I 

113TH CONGRESS 

1ST SESSION H. R. 676 

To provide for comprehensive health insurance coverage for all United States 

residents, improved health care delivery, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 13, 2013 

Mr. CONYERS (for himself, Mr. NADLER, Ms. SCHAKOWSKY, Ms. PINGREE of 

Maine, Mr. GRIJALVA, Mr. ELLISON, Mr. JOHNSON of Georgia, Ms. 

EDDIE BERNICE JOHNSON of Texas, Mr. TAKANO, Ms. NORTON, Ms. 

LOFGREN, Mr. RANGEL, Ms. MOORE, Ms. CHU, Mr. AL GREEN of Texas, 

Mr. FARR, Mr. MCGOVERN, Mr. WELCH, Ms. CLARKE, Ms. LEE of California, Mr. NOLAN, Mr. POCAN, Mr. DOYLE, Mr. ENGEL, Mr. GUTIERREZ, Ms. WILSON of Florida, Mr. COHEN, Ms. EDWARDS, Mr. 

MCDERMOTT, Mr. CLAY, Mr. HUFFMAN, Ms. ROYBAL-ALLARD, Mr. 

CUMMINGS, Mr. YARMUTH, Mr. GEORGE MILLER of California, Mr. 

HONDA, Mrs. CHRISTENSEN, and Mr. RUSH) introduced the following 

bill; which was referred to the Committee on Energy and Commerce, and 

in addition to the Committees on Ways and Means and Natural Resources, 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 provide for comprehensive health insurance coverage for 

all United States residents, improved health care delivery, 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; TABLE OF CONTENTS. 

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

3 ‘‘Expanded & Improved Medicare For All Act’’. 

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

5 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Definitions and terms. 

TITLE I—ELIGIBILITY AND BENEFITS 

Sec. 101. Eligibility and registration. 

Sec. 102. Benefits and portability. 

Sec. 103. Qualification of participating providers. 

Sec. 104. Prohibition against duplicating coverage. 

TITLE II—FINANCES 

Subtitle A—Budgeting and Payments 

Sec. 201. Budgeting process. 

Sec. 202. Payment of providers and health care clinicians. 

Sec. 203. Payment for long-term care. 

Sec. 204. Mental health services. 

Sec. 205. Payment for prescription medications, medical supplies, and medically 

necessary assistive equipment. 

Sec. 206. Consultation in establishing reimbursement levels. 

Subtitle B—Funding 

Sec. 211. Overview: funding the Medicare For All Program. 

Sec. 212. Appropriations for existing programs. 

TITLE III—ADMINISTRATION 

Sec. 301. Public administration; appointment of Director. 

Sec. 302. Office of Quality Control. 

Sec. 303. Regional and State administration; employment of displaced clerical 

workers. 

Sec. 304. Confidential electronic patient record system. 

Sec. 305. National Board of Universal Quality and Access. 

TITLE IV—ADDITIONAL PROVISIONS 

Sec. 401. Treatment of VA and IHS health programs. 

Sec. 402. Public health and prevention. 

Sec. 403. Reduction in health disparities. 

TITLE V—EFFECTIVE DATE 

Sec. 501. Effective date. 


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1 SEC. 2. DEFINITIONS AND TERMS. 

2 In this Act: 

3 (1) MEDICARE FOR ALL PROGRAM; PROGRAM.— 

4 The terms ‘‘Medicare For All Program’’ and ‘‘Pro5 gram’’ mean the program of benefits provided under 

6 this Act and, unless the context otherwise requires, 

7 the Secretary with respect to functions relating to 

8 carrying out such program. 

9 (2) NATIONAL BOARD OF UNIVERSAL QUALITY

10 AND ACCESS.—The term ‘‘National Board of Uni11 versal Quality and Access’’ means such Board estab12 lished under section 305. 

13 (3) REGIONAL OFFICE.—The term ‘‘regional of14 fice’’ means a regional office established under sec15 tion 303. 

16 (4) SECRETARY.—The term ‘‘Secretary’’ means 

17 the Secretary of Health and Human Services. 

18 (5) DIRECTOR.—The term ‘‘Director’’ means, 

19 in relation to the Program, the Director appointed 

20 under section 301. 

