328 
after such a review, the party shall have 
the right to file a claim relating to the in-
jury involved in a State court of competent 
jurisdiction. 
‘‘(ii) FORFEIT
OF
AWARDS.—Any 
party filing an action in a State court 
under clause (i) shall forfeit any compensa-
tion award made under subparagraph (C). 
‘‘(iii) 
ADMISSIBILITY.—The 
deter-
minations of the expert panel pursuant to 
a review under subparagraph (C) shall be 
admissible into evidence in any State court 
proceeding under this subparagraph. 
‘‘(3) ADMINISTRATIVE
HEALTH
CARE
TRIBU-
NALS.— 
‘‘(A) IN
GENERAL.—A State may use 
amounts received under a grant under this sec-
tion to develop and implement an administra-
tive health care tribunal system under which 
the parties involved shall have the right to re-
quest a hearing to review any dispute con-
cerning injuries allegedly caused by health care 
providers or health care organizations before an 
administrative health care tribunal established 
by the State involved. 
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329 
‘‘(B) REQUIREMENTS.—In establishing an 
administrative health care tribunal under this 
paragraph, a State shall— 
‘‘(i) ensure that such tribunals are 
presided over by special judges with health 
care expertise who meet applicable State 
standards for judges and who agree to pre-
side over such court voluntarily; 
‘‘(ii) provide authority to such judges 
to make binding rulings, rendered in writ-
ten decisions, on standards of care, causa-
tion, compensation, and related issues with 
reliance on independent expert witnesses 
commissioned by the tribunal; 
‘‘(iii) establish a legal standard for 
the tribunal that shall be the same as the 
standard that would apply in the State 
court of competent jurisdiction which 
would otherwise handle the claim; and 
‘‘(iv) provide for an appeals process to 
allow for review of decisions by State 
courts. 
‘‘(C) DETERMINATION.—After a tribunal 
conducts a review under this paragraph, the tri-
bunal shall make a determination as to the li-
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330 
ability of the parties involved and the amount 
of compensation that should be paid based on 
a schedule of compensation developed by the 
tribunal. Such a schedule shall at a minimum 
include— 
‘‘(i) payment for the net economic loss 
incurred by the patient, on a periodic 
basis, reduced by any payments received by 
the patient under— 
‘‘(I) any health or accident insur-
ance; 
‘‘(II) any wage or salary continu-
ation plan; or 
‘‘(III) any disability income in-
surance; 
‘‘(ii) payment for the non-economic 
damages incurred by the patient, if appro-
priate for the injury, based on a defined 
payment schedule developed by the State 
in consultation with relevant experts and 
with the Secretary; 
‘‘(iii) reasonable attorney’s fees; and 
‘‘(iv) regular updates of the schedule 
under clause (ii) as necessary. 
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331 
‘‘(D) REVIEW BY STATE COURT AFTER EX-
HAUSTION OF ADMINISTRATIVE REMEDIES.— 
‘‘(i) RIGHT TO FILE.—Nothing in this 
paragraph shall be construed to prohibit 
any individual who is not satisfied with the 
determinations of a tribunal under this 
paragraph, from filing a claim for the in-
jury involved in a State court of competent 
jurisdiction. 
‘‘(ii) FORFEIT OF AWARD.—Any party 
filing an action in a State court under 
clause (i) shall forfeit any compensation 
award made under subparagraph (C). 
‘‘(iii) 
ADMISSIBILITY.—The 
deter-
minations of the tribunal under subpara-
graph (C) shall be admissible into evidence 
in any State court proceeding under this 
subparagraph. 
‘‘(4) EXPERT PANEL REVIEW AND ADMINISTRA-
TIVE
HEALTH
CARE
TRIBUNAL
COMBINATION 
MODEL.— 
‘‘(A) IN
GENERAL.—A State may use 
amounts received under a grant under this sec-
tion to develop and implement an expert panel 
review and administrative health care tribunal 
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332 
combination system to review any dispute con-
cerning injuries allegedly caused by health care 
providers or health care organizations. Under 
such system, a dispute concerning injuries al-
legedly caused by health care providers or 
health care organizations shall proceed through 
the procedures described in this subparagraph 
prior to the submission of such dispute to a 
State court. 
