I 

108TH CONGRESS 

2D SESSION H. R. 4325 

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

insurance coverage. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 11, 2004 

Ms. BALDWIN (for herself, Mr. TIERNEY, Mr. MCDERMOTT, Ms. 

SCHAKOWSKY, Mr. GRIJALVA, Mr. CONYERS, Ms. LEE, Ms. JACKSONLEE of Texas, and Mr. OBEY) 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: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 
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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 

Sec. 501. Full mental health and substance abuse treatment benefits parity. 
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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) 43,600,000 Americans, more than 

11 8,500,000 of whom are children, have no health in12 surance. 

13 (4) Health insurance coverage is unstable; less 

than 1 14 ⁄2 of all adults have been in their current 

15 health plan for 3 years. 

16 (5) The average American will hold at least 7 

17 jobs during their life, risking lack of health coverage 

18 every time they change or are between jobs. 

19 (6) Annual health care expenditures in the 

20 United States total $1.55 trillion. 
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1 (7) In the United States, personal health care 

2 spending grows 2.5 percent faster than the gross do3 mestic product. 

4 (8) Although the United States spends consid5 erably more in health care per person than any other 

6 nation, it ranks only fifteenth among countries 

7 worldwide on an overall index designed to measure 

8 a range of health goals according to the World 

9 Health Organization. 

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

11 say they have gone without needed medical care be12 cause they couldn’t afford it. 

13 (10) Nearly 31,000,000 Americans face collec14 tion agencies annually because they owe money for 

15 medical bills. 

16 (11) The average American worker is paying 

17 twice as much for family coverage than 10 years 

18 ago. 

19 (12) Because many individuals do not have 

20 health insurance coverage, they may incur health 

21 care costs which they do not fully reimburse, result22 ing in cost-shifting to others. 

23 (13) As a consequence of the piecemeal health 

24 care system in the United States, administrative 

25 overhead costs approximately $1,059 per person an-
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1 nually, while other Western industrialized nations 

2 with universal health care systems spend approxi3 mately $200 per person annually for administrative 

4 overhead. 

5 (14) The United States should adopt national 

6 goals of universal, affordable, comprehensive health 

7 insurance coverage and should provide generous 

8 matching grants to the States to achieve those goals 

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

10 TITLE I—HEALTH SECURITY FOR 

11 ALL AMERICANS—EXPANSION 

12 PHASE (PHASE I) 

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

14 UNIVERSAL HEALTH INSURANCE COVERAGE 

15 PLANS. 

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

17 amended by adding at the end the following: 

18 ‘‘TITLE XXII—HEALTH SECURITY 

19 FOR ALL AMERICANS 

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

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

22 ‘‘(a) PURPOSE.—The purpose of this part is to pro23 vide funds to participating States to enable those States 

24 to ensure universal health insurance coverage by estab25 lishing State administered systems targeted to State resi-
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1 dents with a family income that does not exceed 300 per2 cent of the poverty line. 

3 ‘‘(b) EXPANSION PHASE (PHASE I) PLAN RE4 QUIRED.—A State is not eligible for a payment under sec5 tion 2205(a) unless the State has submitted to the Sec6 retary a plan that— 

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

8 funds provided under this part to ensure universal, 

9 affordable, and comprehensive health insurance cov10 erage to eligible residents of the State consistent 

11 with the provisions of this part; and 

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

13 ‘‘SEC. 2202. PLAN REQUIREMENTS. 

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

15 plan shall include provisions for the following: 

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

17 INSURANCE COVERAGE.— 

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

19 within the State as determined under sub20 section (b). 

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

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

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

24 health insurance coverage for uncovered resi25 dents of the State, including the steps the State 
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1 is taking to identify and enroll all uncovered 

2 residents of the State who are eligible to par3 ticipate in public or private health insurance 

4 programs. 

5 ‘‘(2) DETAILS OF, AND TIMELINES FOR, EXPAN6 SION PHASE (PHASE I) PLAN.— 

7 ‘‘(A) USE OF FUNDS; COORDINATION.— 

8 The activities that the State intends to carry 

9 out using funds received under this part, in10 cluding how the State will coordinate efforts 

11 under this part with existing State efforts to in12 crease the health insurance coverage of individ13 uals. 

14 ‘‘(B) TIMELINES.—Consistent with sub15 section (c), the manner in which the State will 

16 reduce the base coverage gap for the year in17 volved, including a timetable with specified tar18 gets for reducing the base coverage gap by— 

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

20 the date of approval of the expansion 

21 phase (phase I) plan; and 

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

23 such date. 

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

25 in which the State will ensure that— 
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1 ‘‘(A) employers within the State will con2 tinue to provide not less than the level of finan3 cial support toward the health insurance pre4 miums required for coverage of their employees 

5 as such employers provided as of the date of en6 actment of this title; and 

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

8 less than the level of State expenditures in9 curred for State-funded health programs as of 

10 such date. 

11 For purposes of this paragraph, any population or 

12 service that was covered under the medicaid pro13 gram under title XIX under a waiver under section 

14 1115 or section 1902(r)(2) shall be treated as if 

15 such State expenditures had been based on the en16 hanced FMAP formula used under the State chil17 dren’s health insurance program under title XXI. 

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

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

20 State will— 

21 ‘‘(A) institute outreach programs; and 

22 ‘‘(B) ensure that all eligible residents of 

23 the State have access to the health insurance 

24 coverage provided under this part. 
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1 ‘‘(5) ASSURANCE OF COVERAGE OF ESSENTIAL

2 SERVICES.—An assurance that the State program 

3 established under this part will comply with the re4 quirements of section 1867 (commonly referred to as 

5 the ‘Emergency Medical Treatment and Active 

6 Labor Act’). 

7 ‘‘(6) REPRESENTATION ON BOARDS AND COM8 MISSIONS.—The manner in which the State will en9 sure that all Boards and Commissions that the State 

10 establishes to administer the plan will include, 

11 among others, representatives of providers, con12 sumers, employers, and health worker unions. 

13 ‘‘(7) DISCLOSURE OF INFORMATION TO THE

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

15 that, with respect to entities and individuals that 

16 provide services for which reimbursement is provided 

17 under this part— 

18 ‘‘(A) financial arrangements between in19 surers and providers and between providers and 

20 medical equipment suppliers are disclosed to the 

21 public; and 

22 ‘‘(B) ownership interests and health care 

23 worker qualifications and credentials are dis24 closed to the public. 
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1 ‘‘(8) CONSUMER PROTECTIONS.—The manner 

2 in which the State will ensure compliance with sec3 tions 2221, 2222, 2223, and 2224. 