21 TITLE I—ELIGIBILITY AND 

22 BENEFITS 

23 SEC. 101. ELIGIBILITY AND REGISTRATION. 

24 (a) IN GENERAL.—All individuals residing in the 

25 United States (including any territory of the United 

26 States) are covered under the Medicare For All Program 


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1 entitling them to a universal, best quality standard of care. 

2 Each such individual shall receive a card with a unique 

3 number in the mail. An individual’s Social Security num4 ber shall not be used for purposes of registration under 

5 this section. 

6 (b) REGISTRATION.—Individuals and families shall 

7 receive a Medicare For All Program Card in the mail, 

8 after filling out a Medicare For All Program application 

9 form at a health care provider. Such application form shall 

10 be no more than 2 pages long. 

11 (c) PRESUMPTION.—Individuals who present them12 selves for covered services from a participating provider 

13 shall be presumed to be eligible for benefits under this Act, 

14 but shall complete an application for benefits in order to 

15 receive a Medicare For All Program Card and have pay16 ment made for such benefits. 

17 (d) RESIDENCY CRITERIA.—The Secretary shall pro18 mulgate a rule that provides criteria for determining resi19 dency for eligibility purposes under the Medicare For All 

20 Program. 

21 (e) COVERAGE FOR VISITORS.—The Secretary shall 

22 promulgate a rule regarding visitors from other countries 

23 who seek premeditated non-emergency surgical proce24 dures. Such a rule should facilitate the establishment of 

25 country-to-country reimbursement arrangements or self 


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1 pay arrangements between the visitor and the provider of 

2 care. 

3 SEC. 102. BENEFITS AND PORTABILITY. 

4 (a) IN GENERAL.—The health care benefits under 

5 this Act cover all medically necessary services, including 

6 at least the following: 

7 (1) Primary care and prevention. 

8 (2) Approved dietary and nutritional therapies. 

9 (3) Inpatient care. 

10 (4) Outpatient care. 

11 (5) Emergency care. 

12 (6) Prescription drugs. 

13 (7) Durable medical equipment. 

14 (8) Long-term care. 

15 (9) Palliative care. 

16 (10) Mental health services. 

17 (11) The full scope of dental services, services, 

18 including periodontics, oral surgery, and 

19 endodontics, but not including cosmetic dentistry. 

20 (12) Substance abuse treatment services. 

21 (13) Chiropractic services, not including elec22 trical stimulation. 

23 (14) Basic vision care and vision correction 

24 (other than laser vision correction for cosmetic pur25 poses). 


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1 (15) Hearing services, including coverage of 

2 hearing aids. 

3 (16) Podiatric care. 

4 (b) PORTABILITY.—Such benefits are available 

5 through any licensed health care clinician anywhere in the 

6 United States that is legally qualified to provide the bene7 fits. 

8 (c) NO COST-SHARING.—No deductibles, copay9 ments, coinsurance, or other cost-sharing shall be imposed 

10 with respect to covered benefits. 

11 SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS. 

12 (a) REQUIREMENT TO BE PUBLIC OR NON-PROF13 IT.— 

14 (1) IN GENERAL.—No institution may be a par15 ticipating provider unless it is a public or not-for16 profit institution. Private physicians, private clinics, 

17 and private health care providers shall continue to 

18 operate as private entities, but are prohibited from 

19 being investor owned. 

20 (2) CONVERSION OF INVESTOR-OWNED PRO21 VIDERS.—For-profit providers of care opting to par22 ticipate shall be required to convert to not-for-profit 

23 status. 

24 (3) PRIVATE DELIVERY OF CARE REQUIRE25 MENT.—For-profit providers of care that convert to 


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1 non-profit status shall remain privately owned and 

2 operated entities. 

3 (4) COMPENSATION FOR CONVERSION.—The 

4 owners of such for-profit providers shall be com5 pensated for reasonable financial losses incurred as 

6 a result of the conversion from for-profit to non7 profit status. 

8 (5) FUNDING.—There are authorized to be ap9 propriated from the Treasury such sums as are nec10 essary to compensate investor-owned providers as 

11 provided for under paragraph (3). 

12 (6) REQUIREMENTS.—The payments to owners 

13 of converting for-profit providers shall occur during 

14 a 15-year period, through the sale of U.S. Treasury 

15 Bonds. Payment for conversions under paragraph 

16 (3) shall not be made for loss of business profits. 

17 (7) MECHANISM FOR CONVERSION PROCESS.— 

18 The Secretary shall promulgate a rule to provide a 

19 mechanism to further the timely, efficient, and fea20 sible conversion of for-profit providers of care. 

