I 

109TH CONGRESS 

1ST SESSION H. R. 2133 

To guarantee for all Americans quality, affordable, and comprehensive health 

insurance coverage. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 5, 2005 

Ms. BALDWIN (for herself, Mrs. CHRISTENSEN, Ms. SCHAKOWSKY, Mr. CONYERS, Mr. RANGEL, Mr. CUMMINGS, Mr. MCDERMOTT, Mr. PAYNE, Ms. 

JACKSON-LEE of Texas, Ms. LEE, Mr. STARK, Mr. OBEY, Mr. OWENS, 

and Ms. EDDIE BERNICE JOHNSON of Texas) introduced the following 

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

in addition to the Committee on Ways and Means, 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 guarantee for all Americans quality, affordable, and 

comprehensive health insurance coverage. 

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; TABLE OF CONTENTS. 

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

5 ‘‘Health Security for All Americans Act’’. 

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

7 the Act is as follows: 
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Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

TITLE I—HEALTH SECURITY FOR ALL AMERICANS—EXPANSION 

PHASE (PHASE I) 

Sec. 101. Expansion phase (phase i) voluntary State universal health insurance 

coverage plans. 

‘‘TITLE XXII—HEALTH SECURITY FOR ALL AMERICANS 

‘‘PART A—EXPANSION PHASE (PHASE I) PLANS

‘‘Sec. 2201. Purpose; voluntary State plans. 

‘‘Sec. 2202. Plan requirements. 

‘‘Sec. 2203. Coverage requirements for expansion phase (phase i) plans. 

‘‘Sec. 2204. Allotments. 

‘‘Sec. 2205. Administration. 

‘‘Sec. 2206. Definitions. 

TITLE II—HEALTH SECURITY FOR ALL AMERICANS—UNIVERSAL 

PHASE (PHASE II) 

Sec. 201. Universal phase (phase II) State universal health insurance coverage 

plans. 

‘‘PART B—UNIVERSAL PHASE (PHASE II) PLANS

‘‘Sec. 2211. Purpose; mandatory State plans. 

‘‘Sec. 2212. Plan requirements. 

‘‘Sec. 2213. Coverage requirements for universal phase (phase II) plans. 

‘‘Sec. 2214. Requirements for employers regarding the provision of benefits. 

‘‘Sec. 2215. Allotments. 

‘‘Sec. 2216. Administration; definitions. 

Sec. 202. Consumer protections. 

‘‘PART C—CONSUMER PROTECTIONS

‘‘Sec. 2221. Home care standards. 

‘‘Sec. 2222. Consumer protection in the event of termination or suspension 

of services. 

‘‘Sec. 2223. Consumer protection through disclosure of information. 

‘‘Sec. 2224. Consumer protection through notice of changes in health care 

delivery. 

TITLE III—PATIENT PROTECTIONS 

Sec. 301. Incorporation of certain protections. 

TITLE IV—HEALTH CARE QUALITY, PATIENT SAFETY, AND 

WORKFORCE STANDARDS 

Sec. 401. Health care quality, patient safety, and Workforce Standards Institute. 

Sec. 402. Health care quality, patient safety, and Workforce Standards Advisory Committee. 

TITLE V—IMPROVING MEDICARE BENEFITS 
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Sec. 501. Full mental health and substance abuse treatment benefits parity. 

TITLE VI—LONG-TERM AND HOME HEALTH CARE 

Sec. 601. Studies and demonstration projects to identify model programs. 

TITLE VII—MISCELLANEOUS 

Sec. 701. Nonapplication of ERISA. 

Sec. 702. Sense of Congress regarding offsets. 

1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) The health of the American people is the 

4 foundation of American strength, productivity, and 

5 wealth. 

6 (2) The guarantee of health care coverage and 

7 access to quality medical care to all Americans is a 

8 fundamental right and is essential to the general 

9 welfare. 

10 (3) 45,000,000 Americans, more than 

11 8,400,000 of whom are children, have no health in12 surance. 

13 (4) The number of Americans receiving health 

14 care through their employers has decreased in recent 

15 years. 

16 (5) Health insurance coverage is unstable; less 

than 1 17 ⁄2 of all adults have been in their current 

18 health plan for 3 years. 

19 (6) The average American will hold at least 7 

20 jobs during their life, risking lack of health coverage 

21 every time they change or are between jobs. 
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1 (7) Annual health care expenditures in the 

2 United States total $1.6 trillion. 

3 (8) In the United States, personal health care 

4 spending grows 2.5 percent faster than the gross do5 mestic product. 

6 (9) Although the United States spends consid7 erably more in health care per person than any other 

8 nation at $5,400 per person, it ranks only fifteenth 

9 among countries worldwide on an overall index de10 signed to measure a range of health goals according 

11 to the World Health Organization. 

12 (10) One of 4 adults, about 40,000,000 people, 

13 say they have gone without needed medical care be14 cause they couldn’t afford it. 

15 (11) Half of all personal bankruptcy cases are 

16 due to medical reasons. 

17 (12) The average American worker is paying 

18 twice as much for family coverage than 10 years 

19 ago. 

20 (13) Because many individuals do not have 

21 health insurance coverage, they may incur health 

22 care costs which they do not fully reimburse, result23 ing in cost-shifting to others. 

24 (14) As a consequence of the piecemeal health 

25 care system in the United States, administrative 
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1 overhead costs approximately $1,059 per person an2 nually, while other Western industrialized nations 

3 with universal health care systems spend approxi4 mately $200 per person annually for administrative 

5 overhead. 

6 (15) The United States should adopt national 

7 goals of universal, affordable, comprehensive health 

8 insurance coverage and should provide generous 

9 matching grants to the States to achieve those goals 

10 within 5 years of the date of enactment of this Act. 

11 TITLE I—HEALTH SECURITY FOR 

12 ALL AMERICANS—EXPANSION 

13 PHASE (PHASE I) 

14 SEC. 101. EXPANSION PHASE (PHASE I) VOLUNTARY STATE 

15 UNIVERSAL HEALTH INSURANCE COVERAGE 

16 PLANS. 

17 The Social Security Act (42 U.S.C. 301 et seq.) is 

18 amended by adding at the end the following: 

19 ‘‘TITLE XXII—HEALTH SECURITY 

20 FOR ALL AMERICANS 

21 ‘‘PART A—EXPANSION PHASE (PHASE I) PLANS 

22 ‘‘SEC. 2201. PURPOSE; VOLUNTARY STATE PLANS. 

23 ‘‘(a) PURPOSE.—The purpose of this part is to pro24 vide funds to participating States to enable those States 

25 to ensure universal health insurance coverage by estab-
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1 lishing State administered systems targeted to State resi2 dents with a family income that does not exceed 300 per3 cent of the poverty line. 

4 ‘‘(b) EXPANSION PHASE (PHASE I) PLAN RE5 QUIRED.—A State is not eligible for a payment under sec6 tion 2205(a) unless the State has submitted to the Sec7 retary a plan that— 

8 ‘‘(1) sets forth how the State intends to use the 

9 funds provided under this part to ensure universal, 

10 affordable, and comprehensive health insurance cov11 erage to eligible residents of the State consistent 

12 with the provisions of this part; and 

13 ‘‘(2) has been approved under section 2202(d). 

14 ‘‘SEC. 2202. PLAN REQUIREMENTS. 

15 ‘‘(a) IN GENERAL.—Every expansion phase (phase I) 

16 plan shall include provisions for the following: 

17 ‘‘(1) INFORMATION ON THE LEVEL OF HEALTH

18 INSURANCE COVERAGE.— 

19 ‘‘(A) The level of health insurance coverage 

20 within the State as determined under sub21 section (b). 

22 ‘‘(B) The base coverage gap for the year 

23 involved as determined under subsection (b)(4). 

24 ‘‘(C) State efforts to provide or obtain 

25 health insurance coverage for uncovered resi-
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1 dents of the State, including the steps the State 

2 is taking to identify and enroll all uncovered 

3 residents of the State who are eligible to par4 ticipate in public or private health insurance 

5 programs. 

6 ‘‘(2) DETAILS OF, AND TIMELINES FOR, EXPAN7 SION PHASE (PHASE I) PLAN.— 

8 ‘‘(A) USE OF FUNDS; COORDINATION.— 

9 The activities that the State intends to carry 

10 out using funds received under this part, in11 cluding how the State will coordinate efforts 

12 under this part with existing State efforts to in13 crease the health insurance coverage of individ14 uals. 