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

5 the State will provide for the public review of insti6 tutional changes in services provided, markets and 

7 regions covered, withdrawal or movement of services, 

8 closures or downsizing, and other actions that affect 

9 the provision of health insurance under the plan. 

10 ‘‘(10) SERVICES IN RURAL AND UNDERSERVED

11 AREAS; CULTURAL COMPETENCY.—The manner in 

12 which the State will ensure— 

13 ‘‘(A) coverage in rural and underserved 

14 areas; and 

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

16 populations are met. 

17 ‘‘(11) MECHANISMS TO MINIMIZE ADVERSE

18 RISK SELECTION.—The manner in which the State 

19 will encourage mechanisms to minimize adverse risk 

20 selection that provide choice of health plans and con21 trol costs. 

22 ‘‘(12) LIMITATION ON ADMINISTRATIVE EX23 PENDITURES.—The manner in which the State will 

24 ensure that all qualified plans in the State expend 

25 at least 90 percent (or, during the first 2 years of 
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1 the plan, 85 percent) of total income received from 

2 premiums on the provision of covered health care ben3 efits (excluding all costs for marketing, advertising, 

4 health plan administration, profits, or capital accu5 mulation) to individuals. 

6 ‘‘(13) SELF-EMPLOYED AND MULTI7 EMPLOYED.—The manner in which the State will 

8 address self-employed individuals and multiwage 

9 earner families. 

10 ‘‘(14) REQUIREMENT TO MAINTAIN MEDICAID

11 BENEFITS.—The manner in which the State will en12 sure that individuals who are eligible for medical as13 sistance under title XIX and who receive benefits 

14 under the expansion phase (phase I) plan shall re15 ceive any items or services that are not available 

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

17 are available under the State medicaid program 

18 under title XIX through ‘wraparound coverage’ 

19 under such program. 

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

21 What cost containment strategies the State will em22 ploy and how the State will reduce adverse risk se23 lection. 

24 ‘‘(16) OTHER MATTERS.—Any other matter de25 termined appropriate by the Secretary. 
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1 ‘‘(b) CURRENT LEVEL OF COVERAGE.— 

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

3 a standardized survey approach that provides timely 

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

5 the population of each State that is currently cov6 ered by a health insurance plan or program that 

7 provides coverage that meets the requirements of 

8 section 2203(a). 

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

10 provide for the conduct of the survey developed 

11 under paragraph (1) not less than biannually to 

12 make coverage determinations for purposes of para13 graph (1). 

14 ‘‘(3) USE OF ALTERNATIVE SYSTEM.—The Sec15 retary shall permit a State to utilize an alternative 

16 population-based monitoring system to make deter17 minations with respect to coverage in the State for 

18 purposes of paragraph (1) if the Secretary deter19 mines that such system meets or exceeds the meth20 odological standards utilized in the survey developed 

21 under paragraph (1). 

22 ‘‘(4) BASE COVERAGE GAP.—For purposes of 

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

24 State shall be equal to 100 percent of the eligible in25 dividuals and families in the State for the year in-
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1 volved, less the current level of coverage for those in2 dividuals and families for such year as determined 

3 under paragraph (1) or (3). 

4 ‘‘(c) REDUCING THE LEVEL OF UNINSURED INDIVID5 UALS.— 

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

7 funds under this part, a State shall agree to admin8 ister an expansion phase (phase I) plan with a goal 

9 of providing health insurance coverage for 100 per10 cent of the eligible residents of the State by not later 

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

12 expansion phase (phase I) plan. 

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

14 use amounts provided under this part for any activi15 ties consistent with this part that are appropriate to 

16 enroll individuals in health plans and health pro17 grams to meet the targets contained in the State 

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

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

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

21 services. 

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

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

24 The provisions of section 2106 apply to an expansion 

25 phase (phase I) plan under this part in the same manner 
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1 as they apply to a State plan under title XXI, except that 

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

3 than January 1, 2004, and all expansion phase (phase I) 

4 plans must be submitted for approval by not later than 

5 December 31, 2005. 

6 ‘‘SEC. 2203. COVERAGE REQUIREMENTS FOR EXPANSION 

7 PHASE (PHASE I) PLANS. 

8 ‘‘(a) REQUIRED SCOPE OF HEALTH INSURANCE COV9 ERAGE.—Health insurance coverage provided under this 

10 part shall consist of at least the benefits provided under 

11 the Federal Employees Health Benefits Program standard 

12 Blue Cross/Blue Shield preferred provider option service 

13 benefit plan, described in and offered under section 

14 8903(1) of part 5, United States Code, plus mental health 

15 and substance abuse treatment benefits parity for all indi16 viduals, and benefits for early and periodic screening and 

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

18 for all individuals under 21 years of age. 

19 ‘‘(b) LIMITATIONS ON PREMIUMS AND COST-SHAR20 ING.— 

21 ‘‘(1) DESCRIPTION; GENERAL CONDITIONS.—An 

22 expansion phase (phase I) plan shall include a de23 scription, consistent with this subsection, of the 

24 amount (if any) of premiums, cost-sharing, or other 
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1 similar charges imposed. Any such charges shall be 

2 imposed pursuant to a public schedule. 

3 ‘‘(2) LIMITATIONS ON PREMIUMS AND COST4 SHARING.— 

5 ‘‘(A) INDIVIDUALS AND FAMILIES WITH IN6 COME BELOW 150 PERCENT OF POVERTY

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

8 whose income is at or below 150 percent of the 

9 poverty line— 

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

11 premium; and 

12 ‘‘(ii) the total annual aggregate 

13 amount of cost-sharing imposed by a State 

14 with respect to all individuals in a family 

15 may not exceed 0.5 percent of the family’s 

16 income for the year involved. 

17 ‘‘(B) INDIVIDUALS AND FAMILIES WITH

18 INCOME BETWEEN 150 AND 300 PERCENT OF

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

20 family whose income exceeds 150 percent but 

21 does not exceed 300 percent of the poverty 

22 line— 

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

24 premium that exceeds an amount that is 

25 equal to— 
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1 ‘‘(I) 20 percent of the average 

2 cost of providing benefits to an indi3 vidual (or a family) under this part in 

4 the year involved; or 

5 ‘‘(II) 3 percent of the family’s in6 come for the year involved; and 

7 ‘‘(ii) the total annual aggregate 

8 amount of premiums and cost-sharing 

9 (combined) imposed by a State with re10 spect to all individuals in a family may not 

11 exceed 5 percent of the family’s income for 

12 the year involved. 