21 (b) QUALITY STANDARDS.— 

22 (1) IN GENERAL.—Health care delivery facili23 ties must meet State quality and licensing guidelines 

24 as a condition of participation under such program, 


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1 including guidelines regarding safe staffing and 

2 quality of care. 

3 (2) LICENSURE REQUIREMENTS.—Participating 

4 clinicians must be licensed in their State of practice 

5 and meet the quality standards for their area of 

6 care. No clinician whose license is under suspension 

7 or who is under disciplinary action in any State may 

8 be a participating provider. 

9 (c) PARTICIPATION OF HEALTH MAINTENANCE OR10 GANIZATIONS.— 

11 (1) IN GENERAL.—Non-profit health mainte12 nance organizations that deliver care in their own 

13 facilities and employ clinicians on a salaried basis 

14 may participate in the program and receive global 

15 budgets or capitation payments as specified in sec16 tion 202. 

17 (2) EXCLUSION OF CERTAIN HEALTH MAINTE18 NANCE ORGANIZATIONS.—Other health maintenance 

19 organizations which principally contract to pay for 

20 services delivered by non-employees shall be classi21 fied as insurance plans. Such organizations shall not 

22 be participating providers, and are subject to the 

23 regulations promulgated by reason of section 104(a) 

24 (relating to prohibition against duplicating cov25 erage). 


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1 (d) FREEDOM OF CHOICE.—Patients shall have free 

2 choice of participating physicians and other clinicians, 

3 hospitals, and inpatient care facilities. 

4 SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE. 

5 (a) IN GENERAL.—It is unlawful for a private health 

6 insurer to sell health insurance coverage that duplicates 

7 the benefits provided under this Act. 

8 (b) CONSTRUCTION.—Nothing in this Act shall be 

9 construed as prohibiting the sale of health insurance cov10 erage for any additional benefits not covered by this Act, 

11 such as for cosmetic surgery or other services and items 

12 that are not medically necessary. 

13 TITLE II—FINANCES 

14 Subtitle A—Budgeting and 

15 Payments 

16 SEC. 201. BUDGETING PROCESS. 

17 (a) ESTABLISHMENT OF OPERATING BUDGET AND

18 CAPITAL EXPENDITURES BUDGET.— 

19 (1) IN GENERAL.—To carry out this Act there 

20 are established on an annual basis consistent with 

21 this title— 

22 (A) an operating budget, including 

23 amounts for optimal physician, nurse, and other 

24 health care professional staffing; 

25 (B) a capital expenditures budget; 


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1 (C) reimbursement levels for providers con2 sistent with subtitle B; and 

3 (D) a health professional education budget, 

4 including amounts for the continued funding of 

5 resident physician training programs. 

6 (2) REGIONAL ALLOCATION.—After Congress 

7 appropriates amounts for the annual budget for the 

8 Medicare For All Program, the Director shall pro9 vide the regional offices with an annual funding al10 lotment to cover the costs of each region’s expendi11 tures. Such allotment shall cover global budgets, re12 imbursements to clinicians, health professional edu13 cation, and capital expenditures. Regional offices 

14 may receive additional funds from the national pro15 gram at the discretion of the Director. 

16 (b) OPERATING BUDGET.—The operating budget 

17 shall be used for— 

18 (1) payment for services rendered by physicians 

19 and other clinicians; 

20 (2) global budgets for institutional providers; 

21 (3) capitation payments for capitated groups; 

22 and 

23 (4) administration of the Program. 

24 (c) CAPITAL EXPENDITURES BUDGET.—The capital 

25 expenditures budget shall be used for funds needed for— 


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1 (1) the construction or renovation of health fa2 cilities; and 

3 (2) for major equipment purchases. 

4 (d) PROHIBITION AGAINST CO-MINGLING OPER5 ATIONS AND CAPITAL IMPROVEMENT FUNDS.—It is pro6 hibited to use funds under this Act that are earmarked— 

7 (1) for operations for capital expenditures; or 

8 (2) for capital expenditures for operations. 

