I 

108TH CONGRESS 

1ST SESSION H. R. 676

To provide for comprehensive health insurance coverage for all United States 

residents, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 11, 2003

Mr. CONYERS (for himself, Mr. MCDERMOTT, Mr. KUCINICH, Mrs. 

CHRISTENSEN, Mr. SCOTT of Virginia, Ms. LEE, Ms. NORTON, Mr. 

DAVIS of Illinois, Mr. OWENS, Mr. JACKSON of Illinois, Mr. HINCHEY, 

Mr. PAYNE, Mr. CUMMINGS, Ms. KILPATRICK, Mr. HASTINGS of Florida, 

Mr. FATTAH, Mr. GRIJALVA, Mr. TOWNS, Mr. LEWIS of Georgia, Mr. 

GUTIERREZ, Mr. THOMPSON of Mississippi, Ms. CARSON of Indiana, Mr. 

PASTOR, Ms. WOOLSEY, Mr. CLAY, and Mr. RANGEL) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Resources, and Veterans’ Affairs, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions 

as fall within the jurisdiction of the committee concerned 

A BILL

To provide for comprehensive health insurance coverage for 

all United States residents, and for other purposes.

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

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

3 ‘‘United States National Health Insurance Act (or the Ex4 panded and Improved Medicare for All Act)’’. 

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

6 this Act is as follows:

Sec. 1. Short title; table of contents. 

Sec. 2. Definitions and terms. 

TITLE I—ELIGIBILITY AND BENEFITS 

Sec. 101. Eligibility and registration. 

Sec. 102. Benefits and portability. 

Sec. 103. Qualification of participating providers. 

Sec. 104. Prohibition against duplicating coverage. 

TITLE II—FINANCES 

Subtitle A—Budgeting and Payments 

Sec. 201. Budgeting process. 

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

Sec. 203. Payment for long-term care. 

Sec. 204. Mental health services. 

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

necessary assistive equipment. 

Sec. 206. Consultation in establishing reimbursement levels. 

Subtitle B—Funding 

Sec. 211. Overview: funding the USNHI Program. 

Sec. 212. Appropriations for existing programs for uninsured and indigent. 

TITLE III—ADMINISTRATION 

Sec. 301. Public administration; appointment of Director. 

Sec. 302. Quality and cost control. 

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

workers. 

Sec. 304. Confidential Electronic Patient Record System. 

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

TITLE IV—ADDITIONAL PROVISIONS 

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

Sec. 402. Public health and prevention. 

Sec. 403. Reduction in health disparities. 

TITLE V—EFFECTIVE DATE 

Sec. 501. Effective date.
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1 SEC. 2. DEFINITIONS AND TERMS. 

2 In this Act: 

3 (1) USNHI PROGRAM; PROGRAM.—The terms 

4 ‘‘USNHI Program’’ and ‘‘Program’’ mean the pro5 gram of benefits provided under this Act and, unless 

6 the context otherwise requires, the Secretary with 

7 respect to functions relating to carrying out such 

8 program. 

9 (2) NATIONAL BOARD OF UNIVERSAL QUALITY

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

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

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

17 the Secretary of Health and Human Services. 

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

19 in relation to the Program, the Director appointed 

20 under section 301. 

21 TITLE I—ELIGIBILITY AND 

22 BENEFITS 

23 SEC. 101. ELIGIBILITY AND REGISTRATION. 

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

25 United States (including any territory of the United 

26 States) are covered under the USNHI Program entitling 
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1 them to a universal, best quality standard of care. Each 

2 such individual shall receive a card with a unique number 

3 in the mail. An individual’s social security number shall 

4 not be used for purposes of registration under this section. 

5 (b) REGISTRATION.—Individuals and families shall 

6 receive a United States National Health Insurance Card 

7 in the mail, after filling out a United States National 

8 Health Insurance application form at a health care pro9 vider. Such application form shall be no more than 2 pages 

10 long. 

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

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

14 but shall complete an application for benefits in order to 

15 receive a United States National Health Insurance Card 

16 and have payment made for such benefits. 