13 ‘‘(C) INDIVIDUALS AND FAMILIES WITH IN14 COME ABOVE 300 PERCENT OF POVERTY

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

16 whose income exceeds 300 percent of the pov17 erty line— 

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

19 premium that exceeds 20 percent of the 

20 average cost of providing benefits to an in21 dividual (or a family of the size involved) 

22 under this part in the year involved; and 

23 ‘‘(ii) the total annual aggregate 

24 amount of premiums and cost-sharing 

25 (combined) imposed by a State with re-
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1 spect to all individuals in a family may not 

2 exceed 7 percent of the family’s income for 

3 the year involved. 

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

5 State shall establish rules for self-employed in6 dividuals based on individual and family in7 come. 

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

9 procedures for collecting any premiums, cost-shar10 ing, or other similar charges imposed under this 

11 part. Such procedures shall provide for annual rec12 onciliations and adjustments. 

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

14 ‘‘(1) RESTRICTION ON APPLICATION OF PRE15 EXISTING CONDITION EXCLUSIONS.—The expansion 

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

17 of any preexisting condition exclusion for covered 

18 benefits under the plan. 

19 ‘‘(2) CHOICE OF PLANS.— 

20 ‘‘(A) IN GENERAL.—Except as provided in 

21 subparagraph (B), the expansion phase (phase 

22 I) plan shall offer eligible individuals and fami23 lies a choice of qualified plans from which to re24 ceive benefits under this part. At least 1 plan 

25 shall be a preferred provider option plan. 
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1 ‘‘(B) WAIVER.—The Secretary— 

2 ‘‘(i) may waive the requirement under 

3 subparagraph (A) if determined appro4 priate; and 

5 ‘‘(ii) shall waive such requirement in 

6 the case of a State that establishes a single 

7 State plan. 

8 ‘‘SEC. 2204. ALLOTMENTS. 

9 ‘‘(a) STATE ALLOTMENTS.— 

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

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

12 expansion phase (phase I) plan approved under this 

13 part the amount determined under paragraph (2) for 

14 such State for such fiscal year. 

15 ‘‘(2) DETERMINATION OF COST OF COV16 ERAGE.—The amount determined under this para17 graph is the amount equal to— 

18 ‘‘(A) the product of— 

19 ‘‘(i) the Federal participation rate for 

20 the State as determined under subsection 

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

22 participation rate for the State, as deter23 mined under subsection (c); 

24 ‘‘(ii) the estimated cost for the min25 imum benefits package required to comply 
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1 under section 2203, not to exceed the sum 

2 of— 

3 ‘‘(I) the total annual Government 

4 and employee contributions required 

5 for individual or self and family health 

6 benefits coverage under the Federal 

7 Employees Health Benefits Program 

8 standard Blue Cross/Blue Shield pre9 ferred provider option service benefit 

10 plan, described in and offered under 

11 section 8903(1) of title 5, United 

12 States Code (adjusted for age and 

13 other factors, as the Secretary deter14 mines appropriate); and 

15 ‘‘(II) the estimated average cost16 sharing expense for an individual or 

17 family; and 

18 ‘‘(iii) the estimated number of resi19 dents to be enrolled in the expansion phase 

20 (phase I) plan; less 

21 ‘‘(B) the sum of— 

22 ‘‘(i) the individual or family health in23 surance contribution and cost-sharing pay24 ments to be made in accordance with sec25 tion 2203(b); and 
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1 ‘‘(ii) any applicable employer contribu2 tion to such payments. 

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

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

5 for a State shall be equal to the enhanced FMAP deter6 mined for the State under section 2105(b). 

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

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

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

10 for a State shall be equal to the Federal participa11 tion rate for such State under subsection (b), as ad12 justed by the Secretary based on the decrease in the 

13 base coverage gap in the State. 

14 ‘‘(2) AMOUNT OF ADJUSTMENT AND APPLICA15 TION.— 

16 ‘‘(A) AMOUNT OF ADJUSTMENT.—The 

17 Federal participation rate under subsection (b) 

18 with respect to a State shall be increased by— 

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

20 coverage gap of the State has decreased by 

21 at least 50 percent within 2 years after the 

22 date of approval of the expansion phase 

23 (phase I) plan, as determined by the Sec24 retary; and 
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1 ‘‘(ii) 3 percentage points if the base 

2 coverage gap of the State has decreased by 

3 100 percent within 4 years after the date 

4 of approval of the expansion phase (phase 

5 I) plan, as determined by the Secretary. 

6 ‘‘(B) APPLICATION.—The increase de7 scribed in— 

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

9 apply to a State for the period beginning 

10 with the month of the determination under 

11 such subparagraph and ending with the 

12 month preceding the month of the deter13 mination under subparagraph (A)(ii) (if 

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

15 months; and 

16 ‘‘(ii) subparagraph (A)(ii) shall apply 

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

18 beginning with the month of the deter19 mination under such subparagraph. 

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

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

22 base coverage gap by 100 percent if the Secretary 

23 determines that— 

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

25 the State are provided health insurance cov-
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1 erage under the expansion phase (phase I) plan; 

2 and 

3 ‘‘(B) the remaining 2 percent of such resi4 dents are served by alternative health care de5 livery systems as demonstrated by the State. 

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

7 ORGANIZATIONS, AND ALASKA NATIVE ORGANIZA8 TIONS.— 

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

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

11 amount, not to exceed 1 percent of the total allot12 ments determined under subsection (a) for a fiscal 

13 year, to make grants to Indian tribes, Native Hawai14 ian organizations, and Alaska Native organizations 

15 for development and implementation of universal 

16 health insurance coverage plans for members of such 

17 tribes and organizations. 

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

19 under paragraph (1), an Indian tribe, Native Hawai20 ian organization, or Alaska Native organization shall 

21 submit a universal health insurance coverage plan to 

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

23 containing such information, as the Secretary may 

24 require. 
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1 ‘‘(3) REGULATIONS.—The Secretary shall issue 

2 regulations specifying the requirements of this part 

3 that apply to Indian tribes, Native Hawaiian organi4 zations, and Alaska Native organizations receiving 

5 grants under paragraph (1). 

6 ‘‘(e) APPROPRIATION.— 

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

8 Treasury not otherwise appropriated, there is appro9 priated to carry out this title such sums as may be 

10 necessary for fiscal year 2004 and each fiscal year 

11 thereafter. 