9 SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLI10 NICIANS. 

11 (a) ESTABLISHING GLOBAL BUDGETS; MONTHLY

12 LUMP SUM.— 

13 (1) IN GENERAL.—The Medicare For All Pro14 gram, through its regional offices, shall pay each in15 stitutional provider of care, including hospitals, 

16 nursing homes, community or migrant health cen17 ters, home care agencies, or other institutional pro18 viders or pre-paid group practices, a monthly lump 

19 sum to cover all operating expenses under a global 

20 budget. 

21 (2) ESTABLISHMENT OF GLOBAL BUDGETS.— 

22 The global budget of a provider shall be set through 

23 negotiations between providers, State directors, and 

24 regional directors, but are subject to the approval of 

25 the Director. The budget shall be negotiated annuVerDate Mar 15 2010 04:57 Feb 22, 2013 Jkt 029200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H676.IH H676

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1 ally, based on past expenditures, projected changes 

2 in levels of services, wages and input, costs, a pro3 vider’s maximum capacity to provide care, and pro4 posed new and innovative programs. 

5 (b) THREE PAYMENT OPTIONS FOR PHYSICIANS AND

6 CERTAIN OTHER HEALTH PROFESSIONALS.— 

7 (1) IN GENERAL.—The Program shall pay phy8 sicians, dentists, doctors of osteopathy, pharmacists, 

9 psychologists, chiropractors, doctors of optometry, 

10 nurse practitioners, nurse midwives, physicians’ as11 sistants, and other advanced practice clinicians as li12 censed and regulated by the States by the following 

13 payment methods: 

14 (A) Fee for service payment under para15 graph (2). 

16 (B) Salaried positions in institutions re17 ceiving global budgets under paragraph (3). 

18 (C) Salaried positions within group prac19 tices or non-profit health maintenance organiza20 tions receiving capitation payments under para21 graph (4). 

22 (2) FEE FOR SERVICE.— 

23 (A) IN GENERAL.—The Program shall ne24 gotiate a simplified fee schedule that is fair and 

25 optimal with representatives of physicians and 


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1 other clinicians, after close consultation with 

2 the National Board of Universal Quality and 

3 Access and regional and State directors. Ini4 tially, the current prevailing fees or reimburse5 ment would be the basis for the fee negotiation 

6 for all professional services covered under this 

7 Act. 

8 (B) CONSIDERATIONS.—In establishing 

9 such schedule, the Director shall take into con10 sideration the following: 

11 (i) The need for a uniform national 

12 standard. 

13 (ii) The goal of ensuring that physi14 cians, clinicians, pharmacists, and other 

15 medical professionals be compensated at a 

16 rate which reflects their expertise and the 

17 value of their services, regardless of geo18 graphic region and past fee schedules. 

19 (C) STATE PHYSICIAN PRACTICE REVIEW

20 BOARDS.—The State director for each State, in 

21 consultation with representatives of the physi22 cian community of that State, shall establish 

23 and appoint a physician practice review board 

24 to assure quality, cost effectiveness, and fair re25 imbursements for physician delivered services. 


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1 (D) FINAL GUIDELINES.—The Director 

2 shall be responsible for promulgating final 

3 guidelines to all providers. 

4 (E) BILLING.—Under this Act physicians 

5 shall submit bills to the regional director on a 

6 simple form, or via computer. Interest shall be 

7 paid to providers who are not reimbursed within 

8 30 days of submission. 

9 (F) NO BALANCE BILLING.—Licensed 

10 health care clinicians who accept any payment 

11 from the Medicare For All Program may not 

12 bill any patient for any covered service. 

13 (G) UNIFORM COMPUTER ELECTRONIC

14 BILLING SYSTEM.—The Director shall create a 

15 uniform computerized electronic billing system, 

16 including those areas of the United States 

17 where electronic billing is not yet established. 

18 (3) SALARIES WITHIN INSTITUTIONS RECEIVING

19 GLOBAL BUDGETS.— 

20 (A) IN GENERAL.—In the case of an insti21 tution, such as a hospital, health center, group 

22 practice, community and migrant health center, 

23 or a home care agency that elects to be paid a 

24 monthly global budget for the delivery of health 

25 care as well as for education and prevention 


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1 programs, physicians and other clinicians em2 ployed by such institutions shall be reimbursed 

3 through a salary included as part of such a 

4 budget. 

5 (B) SALARY RANGES.—Salary ranges for 

6 health care providers shall be determined in the 

7 same way as fee schedules under paragraph (2). 