15 ‘‘(B) TIMELINES.—Consistent with sub16 section (c), the manner in which the State will 

17 reduce the base coverage gap for the year in18 volved, including a timetable with specified tar19 gets for reducing the base coverage gap by— 

20 ‘‘(i) 50 percent within 2 years after 

21 the date of approval of the expansion 

22 phase (phase I) plan; and 

23 ‘‘(ii) 100 percent within 4 years after 

24 such date. 
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1 ‘‘(3) MAINTENANCE OF EFFORT.—The manner 

2 in which the State will ensure that— 

3 ‘‘(A) employers within the State will con4 tinue to provide not less than the level of finan5 cial support toward the health insurance pre6 miums required for coverage of their employees 

7 as such employers provided as of the date of en8 actment of this title; and 

9 ‘‘(B) the State will continue to provide not 

10 less than the level of State expenditures in11 curred for State-funded health programs as of 

12 such date. 

13 For purposes of this paragraph, any population or 

14 service that was covered under the medicaid pro15 gram under title XIX under a waiver under section 

16 1115 or section 1902(r)(2) shall be treated as if 

17 such State expenditures had been based on the en18 hanced FMAP formula used under the State chil19 dren’s health insurance program under title XXI. 

20 ‘‘(4) STATE OUTREACH PROGRAMS; ACCESS.— 

21 The manner in which, and a timetable for when, the 

22 State will— 

23 ‘‘(A) institute outreach programs; and 
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1 ‘‘(B) ensure that all eligible residents of 

2 the State have access to the health insurance 

3 coverage provided under this part. 

4 ‘‘(5) ASSURANCE OF COVERAGE OF ESSENTIAL

5 SERVICES.—An assurance that the State program 

6 established under this part will comply with the re7 quirements of section 1867 (commonly referred to as 

8 the ‘Emergency Medical Treatment and Active 

9 Labor Act’). 

10 ‘‘(6) REPRESENTATION ON BOARDS AND COM11 MISSIONS.—The manner in which the State will en12 sure that all Boards and Commissions that the State 

13 establishes to administer the plan will include, 

14 among others, representatives of providers, con15 sumers, employers, and health worker unions. 

16 ‘‘(7) DISCLOSURE OF INFORMATION TO THE

17 PUBLIC.—The manner in which the State will ensure 

18 that, with respect to entities and individuals that 

19 provide services for which reimbursement is provided 

20 under this part— 

21 ‘‘(A) financial arrangements between in22 surers and providers and between providers and 

23 medical equipment suppliers are disclosed to the 

24 public; and 
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1 ‘‘(B) ownership interests and health care 

2 worker qualifications and credentials are dis3 closed to the public. 

4 ‘‘(8) CONSUMER PROTECTIONS.—The manner 

5 in which the State will ensure compliance with sec6 tions 2221, 2222, 2223, and 2224. 

7 ‘‘(9) PUBLIC REVIEW.—The manner in which 

8 the State will provide for the public review of insti9 tutional changes in services provided, markets and 

10 regions covered, withdrawal or movement of services, 

11 closures or downsizing, and other actions that affect 

12 the provision of health insurance under the plan. 

13 ‘‘(10) SERVICES IN RURAL AND UNDERSERVED

14 AREAS; CULTURAL COMPETENCY.—The manner in 

15 which the State will ensure— 

16 ‘‘(A) coverage in rural and underserved 

17 areas; and 

18 ‘‘(B) that the needs of culturally diverse 

19 populations are met. 

20 ‘‘(11) MECHANISMS TO MINIMIZE ADVERSE

21 RISK SELECTION.—The manner in which the State 

22 will encourage mechanisms to minimize adverse risk 

23 selection that provide choice of health plans and con24 trol costs. 
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1 ‘‘(12) LIMITATION ON ADMINISTRATIVE EX2 PENDITURES.—The manner in which the State will 

3 ensure that all qualified plans in the State expend 

4 at least 90 percent (or, during the first 2 years of 

5 the plan, 85 percent) of total income received from 

6 premiums on the provision of covered health care 

7 benefits (excluding all costs for marketing, adver8 tising, health plan administration, profits, or capital 

9 accumulation) to individuals. 

10 ‘‘(13) SELF-EMPLOYED AND MULTI11 EMPLOYED.—The manner in which the State will 

12 address self-employed individuals and multiwage 

13 earner families. 

14 ‘‘(14) REQUIREMENT TO MAINTAIN MEDICAID

15 BENEFITS.—The manner in which the State will en16 sure that individuals who are eligible for medical as17 sistance under title XIX and who receive benefits 

18 under the expansion phase (phase I) plan shall re19 ceive any items or services that are not available 

20 under the expansion phase (phase I) plan but that 

21 are available under the State medicaid program 

22 under title XIX through ‘wraparound coverage’ 

23 under such program. 

24 ‘‘(15) COST CONTAINMENT; RISK SELECTION.— 

25 What cost containment strategies the State will em-
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1 ploy and how the State will reduce adverse risk se2 lection. 

3 ‘‘(16) OTHER MATTERS.—Any other matter de4 termined appropriate by the Secretary. 

5 ‘‘(b) CURRENT LEVEL OF COVERAGE.— 

6 ‘‘(1) IN GENERAL.—The Secretary shall develop 

7 a standardized survey approach that provides timely 

8 and up-to-date data to determine the percentage of 

9 the population of each State that is currently cov10 ered by a health insurance plan or program that 

11 provides coverage that meets the requirements of 

12 section 2203(a). 

13 ‘‘(2) BIANNUAL SURVEY.—The Secretary shall 

14 provide for the conduct of the survey developed 

15 under paragraph (1) not less than biannually to 

16 make coverage determinations for purposes of para17 graph (1). 

18 ‘‘(3) USE OF ALTERNATIVE SYSTEM.—The Sec19 retary shall permit a State to utilize an alternative 

20 population-based monitoring system to make deter21 minations with respect to coverage in the State for 

22 purposes of paragraph (1) if the Secretary deter23 mines that such system meets or exceeds the meth24 odological standards utilized in the survey developed 

25 under paragraph (1). 
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1 ‘‘(4) BASE COVERAGE GAP.—For purposes of 

2 subsection (a)(1)(A), the base coverage gap for a 

3 State shall be equal to 100 percent of the eligible in4 dividuals and families in the State for the year in5 volved, less the current level of coverage for those in6 dividuals and families for such year as determined 

7 under paragraph (1) or (3). 

8 ‘‘(c) REDUCING THE LEVEL OF UNINSURED INDIVID9 UALS.— 

10 ‘‘(1) IN GENERAL.—To be eligible to receive 

11 funds under this part, a State shall agree to admin12 ister an expansion phase (phase I) plan with a goal 

13 of providing health insurance coverage for 100 per14 cent of the eligible residents of the State by not later 

15 than 4 years after the date of approval of the State’s 

16 expansion phase (phase I) plan. 

17 ‘‘(2) PERMISSIBLE ACTIVITIES.—A State may 

18 use amounts provided under this part for any activi19 ties consistent with this part that are appropriate to 

20 enroll individuals in health plans and health pro21 grams to meet the targets contained in the State 

22 plan under subsection (a)(2)(B), including through 

23 the use of direct payments to health plans or, in the 

24 case of a single State plan, directly to providers of 

25 services. 
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1 ‘‘(d) PROCESS FOR SUBMISSION, APPROVAL, AND

2 AMENDMENT OF EXPANSION PHASE (PHASE I) PLAN.— 

3 The provisions of section 2106 apply to an expansion 

4 phase (phase I) plan under this part in the same manner 

5 as they apply to a State plan under title XXI, except that 

6 no expansion phase (phase I) plan may be effective earlier 

7 than January 1, 2005, and all expansion phase (phase I) 

8 plans must be submitted for approval by not later than 

9 December 31, 2006. 

10 ‘‘SEC. 2203. COVERAGE REQUIREMENTS FOR EXPANSION 

11 PHASE (PHASE I) PLANS. 

12 ‘‘(a) REQUIRED SCOPE OF HEALTH INSURANCE COV13 ERAGE.—Health insurance coverage provided under this 

14 part shall consist of at least the benefits provided under 

15 the Federal Employees Health Benefits Program standard 

16 Blue Cross/Blue Shield preferred provider option service 

17 benefit plan, described in and offered under section 

18 8903(1) of part 5, United States Code, plus mental health 

19 and substance abuse treatment benefits parity for all indi20 viduals, and benefits for early and periodic screening and 

21 diagnosis services (EPSDT) under section 1905(a)(4)(B) 

22 for all individuals under 21 years of age. 