‘‘(B) GENERAL PROCEDURE.— 
‘‘(i) ESTABLISHMENT
OF
EXPERT 
PANEL.—Prior to submitting any dispute 
described in subparagraph (A) to an ad-
ministrative health care tribunal under the 
system established under this paragraph, 
the State shall establish an expert panel 
(in accordance with subparagraph (C)) to 
review the allegations involved in such dis-
pute. 
‘‘(ii) REFERRAL TO TRIBUNAL.—If ei-
ther party to a dispute described in clause 
(i) fails to accept the determination of the 
expert panel, the dispute shall then be re-
ferred to an administrative health care tri-
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333 
bunal (in accordance with subparagraph 
(D). 
‘‘(C) EXPERT REVIEW PANEL.— 
‘‘(i) IN GENERAL.—The provisions of 
paragraph (2) shall apply with respect to 
the establishment and operation of an ex-
pert review panel under this subparagraph, 
except that the subparagraphs (F) and (G) 
of such paragraph shall not apply. 
‘‘(ii) FAILURE
TO
ACCEPT
DETER-
MINATION OF PANEL.—If any party to a 
dispute before an expert panel under this 
subparagraph refuses to accept the panel’s 
determination, the dispute shall be referred 
to an administrative health care tribunal 
under subparagraph (D). 
‘‘(D) ADMINISTRATIVE HEALTH CARE TRI-
BUNALS.— 
‘‘(i) IN GENERAL.—Upon the failure 
of any party to accept the determination of 
an expert panel under subparagraph (C), 
the parties shall request a hearing con-
cerning the liability or compensation in-
volved by an administrative health care tri-
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334 
bunal established by the State involved 
under this subparagraph. 
‘‘(ii) REQUIREMENTS.—The provisions 
of paragraph (3) shall apply with respect 
to the establishment and operation of an 
administrative health care tribunal under 
this subparagraph. 
‘‘(iii) FORFEIT
OF
AWARDS.—Any 
party proceeding to the second step-admin-
istrative health care tribunal-under this 
model shall forfeit any compensation 
awarded by the expert panel. 
‘‘(iv) 
ADMISSIBILITY.—The 
deter-
minations of the expert panel under sub-
paragraph (C) shall be admissible into evi-
dence in any administrative health care tri-
bunal proceeding under this subparagraph. 
‘‘(E) RIGHT
TO
FILE.—Nothing in this 
paragraph shall be construed to prohibit any in-
dividual who is not satisfied with the deter-
mination of the tribunal (after having proceeded 
through both the expert panel under subpara-
graph (C) and the tribunal under subparagraph 
(D)) from filing a claim for the injury involved 
in a State court of competent jurisdiction. 
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335 
‘‘(F) ADMISSIBILITY.—The determinations 
of both the expert panel and the tribunal under 
this paragraph shall be admissible into evidence 
in any State court proceeding under this para-
graph. 
‘‘(G) FORFEIT OF AWARDS.—Any party fil-
ing an action in State court under subpara-
graph (E) shall forfeit any compensation award 
made by both the expert panel and the adminis-
trative health care tribunal under this para-
graph. 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) CURRENT
TORT
LITIGATION.—The term 
‘current tort litigation’ means the tort litigation sys-
tem existing in the State on the date on which the 
State submits an application under subsection 
(b)(1), for the resolution of disputes concerning inju-
ries allegedly caused by health care providers or 
health care organizations. 
‘‘(2) HEALTH CARE ORGANIZATION.—The term 
‘health care organization’ means any individual or 
entity that is obligated to provide, pay for, or admin-
ister health benefits under any health plan. 
‘‘(3) NET ECONOMIC LOSS.—The term ‘net eco-
nomic loss’ means— 
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353 
‘‘(2) AMOUNTS IN FUND.—The Tier I Invest-
ment Fund consists of all amounts derived from 
payments into the Fund under section 252(b) and 
remaining after investment of such amounts under 
subsection (b), including additional amounts derived 
as income from such investments. 
‘‘(3) USE OF FUNDS.—The amounts held in the 
Fund are appropriated and shall remain available 
without fiscal year limitation— 
‘‘(A) to be held for investment on behalf of 
participating individuals under subsection (b), 
‘‘(B) to pay the administrative expenses re-
lated to the Fund, and 
‘‘(C) to make transfers from the Fund 
under subsection (c)(2). 