8 (4) SALARIES WITHIN CAPITATED GROUPS.— 

9 (A) IN GENERAL.—Health maintenance or10 ganizations, group practices, and other institu11 tions may elect to be paid capitation payments 

12 to cover all outpatient, physician, and medical 

13 home care provided to individuals enrolled to 

14 receive benefits through the organization or en15 tity. 

16 (B) SCOPE.—Such capitation may include 

17 the costs of services of licensed physicians and 

18 other licensed, independent practitioners pro19 vided to inpatients. Other costs of inpatient and 

20 institutional care shall be excluded from capita21 tion payments, and shall be covered under insti22 tutions’ global budgets. 

23 (C) PROHIBITION OF SELECTIVE ENROLL24 MENT.—Patients shall be permitted to enroll or 

25 disenroll from such organizations or entities 


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1 without discrimination and with appropriate no2 tice. 

3 (D) HEALTH MAINTENANCE ORGANIZA4 TIONS.—Under this Act— 

5 (i) health maintenance organizations 

6 shall be required to reimburse physicians 

7 based on a salary; and 

8 (ii) financial incentives between such 

9 organizations and physicians based on uti10 lization are prohibited. 

11 SEC. 203. PAYMENT FOR LONG-TERM CARE. 

12 (a) ALLOTMENT FOR REGIONS.—The Program shall 

13 provide for each region a single budgetary allotment to 

14 cover a full array of long-term care services under this 

15 Act. 

16 (b) REGIONAL BUDGETS.—Each region shall provide 

17 a global budget to local long-term care providers for the 

18 full range of needed services, including in-home, nursing 

19 home, and community based care. 

20 (c) BASIS FOR BUDGETS.—Budgets for long-term 

21 care services under this section shall be based on past ex22 penditures, financial and clinical performance, utilization, 

23 and projected changes in service, wages, and other related 

24 factors. 


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1 (d) FAVORING NON-INSTITUTIONAL CARE.—All ef2 forts shall be made under this Act to provide long-term 

3 care in a home- or community-based setting, as opposed 

4 to institutional care. 

5 SEC. 204. MENTAL HEALTH SERVICES. 

6 (a) IN GENERAL.—The Program shall provide cov7 erage for all medically necessary mental health care on 

8 the same basis as the coverage for other conditions. Li9 censed mental health clinicians shall be paid in the same 

10 manner as specified for other health professionals, as pro11 vided for in section 202(b). 

12 (b) FAVORING COMMUNITY-BASED CARE.—The 

13 Medicare For All Program shall cover supportive resi14 dences, occupational therapy, and ongoing mental health 

15 and counseling services outside the hospital for patients 

16 with serious mental illness. In all cases the highest quality 

17 and most effective care shall be delivered, and, for some 

18 individuals, this may mean institutional care. 

19 SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS, 

20 MEDICAL SUPPLIES, AND MEDICALLY NEC21 ESSARY ASSISTIVE EQUIPMENT. 

22 (a) NEGOTIATED PRICES.—The prices to be paid 

23 each year under this Act for covered pharmaceuticals, 

24 medical supplies, and medically necessary assistive equip25 ment shall be negotiated annually by the Program. 


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1 (b) PRESCRIPTION DRUG FORMULARY.— 

2 (1) IN GENERAL.—The Program shall establish 

3 a prescription drug formulary system, which shall 

4 encourage best-practices in prescribing and discour5 age the use of ineffective, dangerous, or excessively 

6 costly medications when better alternatives are avail7 able. 

8 (2) PROMOTION OF USE OF GENERICS.—The 

9 formulary shall promote the use of generic medica10 tions but allow the use of brand-name and off-for11 mulary medications. 

12 (3) FORMULARY UPDATES AND PETITION

13 RIGHTS.—The formulary shall be updated frequently 

14 and clinicians and patients may petition their region 

15 or the Director to add new pharmaceuticals or to re16 move ineffective or dangerous medications from the 

17 formulary. 

18 SEC. 206. CONSULTATION IN ESTABLISHING REIMBURSE19 MENT LEVELS. 

20 Reimbursement levels under this subtitle shall be set 

21 after close consultation with regional and State Directors 

22 and after the annual meeting of National Board of Uni23 versal Quality and Access. 


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1 Subtitle B—Funding 

2 SEC. 211. OVERVIEW: FUNDING THE MEDICARE FOR ALL 

3 PROGRAM. 

4 (a) IN GENERAL.—The Medicare For All Program 

5 is to be funded as provided in subsection (c)(1). 