12 ‘‘(2) BUDGET AUTHORITY.—Paragraph (1) con13 stitutes budget authority in advance of appropria14 tions Acts and represents the obligation of the Fed15 eral Government to provide States, Indian tribes, 

16 Native Hawaiian organizations, and Alaska Native 

17 organizations with the allotments determined under 

18 this section and the grants for administrative and 

19 outreach activities under section 2205. 

20 ‘‘SEC. 2205. ADMINISTRATION. 

21 ‘‘(a) PAYMENTS.— 

22 ‘‘(1) IN GENERAL.— 

23 ‘‘(A) QUARTERLY.—Subject to subpara24 graph (B) and subsection (b), the Secretary 

25 shall make quarterly payments to each State 
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1 with an expansion phase (phase I) plan ap2 proved under this part, from its allotment 

3 under section 2204. 

4 ‘‘(B) FUNDING FOR ADMINISTRATION AND

5 OUTREACH.— 

6 ‘‘(i) AUTHORITY TO MAKE GRANTS.— 

7 In addition to the allotments determined 

8 under section 2204, the Secretary may 

9 make grants to States, Indian tribes, Na10 tive Hawaiian organizations, and Alaska 

11 Native organizations for expenditures for 

12 administrative and outreach activities. 

13 ‘‘(ii) AMOUNTS.— 

14 ‘‘(I) IN GENERAL.—A grant 

15 awarded under this subparagraph 

16 shall not exceed the applicable per17 centage (as determined under sub18 clause (II)) of the total amount allot19 ted to the State, Indian tribe, Native 

20 Hawaiian organization, or Alaska Na21 tive organization under section 2204. 

22 ‘‘(II) APPLICABLE PERCENT23 AGE.—For purposes of subclause (I), 

24 the applicable percentage is— 
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1 ‘‘(aa) 10 percent for 2005 

2 through 2009; and 

3 ‘‘(bb) 3 percent for 2010 

4 and each year thereafter. 

5 ‘‘(2) ADVANCE PAYMENT; RETROSPECTIVE AD6 JUSTMENT.—The Secretary may make payments 

7 under this part for each quarter on the basis of ad8 vance estimates by the State and such other inves9 tigation as the Secretary may find necessary, and 

10 may reduce or increase the payments as necessary to 

11 adjust for any overpayment or underpayment for 

12 prior quarters. 

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

14 Nothing in this subsection shall be construed as pre15 venting a State from claiming as expenditures in the 

16 quarter expenditures that were incurred in a pre17 vious quarter. 

18 ‘‘(b) AUTHORITY FOR BLENDED RATE FOR HEALTH

19 SECURITY, MEDICAID, AND SCHIP FUNDS.—The Sec20 retary shall establish procedures for blending the pay21 ments that a State is entitled to receive under this title, 

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

23 ‘‘(1) the State requests such a blended pay24 ment; and 
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1 ‘‘(2) the Secretary finds that the State meets 

2 maintenance of effort requirements established by 

3 the Secretary. 

4 ‘‘(c) LIMITATIONS ON FEDERAL PAYMENTS BASED

5 ON COST CONTAINMENT.— 

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

7 year (beginning with 2004), the Secretary shall es8 tablish a baseline projection for the national rate of 

9 growth in private health insurance premiums for 

10 such year. 

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

12 year 2005 and each fiscal year thereafter, any pay13 ment made to a State under section 2204 shall not 

14 exceed the amount paid to the State under such sec15 tion for the preceding fiscal year, adjusted for 

16 changes in enrollment and a premium inflation ad17 justment that is 0.5 percent below the baseline pro18 jection determined under paragraph (1) for the year, 

19 unless the State adopts (and the Secretary approves) 

20 cost containment strategy that will reduce the rate 

21 of growth of spending. 

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

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

24 part A, and, effective January 1, 2008, all States 

25 under part B, shall ensure that any payments re-
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1 ceived by the State under section 2205 or 2116(a) 

2 are not used by any individual or entity, including 

3 providers or health plans that contract to provide 

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

5 otherwise facilitate expenditures to influence health 

6 care workers of such individual or entity with re7 spect to issues related to unionization. 

8 ‘‘(2) CONSTRUCTION.—Nothing in this sub9 section shall be construed to limit expenditures made 

10 for the purpose of good faith collective bargaining or 

11 pursuant to the terms of a bona fide collective bar12 gaining agreement. 

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

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

15 of any provision of Federal law that the State determines 

16 is necessary in order to carry out an approved expansion 

17 phase (phase I) plan under this part. 

18 ‘‘(f) REPORT.—Not later than January 1, 2005, and 

19 each January 1 thereafter, the Secretary, in consultation 

20 with the General Accounting Office and the Congressional 

21 Budget Office, shall prepare and submit to the appro22 priate committees of Congress a report on the number of 

23 States receiving payments under this part for the year for 

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

25 insurance coverage attained by each such State. 
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1 ‘‘SEC. 2206. DEFINITIONS. 

2 ‘‘In this title: 

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

4 has the meaning given such term under the Federal 

5 Employees Health Benefits Program standard Blue 

6 Cross/Blue Shield preferred provider option service 

7 benefit plan described in and offered under section 

8 8903(1) of part 5, United States Code, and includes 

9 deductibles, copayments, coinsurance, as such terms 

10 are defined for purposes of such plan. 

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

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

13 residents of a State’ means an individual or 

14 family who— 

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

16 the State involved; 

17 ‘‘(ii) except as provided in subpara18 graph (B), has a family income that does 

19 not exceed 300 percent of the poverty line; 

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

21 the United States, a legal resident alien, or 

22 an individual otherwise residing in the 

23 United States under the authority of Fed24 eral law; and 

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

26 not eligible for benefits under the medicare 
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1 program under title XVIII or for medical 

2 assistance under the medicaid program 

3 under title XIX (other than under the ap4 plication of section 

5 1902(a)(10)(A)(ii)(XIV)). 

6 ‘‘(B) OPTION TO PROVIDE COVERAGE FOR

7 INDIVIDUALS AND FAMILIES WITH HIGHER IN8 COME.—If approved by the Secretary, a State 

9 may increase the percentage described in sub10 paragraph (A)(ii), or eliminate all income eligi11 bility criteria in order to provide coverage under 

12 this part to more individuals and families. 

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

14 term ‘expansion phase (phase I) plan’ means the 

15 State universal health insurance coverage plan sub16 mitted under section 2201(b). 

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

18 ‘health care services’ includes medical, surgical, 

19 mental health, and substance abuse services, wheth20 er provided on an inpatient or outpatient basis. 