23 ‘‘(b) LIMITATIONS ON PREMIUMS AND COST-SHAR24 ING.— 
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1 ‘‘(1) DESCRIPTION; GENERAL CONDITIONS.—An 

2 expansion phase (phase I) plan shall include a de3 scription, consistent with this subsection, of the 

4 amount (if any) of premiums, cost-sharing, or other 

5 similar charges imposed. Any such charges shall be 

6 imposed pursuant to a public schedule. 

7 ‘‘(2) LIMITATIONS ON PREMIUMS AND COST8 SHARING.— 

9 ‘‘(A) INDIVIDUALS AND FAMILIES WITH IN10 COME BELOW 150 PERCENT OF POVERTY

11 LINE.—In the case of an individual or family 

12 whose income is at or below 150 percent of the 

13 poverty line— 

14 ‘‘(i) the State plan may not impose a 

15 premium; and 

16 ‘‘(ii) the total annual aggregate 

17 amount of cost-sharing imposed by a State 

18 with respect to all individuals in a family 

19 may not exceed 0.5 percent of the family’s 

20 income for the year involved. 

21 ‘‘(B) INDIVIDUALS AND FAMILIES WITH

22 INCOME BETWEEN 150 AND 300 PERCENT OF

23 POVERTY LINE.—In the case of an individual or 

24 family whose income exceeds 150 percent but 
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1 does not exceed 300 percent of the poverty 

2 line— 

3 ‘‘(i) the State plan may not impose a 

4 premium that exceeds an amount that is 

5 equal to— 

6 ‘‘(I) 20 percent of the average 

7 cost of providing benefits to an indi8 vidual (or a family) under this part in 

9 the year involved; or 

10 ‘‘(II) 3 percent of the family’s in11 come for the year involved; and 

12 ‘‘(ii) the total annual aggregate 

13 amount of premiums and cost-sharing 

14 (combined) imposed by a State with re15 spect to all individuals in a family may not 

16 exceed 5 percent of the family’s income for 

17 the year involved. 

18 ‘‘(C) INDIVIDUALS AND FAMILIES WITH IN19 COME ABOVE 300 PERCENT OF POVERTY

20 LINE.—In the case of an individual or family 

21 whose income exceeds 300 percent of the pov22 erty line— 

23 ‘‘(i) the State plan may not impose a 

24 premium that exceeds 20 percent of the 

25 average cost of providing benefits to an in-
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1 dividual (or a family of the size involved) 

2 under this part in the year involved; and 

3 ‘‘(ii) the total annual aggregate 

4 amount of premiums and cost-sharing 

5 (combined) imposed by a State with re6 spect to all individuals in a family may not 

7 exceed 7 percent of the family’s income for 

8 the year involved. 

9 ‘‘(D) SELF-EMPLOYED INDIVIDUALS.—The 

10 State shall establish rules for self-employed in11 dividuals based on individual and family in12 come. 

13 ‘‘(3) COLLECTION.—The State shall establish 

14 procedures for collecting any premiums, cost-shar15 ing, or other similar charges imposed under this 

16 part. Such procedures shall provide for annual rec17 onciliations and adjustments. 

18 ‘‘(c) APPLICATION OF CERTAIN REQUIREMENTS.— 

19 ‘‘(1) RESTRICTION ON APPLICATION OF PRE20 EXISTING CONDITION EXCLUSIONS.—The expansion 

21 phase (phase I) plan shall not permit the imposition 

22 of any preexisting condition exclusion for covered 

23 benefits under the plan. 

24 ‘‘(2) CHOICE OF PLANS.— 
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1 ‘‘(A) IN GENERAL.—Except as provided in 

2 subparagraph (B), the expansion phase (phase 

3 I) plan shall offer eligible individuals and fami4 lies a choice of qualified plans from which to re5 ceive benefits under this part. At least 1 plan 

6 shall be a preferred provider option plan. 

7 ‘‘(B) WAIVER.—The Secretary— 

8 ‘‘(i) may waive the requirement under 

9 subparagraph (A) if determined appro10 priate; and 

11 ‘‘(ii) shall waive such requirement in 

12 the case of a State that establishes a single 

13 State plan. 

14 ‘‘SEC. 2204. ALLOTMENTS. 

15 ‘‘(a) STATE ALLOTMENTS.— 

16 ‘‘(1) IN GENERAL.—With respect to a fiscal 

17 year, the Secretary shall allot to each State with an 

18 expansion phase (phase I) plan approved under this 

19 part the amount determined under paragraph (2) for 

20 such State for such fiscal year. 

21 ‘‘(2) DETERMINATION OF COST OF COV22 ERAGE.—The amount determined under this para23 graph is the amount equal to— 

24 ‘‘(A) the product of— 
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1 ‘‘(i) the Federal participation rate for 

2 the State as determined under subsection 

3 (b) or, if applicable, the enhanced Federal 

4 participation rate for the State, as deter5 mined under subsection (c); 

6 ‘‘(ii) the estimated cost for the min7 imum benefits package required to comply 

8 under section 2203, not to exceed the sum 

9 of— 

10 ‘‘(I) the total annual Government 

11 and employee contributions required 

12 for individual or self and family health 

13 benefits coverage under the Federal 

14 Employees Health Benefits Program 

15 standard Blue Cross/Blue Shield pre16 ferred provider option service benefit 

17 plan, described in and offered under 

18 section 8903(1) of title 5, United 

19 States Code (adjusted for age and 

20 other factors, as the Secretary deter21 mines appropriate); and 

22 ‘‘(II) the estimated average cost23 sharing expense for an individual or 

24 family; and 
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1 ‘‘(iii) the estimated number of resi2 dents to be enrolled in the expansion phase 

3 (phase I) plan; less 

4 ‘‘(B) the sum of— 

5 ‘‘(i) the individual or family health in6 surance contribution and cost-sharing pay7 ments to be made in accordance with sec8 tion 2203(b); and 

9 ‘‘(ii) any applicable employer contribu10 tion to such payments. 

11 ‘‘(b) FEDERAL PARTICIPATION RATE.—For purposes 

12 of subsection (a)(2)(A)(i), the Federal participation rate 

13 for a State shall be equal to the enhanced FMAP deter14 mined for the State under section 2105(b). 

15 ‘‘(c) ENHANCED FEDERAL PARTICIPATION RATE.— 

16 ‘‘(1) IN GENERAL.—For purposes of subsection 

17 (a)(2)(A)(i), the enhanced Federal participation rate 

18 for a State shall be equal to the Federal participa19 tion rate for such State under subsection (b), as ad20 justed by the Secretary based on the decrease in the 

21 base coverage gap in the State. 

22 ‘‘(2) AMOUNT OF ADJUSTMENT AND APPLICA23 TION.— 
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1 ‘‘(A) AMOUNT OF ADJUSTMENT.—The 

2 Federal participation rate under subsection (b) 

3 with respect to a State shall be increased by— 

4 ‘‘(i) 1 percentage point if the base 

5 coverage gap of the State has decreased by 

6 at least 50 percent within 2 years after the 

7 date of approval of the expansion phase 

8 (phase I) plan, as determined by the Sec9 retary; and 

10 ‘‘(ii) 3 percentage points if the base 

11 coverage gap of the State has decreased by 

12 100 percent within 4 years after the date 

13 of approval of the expansion phase (phase 

14 I) plan, as determined by the Secretary. 

15 ‘‘(B) APPLICATION.—The increase de16 scribed in— 

17 ‘‘(i) subparagraph (A)(i) shall only 

18 apply to a State for the period beginning 

19 with the month of the determination under 

20 such subparagraph and ending with the 

21 month preceding the month of the deter22 mination under subparagraph (A)(ii) (if 

23 any), but in no event for more than 24 

24 months; and 
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1 ‘‘(ii) subparagraph (A)(ii) shall apply 

2 to a State for any year (or portion thereof) 

3 beginning with the month of the deter4 mination under such subparagraph. 