6 (b) MEDICARE FOR ALL TRUST FUND.—There shall 

7 be established a Medicare For All Trust Fund in which 

8 funds provided under this section are deposited and from 

9 which expenditures under this Act are made. 

10 (c) FUNDING.— 

11 (1) IN GENERAL.—There are appropriated to 

12 the Medicare For All Trust Fund amounts sufficient 

13 to carry out this Act from the following sources: 

14 (A) Existing sources of Federal Govern15 ment revenues for health care. 

16 (B) Increasing personal income taxes on 

17 the top 5 percent income earners. 

18 (C) Instituting a modest and progressive 

19 excise tax on payroll and self-employment in20 come. 

21 (D) Instituting a modest tax on unearned 

22 income. 

23 (E) Instituting a small tax on stock and 

24 bond transactions. 


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1 (2) SYSTEM SAVINGS AS A SOURCE OF FINANC2 ING.—Funding otherwise required for the Program 

3 is reduced as a result of— 

4 (A) vastly reducing paperwork; 

5 (B) requiring a rational bulk procurement 

6 of medications under section 205(a); and 

7 (C) improved access to preventive health 

8 care. 

9 (3) ADDITIONAL ANNUAL APPROPRIATIONS TO

10 MEDICARE FOR ALL PROGRAM.—Additional sums are 

11 authorized to be appropriated annually as needed to 

12 maintain maximum quality, efficiency, and access 

13 under the Program. 

14 SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS. 

15 Notwithstanding any other provision of law, there are 

16 hereby transferred and appropriated to carry out this Act, 

17 amounts from the Treasury equivalent to the amounts the 

18 Secretary estimates would have been appropriated and ex19 pended for Federal public health care programs, including 

20 funds that would have been appropriated under the Medi21 care program under title XVIII of the Social Security Act, 

22 under the Medicaid program under title XIX of such Act, 

23 and under the Children’s Health Insurance Program 

24 under title XXI of such Act. 


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1 TITLE III—ADMINISTRATION 

2 SEC. 301. PUBLIC ADMINISTRATION; APPOINTMENT OF DI3 RECTOR. 

4 (a) IN GENERAL.—Except as otherwise specifically 

5 provided, this Act shall be administered by the Secretary 

6 through a Director appointed by the Secretary. 

7 (b) LONG-TERM CARE.—The Director shall appoint 

8 a director for long-term care who shall be responsible for 

9 administration of this Act and ensuring the availability 

10 and accessibility of high quality long-term care services. 

11 (c) MENTAL HEALTH.—The Director shall appoint a 

12 director for mental health who shall be responsible for ad13 ministration of this Act and ensuring the availability and 

14 accessibility of high quality mental health services. 

15 SEC. 302. OFFICE OF QUALITY CONTROL. 

16 The Director shall appoint a director for an Office 

17 of Quality Control. Such director shall, after consultation 

18 with state and regional directors, provide annual rec19 ommendations to Congress, the President, the Secretary, 

20 and other Program officials on how to ensure the highest 

21 quality health care service delivery. The director of the Of22 fice of Quality Control shall conduct an annual review on 

23 the adequacy of medically necessary services, and shall 

24 make recommendations of any proposed changes to the 


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1 Congress, the President, the Secretary, and other Medi2 care For All Program officials. 

3 SEC. 303. REGIONAL AND STATE ADMINISTRATION; EM4 PLOYMENT OF DISPLACED CLERICAL WORK5 ERS. 

6 (a) ESTABLISHMENT OF MEDICARE FOR ALL PRO7 GRAM REGIONAL OFFICES.—The Secretary shall establish 

8 and maintain Medicare For All regional offices for the 

9 purpose of distributing funds to providers of care. When10 ever possible, the Secretary should incorporate pre-exist11 ing Medicare infrastructure for this purpose. 

12 (b) APPOINTMENT OF REGIONAL AND STATE DIREC13 TORS.—In each such regional office there shall be— 

14 (1) one regional director appointed by the Di15 rector; and 

16 (2) for each State in the region, a deputy direc17 tor (in this Act referred to as a ‘‘State Director’’) 

18 appointed by the governor of that State. 