17 SEC. 102. BENEFITS AND PORTABILITY. 

18 (a) IN GENERAL.—The health insurance benefits 

19 under this Act cover all medically necessary services, in20 cluding—

21 (1) primary care and prevention; 

22 (2) inpatient care; 

23 (3) outpatient care; 

24 (4) emergency care; 

25 (5) prescription drugs; 
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1 (6) durable medical equipment; 

2 (7) long term care; 

3 (8) mental health services; 

4 (9) the full scope of dental services (other than 

5 cosmetic dentistry); 

6 (10) substance abuse treatment services; 

7 (11) chiropractic services; and 

8 (12) basic vision care and vision correction 

9 (other than laser vision correction for cosmetic pur10 poses). 

11 (b) PORTABILITY.—Such benefits are available 

12 through any licensed health care clinician anywhere in the 

13 United States that is legally qualified to provide the bene14 fits. 

15 (c) NO COST-SHARING.—No deductibles, copay16 ments, coinsurance, or other cost-sharing shall be imposed 

17 with respect to covered benefits. 

18 SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS. 

19 (a) REQUIREMENT TO BE PUBLIC OR NON-PROF20 IT.—

21 (1) IN GENERAL.—No institution may be a par22 ticipating provider unless it is a public or not-for23 profit institution. 

24 (2) CONVERSION OF INVESTOR-OWNED PRO25 VIDERS.—Investor-owned providers of care opting to 
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1 participate shall be required to convert to not-for2 profit status. 

3 (3) COMPENSATION FOR CONVERSION.—The 

4 owners of such investor-owned providers shall be 

5 compensated for the actual appraised value of con6 verted facilities used in the delivery of care. 

7 (4) FUNDING.—There are authorized to be ap8 propriated from the Treasury such sums as are nec9 essary to compensate investor-owned providers as 

10 provided for under paragraph (3). 

11 (5) REQUIREMENTS.—The conversion to a not12 for-profit health care system shall take place over a 

13 15-year period, through the sale of US Treasury 

14 Bonds. Payment for conversions under paragraph 

15 (3) shall not be made for loss of business profits, 

16 but may be made only for costs associated with the 

17 conversion of real property and equipment. 

18 (b) QUALITY STANDARDS.—

19 (1) IN GENERAL.—Health care delivery facili20 ties must meet regional and State quality and licens21 ing guidelines as a condition of participation under 

22 such program, including guidelines regarding safe 

23 staffing and quality of care. 

24 (2) LICENSURE REQUIREMENTS.—Participating 

25 clinicians must be licensed in their State of practice 
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1 and meet the quality standards for their area of 

2 care. No clinician whose license is under suspension 

3 or who is under disciplinary action in any State may 

4 be a participating provider. 

5 (c) PARTICIPATION OF HEALTH MAINTENANCE OR6 GANIZATIONS.—

7 (1) IN GENERAL.—Non-profit health mainte8 nance organizations that actually deliver care in 

9 their own facilities and employ clinicians on a sala10 ried basis may participate in the program and re11 ceive global budgets or capitation payments as speci12 fied in section 202. 

13 (2) EXCLUSION OF CERTAIN HEALTH MAINTE14 NANCE ORGANIZATIONS.—Other health maintenance 

15 organizations, including those which principally con16 tract to pay for services delivered by non-employees, 

17 shall be classified as insurance plans. Such organiza18 tions shall not be participating providers, and are 

19 subject to the regulations promulgated by reason of 

20 section 104(a) (relating to prohibition against dupli21 cating coverage). 

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

23 choice of participating physicians and other clinicians, 

24 hospitals, and inpatient care facilities. 
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1 SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE. 

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

3 insurer to sell health insurance coverage that duplicates 

4 the benefits provided under this Act. 

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

6 construed as prohibiting the sale of health insurance cov7 erage for any additional benefits not covered by this Act, 

8 such as for cosmetic surgery or other services and items 

9 that are not medically necessary. 