5 ‘‘(3) FULL COVERAGE.—For purposes of this 

6 part, a State shall be deemed to have decreased its 

7 base coverage gap by 100 percent if the Secretary 

8 determines that— 

9 ‘‘(A) 98 percent of all eligible residents of 

10 the State are provided health insurance cov11 erage under the expansion phase (phase I) plan; 

12 and 

13 ‘‘(B) the remaining 2 percent of such resi14 dents are served by alternative health care de15 livery systems as demonstrated by the State. 

16 ‘‘(d) GRANTS TO INDIAN TRIBES, NATIVE HAWAIIAN

17 ORGANIZATIONS, AND ALASKA NATIVE ORGANIZA18 TIONS.— 

19 ‘‘(1) IN GENERAL.—Out of funds appropriated 

20 under subsection (e), the Secretary shall reserve an 

21 amount, not to exceed 1 percent of the total allot22 ments determined under subsection (a) for a fiscal 

23 year, to make grants to Indian tribes, Native Hawai24 ian organizations, and Alaska Native organizations 

25 for development and implementation of universal 
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1 health insurance coverage plans for members of such 

2 tribes and organizations. 

3 ‘‘(2) PLAN.—To be eligible to receive a grant 

4 under paragraph (1), an Indian tribe, Native Hawai5 ian organization, or Alaska Native organization shall 

6 submit a universal health insurance coverage plan to 

7 the Secretary at such time, in such manner, and 

8 containing such information, as the Secretary may 

9 require. 

10 ‘‘(3) REGULATIONS.—The Secretary shall issue 

11 regulations specifying the requirements of this part 

12 that apply to Indian tribes, Native Hawaiian organi13 zations, and Alaska Native organizations receiving 

14 grants under paragraph (1). 

15 ‘‘(e) APPROPRIATION.— 

16 ‘‘(1) IN GENERAL.—Out of any funds in the 

17 Treasury not otherwise appropriated, there is appro18 priated to carry out this title such sums as may be 

19 necessary for fiscal year 2005 and each fiscal year 

20 thereafter. 

21 ‘‘(2) BUDGET AUTHORITY.—Paragraph (1) con22 stitutes budget authority in advance of appropria23 tions Acts and represents the obligation of the Fed24 eral Government to provide States, Indian tribes, 

25 Native Hawaiian organizations, and Alaska Native 
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1 organizations with the allotments determined under 

2 this section and the grants for administrative and 

3 outreach activities under section 2205. 

4 ‘‘SEC. 2205. ADMINISTRATION. 

5 ‘‘(a) PAYMENTS.— 

6 ‘‘(1) IN GENERAL.— 

7 ‘‘(A) QUARTERLY.—Subject to subpara8 graph (B) and subsection (b), the Secretary 

9 shall make quarterly payments to each State 

10 with an expansion phase (phase I) plan ap11 proved under this part, from its allotment 

12 under section 2204. 

13 ‘‘(B) FUNDING FOR ADMINISTRATION AND

14 OUTREACH.— 

15 ‘‘(i) AUTHORITY TO MAKE GRANTS.— 

16 In addition to the allotments determined 

17 under section 2204, the Secretary may 

18 make grants to States, Indian tribes, Na19 tive Hawaiian organizations, and Alaska 

20 Native organizations for expenditures for 

21 administrative and outreach activities. 

22 ‘‘(ii) AMOUNTS.— 

23 ‘‘(I) IN GENERAL.—A grant 

24 awarded under this subparagraph 

25 shall not exceed the applicable per-
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1 centage (as determined under sub2 clause (II)) of the total amount allot3 ted to the State, Indian tribe, Native 

4 Hawaiian organization, or Alaska Na5 tive organization under section 2204. 

6 ‘‘(II) APPLICABLE PERCENT7 AGE.—For purposes of subclause (I), 

8 the applicable percentage is— 

9 ‘‘(aa) 10 percent for 2006 

10 through 2010; and 

11 ‘‘(bb) 3 percent for 2011 

12 and each year thereafter. 

13 ‘‘(2) ADVANCE PAYMENT; RETROSPECTIVE AD14 JUSTMENT.—The Secretary may make payments 

15 under this part for each quarter on the basis of ad16 vance estimates by the State and such other inves17 tigation as the Secretary may find necessary, and 

18 may reduce or increase the payments as necessary to 

19 adjust for any overpayment or underpayment for 

20 prior quarters. 

21 ‘‘(3) FLEXIBILITY IN SUBMITTAL OF CLAIMS.— 

22 Nothing in this subsection shall be construed as pre23 venting a State from claiming as expenditures in the 

24 quarter expenditures that were incurred in a pre25 vious quarter. 
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1 ‘‘(b) AUTHORITY FOR BLENDED RATE FOR HEALTH

2 SECURITY, MEDICAID, AND SCHIP FUNDS.—The Sec3 retary shall establish procedures for blending the pay4 ments that a State is entitled to receive under this title, 

5 title XIX, and title XXI into 1 payment rate if— 

6 ‘‘(1) the State requests such a blended pay7 ment; and 

8 ‘‘(2) the Secretary finds that the State meets 

9 maintenance of effort requirements established by 

10 the Secretary. 

11 ‘‘(c) LIMITATIONS ON FEDERAL PAYMENTS BASED

12 ON COST CONTAINMENT.— 

13 ‘‘(1) DETERMINATION OF BASELINE.—Each 

14 year (beginning with 2005), the Secretary shall es15 tablish a baseline projection for the national rate of 

16 growth in private health insurance premiums for 

17 such year. 

18 ‘‘(2) REQUIREMENT.—Beginning with fiscal 

19 year 2006 and each fiscal year thereafter, any pay20 ment made to a State under section 2204 shall not 

21 exceed the amount paid to the State under such sec22 tion for the preceding fiscal year, adjusted for 

23 changes in enrollment and a premium inflation ad24 justment that is 0.5 percent below the baseline pro25 jection determined under paragraph (1) for the year, 
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1 unless the State adopts (and the Secretary approves) 

2 cost containment strategy that will reduce the rate 

3 of growth of spending. 

4 ‘‘(d) OTHER LIMITATIONS ON USE OF FUNDS.— 

5 ‘‘(1) IN GENERAL.—A State participating under 

6 part A, and, effective January 1, 2009, all States 

7 under part B, shall ensure that any payments re8 ceived by the State under section 2205 or 2116(a) 

9 are not used by any individual or entity, including 

10 providers or health plans that contract to provide 

11 services herein, to finance directly or indirectly, or to 

12 otherwise facilitate expenditures to influence health 

13 care workers of such individual or entity with re14 spect to issues related to unionization. 

15 ‘‘(2) CONSTRUCTION.—Nothing in this sub16 section shall be construed to limit expenditures made 

17 for the purpose of good faith collective bargaining or 

18 pursuant to the terms of a bona fide collective bar19 gaining agreement. 

20 ‘‘(e) WAIVER OF FEDERAL REQUIREMENTS.—A 

21 State may request (and the Secretary may grant) a waiver 

22 of any provision of Federal law that the State determines 

23 is necessary in order to carry out an approved expansion 

24 phase (phase I) plan under this part. 
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1 ‘‘(f) REPORT.—Not later than January 1, 2006, and 

2 each January 1 thereafter, the Secretary, in consultation 

3 with the General Accounting Office and the Congressional 

4 Budget Office, shall prepare and submit to the appro5 priate committees of Congress a report on the number of 

6 States receiving payments under this part for the year for 

7 which the report is being prepared as well as the level of 

8 insurance coverage attained by each such State. 

9 ‘‘SEC. 2206. DEFINITIONS. 

10 ‘‘In this title: 

11 ‘‘(1) COST-SHARING.—The term ‘cost-sharing’ 

12 has the meaning given such term under the Federal 

13 Employees Health Benefits Program standard Blue 

14 Cross/Blue Shield preferred provider option service 

15 benefit plan described in and offered under section 

16 8903(1) of part 5, United States Code, and includes 

17 deductibles, copayments, coinsurance, as such terms 

18 are defined for purposes of such plan. 