19 (c) REGIONAL OFFICE DUTIES.—Regional offices of 

20 the Program shall be responsible for— 

21 (1) coordinating funding to health care pro22 viders and physicians; and 

23 (2) coordinating billing and reimbursements 

24 with physicians and health care providers through a 

25 State-based reimbursement system. 


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1 (d) STATE DIRECTOR’S DUTIES.—Each State Direc2 tor shall be responsible for the following duties: 

3 (1) Providing an annual state health care needs 

4 assessment report to the National Board of Uni5 versal Quality and Access, and the regional board, 

6 after a thorough examination of health needs, in 

7 consultation with public health officials, clinicians, 

8 patients, and patient advocates. 

9 (2) Health planning, including oversight of the 

10 placement of new hospitals, clinics, and other health 

11 care delivery facilities. 

12 (3) Health planning, including oversight of the 

13 purchase and placement of new health equipment to 

14 ensure timely access to care and to avoid duplica15 tion. 

16 (4) Submitting global budgets to the regional 

17 director. 

18 (5) Recommending changes in provider reim19 bursement or payment for delivery of health services 

20 in the State. 

21 (6) Establishing a quality assurance mechanism 

22 in the State in order to minimize both under utiliza23 tion and over utilization and to assure that all pro24 viders meet high quality standards. 


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1 (7) Reviewing program disbursements on a 

2 quarterly basis and recommending needed adjust3 ments in fee schedules needed to achieve budgetary 

4 targets and assure adequate access to needed care. 

5 (e) FIRST PRIORITY IN RETRAINING AND JOB

6 PLACEMENT; 2 YEARS OF SALARY PARITY BENEFITS.— 

7 The Program shall provide that clerical, administrative, 

8 and billing personnel in insurance companies, doctors of9 fices, hospitals, nursing facilities, and other facilities 

10 whose jobs are eliminated due to reduced administration— 

11 (1) should have first priority in retraining and 

12 job placement in the new system; and 

13 (2) shall be eligible to receive two years of 

14 Medicare For All employment transition benefits 

15 with each year’s benefit equal to salary earned dur16 ing the last 12 months of employment, but shall not 

17 exceed $100,000 per year. 

18 (f) ESTABLISHMENT OF MEDICARE FOR ALL EM19 PLOYMENT TRANSITION FUND.—The Secretary shall es20 tablish a trust fund from which expenditures shall be 

21 made to recipients of the benefits allocated in subsection 

22 (e). 

23 (g) ANNUAL APPROPRIATIONS TO MEDICARE FOR

24 ALL EMPLOYMENT TRANSITION FUND.—Sums are auVerDate Mar 15 2010 22:33 Feb 21, 2013 Jkt 029200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H676.IH H676

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1 thorized to be appropriated annually as needed to fund 

2 the Medicare For All Employment Transition Benefits. 

3 (h) RETENTION OF RIGHT TO UNEMPLOYMENT BEN4 EFITS.—Nothing in this section shall be interpreted as a 

5 waiver of Medicare For All Employment Transition ben6 efit recipients’ right to receive Federal and State unem7 ployment benefits. 

8 SEC. 304. CONFIDENTIAL ELECTRONIC PATIENT RECORD 

9 SYSTEM. 

10 (a) IN GENERAL.—The Secretary shall create a 

11 standardized, confidential electronic patient record system 

12 in accordance with laws and regulations to maintain accu13 rate patient records and to simplify the billing process, 

14 thereby reducing medical errors and bureaucracy. 

15 (b) PATIENT OPTION.—Notwithstanding that all bill16 ing shall be preformed electronically, patients shall have 

17 the option of keeping any portion of their medical records 

18 separate from their electronic medical record. 

19 SEC. 305. NATIONAL BOARD OF UNIVERSAL QUALITY AND 

20 ACCESS. 

21 (a) ESTABLISHMENT.— 

22 (1) IN GENERAL.—There is established a Na23 tional Board of Universal Quality and Access (in 

24 this section referred to as the ‘‘Board’’) consisting 


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1 of 15 members appointed by the President, by and 

2 with the advice and consent of the Senate. 

3 (2) QUALIFICATIONS.—The appointed members 

4 of the Board shall include at least one of each of the 

5 following: 

6 (A) Health care professionals. 

7 (B) Representatives of institutional pro8 viders of health care. 

9 (C) Representatives of health care advo10 cacy groups. 

11 (D) Representatives of labor unions. 

12 (E) Citizen patient advocates. 