10 TITLE II—FINANCES 

11 Subtitle A—Budgeting and 

12 Payments 

13 SEC. 201. BUDGETING PROCESS. 

14 (a) ESTABLISHMENT OF OPERATING BUDGET AND

15 CAPITAL EXPENDITURES BUDGET.—

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

17 are established on an annual basis consistent with 

18 this title—

19 (A) an operating budget; 

20 (B) a capital expenditures budget; 

21 (C) reimbursement levels for providers con22 sistent with subtitle B; and 

23 (D) a health professional education budget, 

24 including amounts for the continued funding of 

25 resident physician training programs. 
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1 (2) REGIONAL ALLOCATION.—After Congress 

2 appropriates amounts for the annual budget for the 

3 USNHI Program, the Director shall provide the re4 gional offices with an annual funding allotment to 

5 cover the costs of each region’s expenditures. Such 

6 allotment shall cover global budgets, reimbursements 

7 to clinicians, and capital expenditures. Regional of8 fices may receive additional funds from the national 

9 program at the discretion of the Director. 

10 (b) OPERATING BUDGET.—The operating budget 

11 shall be used for—

12 (1) payment for services rendered by physicians 

13 and other clinicians; 

14 (2) global budgets for institutional providers; 

15 (3) capitation payments for capitated groups; 

16 and 

17 (4) administration of the Program. 

18 (c) CAPITAL EXPENDITURES BUDGET.—The capital 

19 expenditures budget shall be used for funds needed for—

20 (1) the construction or renovation of health fa21 cilities; and 

22 (2) for major equipment purchases. 

23 (d) PROHIBITION AGAINST CO-MINGLING OPER24 ATIONS AND CAPITAL IMPROVEMENT FUNDS.—It is pro25 hibited to use funds under this Act that are earmarked—
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1 (1) for operations for capital expenditures; or 

2 (2) for capital expenditures for operations. 

3 SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLI4 NICIANS. 

5 (a) ESTABLISHING GLOBAL BUDGETS; MONTHLY

6 LUMP SUM.—

7 (1) IN GENERAL.—The USNHI Program, 

8 through its regional offices, shall pay each hospital, 

9 nursing home, community or migrant health center, 

10 home care agencies, or other institutional provider 

11 or pre-paid group practice a monthly lump sum to 

12 cover all operating expenses under a global budget. 

13 (2) ESTABLISHMENT OF GLOBAL BUDGETS.—

14 The global budget of a provider shall be set through 

15 negotiations between providers and regional direc16 tors, but are subject to the approval of the Director. 

17 The budget shall be negotiated annually, based on 

18 past expenditures, projected changes in levels of 

19 services, wages and input, costs, and proposed new 

20 and innovative programs. 

21 (b) THREE PAYMENT OPTIONS FOR PHYSICIANS AND

22 CERTAIN OTHER HEALTH PROFESSIONALS.—

23 (1) IN GENERAL.—The Program shall pay phy24 sicians, dentists, doctors of osteopathy, psycholo25 gists, chiropractors, doctors of optometry, nurse
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1 practitioners, nurse midwives, physicians’ assistants, 

2 and other advanced practice clinicians as licensed 

3 and regulated by the States by the following pay4 ment methods: 

5 (A) Fee for service payment under para6 graph (2). 

7 (B) Salaried positions in institutions re8 ceiving global budgets under paragraph (3). 

9 (C) Salaried positions within group prac10 tices or non-profit health maintenance organiza11 tions receiving capitation payments under para12 graph (4). 

13 (2) FEE FOR SERVICE.—

14 (A) IN GENERAL.—The Program shall ne15 gotiate a simplified fee schedule with clinician 

16 representatives, after close consultation with the 

17 National Board of Universal Quality and Access 

18 and regional and State directors. 

19 (B) CONSIDERATIONS.—In establishing 

20 such schedule, the Director shall take into con21 sideration regional differences in reimburse22 ment, but strive for a uniform national stand23 ard. 
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1 (C) FINAL GUIDELINES.—The regional di2 rectors shall be responsible for promulgating 

3 final guidelines to all providers. 

4 (D) BILLING.—Under the Act physicians 

5 shall submit bills to the regional director on a 

6 simple form, or via computer. Interest shall be 

7 paid to providers whose bills are not paid within 

8 30 days of submission. 

9 (E) NO BALANCE BILLING.—Licensed 

10 health care clinicians who accept any payment 

11 from the USNHI Program may not bill any pa12 tient for any covered service. 