21 ‘‘(5) HEALTH CARE WORKER.—The term 

22 ‘health care worker’ means an individual employed 

23 by an employer that provides— 

24 ‘‘(A) health care services; or 
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1 ‘‘(B) necessary related services, including 

2 administrative, food service, janitorial, or main3 tenance service to an entity that provides such 

4 health care services. 

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

6 includes health insurance coverage, as defined in sec7 tion 2791(b)(1) of the Public Health Service Act (42 

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

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

10 300gg91(b)(1)). 

11 ‘‘(7) MENTAL HEALTH AND SUBSTANCE ABUSE

12 TREATMENT BENEFITS PARITY.— 

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

14 health and substance abuse treatment benefits 

15 parity’ means, with respect to health coverage, 

16 that the coverage does not impose treatment 

17 limitations or financial requirements on the cov18 erage of mental health benefits if similar re19 quirements are not imposed on coverage of 

20 medical and surgical benefits in comparable set21 tings (including inpatient and outpatient set22 tings). 

23 ‘‘(B) TREATMENT LIMITATIONS.—The 

24 term ‘treatment limitations’ means limits on the 

25 frequency of treatment, number of visits, or 
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1 other limits on the scope and duration of treat2 ment, as covered by a group health plan (or 

3 health insurance coverage offered in connection 

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

5 limits on benefits or coverage based solely on 

6 medical necessity. 

7 ‘‘(C) FINANCIAL REQUIREMENTS.—The 

8 term ‘financial requirements’ means copay9 ments, deductibles, out-of-network charges, out10 of-pocket contributions or fees, annual limits, 

11 and lifetime aggregate limits imposed on cov12 ered individuals. 

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

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

15 of the Community Services Block Grant Act (42 

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

17 such section. 

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

19 any enrollment fees and other similar charges. 

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

21 plan’ means a health plan that satisfies the coverage 

22 requirements described under section 2203 and par23 ticipates in an expansion phase (phase I) plan.’’. 
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1 TITLE II—HEALTH SECURITY 

2 FOR ALL AMERICANS—UNI3 VERSAL PHASE (PHASE II) 

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

5 HEALTH INSURANCE COVERAGE PLANS. 

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

7 section 101, is amended by adding at the end the fol8 lowing: 

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

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

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

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

13 State-administered systems to ensure universal 

14 health insurance coverage; and 

15 ‘‘(2) provide funds to States for the establish16 ment and implementation of such systems. 

17 ‘‘(b) UNIVERSAL PHASE (PHASE II) PLAN RE18 QUIRED.— 

19 ‘‘(1) IN GENERAL.—Except as provided in para20 graph (2), not later than January 1, 2007, a State 

21 shall submit to the Secretary a plan that sets forth 

22 how the State intends to use the funds provided 

23 under this part to ensure universal, affordable, and 

24 comprehensive health insurance coverage to eligible 
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1 residents of the State consistent with the provisions 

2 of this part. 

3 ‘‘(2) STATES WITH PHASE I PLANS.— 

4 ‘‘(A) IN GENERAL.—Not later than Janu5 ary 1, 2007, a State with a phase I State plan 

6 shall submit an addendum to such plan that 

7 provides assurances to the Secretary that such 

8 plan conforms to the requirements of this part. 

9 ‘‘(B) CONVERSION TO UNIVERSAL PHASE

10 (PHASE II) PLAN.—If an addendum to an ex11 pansion phase (phase I) plan is approved by the 

12 Secretary— 

13 ‘‘(i) the plan shall be automatically 

14 converted to a universal phase (phase II) 

15 plan; and 

16 ‘‘(ii) section 2214 and any provision 

17 of part A that is inconsistent with this 

18 part shall not apply to the plan. 

19 ‘‘(3) FAILURE TO SUBMIT PLAN OR ADDEN20 DUM.—If a State fails to submit a plan as required 

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

22 paragraph (2)), or fails to have such plan or adden23 dum approved by the Secretary, such State shall be 

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

25 a State may bring a cause of action against the 
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1 State in Federal district court to require the State 

2 to comply with the provisions of this part. 

3 ‘‘SEC. 2212. PLAN REQUIREMENTS. 

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

5 plan shall include a description, consistent with the re6 quirements of this part, of the following: 

7 ‘‘(1) DETAILS OF THE UNIVERSAL PHASE

8 (PHASE II) PLAN.—The activities that the State in9 tends to carry out using funds received under this 

10 part to ensure that all eligible residents of the State 

11 have access to the coverage provided under this part, 

12 including how the State will coordinate efforts under 

13 the program under this part with existing State ef14 forts to increase to 100 percent the health insurance 

15 coverage of eligible residents of the State by Janu16 ary 1, 2009. 

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

18 manner in which the State will ensure that employ19 ers within the State will comply with the require20 ments of section 2214. 

21 ‘‘(3) PART A PROVISIONS.—The following provi22 sions apply to a universal phase (phase II) plan 

23 under this part in the same manner as such provi24 sions apply to an expansion phase (phase I) plan 

25 under part A: 
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1 ‘‘(A) STATE OUTREACH PROGRAMS; AC2 CESS.—Section 2202(a)(4). 

3 ‘‘(B) ASSURANCE OF COVERAGE OF ESSEN4 TIAL SERVICES.—Section 2202(a)(5). 

5 ‘‘(C) REPRESENTATION ON BOARDS AND

6 COMMISSIONS.—Section 2202(a)(6). 

7 ‘‘(D) DISCLOSURE OF INFORMATION TO

8 THE PUBLIC.—Section 2202(a)(7). 

9 ‘‘(E) CONSUMER PROTECTIONS AND WORK10 FORCE STANDARDS.—Section 2202(a)(8). 

11 ‘‘(F) PUBLIC REVIEW.—Section 

12 2202(a)(9). 

13 ‘‘(G) SERVICES IN RURAL AND UNDER14 SERVED AREAS; CULTURAL COMPETENCY.—Sec15 tion 2202(a)(10). 

16 ‘‘(H) PURCHASING POOLS.—Section 

17 2202(a)(11). 

18 ‘‘(I) LIMITATION ON ADMINISTRATIVE EX19 PENDITURES.—Section 2202(a)(12). 

20 ‘‘(J) SELF-EMPLOYED AND MULTI21 EMPLOYED.—Section 2202(a)(13). 

22 ‘‘(K) MEDICAID WRAPAROUND COV23 ERAGE.—Section 2202(a)(14). 