19 ‘‘(2) ELIGIBLE RESIDENTS OF A STATE.— 

20 ‘‘(A) IN GENERAL.—The term ‘eligible 

21 residents of a State’ means an individual or 

22 family who— 

23 ‘‘(i) is (or consists of) a resident of 

24 the State involved; 
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1 ‘‘(ii) except as provided in subpara2 graph (B), has a family income that does 

3 not exceed 300 percent of the poverty line; 

4 ‘‘(iii) is (or consists of) a citizen of 

5 the United States, a legal resident alien, or 

6 an individual otherwise residing in the 

7 United States under the authority of Fed8 eral law; and 

9 ‘‘(iv) in the case of an individual, is 

10 not eligible for benefits under the medicare 

11 program under title XVIII or for medical 

12 assistance under the medicaid program 

13 under title XIX (other than under the ap14 plication of section 

15 1902(a)(10)(A)(ii)(XIV)). 

16 ‘‘(B) OPTION TO PROVIDE COVERAGE FOR

17 INDIVIDUALS AND FAMILIES WITH HIGHER IN18 COME.—If approved by the Secretary, a State 

19 may increase the percentage described in sub20 paragraph (A)(ii), or eliminate all income eligi21 bility criteria in order to provide coverage under 

22 this part to more individuals and families. 

23 ‘‘(3) EXPANSION PHASE (PHASE I) PLAN.—The 

24 term ‘expansion phase (phase I) plan’ means the 
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1 State universal health insurance coverage plan sub2 mitted under section 2201(b). 

3 ‘‘(4) HEALTH CARE SERVICES.—The term 

4 ‘health care services’ includes medical, surgical, 

5 mental health, and substance abuse services, wheth6 er provided on an inpatient or outpatient basis. 

7 ‘‘(5) HEALTH CARE WORKER.—The term 

8 ‘health care worker’ means an individual employed 

9 by an employer that provides— 

10 ‘‘(A) health care services; or 

11 ‘‘(B) necessary related services, including 

12 administrative, food service, janitorial, or main13 tenance service to an entity that provides such 

14 health care services. 

15 ‘‘(6) HEALTH PLAN.—The term ‘health plan’ 

16 includes health insurance coverage, as defined in sec17 tion 2791(b)(1) of the Public Health Service Act (42 

18 U.S.C. 300gg–91(b)(1)) and group health plans, as 

19 defined in section 2791(a) of such Act (42 U.S.C. 

20 300gg91(b)(1)). 

21 ‘‘(7) MENTAL HEALTH AND SUBSTANCE ABUSE

22 TREATMENT BENEFITS PARITY.— 

23 ‘‘(A) IN GENERAL.—The term ‘mental 

24 health and substance abuse treatment benefits 

25 parity’ means, with respect to health coverage, 
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1 that the coverage does not impose treatment 

2 limitations or financial requirements on the cov3 erage of mental health benefits if similar re4 quirements are not imposed on coverage of 

5 medical and surgical benefits in comparable set6 tings (including inpatient and outpatient set7 tings). 

8 ‘‘(B) TREATMENT LIMITATIONS.—The 

9 term ‘treatment limitations’ means limits on the 

10 frequency of treatment, number of visits, or 

11 other limits on the scope and duration of treat12 ment, as covered by a group health plan (or 

13 health insurance coverage offered in connection 

14 with such a plan). Such term does not include 

15 limits on benefits or coverage based solely on 

16 medical necessity. 

17 ‘‘(C) FINANCIAL REQUIREMENTS.—The 

18 term ‘financial requirements’ means copay19 ments, deductibles, out-of-network charges, out20 of-pocket contributions or fees, annual limits, 

21 and lifetime aggregate limits imposed on cov22 ered individuals. 

23 ‘‘(8) POVERTY LINE.—The term ‘poverty line’ 

24 has the meaning given such term in section 673(2) 

25 of the Community Services Block Grant Act (42 
32 

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1 U.S.C. 9902(2)), including any revision required by 

2 such section. 

3 ‘‘(9) PREMIUM.—The term ‘premium’ includes 

4 any enrollment fees and other similar charges. 

5 ‘‘(10) QUALIFIED PLAN.—The term ‘qualified 

6 plan’ means a health plan that satisfies the coverage 

7 requirements described under section 2203 and par8 ticipates in an expansion phase (phase I) plan.’’. 

9 TITLE II—HEALTH SECURITY 

10 FOR ALL AMERICANS—UNI11 VERSAL PHASE (PHASE II) 

12 SEC. 201. UNIVERSAL PHASE (PHASE II) STATE UNIVERSAL 

13 HEALTH INSURANCE COVERAGE PLANS. 

14 Title XXII of the Social Security Act, as added by 

15 section 101, is amended by adding at the end the fol16 lowing: 

17 ‘‘PART B—UNIVERSAL PHASE (PHASE II) PLANS 

18 ‘‘SEC. 2211. PURPOSE; MANDATORY STATE PLANS. 

19 ‘‘(a) PURPOSE.—The purposes of this part are to— 

20 ‘‘(1) require States to establish and implement 

21 State-administered systems to ensure universal 

22 health insurance coverage; and 

23 ‘‘(2) provide funds to States for the establish24 ment and implementation of such systems. 
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1 ‘‘(b) UNIVERSAL PHASE (PHASE II) PLAN RE2 QUIRED.— 

3 ‘‘(1) IN GENERAL.—Except as provided in para4 graph (2), not later than January 1, 2008, a State 

5 shall submit to the Secretary a plan that sets forth 

6 how the State intends to use the funds provided 

7 under this part to ensure universal, affordable, and 

8 comprehensive health insurance coverage to eligible 

9 residents of the State consistent with the provisions 

10 of this part. 

11 ‘‘(2) STATES WITH PHASE I PLANS.— 

12 ‘‘(A) IN GENERAL.—Not later than Janu13 ary 1, 2008, a State with a phase I State plan 

14 shall submit an addendum to such plan that 

15 provides assurances to the Secretary that such 

16 plan conforms to the requirements of this part. 

17 ‘‘(B) CONVERSION TO UNIVERSAL PHASE

18 (PHASE II) PLAN.—If an addendum to an ex19 pansion phase (phase I) plan is approved by the 

20 Secretary— 

21 ‘‘(i) the plan shall be automatically 

22 converted to a universal phase (phase II) 

23 plan; and 
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1 ‘‘(ii) section 2214 and any provision 

2 of part A that is inconsistent with this 

3 part shall not apply to the plan. 

4 ‘‘(3) FAILURE TO SUBMIT PLAN OR ADDEN5 DUM.—If a State fails to submit a plan as required 

6 in paragraph (1) (or an addendum as required in 

7 paragraph (2)), or fails to have such plan or adden8 dum approved by the Secretary, such State shall be 

9 in violation of this part; and any residents of such 

10 a State may bring a cause of action against the 

11 State in Federal district court to require the State 

12 to comply with the provisions of this part. 

13 ‘‘SEC. 2212. PLAN REQUIREMENTS. 

14 ‘‘(a) IN GENERAL.—A universal phase (phase II) 

15 plan shall include a description, consistent with the re16 quirements of this part, of the following: 

17 ‘‘(1) DETAILS OF THE UNIVERSAL PHASE

18 (PHASE II) PLAN.—The activities that the State in19 tends to carry out using funds received under this 

20 part to ensure that all eligible residents of the State 

21 have access to the coverage provided under this part, 

22 including how the State will coordinate efforts under 

23 the program under this part with existing State ef24 forts to increase to 100 percent the health insurance 
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1 coverage of eligible residents of the State by Janu2 ary 1, 2010. 

3 ‘‘(2) REQUIREMENTS FOR EMPLOYERS.—The 

4 manner in which the State will ensure that employ5 ers within the State will comply with the require6 ments of section 2214. 

7 ‘‘(3) PART A PROVISIONS.—The following pro8 visions apply to a universal phase (phase II) plan 

9 under this part in the same manner as such provi10 sions apply to an expansion phase (phase I) plan 

11 under part A: 

12 ‘‘(A) STATE OUTREACH PROGRAMS; AC13 CESS.—Section 2202(a)(4). 

14 ‘‘(B) ASSURANCE OF COVERAGE OF ESSEN15 TIAL SERVICES.—Section 2202(a)(5). 