‘‘(b) INVESTMENT OF FUND BALANCE.—For pur-
poses of investment of the Tier I Investment Fund, the 
Board shall contract with appropriate professional asset 
managers, recordkeepers, and custodians selected for in-
vestment of amounts held in the Fund, so as to provide 
for investment of the balance of the Fund, in a manner 
providing broad diversification in accordance with regula-
tions of the Board, in— 
‘‘(1) insurance contracts, 
‘‘(2) certificates of deposit, or 
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365 
‘‘(i) INTERNATIONAL STOCK INDEX INVESTMENT 
ACCOUNT.— 
‘‘(1) PORTFOLIO DESIGN.—Amounts held in the 
International Stock Index Investment Account shall 
be invested in a portfolio of stock designed to rep-
licate the performance of the index selected under 
paragraph (2). The portfolio shall be designed such 
that, to the extent practicable, the percentage of the 
balance in the International Stock Index Investment 
Account that is invested in each stock is the same 
as the percentage determined by dividing the aggre-
gate market value of all shares of that stock by the 
aggregate market value of all shares of all stocks in-
cluded in such index. 
‘‘(2) SELECTION OF INDEX.—The Board shall 
select, for purposes of investment of amounts held in 
the International Stock Index Investment Account, 
an index which is a commonly recognized index com-
prised of common stock the aggregate market value 
of which is a reasonably complete representation of 
the international equity markets excluding the 
United States equity markets. 
‘‘(j) 
ADDITIONAL
INVESTMENT
OPTIONS.—The 
Board may from time to time, as determined by regulation 
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386 
cess of such sum of such deposits, as so adjusted, over 
such amount credited to such account. 
‘‘(b) ADJUSTMENTS.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(a), deposits described in subsection (a) which are 
made in any calendar year shall be deemed to be 
equal to the product of— 
‘‘(A) the deposits made in such year (as 
determined without regard to this subsection); 
and 
‘‘(B) the quotient obtained by dividing— 
‘‘(i) the Consumer Price Index for the 
calendar quarter beginning on July 1 and 
ending on September 30 preceding the 
year in which the month referred to in sub-
section (a) occurs; by 
‘‘(ii) the Consumer Price Index for 
the calendar quarter beginning on July 1 
and ending on September 30 preceding the 
calendar year in which such deposits were 
made. 
‘‘(2) CONSUMER PRICE INDEX.—For purposes 
of paragraph (1), the Consumer Price Index for a 
calendar quarter shall be the arithmetical mean of 
the Consumer Price Index for Urban Wage Earners 
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387 
and Clerical Workers (CPI–W) for the 3 months in 
such quarter. 
‘‘SEC. 260. PERSONAL SOCIAL SECURITY SAVINGS BOARD. 
‘‘(a) ESTABLISHMENT.—There is established in the 
executive branch of the Government a Personal Social Se-
curity Savings Board. 
‘‘(b) COMPOSITION.—The Board shall be composed 
of— 
‘‘(1) 3 members appointed by the President, of 
whom 1 shall be designated by the President as 
Chairman; and 
‘‘(2) 2 members appointed by the President, of 
whom— 
‘‘(A) 1 shall be appointed by the President 
after taking into consideration the recommenda-
tion made by the Speaker of the House of Rep-
resentatives in consultation with the minority 
leader of the House of Representatives; and 
‘‘(B) 1 shall be appointed by the President 
after taking into consideration the recommenda-
tion made by the majority leader of the Senate 
in consultation with the minority leader of the 
Senate. 
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388 
‘‘(c) ADVICE AND CONSENT.—Appointments under 
subsection (b) shall be made by and with the advice and 
consent of the Senate. 
‘‘(d) MEMBERSHIP REQUIREMENTS.—Members of 
the Board shall have substantial experience, training, and 
expertise in the management of financial investments and 
pension benefit plans. 
‘‘(e) LENGTH OF APPOINTMENTS.— 
‘‘(1) TERMS.—A member of the Board shall be 
appointed for a term of 4 years, except that of the 
members first appointed under subsection (b)— 
‘‘(A) the Chairman shall be appointed for 
a term of 4 years; 
‘‘(B) the members appointed under sub-
section (b)(2) shall be appointed for terms of 3 
years; and 
‘‘(C) the remaining members shall be ap-
pointed for terms of 2 years. 
‘‘(2) VACANCIES.— 
‘‘(A) IN
GENERAL.—A vacancy on the 
Board shall be filled in the manner in which the 
original appointment was made and shall be 
subject to any conditions that applied with re-
spect to the original appointment. 
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