24 ‘‘(4) OTHER MATTERS.—Any other matter de25 termined appropriate by the Secretary. 
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1 ‘‘(b) PERMISSIBLE ACTIVITIES.—A State may use 

2 amounts provided under this part for any activities con3 sistent with this part that are appropriate to enroll indi4 viduals in health plans to ensure that all eligible residents 

5 of the State are provided coverage under this part, includ6 ing through the use of direct payments to health plans 

7 or providers of services. 

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

9 Notwithstanding subsection (b), State purchasing pools 

10 shall solicit bids from health plans at least annually. 

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

12 AMENDMENT OF UNIVERSAL PHASE (PHASE II) PLAN.— 

13 Section 2106 applies to a universal phase (phase II) plan 

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

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

16 phase (phase II) plan may be effective earlier than Janu17 ary 1, 2008, and all such plans must be submitted for 

18 approval by not later than January 1, 2007. 

19 ‘‘SEC. 2213. COVERAGE REQUIREMENTS FOR UNIVERSAL 

20 PHASE (PHASE II) PLANS. 

21 ‘‘(a) REQUIRED SCOPE OF HEALTH INSURANCE COV22 ERAGE.—Section 2203(a) applies to a universal phase 

23 (phase II) plan under this part. 

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

25 that by January 1, 2009, 100 percent of eligible residents 
37 

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1 of the State have health insurance coverage that meets 

2 the requirements of section 2203(a). 

3 ‘‘(c) LIMITATIONS ON PREMIUMS AND COST-SHAR4 ING.—Section 2203(b) applies to a universal phase (phase 

5 II) plan under this part. 

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

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

8 plan under this part. 

9 ‘‘SEC. 2214. REQUIREMENTS FOR EMPLOYERS REGARDING 

10 THE PROVISION OF BENEFITS. 

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

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

13 following requirements: 

14 ‘‘(1) EMPLOYERS WITH LESS THAN 500 EM15 PLOYEES.— 

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

17 than 500 employees shall enroll each employee 

18 in a State-designated purchasing pool. 

19 ‘‘(B) CONTRIBUTIONS.— 

20 ‘‘(i) IN GENERAL.—Notwithstanding 

21 subparagraph (A) and subject to clause 

22 (ii), the employer shall make a contribution 

23 on behalf of each employee for health in24 surance coverage that is equal to at least 

25 80 percent of the total premiums for such 
38 

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1 coverage for employees and their families if 

2 the employee elects dependent coverage. 

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

4 not be liable under subparagraph (B) for 

5 more than 10 percent of each employee’s 

6 annual wages. 

7 ‘‘(2) EMPLOYERS WITH AT LEAST 500 EMPLOY8 EES.— 

9 ‘‘(A) IN GENERAL.—An employer with at 

10 least 500 employees, a majority of whose wages 

11 fall below an amount equal to 300 percent of 

12 the poverty line applicable to a family of the 

13 size involved, shall comply with the require14 ments applicable to an employer under para15 graph (1). 

16 ‘‘(B) OTHER EMPLOYERS.— 

17 ‘‘(i) IN GENERAL.—An employer with 

18 at least 500 employees that is not de19 scribed in subparagraph (A) shall, at the 

20 option of the employer, either— 

21 ‘‘(I) comply with the require22 ments applicable to an employer 

23 under paragraph (1); or 

24 ‘‘(II) provide health insurance 

25 coverage to all employees and their 
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1 families (if the employee elects de2 pendent coverage) that meets the re3 quirements of section 2213 and the 

4 employer contribution required under 

5 paragraph (1)(B). 

6 ‘‘(ii) ADDITIONAL EMPLOYER CON7 TRIBUTION.—An employer that elects to 

8 comply with clause (i)(I) shall contribute 

9 an additional 1 percent of payroll into the 

10 State-designated purchasing pool in which 

11 it participates. 

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

13 this title shall be construed as prohibiting a labor or14 ganization from collectively bargaining for an em15 ployer contribution that is greater than the contribu16 tion that is required under paragraph (1)(B) or, as 

17 applicable, for health insurance benefits that are 

18 greater than the coverage required under paragraph 

19 section 2203(a). 

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

21 shall be responsible for meeting the requirements 

22 under this subsection for all employees of the em23 ployer. 

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

25 of a family with more than 1 employer, the employ-
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1 ers of individuals within the family shall apportion 

2 their contributions in accordance with rules estab3 lished by the State. 

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

5 apply— 

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

7 payor system; or 

8 ‘‘(2) to any State that established a universal 

9 phase (phase II) plan through an approved adden10 dum to an expansion phase (phase I) plan. 

11 ‘‘(c) PRIVATE CAUSE OF ACTION.— 

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

13 comply with the requirements of subsection (a) or 

14 otherwise takes adverse action against an employee 

15 for the purpose of interfering with the attainment of 

16 any right to which the employee may be entitled to 

17 under this title, shall be liable to the employee af18 fected. 

19 ‘‘(2) AMOUNT.—The amount of the liability de20 scribed in paragraph (1) shall be an amount equal 

21 to— 

22 ‘‘(A) the contributions that otherwise 

23 would have been made by the employer on be24 half of the employee under this section; 
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1 ‘‘(B) an additional amount as liquidated 

2 damages; and 

3 ‘‘(C) consequential damages for reasonably 

4 foreseeable injuries resulting from such action. 

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

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

7 subsection may be maintained against any em8 ployer in any Federal or State court of com9 petent jurisdiction by any 1 or more employees. 

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

11 the damages described in paragraph (2), a 

12 court may enjoin any act or practice that vio13 lates this title. 

14 ‘‘(4) ATTORNEY’S FEES.—If a plaintiff or plain15 tiffs prevail in an action brought under this sub16 section, the court shall, in addition to any judgment 

17 awarded to the plaintiff or plaintiffs, award the rea18 sonable attorney’s fees and costs associated with the 

19 bringing of the action. 

20 ‘‘SEC. 2215. ALLOTMENTS. 

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

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

23 under this part in the same manner as such subsections 

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

25 A. 
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1 ‘‘(b) SPECIAL RULE FOR EXPANSION PHASE (PHASE

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

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

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

5 shall continue to be eligible for the enhanced Federal par6 ticipation rate determined under section 2204(c). 

7 ‘‘(c) GRANTS TO INDIAN TRIBES, NATIVE HAWAIIAN

8 ORGANIZATIONS, AND ALASKA NATIVE ORGANIZA9 TIONS.—Section 2204(d) applies to a universal phase 

10 (phase II) plan under this part. 

11 ‘‘(d) APPROPRIATION.— 

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

13 Treasury not otherwise appropriated, there is appro14 priated to carry out this title such sums as may be 

15 necessary for fiscal year 2008 and each fiscal year 

16 thereafter. 