13 (F) UNIFORM COMPUTER ELECTRONIC

14 BILLING SYSTEM.—The Director shall make a 

15 good faith effort to create a uniform computer16 ized electronic billing system, including in those 

17 areas of the United States where electronic bill18 ing is not yet established. 

19 (3) SALARIES WITHIN INSTITUTIONS RECEIVING

20 GLOBAL BUDGETS.—

21 (A) IN GENERAL.—In the case of an insti22 tution, such as a hospital, health center, group 

23 practice, community and migrant health center, 

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

25 monthly global budget for the delivery of health 
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1 care as well as for education and prevention 

2 programs, physicians employed by such institu3 tions shall be reimbursed through a salary in4 cluded as part of such a budget. 

5 (B) SALARY RANGES.—Salary ranges for 

6 health care providers shall be determined in the 

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

8 (4) SALARIES WITHIN CAPITATED GROUPS.—

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

12 to cover all outpatient, physician, and medical 

13 home care provided to individuals enrolled to 

14 receive benefits through the organization or en15 tity. 

16 (B) SCOPE.—Such capitation may include 

17 the costs of services of licensed physicians and 

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

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

23 (C) PROHIBITION OF SELECTIVE ENROLL24 MENT.—Selective enrollment policies are pro25 hibited, and patients shall be permitted to en-
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1 roll or disenroll from such organizations or enti2 ties with appropriate notice. 

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

5 (i) health maintenance organizations 

6 shall be required to reimburse physicians 

7 based on a salary; and 

8 (ii) financial incentives between such 

9 organizations and physicians based on uti10 lization are prohibited. 

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

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

13 provide for each region a single budgetary allotment to 

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

15 Act. 

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

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

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

19 home, and community based care. 

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

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

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

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

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

4 to institutional care. 

5 SEC. 204. MENTAL HEALTH SERVICES. 

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

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

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

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

13 USNHI Program shall cover supportive residences, occu14 pational therapy, and ongoing mental health and coun15 seling services outside the hospital for patients with seri16 ous mental illness. In all cases the highest quality and 

17 most effective care shall be delivered, and, for some indi18 viduals, this may mean institutional care. 

19 SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS, 

20 MEDICAL SUPPLIES, AND MEDICALLY NEC21 ESSARY ASSISTIVE EQUIPMENT. 

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

23 each year under this Act for covered pharmaceuticals, 

24 medical supplies, and medically necessary assistive equip25 ment shall be negotiated annually by the Program.
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1 (b) PRESCRIPTION DRUG FORMULARY.—

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

3 a prescription drug formulary system, which shall 

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

6 costly medications when better alternatives are avail7 able. 

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

9 formulary shall promote the use of generic medica10 tions but allow the use of brand-name and off-for11 mulary medications when indicated for a specific pa12 tient or condition. 

13 (3) FORMULARY UPDATES AND PETITION

14 RIGHTS.—The formulary shall be updated frequently 

15 and clinicians and patients may petition their region 

16 or the Director to add new pharmaceuticals or to re17 move ineffective or dangerous medications from the 

18 formulary. 

19 SEC. 206. CONSULTATION IN ESTABLISHING REIMBURSE20 MENT LEVELS. 

21 Reimbursement levels under this subtitle shall be set 

22 after close consultation with regional and State Directors 

23 and after the annual meeting of National Board of Uni24 versal Quality and Access. 
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1 Subtitle B—Funding 

2 SEC. 211. OVERVIEW: FUNDING THE USNHI PROGRAM. 

3 (a) IN GENERAL.—The USNHI Program is to be 

4 funded as provided in subsections (b) and (c). 

5 (b) ANNUAL APPROPRIATION FOR FUNDING OF

6 USNHI PROGRAM.—There are authorized to be appro7 priated to carry out this Act such sums as may be nec8 essary. 

9 (c) INTENT.—Sums appropriated pursuant to sub10 section (b) shall be paid for—

11 (1) by vastly reducing paperwork; 

12 (2) by requiring a rational bulk procurement of 

13 medications; 

14 (3) from existing sources of Federal govern15 ment revenues for health care; 

16 (4) by increasing personal income taxes on the 

17 top 5 percent income earners; 

18 (5) by instituting a modest payroll tax; and 

19 (6) by instituting a small tax on stock and bond 

20 transactions.