16 ‘‘(C) REPRESENTATION ON BOARDS AND

17 COMMISSIONS.—Section 2202(a)(6). 

18 ‘‘(D) DISCLOSURE OF INFORMATION TO

19 THE PUBLIC.—Section 2202(a)(7). 

20 ‘‘(E) CONSUMER PROTECTIONS AND WORK21 FORCE STANDARDS.—Section 2202(a)(8). 

22 ‘‘(F) PUBLIC REVIEW.—Section 

23 2202(a)(9). 
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1 ‘‘(G) SERVICES IN RURAL AND UNDER2 SERVED AREAS; CULTURAL COMPETENCY.—Sec3 tion 2202(a)(10). 

4 ‘‘(H) PURCHASING POOLS.—Section 

5 2202(a)(11). 

6 ‘‘(I) LIMITATION ON ADMINISTRATIVE EX7 PENDITURES.—Section 2202(a)(12). 

8 ‘‘(J) SELF-EMPLOYED AND MULTI9 EMPLOYED.—Section 2202(a)(13). 

10 ‘‘(K) MEDICAID WRAPAROUND COV11 ERAGE.—Section 2202(a)(14). 

12 ‘‘(4) OTHER MATTERS.—Any other matter de13 termined appropriate by the Secretary. 

14 ‘‘(b) PERMISSIBLE ACTIVITIES.—A State may use 

15 amounts provided under this part for any activities con16 sistent with this part that are appropriate to enroll indi17 viduals in health plans to ensure that all eligible residents 

18 of the State are provided coverage under this part, includ19 ing through the use of direct payments to health plans 

20 or providers of services. 

21 ‘‘(c) COST CONTAINMENT; COMPETITIVE BIDDING.— 

22 Notwithstanding subsection (b), State purchasing pools 

23 shall solicit bids from health plans at least annually. 

24 ‘‘(d) PROCESS FOR SUBMISSION, APPROVAL, AND

25 AMENDMENT OF UNIVERSAL PHASE (PHASE II) PLAN.— 
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1 Section 2106 applies to a universal phase (phase II) plan 

2 under this part in the same manner as such section applies 

3 to a State plan under title XXI, except that no universal 

4 phase (phase II) plan may be effective earlier than Janu5 ary 1, 2009, and all such plans must be submitted for 

6 approval by not later than January 1, 2008. 

7 ‘‘SEC. 2213. COVERAGE REQUIREMENTS FOR UNIVERSAL 

8 PHASE (PHASE II) PLANS. 

9 ‘‘(a) REQUIRED SCOPE OF HEALTH INSURANCE COV10 ERAGE.—Section 2203(a) applies to a universal phase 

11 (phase II) plan under this part. 

12 ‘‘(b) UNIVERSAL COVERAGE.—All States shall ensure 

13 that by January 1, 2010, 100 percent of eligible residents 

14 of the State have health insurance coverage that meets 

15 the requirements of section 2203(a). 

16 ‘‘(c) LIMITATIONS ON PREMIUMS AND COST-SHAR17 ING.—Section 2203(b) applies to a universal phase (phase 

18 II) plan under this part. 

19 ‘‘(d) APPLICATION OF CERTAIN REQUIREMENTS.— 

20 Section 2203(c) applies to a universal phase (phase II) 

21 plan under this part. 
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1 ‘‘SEC. 2214. REQUIREMENTS FOR EMPLOYERS REGARDING 

2 THE PROVISION OF BENEFITS. 

3 ‘‘(a) REQUIREMENTS.—Subject to subsection 

4 (c)(2)(B), an employer in a State shall comply with the 

5 following requirements: 

6 ‘‘(1) EMPLOYERS WITH LESS THAN 500 EM7 PLOYEES.— 

8 ‘‘(A) IN GENERAL.—An employer with less 

9 than 500 employees shall enroll each employee 

10 in a State-designated purchasing pool. 

11 ‘‘(B) CONTRIBUTIONS.— 

12 ‘‘(i) IN GENERAL.—Notwithstanding 

13 subparagraph (A) and subject to clause 

14 (ii), the employer shall make a contribution 

15 on behalf of each employee for health in16 surance coverage that is equal to at least 

17 80 percent of the total premiums for such 

18 coverage for employees and their families if 

19 the employee elects dependent coverage. 

20 ‘‘(ii) LIMITATION.—An employer shall 

21 not be liable under subparagraph (B) for 

22 more than 10 percent of each employee’s 

23 annual wages. 

24 ‘‘(2) EMPLOYERS WITH AT LEAST 500 EMPLOY25 EES.— 
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1 ‘‘(A) IN GENERAL.—An employer with at 

2 least 500 employees, a majority of whose wages 

3 fall below an amount equal to 300 percent of 

4 the poverty line applicable to a family of the 

5 size involved, shall comply with the require6 ments applicable to an employer under para7 graph (1). 

8 ‘‘(B) OTHER EMPLOYERS.— 

9 ‘‘(i) IN GENERAL.—An employer with 

10 at least 500 employees that is not de11 scribed in subparagraph (A) shall, at the 

12 option of the employer, either— 

13 ‘‘(I) comply with the require14 ments applicable to an employer 

15 under paragraph (1); or 

16 ‘‘(II) provide health insurance 

17 coverage to all employees and their 

18 families (if the employee elects de19 pendent coverage) that meets the re20 quirements of section 2213 and the 

21 employer contribution required under 

22 paragraph (1)(B). 

23 ‘‘(ii) ADDITIONAL EMPLOYER CON24 TRIBUTION.—An employer that elects to 

25 comply with clause (i)(I) shall contribute 
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1 an additional 1 percent of payroll into the 

2 State-designated purchasing pool in which 

3 it participates. 

4 ‘‘(3) RULE OF CONSTRUCTION.—Nothing in 

5 this title shall be construed as prohibiting a labor or6 ganization from collectively bargaining for an em7 ployer contribution that is greater than the contribu8 tion that is required under paragraph (1)(B) or, as 

9 applicable, for health insurance benefits that are 

10 greater than the coverage required under paragraph 

11 section 2203(a). 

12 ‘‘(4) PART-TIME EMPLOYEES.—An employer 

13 shall be responsible for meeting the requirements 

14 under this subsection for all employees of the em15 ployer. 

16 ‘‘(5) MULTIEMPLOYER FAMILIES.—In the case 

17 of a family with more than 1 employer, the employ18 ers of individuals within the family shall apportion 

19 their contributions in accordance with rules estab20 lished by the State. 

21 ‘‘(b) NONAPPLICABILITY.—This section shall not 

22 apply— 

23 ‘‘(1) to any State that establishes a single 

24 payor system; or 
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1 ‘‘(2) to any State that established a universal 

2 phase (phase II) plan through an approved adden3 dum to an expansion phase (phase I) plan. 

4 ‘‘(c) PRIVATE CAUSE OF ACTION.— 

5 ‘‘(1) LIABILITY.—An employer that fails to 

6 comply with the requirements of subsection (a) or 

7 otherwise takes adverse action against an employee 

8 for the purpose of interfering with the attainment of 

9 any right to which the employee may be entitled to 

10 under this title, shall be liable to the employee af11 fected. 

12 ‘‘(2) AMOUNT.—The amount of the liability de13 scribed in paragraph (1) shall be an amount equal 

14 to— 

15 ‘‘(A) the contributions that otherwise 

16 would have been made by the employer on be17 half of the employee under this section; 

18 ‘‘(B) an additional amount as liquidated 

19 damages; and 

20 ‘‘(C) consequential damages for reasonably 

21 foreseeable injuries resulting from such action. 

22 ‘‘(3) JURISDICTION; EQUITABLE RELIEF.— 

23 ‘‘(A) JURISDICTION.—An action under this 

24 subsection may be maintained against any em-
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1 ployer in any Federal or State court of com2 petent jurisdiction by any 1 or more employees. 

3 ‘‘(B) EQUITABLE RELIEF.—In addition to 

4 the damages described in paragraph (2), a 

5 court may enjoin any act or practice that vio6 lates this title. 

7 ‘‘(4) ATTORNEY’S FEES.—If a plaintiff or plain8 tiffs prevail in an action brought under this sub9 section, the court shall, in addition to any judgment 

10 awarded to the plaintiff or plaintiffs, award the rea11 sonable attorney’s fees and costs associated with the 

12 bringing of the action. 