13 (3) TERMS.—Each member shall be appointed 

14 for a term of 6 years, except that the President shall 

15 stagger the terms of members initially appointed so 

16 that the term of no more than 3 members expires 

17 in any year. 

18 (4) PROHIBITION ON CONFLICTS OF INTER19 EST.—No member of the Board shall have a finan20 cial conflict of interest with the duties before the 

21 Board. 

22 (b) DUTIES.— 

23 (1) IN GENERAL.—The Board shall meet at 

24 least twice per year and shall advise the Secretary 


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1 and the Director on a regular basis to ensure qual2 ity, access, and affordability. 

3 (2) SPECIFIC ISSUES.—The Board shall specifi4 cally address the following issues: 

5 (A) Access to care. 

6 (B) Quality improvement. 

7 (C) Efficiency of administration. 

8 (D) Adequacy of budget and funding. 

9 (E) Appropriateness of reimbursement lev10 els of physicians and other providers. 

11 (F) Capital expenditure needs. 

12 (G) Long-term care. 

13 (H) Mental health and substance abuse 

14 services. 

15 (I) Staffing levels and working conditions 

16 in health care delivery facilities. 

17 (3) ESTABLISHMENT OF UNIVERSAL, BEST

18 QUALITY STANDARD OF CARE.—The Board shall 

19 specifically establish a universal, best quality of 

20 standard of care with respect to— 

21 (A) appropriate staffing levels; 

22 (B) appropriate medical technology; 

23 (C) design and scope of work in the health 

24 workplace; 

25 (D) best practices; and 


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1 (E) salary level and working conditions of 

2 physicians, clinicians, nurses, other medical pro3 fessionals, and appropriate support staff. 

4 (4) TWICE-A-YEAR REPORT.—The Board shall 

5 report its recommendations twice each year to the 

6 Secretary, the Director, Congress, and the Presi7 dent. 

8 (c) COMPENSATION, ETC.—The following provisions 

9 of section 1805 of the Social Security Act shall apply to 

10 the Board in the same manner as they apply to the Medi11 care Payment Assessment Commission (except that any 

12 reference to the Commission or the Comptroller General 

13 shall be treated as references to the Board and the Sec14 retary, respectively): 

15 (1) Subsection (c)(4) (relating to compensation 

16 of Board members). 

17 (2) Subsection (c)(5) (relating to chairman and 

18 vice chairman). 

19 (3) Subsection (c)(6) (relating to meetings). 

20 (4) Subsection (d) (relating to director and 

21 staff; experts and consultants). 

22 (5) Subsection (e) (relating to powers). 


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1 TITLE IV—ADDITIONAL 

2 PROVISIONS 

3 SEC. 401. TREATMENT OF VA AND IHS HEALTH PROGRAMS. 

4 (a) VA HEALTH PROGRAMS.—This Act provides for 

5 health programs of the Department of Veterans’ Affairs 

6 to initially remain independent for the 10-year period that 

7 begins on the date of the establishment of the Medicare 

8 For All Program. After such 10-year period, the Congress 

9 shall reevaluate whether such programs shall remain inde10 pendent or be integrated into the Medicare For All Pro11 gram. 

12 (b) INDIAN HEALTH SERVICE PROGRAMS.—This Act 

13 provides for health programs of the Indian Health Service 

14 to initially remain independent for the 5-year period that 

15 begins on the date of the establishment of the Medicare 

16 For All Program, after which such programs shall be inte17 grated into the Medicare For All Program. 

18 SEC. 402. PUBLIC HEALTH AND PREVENTION. 

19 It is the intent of this Act that the Program at all 

20 times stress the importance of good public health through 

21 the prevention of diseases. 

22 SEC. 403. REDUCTION IN HEALTH DISPARITIES. 

23 It is the intent of this Act to reduce health disparities 

24 by race, ethnicity, income and geographic region, and to 

25 provide high quality, cost-effective, culturally appropriate 


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1 care to all individuals regardless of race, ethnicity, sexual 

2 orientation, or language. 

3 TITLE V—EFFECTIVE DATE 

4 SEC. 501. EFFECTIVE DATE. 

5 Except as otherwise specifically provided, this Act 

6 shall take effect on the first day of the first year that be7 gins more than 1 year after the date of the enactment 

8 of this Act, and shall apply to items and services furnished 

9 on or after such date. 

Æ 


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