21 SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS FOR 

22 UNINSURED AND INDIGENT. 

23 Notwithstanding any other provision of law, there are 

24 hereby transferred and appropriated to carry out this Act, 

25 amounts equivalent to the amounts the Secretary esti-
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1 mates would have been appropriated and expended for 

2 Federal public health care programs for the uninsured and 

3 indigent, including funds appropriated under the Medicare 

4 program under title XVIII of the Social Security Act, 

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

6 and under the Children’s Health Insurance Program 

7 under title XXI of such Act. 

8 TITLE III—ADMINISTRATION 

9 SEC. 301. PUBLIC ADMINISTRATION; APPOINTMENT OF DI10 RECTOR. 

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

12 provided, this Act shall be administered by the Secretary 

13 through a Director appointed by the Secretary. 

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

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

16 administration of this Act and ensuring the availability 

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

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

19 director for mental health who shall be responsible for ad20 ministration of this Act and ensuring the availability and 

21 accessibility of high quality mental health services. 

22 SEC. 302. OFFICE OF QUALITY CONTROL. 

23 The Director shall appoint a director for an Office 

24 of Quality Control. Such director shall, after consultation 

25 with state and regional directors, provide annual rec-
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1 ommendations to Congress, the President, the Secretary, 

2 and other Program officials on how to ensure the highest 

3 quality health care service delivery. The director of the Of4 fice of Quality Control shall conduct an annual review on 

5 the adequacy of medically necessary services, and shall 

6 make recommendations of any proposed changes to the 

7 Congress, the President, the Secretary, and other USNHI 

8 program officials. 

9 SEC. 303. REGIONAL AND STATE ADMINISTRATION; EM10 PLOYMENT OF DISPLACED CLERICAL WORK11 ERS. 

12 (a) USE OF REGIONAL OFFICES.—The Program 

13 shall establish and maintain regional offices. Such regional 

14 offices shall replace all regional Medicare offices. 

15 (b) APPOINTMENT OF REGIONAL AND STATE DIREC16 TORS.—In each such regional office there shall be—

17 (1) one regional director appointed by the Di18 rector; and 

19 (2) for each State in the region, a deputy direc20 tor (in this Act referred to as a ‘‘State Director’’) 

21 appointed by the governor of that State. 

22 (c) REGIONAL OFFICE DUTIES.—

23 (1) IN GENERAL.—Regional offices of the Pro24 gram shall be responsible for—
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1 (A) coordinating funding to health care 

2 providers and physicians; and 

3 (B) coordinating billing and reimburse4 ments with physicians and health care providers 

5 through a State-based reimbursement system. 

6 (d) STATE DIRECTOR’S DUTIES.—Each State Direc7 tor shall be responsible for the following duties: 

8 (1) Providing an annual state health care needs 

9 assessment report to the National Board of Uni10 versal Quality and Access, and the regional board, 

11 after a thorough examination of health needs, in 

12 consultation with public health officials, clinicians, 

13 patients and patient advocates. 

14 (2) Health planning, including oversight of the 

15 placement of new hospitals, clinics, and other health 

16 care delivery facilities. 

17 (3) Health planning, including oversight of the 

18 purchase and placement of new health equipment to 

19 ensure timely access to care and to avoid duplica20 tion. 

21 (4) Submitting global budgets to the regional 

22 director. 

23 (5) Recommending changes in provider reim24 bursement or payment for delivery of health services 

25 in the State.
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1 (6) Establishing a quality assurance mechanism 

2 in the State in order to minimize both under utiliza3 tion and over utilization and to assure that all pro4 viders meet high quality standards. 

5 (7) Reviewing program disbursements on a 

6 quarterly basis and recommending needed adjust7 ments in fee schedules needed to achieve budgetary 

8 targets and assure adequate access to needed care. 

9 (e) FIRST PRIORITY IN RETRAINING AND JOB

10 PLACEMENT.—The Program shall provide that clerical 

11 and administrative workers in insurance companies, doc12 tors offices, hospitals, nursing facilities and other facilities 

13 whose jobs are eliminated due to reduced administration, 

14 should have first priority in retraining and job placement 

15 in the new system. 