13 ‘‘SEC. 2215. ALLOTMENTS. 

14 ‘‘(a) STATE ALLOTMENTS.—Subsections (a) and (b) 

15 of section 2204 apply to a universal phase (phase II) plan 

16 under this part in the same manner as such subsections 

17 apply to an expansion phase (phase I) plan under part 

18 A. 

19 ‘‘(b) SPECIAL RULE FOR EXPANSION PHASE (PHASE

20 I) PLANS.—A State that operated an expansion phase 

21 (phase I) plan and converted such plan to a universal 

22 phase (phase II) plan pursuant to section 2211(b)(2)(B) 

23 shall continue to be eligible for the enhanced Federal par24 ticipation rate determined under section 2204(c). 
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1 ‘‘(c) GRANTS TO INDIAN TRIBES, NATIVE HAWAIIAN

2 ORGANIZATIONS, AND ALASKA NATIVE ORGANIZA3 TIONS.—Section 2204(d) applies to a universal phase 

4 (phase II) plan under this part. 

5 ‘‘(d) APPROPRIATION.— 

6 ‘‘(1) IN GENERAL.—Out of any funds in the 

7 Treasury not otherwise appropriated, there is appro8 priated to carry out this title such sums as may be 

9 necessary for fiscal year 2009 and each fiscal year 

10 thereafter. 

11 ‘‘(2) BUDGET AUTHORITY.—Paragraph (1) con12 stitutes budget authority in advance of appropria13 tions Acts and represents the obligation of the Fed14 eral Government to provide States, Indian tribes, 

15 Native Hawaiian organizations, and Alaska Native 

16 organizations with the allotments determined under 

17 this section and the grants for administrative and 

18 outreach activities under section 2205(a)(1)(B) (as 

19 applied to this part under section 2216(a)). 

20 ‘‘SEC. 2216. ADMINISTRATION; DEFINITIONS. 

21 ‘‘(a) ADMINISTRATION.—The provisions of section 

22 2205 (other than subsection (c) of such section) apply to 

23 a universal phase (phase II) plan under this part in the 

24 same manner as such provisions apply to an expansion 

25 phase (phase I) plan under part A. 
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1 ‘‘(b) DEFINITIONS.— 

2 ‘‘(1) APPLICATION OF SECTION 2206.—The 

3 definitions set forth in section 2206 apply to a uni4 versal phase (phase II) plan under this part in the 

5 same manner as such provisions apply to an expan6 sion phase (phase I) plan under part A except that 

7 for purposes of this part, the definition of ‘eligible 

8 residents of a State’ set forth in section 2206(2) 

9 shall be applied without regard to subparagraphs 

10 (A)(ii) and (B). 

11 ‘‘(2) UNIVERSAL PHASE (PHASE II) PLAN.—In 

12 this title, the term ‘universal phase (phase II) plan’ 

13 means the State universal health insurance coverage 

14 plan submitted under section 2211(b).’’. 

15 SEC. 202. CONSUMER PROTECTIONS. 

16 Title XXII of the Social Security Act, as amended 

17 by section 201, is amended by adding at the end the fol18 lowing: 

19 ‘‘PART C—CONSUMER PROTECTIONS 

20 ‘‘SEC. 2221. HOME CARE STANDARDS. 

21 ‘‘In order to ensure that home care services are pro22 vided in a consumer-directed manner, a State partici23 pating under part A, and, effective January 1, 2009, all 

24 States under part B, shall satisfy the Secretary that any 

25 health plan that provides home care services under this 
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1 title creates, or contracts with, a viable entity other than 

2 the consumer or individual provider to provide effective 

3 billing, payments for services, tax withholding, unemploy4 ment insurance, and workers compensation coverage, and 

5 to serve as the statutory employer of the home care pro6 vider. Recipients of such services shall retain the right to 

7 independently select, hire, terminate, and direct the work 

8 of the home care provider. 

9 ‘‘SEC. 2222. CONSUMER PROTECTION IN THE EVENT OF 

10 TERMINATION OR SUSPENSION OF SERVICES. 

11 ‘‘A State participating under part A, and, effective 

12 January 1, 2009, all States under part B, shall satisfy 

13 the Secretary that any health plan providing services 

14 under this title shall ensure that enrollees will receive con15 tinued health services in the event that the plan’s health 

16 care services are terminated or suspended, including as 

17 the result of the plan filing for bankruptcy relief under 

18 title 11, United States Code, or the failure of the plan 

19 to provide payments to providers, lockouts, work stop20 pages, or other labor management problems. 

21 ‘‘SEC. 2223. CONSUMER PROTECTION THROUGH DISCLO22 SURE OF INFORMATION. 

23 ‘‘(a) IN GENERAL.—A State participating under part 

24 A, and, effective January 1, 2009, all States under part 

25 B, shall satisfy the Secretary that any health care provider 
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1 that provides services to individuals under this title shall 

2 provide to the State information regarding the identity, 

3 employment location, and qualifications of health care 

4 workers providing services under— 

5 ‘‘(1) the licensure of the provider; or 

6 ‘‘(2) a contract between the provider and a 

7 health plan or the State. 

8 ‘‘(b) AVAILABILITY TO PUBLIC.—A health care pro9 vider shall make the information described in subsection 

10 (a) available to the public. 

11 ‘‘SEC. 2224. CONSUMER PROTECTION THROUGH NOTICE OF 

12 CHANGES IN HEALTH CARE DELIVERY. 

13 ‘‘A State participating under part A, and, effective 

14 January 1, 2009, all States under part B, shall describe 

15 how the State will provide, at a minimum, the following 

16 protections: 

17 ‘‘(1) Adequate advance notice to the public, the 

18 affected health care workers, and labor organizations 

19 representing such workers, of a pending— 

20 ‘‘(A) facility or operating unit closure; 

21 ‘‘(B) sale, merger, or consolidation of a fa22 cility or operating unit; 

23 ‘‘(C) transfer of work from 1 facility or en24 tity to another facility or entity; or 

25 ‘‘(D) reduction of services. 
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1 ‘‘(2) A right of first refusal for similar vacant 

2 positions with— 

3 ‘‘(A) the resulting entity, in the case of a 

4 health care worker whose position was elimi5 nated following a merger of the worker’s origi6 nal employer with a new entity; or 

7 ‘‘(B) the contractor, in the case of a health 

8 care worker whose position was eliminated fol9 lowing the contracting out of the work the 

10 worker formerly performed.’’. 

11 TITLE III—PATIENT 

12 PROTECTIONS 

13 SEC. 301. INCORPORATION OF CERTAIN PROTECTIONS. 

14 (a) INCORPORATION.—The provisions of the following 

15 bills are hereby enacted into law: 

16 (1) S. 1052 of the 107th Congress, as passed 

17 by the Senate on June 29, 2001. 

18 (2) H.R. 2340 of the 107th Congress, as intro19 duced on June 27, 2001. 

20 (b) PUBLICATION.—In publishing this Act in slip 

21 form and in the United States Statutes at Large pursuant 

22 to section 112, of title 1, United States Code, the Archivist 

23 of the United States shall include after the date of ap24 proval at the end appendixes setting forth the texts of the 

25 bills referred to in subsection (a) of this section. 
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1 TITLE IV—HEALTH CARE QUAL2 ITY, PATIENT SAFETY, AND 

3 WORKFORCE STANDARDS 

4 SEC. 401. HEALTH CARE QUALITY, PATIENT SAFETY, AND 

5 WORKFORCE STANDARDS INSTITUTE. 

6 (a) ESTABLISHMENT.— 

7 (1) INSTITUTE.—There is established within 

8 the Agency for Healthcare Research and Quality, an 

9 institute to be known as the Health Care Quality, 

10 Patient Safety, and Workforce Standards Institute 

11 (in this section referred to as the ‘‘Institute’’). 

12 (2) DIRECTOR.—The Secretary of Health and 

13 Human Services shall appoint a director of the Insti14 tute. The director shall administer the Institute and 

15 carry out the duties of the director under this sec16 tion subject to the authority, direction, and control 

17 of the Secretary. 