17 ‘‘(2) BUDGET AUTHORITY.—Paragraph (1) con18 stitutes budget authority in advance of appropria19 tions Acts and represents the obligation of the Fed20 eral Government to provide States, Indian tribes, 

21 Native Hawaiian organizations, and Alaska Native 

22 organizations with the allotments determined under 

23 this section and the grants for administrative and 

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

25 applied to this part under section 2216(a)). 
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1 ‘‘SEC. 2216. ADMINISTRATION; DEFINITIONS. 

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

3 2205 (other than subsection (c) of such section) apply to 

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

5 same manner as such provisions apply to an expansion 

6 phase (phase I) plan under part A. 

7 ‘‘(b) DEFINITIONS.— 

8 ‘‘(1) APPLICATION OF SECTION 2206.—The defi9 nitions set forth in section 2206 apply to a universal 

10 phase (phase II) plan under this part in the same 

11 manner as such provisions apply to an expansion 

12 phase (phase I) plan under part A except that for 

13 purposes of this part, the definition of ‘eligible resi14 dents of a State’ set forth in section 2206(2) shall 

15 be applied without regard to subparagraphs (A)(ii) 

16 and (B). 

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

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

19 means the State universal health insurance coverage 

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

21 SEC. 202. CONSUMER PROTECTIONS. 

22 Title XXII of the Social Security Act, as amended 

23 by section 201, is amended by adding at the end the fol24 lowing: 
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1 ‘‘PART C—CONSUMER PROTECTIONS 

2 ‘‘SEC. 2221. HOME CARE STANDARDS. 

3 ‘‘In order to ensure that home care services are pro4 vided in a consumer-directed manner, a State partici5 pating under part A, and, effective January 1, 2008, all 

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

7 health plan that provides home care services under this 

8 title creates, or contracts with, a viable entity other than 

9 the consumer or individual provider to provide effective 

10 billing, payments for services, tax withholding, unemploy11 ment insurance, and workers compensation coverage, and 

12 to serve as the statutory employer of the home care pro13 vider. Recipients of such services shall retain the right to 

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

15 of the home care provider. 

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

17 TERMINATION OR SUSPENSION OF SERVICES. 

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

19 January 1, 2008, all States under part B, shall satisfy 

20 the Secretary that any health plan providing services 

21 under this title shall ensure that enrollees will receive con22 tinued health services in the event that the plan’s health 

23 care services are terminated or suspended, including as 

24 the result of the plan filing for bankruptcy relief under 

25 title 11, United States Code, or the failure of the plan 
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1 to provide payments to providers, lockouts, work stop2 pages, or other labor management problems. 

3 ‘‘SEC. 2223. CONSUMER PROTECTION THROUGH DISCLO4 SURE OF INFORMATION. 

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

6 A, and, effective January 1, 2008, all States under part 

7 B, shall satisfy the Secretary that any health care provider 

8 that provides services to individuals under this title shall 

9 provide to the State information regarding the identity, 

10 employment location, and qualifications of health care 

11 workers providing services under— 

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

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

14 health plan or the State. 

15 ‘‘(b) AVAILABILITY TO PUBLIC.—A health care pro16 vider shall make the information described in subsection 

17 (a) available to the public. 

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

19 CHANGES IN HEALTH CARE DELIVERY. 

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

21 January 1, 2008, all States under part B, shall describe 

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

23 protections: 
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1 ‘‘(1) Adequate advance notice to the public, the 

2 affected health care workers, and labor organizations 

3 representing such workers, of a pending— 

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

5 ‘‘(B) sale, merger, or consolidation of a fa6 cility or operating unit; 

7 ‘‘(C) transfer of work from 1 facility or en8 tity to another facility or entity; or 

9 ‘‘(D) reduction of services. 

10 ‘‘(2) A right of first refusal for similar vacant 

11 positions with— 

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

13 health care worker whose position was elimi14 nated following a merger of the worker’s origi15 nal employer with a new entity; or 

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

17 care worker whose position was eliminated fol18 lowing the contracting out of the work the 

19 worker formerly performed.’’. 

20 TITLE III—PATIENT 

21 PROTECTIONS 

22 SEC. 301. INCORPORATION OF CERTAIN PROTECTIONS. 

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

24 bills are hereby enacted into law: 
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1 (1) S. 1052 of the 107th Congress, as passed 

2 by the Senate on June 29, 2001. 

3 (2) H.R. 2340 of the 107th Congress, as intro4 duced on June 27, 2001. 

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

6 form and in the United States Statutes at Large pursuant 

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

8 of the United States shall include after the date of ap9 proval at the end appendixes setting forth the texts of the 

10 bills referred to in subsection (a) of this section. 

11 TITLE IV—HEALTH CARE QUAL12 ITY, PATIENT SAFETY, AND 

13 WORKFORCE STANDARDS 

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

15 WORKFORCE STANDARDS INSTITUTE. 

16 (a) ESTABLISHMENT.— 

17 (1) INSTITUTE.—There is established within 

18 the Agency for Healthcare Research and Quality, an 

19 institute to be known as the Health Care Quality, 

20 Patient Safety, and Workforce Standards Institute 

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

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

23 Human Services shall appoint a director of the Insti24 tute. The director shall administer the Institute and 

25 carry out the duties of the director under this sec-
48 

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1 tion subject to the authority, direction, and control 

2 of the Secretary. 

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

4 (1) demonstrate how patient safety issues and 

5 workplace conditions are linked to quality patient 

6 care and the reduction of the incidence of medical 

7 errors; and 

8 (2) reduce the incidence of medical errors and 

9 improve patient safety and quality of care. 

10 (c) DUTIES.—In carrying out the mission of the In11 stitute, the director of the Institute shall— 

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

13 for Healthcare Research and Quality to ensure that 

14 issues related to workplace conditions are reflected 

15 in the activities conducted by such agency in order 

16 to reduce the incidence of medical errors and im17 prove patient safety and quality of care, including— 

18 (A) the establishment of national goals; 

19 (B) the development and implementation 

20 of a research agenda; 

21 (C) the development and promotion of best 

22 practices; 

23 (D) the development of performance and 

24 staffing standards in consultation with the 
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1 Health Care Financing Administration and 

2 other Federal agencies, as appropriate; and 

3 (E) the development and dissemination of 

4 information, educational and training materials, 

5 and other criteria as it relates to the delivery of 

6 quality care; 

7 (2) provide recommendations to the Secretary 

8 of Health and Human Services and other Federal 

9 agencies with responsibility for health care quality 

10 and the development of standards that impact on 

11 the delivery of quality patient care on standards re12 lated to workplace conditions and patient safety; 

13 (3) support the activities of the Health Care Fi14 nancing Administration related to the development 

15 of new or revised conditions of participation under 

16 the medicare and medicaid programs and subsequent 

17 rulemaking on issues related to workplace condi18 tions, medical errors, and patient safety and quality 

19 of care; and 

20 (4) conduct other activities determined appro21 priate by the director of the Institute. 