16 SEC. 304. CONFIDENTIAL ELECTRONIC PATIENT RECORD 

17 SYSTEM. 

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

19 standardized, confidential electronic patient record system 

20 in accordance with laws and regulations to maintain accu21 rate patient records and to simplify the billing process, 

22 thereby reducing medical errors and bureaucracy. 

23 (b) PATIENT OPTION.—Notwithstanding that all bill24 ing shall be preformed electronically, patients shall have 
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1 the option of keeping any portion of their medical records 

2 separate from their electronic medical record. 

3 SEC. 305. NATIONAL BOARD OF UNIVERSAL QUALITY AND 

4 ACCESS. 

5 (a) ESTABLISHMENT.—

6 (1) IN GENERAL.—There is established a Na7 tional Board of Universal Quality and Access (in 

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

9 of 15 members appointed by the President, by and 

10 with the advice and consent of the Senate. 

11 (2) QUALIFICATIONS.—The appointed members 

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

13 following: 

14 (A) Health care professionals. 

15 (B) Representatives of institutional pro16 viders of health care. 

17 (C) Representatives of health care advo18 cacy groups. 

19 (D) Representatives of labor unions. 

20 (E) Citizen patient advocates. 

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

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

23 stagger the terms of members initially appointed so 

24 that the term of no more than 3 members expires 

25 in any year. 
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1 (4) PROHIBITION ON CONFLICTS OF INTER2 EST.—No member of the Board shall have a finan3 cial conflict of interest with the duties before the 

4 Board. 

5 (b) DUTIES.—

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

7 least twice per year and shall advise the Secretary 

8 and the Director on a regular basis to ensure qual9 ity, access, and affordability. 

10 (2) SPECIFIC ISSUES.—The Board shall specifi11 cally address the following issues: 

12 (A) Access to care. 

13 (B) Quality improvement. 

14 (C) Efficiency of administration. 

15 (D) Adequacy of budget and funding. 

16 (E) Appropriateness of reimbursement lev17 els of physicians and other providers. 

18 (F) Capital expenditure needs. 

19 (G) Long-term care. 

20 (H) Mental health and substance abuse 

21 services. 

22 (I) Staffing levels and working conditions 

23 in health care delivery facilities. 

24 (3) ESTABLISHMENT OF UNIVERSAL, BEST

25 QUALITY STANDARD OF CARE.—The Board shall 
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1 specifically establish a universal, best quality of 

2 standard of care with respect to—

3 (A) appropriate staffing levels; 

4 (B) appropriate medical technology; 

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

6 workplace; and 

7 (D) best practices. 

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

9 report its recommendations twice each year to the 

10 Secretary, the Director, Congress, and the Presi11 dent. 

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

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

14 the Board in the same manner as they apply to the Medi15 care Payment Assessment Commission (except that any 

16 reference to the Commission or the Comptroller General 

17 shall be treated as references to the Board and the Sec18 retary, respectively): 

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

20 of Board members). 

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

22 vice chairman) 

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

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

25 staff; experts and consultants). 
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1 (5) Subsection (e) (relating to powers). 

2 TITLE IV—ADDITIONAL 

3 PROVISIONS 

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

5 This Act provides for health programs of the Depart6 ment of Veterans’ Affairs and of the Indian Health Serv7 ice to initially remain independent for the 5-year period 

8 that begins on the date of the establishment of the 

9 USNHI program, but after such period those programs 

10 shall be integrated into the USNHI program. 

11 SEC. 402. PUBLIC HEALTH AND PREVENTION. 

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

13 times stress the importance of good public health through 

14 the prevention of diseases. 

15 SEC. 403. REDUCTION IN HEALTH DISPARITIES. 

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

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

18 provide high quality, cost-effective, culturally appropriate 

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

20 orientation, or language. 
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1 TITLE V—EFFECTIVE DATE 

2 SEC. 501. EFFECTIVE DATE. 

3 Except as otherwise specifically provided, this Act 

4 shall take effect on January 1, 2005, and shall apply to 

5 items and services furnished on or after such date.

Æ