18 (b) MISSION.—The mission of the Institute is to— 

19 (1) demonstrate how patient safety issues and 

20 workplace conditions are linked to quality patient 

21 care and the reduction of the incidence of medical 

22 errors; and 

23 (2) reduce the incidence of medical errors and 

24 improve patient safety and quality of care. 
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1 (c) DUTIES.—In carrying out the mission of the In2 stitute, the director of the Institute shall— 

3 (1) work closely with the director of the Agency 

4 for Healthcare Research and Quality to ensure that 

5 issues related to workplace conditions are reflected 

6 in the activities conducted by such agency in order 

7 to reduce the incidence of medical errors and im8 prove patient safety and quality of care, including— 

9 (A) the establishment of national goals; 

10 (B) the development and implementation 

11 of a research agenda; 

12 (C) the development and promotion of best 

13 practices; 

14 (D) the development of performance and 

15 staffing standards in consultation with the 

16 Health Care Financing Administration and 

17 other Federal agencies, as appropriate; and 

18 (E) the development and dissemination of 

19 information, educational and training materials, 

20 and other criteria as it relates to the delivery of 

21 quality care; 

22 (2) provide recommendations to the Secretary 

23 of Health and Human Services and other Federal 

24 agencies with responsibility for health care quality 

25 and the development of standards that impact on 
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1 the delivery of quality patient care on standards re2 lated to workplace conditions and patient safety; 

3 (3) support the activities of the Health Care Fi4 nancing Administration related to the development 

5 of new or revised conditions of participation under 

6 the medicare and medicaid programs and subsequent 

7 rulemaking on issues related to workplace condi8 tions, medical errors, and patient safety and quality 

9 of care; and 

10 (4) conduct other activities determined appro11 priate by the director of the Institute. 

12 (d) WORKPLACE CONDITIONS.—For purposes of this 

13 section, the term ‘‘workplace conditions’’ shall include 

14 issues related to— 

15 (1) health care worker staffing; 

16 (2) hours of work; 

17 (3) confidentiality and whistleblower protec18 tions; 

19 (4) employee participation in decisionmaking 

20 roles that contribute to improved quality of care and 

21 the reduction of the incidence of medical errors; 

22 (5) workforce training; and 

23 (6) the impact of health care delivery restruc24 turing on communities and health care workers. 

25 (e) DEFINITION OF HEALTH CARE WORKER.— 
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1 (1) IN GENERAL.—In this section, the term 

2 ‘‘health care worker’’ means an individual employed 

3 by an employer that provides— 

4 (A) health care services; or 

5 (B) necessary related services, including 

6 administrative, food service, janitorial, or main7 tenance service to an entity that provides such 

8 health care services. 

9 (2) HEALTH CARE SERVICES.—In paragraph 

10 (1), the term ‘‘health care services’’ includes med11 ical, surgical, mental health, and substance abuse 

12 services, whether provided on an in-patient or out13 patient basis. 

14 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

15 are authorized to be appropriated to the Institute such 

16 sums as may be necessary to carry out the purposes of 

17 this section. 

18 SEC. 402. HEALTH CARE QUALITY, PATIENT SAFETY, AND 

19 WORKFORCE STANDARDS ADVISORY COM20 MITTEE. 

21 (a) ESTABLISHMENT OF COMMITTEE.—There is es22 tablished a Health Care Quality, Patient Safety, and 

23 Workforce Standards Committee (in this section referred 

24 to as the ‘‘Committee’’). 

25 (b) FUNCTIONS OF COMMITTEE.— 
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1 (1) ADVICE TO INSTITUTE.—The Committee 

2 shall provide advice to the Director of the Health 

3 Care Quality, Patient Safety, and Workforce Stand4 ards Institute established under section 401 on 

5 issues related to the duties of the Director. 

6 (2) INITIAL REPORT.—Not later than December 

7 31, 2005, the Committee shall submit an initial re8 port to the Secretary that contains— 

9 (A) recommendations regarding minimal 

10 workforce standards that are critical for im11 proved health care quality and patient safety; 

12 and 

13 (B) recommendations regarding additional 

14 ways to reduce the incidence of medical errors 

15 and to improve patient safety and quality of 

16 care. 

17 (3) FINAL REPORT.—Not later than December 

18 31, 2006, the Committee shall submit a final report 

19 to the Secretary of Health and Human Services re20 garding the recommendations contained in the initial 

21 report required under paragraph (2), including any 

22 modifications of such recommendations. 

23 (c) STRUCTURE AND MEMBERSHIP OF THE COM24 MITTEE.— 
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1 (1) STRUCTURE.—The Committee shall be com2 posed of the Director of the Health Care Quality, 

3 Patient Safety, and Workforce Standards Institute 

4 established under section 401 and 15 additional 

5 members who shall be appointed by the Secretary of 

6 Health and Human Services. 

7 (2) MEMBERSHIP.— 

8 (A) IN GENERAL.—The members of the 

9 Committee shall be chosen on the basis of their 

10 integrity, impartiality, and good judgment, and 

11 shall be individuals who are, by reason of their 

12 education, experience, and attainments, excep13 tionally qualified to perform the duties of mem14 bers of the Committee. 

15 (B) SPECIFIC MEMBERS.—In making ap16 pointments under paragraph (1), the Secretary 

17 of Health and Human Services shall ensure 

18 that the following groups are represented: 

19 (i) Health care providers and health 

20 care workers, including labor unions rep21 resenting health care workers. 

22 (ii) Consumer organizations. 

23 (iii) Health care institutions. 

24 (iv) Health education organizations. 
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1 (d) CHAIRMAN.—The Director of the Health Care 

2 Quality, Patient Safety, and Workforce Standards Insti3 tute established under section 401 shall chair the Com4 mittee. 

5 TITLE V—IMPROVING MEDICARE 

6 BENEFITS 

7 SEC. 501. FULL MENTAL HEALTH AND SUBSTANCE ABUSE 

8 TREATMENT BENEFITS PARITY. 

9 Notwithstanding any provision of title XVIII of the 

10 Social Security Act (42 U.S.C. 1395 et seq.), beginning 

11 January 1, 2006, each individual who is entitled to bene12 fits under part A or enrolled under part B of the medicare 

13 program, including an individual enrolled in a 

14 MedicareAdvantae plan offered by a MedicareAdvantage 

15 organization under part C of such program, shall be pro16 vided full mental health and substance abuse treatment 

17 parity under the medicare program established under such 

18 title of such Act consistent with title XXII of the Social 

19 Security Act (as added by this Act). 

20 TITLE VI—LONG-TERM AND 

21 HOME HEALTH CARE 

22 SEC. 601. STUDIES AND DEMONSTRATION PROJECTS TO 

23 IDENTIFY MODEL PROGRAMS. 

24 The Secretary of Health and Human Services shall— 
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1 (1) conduct studies and demonstration projects, 

2 through grant, contract, or interagency agreement, 

3 that are designed to identify model programs for the 

4 provision of long-term and home health care serv5 ices; 

6 (2) report regularly to Congress on the results 

7 of such studies and demonstration projects; and 

8 (3) include in such report any recommendations 

9 for legislation to expand or continue such studies 

10 and projects. 

11 TITLE VII—MISCELLANEOUS 

12 SEC. 701. NONAPPLICATION OF ERISA. 

13 The provisions of section 514 of the Employee Retire14 ment Income Security Act of 1974 (29 U.S.C. 1144) shall 

15 not apply with respect to health benefits provided under 

16 a group health plan (as defined in section 733(a) of that 

17 Act (29 U.S.C. 1191b(a))) qualified to offer such benefits 

18 under an expansion phase (phase I) plan under title XXII 

19 of the Social Security Act (as added by this Act) or under 

20 a universal phase (phase II) plan under such title. 

21 SEC. 702. SENSE OF CONGRESS REGARDING OFFSETS. 

22 It is the sense of Congress that any sums necessary 

23 for the implementation of this Act, and the amendments 

24 made by this Act, should be offset by— 
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1 (1) general revenues available as a result of an 

2 on-budget surplus for a fiscal year; 

3 (2) direct savings in health care expenditures 

4 resulting from the implementation of this Act; and 

5 (3) reductions in unnecessary Federal tax bene6 fits available only to individuals and large corpora7 tions that are in the maximum tax brackets. 

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