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

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

24 issues related to— 

25 (1) health care worker staffing; 
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1 (2) hours of work; 

2 (3) confidentiality and whistleblower protec3 tions; 

4 (4) employee participation in decisionmaking 

5 roles that contribute to improved quality of care and 

6 the reduction of the incidence of medical errors; 

7 (5) workforce training; and 

8 (6) the impact of health care delivery restruc9 turing on communities and health care workers. 

10 (e) DEFINITION OF HEALTH CARE WORKER.— 

11 (1) IN GENERAL.—In this section, the term 

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

13 by an employer that provides— 

14 (A) health care services; or 

15 (B) necessary related services, including 

16 administrative, food service, janitorial, or main17 tenance service to an entity that provides such 

18 health care services. 

19 (2) HEALTH CARE SERVICES.—In paragraph 

20 (1), the term ‘‘health care services’’ includes med21 ical, surgical, mental health, and substance abuse 

22 services, whether provided on an in-patient or out23 patient basis. 

24 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

25 are authorized to be appropriated to the Institute such 
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1 sums as may be necessary to carry out the purposes of 

2 this section. 

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

4 WORKFORCE STANDARDS ADVISORY COM5 MITTEE. 

6 (a) ESTABLISHMENT OF COMMITTEE.—There is es7 tablished a Health Care Quality, Patient Safety, and 

8 Workforce Standards Committee (in this section referred 

9 to as the ‘‘Committee’’). 

10 (b) FUNCTIONS OF COMMITTEE.— 

11 (1) ADVICE TO INSTITUTE.—The Committee 

12 shall provide advice to the Director of the Health 

13 Care Quality, Patient Safety, and Workforce Stand14 ards Institute established under section 401 on 

15 issues related to the duties of the Director. 

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

17 31, 2004, the Committee shall submit an initial re18 port to the Secretary that contains— 

19 (A) recommendations regarding minimal 

20 workforce standards that are critical for im21 proved health care quality and patient safety; 

22 and 

23 (B) recommendations regarding additional 

24 ways to reduce the incidence of medical errors 
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1 and to improve patient safety and quality of 

2 care. 

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

4 31, 2005, the Committee shall submit a final report 

5 to the Secretary of Health and Human Services re6 garding the recommendations contained in the initial 

7 report required under paragraph (2), including any 

8 modifications of such recommendations. 

9 (c) STRUCTURE AND MEMBERSHIP OF THE COM10 MITTEE.— 

11 (1) STRUCTURE.—The Committee shall be com12 posed of the Director of the Health Care Quality, 

13 Patient Safety, and Workforce Standards Institute 

14 established under section 401 and 15 additional 

15 members who shall be appointed by the Secretary of 

16 Health and Human Services. 

17 (2) MEMBERSHIP.— 

18 (A) IN GENERAL.—The members of the 

19 Committee shall be chosen on the basis of their 

20 integrity, impartiality, and good judgment, and 

21 shall be individuals who are, by reason of their 

22 education, experience, and attainments, excep23 tionally qualified to perform the duties of mem24 bers of the Committee. 
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1 (B) SPECIFIC MEMBERS.—In making ap2 pointments under paragraph (1), the Secretary 

3 of Health and Human Services shall ensure 

4 that the following groups are represented: 

5 (i) Health care providers and health 

6 care workers, including labor unions rep7 resenting health care workers. 

8 (ii) Consumer organizations. 

9 (iii) Health care institutions. 

10 (iv) Health education organizations. 

11 (d) CHAIRMAN.—The Director of the Health Care 

12 Quality, Patient Safety, and Workforce Standards Insti13 tute established under section 401 shall chair the Com14 mittee. 

15 TITLE V—IMPROVING MEDICARE 

16 BENEFITS 

17 SEC. 501. FULL MENTAL HEALTH AND SUBSTANCE ABUSE 

18 TREATMENT BENEFITS PARITY. 

19 Notwithstanding any provision of title XVIII of the 

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

21 January 1, 2004, each individual who is entitled to bene22 fits under part A or enrolled under part B of the medicare 

23 program, including an individual enrolled in a 

24 Medicare+Choice plan offered by a Medicare+Choice or25 ganization under part C of such program, shall be pro-
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1 vided full mental health and substance abuse treatment 

2 parity under the medicare program established under such 

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

4 Security Act (as added by this Act). 

5 TITLE VI—LONG-TERM AND 

6 HOME HEALTH CARE 

7 SEC. 601. STUDIES AND DEMONSTRATION PROJECTS TO 

8 IDENTIFY MODEL PROGRAMS. 

9 The Secretary of Health and Human Services shall— 

10 (1) conduct studies and demonstration projects, 

11 through grant, contract, or interagency agreement, 

12 that are designed to identify model programs for the 

13 provision of long-term and home health care serv14 ices; 

15 (2) report regularly to Congress on the results 

16 of such studies and demonstration projects; and 

17 (3) include in such report any recommendations 

18 for legislation to expand or continue such studies 

19 and projects. 

20 TITLE VII—MISCELLANEOUS 

21 SEC. 701. NONAPPLICATION OF ERISA. 

22 The provisions of section 514 of the Employee Retire23 ment Income Security Act of 1974 (29 U.S.C. 1144) shall 

24 not apply with respect to health benefits provided under 

25 a group health plan (as defined in section 733(a) of that 
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1 Act (29 U.S.C. 1191b(a))) qualified to offer such benefits 

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

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

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

5 SEC. 702. SENSE OF CONGRESS REGARDING OFFSETS. 

6 It is the sense of Congress that any sums necessary 

7 for the implementation of this Act, and the amendments 

8 made by this Act, should be offset by— 

9 (1) general revenues available as a result of an 

10 on-budget surplus for a fiscal year; 

11 (2) direct savings in health care expenditures 

12 resulting from the implementation of this Act; and 

13 (3) reductions in unnecessary Federal tax bene14 fits available only to individuals and large corpora15 tions that are in the maximum tax brackets. 

Æ