’. The

10 Wellness Trust Fund shall consist of such gifts and be11 quests as may be made and such amounts as may be de12 posited in, or appropriated to, such fund.
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1 (b) There are hereby appropriated to the Trust Fund

2 for each year 4 percent of all health care premiums, as

3 well as 4 percent of all Federal expenditures on health

4 care for populations served outside of health care plans.

5 SEC. 3. WELLNESS PROGRAM.

6 (a) WELLNESS VOUCHER.—The Secretary shall issue

7 to each enrollee satisfying the conditions of paragraph (b)

8 a wellness voucher card which may be used for identifica9 tion, verifying eligibility for benefits under this section,

10 and processing of payments under this section to partici11 pating wellness providers selected by the enrollee. The

12 wellness voucher card shall bear an indication of its total

13 value as computed under paragraph (g), the portion of its

14 value used and the portion remaining at any time. The

15 wellness voucher card function may be incorporated into

16 the health security card.

17 (b) ELIGIBILITY.—Those eligible for wellness benefits

18 are:

19 (1) Any enrollee thirty years of age or older;

20 (2) Any enrollee under thirty years of age who

21 is certified by his or her primary care provider as in

22 special need of wellness benefits as a result of un23 usual physical characteristics or conditions; or

24 (3) Any enrollee under thirty years of age who

25 uses tobacco, for the purpose of a tobacco-use-ces-
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1 sation program; or whose cholesterol condition is

2 certified by his primary care provider to place him

3 or her at high health risk, for the purpose of a

4 weight-loss, nutrition, or exercise program; or whose

5 body weight is certified by his primary care physi6 cian to place him or her at high health risk, for the

7 purpose of a weight-loss, nutrition or exercise pro8 gram.

9 (c) BENEFITS.—Benefits provided under this section

10 are intended to promote greater health and reduced injury

11 and illness through programs which increase general

12 health status, or promote healthier lifestyles by changing

13 health related behaviors, such as hygiene or nutritional

14 education programs. They are not intended to duplicate

15 or substitute for therapeutic or rehabilitative services more

16 properly included in treatments for illnesses, injuries or

17 conditions covered by medical benefits. In addition to the

18 activities specified in paragraph (b)(3), States shall peri19 odically determine the range of other services eligible for

20 reimbursement from wellness voucher funds. Enrollees eli21 gible under paragraph (b)(2) are eligible only for such

22 benefits related to the characteristic or condition certified

23 by the primary care provider.

24 (d) ENROLLEE USE.—An eligible enrollee obtains

25 benefits under this section by presenting the wellness
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1 voucher card to a participating wellness provider in return

2 for covered benefits up to the total value remaining on

3 the card. Covered benefits costing more than the value re4 maining on the card may be purchased, but the enrollee

5 is personally responsible for the portion of the cost which

6 exceeds the value remaining on the voucher card.

7 (e) PARTICIPATING PROVIDERS.—

8 (1) Wellness providers must be licensed under

9 any applicable State laws relating to the activities

10 provided. The States may establish standards for

11 minimum solvency and insurance (which may include

12 bonding) for participating providers.

13 (2) As a condition of participation in the pro14 gram established by this section, providers agree to

15 provide a defined course of covered benefits in re16 turn for the payment made by the Secretary under

17 this section, to provide covered benefits in return for

18 payment in full by the Secretary from a portion of

19 the value of the wellness voucher, or to provide cov20 ered benefits to be paid in part by payment from the

21 Secretary under this section.

22 (3) As a condition of participation in the pro23 gram established by this section, providers must

24 agree to inform the enrollee’s primary care physician

25 of the services rendered and consult with the pri-
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1 mary care physician if requested on any ongoing

2 course of services.

3 (4) Each State shall maintain a list of wellness

4 providers satisfying the requirements of this Act,

5 which it shall make public and shall transmit to the

6 Secretary, and shall promptly notify the Secretary of

7 any additions thereto or deletions therefrom.

8 (f) PAYMENT.—The Secretary shall establish a mech9 anism for paying to participating providers from the

10 Wellness Trust Fund the cost of covered benefits under

11 this section as they are provided, and as claims for same

12 are made. In no event shall the Secretary be liable for

13 so much of claims which individually or in the aggregate

14 exceed the value of the enrollee’s wellness voucher.

15 (g) COMPUTATION OF WELLNESS VOUCHER

16 VALUE.—Prior to the beginning of each year, the Sec17 retary shall project the total income to the Wellness Trust

18 Fund for the coming year, and shall divide this figure,

19 less a contingency reserve not to exceed 2 percent, by the

20 number of enrollees whom the Secretary projects will be

21 eligible for benefits under this section in that year. The

22 quotient is the value of the wellness voucher of each eligi23 ble enrollee for that year, except that the Secretary may

24 adjust the value of wellness vouchers relative to each other

25 to take into consideration differences in the cost of serv-
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1 ices among States or alliance service areas. Such process

2 of adjustment shall not increase the total aggregate value

3 of all wellness vouchers.

4 SEC. 4. DEFINITIONS.—

5 For purposes of this title:

6 (a) ‘‘Enrollee’’ means an individual—

7 (i) who is entitled to participate in an alli8 ance or who is provided health benefits through

9 a Federal health care program outside of an al10 liance, and

11 (ii) who is entitled to receive services under

12 this Act.

13 (b) ‘‘Primary care providers’’ means a primary

14 care physician with the training and experience to

15 assess and treat the full range of basic health care

16 needs, and properly coordinate and refer to others

17 for specialized treatment, or, if licensed or certified

18 as such under State law, a nurse practitioner with

19 equivalent training and experience.

20 (c) ‘‘Provider’’ means any person who provides

21 services to enrollees or to other providers for enroll22 ees within the meaning of this Act.

23 (d) ‘‘Participating provider’’ means providers

24 who have agreed to abide by the conditions and re25 quirements of this Act.
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1 (e) ‘‘Secretary’’ means the Secretary of the

2 Treasury unless otherwise specified.

3 (f) ‘‘Services’’ includes goods, such as equip4 ment.

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