(G) by striking ‘‘or unpaid overtime com-
pensation under sections 6 and 7’’ in the third 
sentence of subsection (c) and inserting ‘‘, un-
paid overtime compensation, or unpaid health 
leave compensation under sections 6, 7, and 
7A’’; and 
(6) in section 18— 
(A) by inserting ‘‘or minimum health leave 
compensation higher than the minimum health 
leave compensation established under this Act’’ 
in the first sentence of subsection (a) before ‘‘, 
and no provision’’; and 
(B) by inserting ‘‘, or justify any employer 
in reducing health leave compensation provided 
by him which is in excess of the applicable min-
imum health leave compensation under this 
Act’’ before the period at the end of the second 
sentence of subsection (a). 
Subtitle B—Eligibility for, Nature 
of, and Scope of Services Pro-
vided by the Service 
SEC. 211. ELIGIBILITY FOR SERVICES. 
(a) IN GENERAL.—All individuals while within the 
United States are eligible to receive health care and sup-
plemental services under this Act.
(b) UNITED STATES DEFINED.—For purposes of this 
section, the term ‘‘United States’’ includes Indian reserva-
tions, the District of Columbia, the Commonwealth of 
Puerto Rico, the Virgin Islands, Guam, Samoa, and the 
Northern Mariana Islands. 
SEC. 212. ENTITLEMENT TO SERVICES. 
(a) IN GENERAL.—Except as provided in subsection 
(b), the Service shall, on and after the effective date of 
health services, provide users with all health care services 
and supplemental services described in section 213 which 
the Service determines, in accordance with this title, to 
be necessary or appropriate for the promotion and en-
hancement of health, for the prevention of disease, and 
for the diagnosis and treatment of, and rehabilitation fol-
lowing, injury, disability, or disease. 
(b) EXCLUSION.—Services provided under this Act 
shall not include personal comfort or cosmetic services un-
less the National Health Board or its designee determines 
that the services are required for health-related reasons. 
SEC. 213. PROVISION OF HEALTH CARE AND SUPPLE-
MENTAL SERVICES. 
(a) IN GENERAL.—The Service shall provide in the 
United States the following health care services in or 
through facilities established by the Service—
(1) the promotion of health and well-being 
through health education programs to be carried out 
in facilities of the Service as well as in workplaces, 
schools, and elsewhere utilizing all appropriate 
media, and by assisting other Government agencies 
in taking appropriate actions to promote health and 
well-being; 
(2) the prevention of illness, injury, and death 
through education and advocacy addressed to the so-
cial, occupational, and environmental causes of ill 
health; through the provision of appropriate preven-
tive services including social, medical, occupational, 
and environmental health services, on both an emer-
gency and sustained basis; through screening and 
other early detection programs to identify and ame-
liorate the primary causes of ill health; and, where 
appropriate, through actions taken on an emergency 
basis to halt environmental threats to life and 
health; 
(3) the diagnosis and treatment of illness and 
injury, including emergency medical services, com-
prehensive outpatient and inpatient health care serv-
ices, occupational health services, mental health 
services, dental care, vision care, long-term care, and 
home health services;
(4) the rehabilitation of the sick and disabled, 
including physical, psychological, occupational, and 
other specialized therapies; and 
(5) the provision of drugs, therapeutic devices, 
appliances, equipment, and other medical supplies 
(including eyeglasses, other visual aids, dental aids, 
hearing aids, and prosthetic devices) certified effec-
tive in the National Pharmacy and Medical Supply 
Formulary (published under section 432(a)) and fur-
nished or prescribed by authorized health workers. 
(b) SUPPLEMENTAL SERVICES.—The Service shall 
provide the following services supplemental to the delivery 
of health care services in or through health care facilities 
established by the Service— 
(1) ambulance and other transportation services 
to insure ready and timely access to necessary health 
care; 
(2) child care services for individuals who, dur-
ing the time they receive outpatient health care serv-
ices from the Service or are working in a health care 
facility of the Service, are responsible for a child’s 
care; 
(3) homemaking and home health services— 
(A) to enable the provision of inpatient 
health services at a health care facility of the
Service to an individual who has the sole re-
sponsibility for the care 
(i) of a child under 15 years of age, 
or 
(ii) of a physically or mentally handi-
capped individual who requires the care of 
another individual, and 
(B) for the bedfast or severely handicapped 
individual; and 
(4) such counseling and social service assistance 
as will avoid the unnecessary provision of health care 
services. 
(c) LOCAL PUBLIC HEALTH SERVICES.—The Service 
shall maintain the functions, especially those related to en-
vironmental health and the prevention of illness, currently 
performed by the departments of health of the States and 
localities, to the extent consistent with Federal, State, and 
local law, and shall cooperate with State and local govern-
ments in its conduct of such functions. 
(d) EMERGENCY HEALTH CARE SERVICES.—The 
Service shall provide, at rates established by the National 
Health Board, for reimbursement of the cost of emergency 
health care services furnished in facilities not operated by 
the Service or by health workers not employed by the Serv-
ice, when an injury or acute illness requires immediate
medical attention under circumstances making it medi-
cally impractical for the ill or injured individual to receive 
care in a Service facility or by an employee of the Service. 
Subtitle C—Health Care Facilities 
and Delivery of Health Care 
Services 
SEC. 221. ESTABLISHMENT OF HEALTH CARE FACILITIES 
AND 
DISTRIBUTION 
OF 
DELIVERY 
OF 
HEALTH CARE AND OTHER SERVICES. 
(a) HEALTH SERVICE AREAS.—The National Health 
Board, in consultation with local authorities and residents 
of the local communities affected, shall establish such 
health care facilities as are necessary to provide all nec-
essary comprehensive primary and specialized health care 
services, including distributing such health care resources 
in a manner as to overcome present shortages and ensure 
equitable access for every resident to needed health care 
resources. In establishing such facilities, the National 
Health Board shall rely primarily on existing political 
boundaries for the purposes of allocating health services, 
including cities, counties, perinatal services regions, 
States, and Federal Medicare regions, and shall determine 
the need to establish additional or supplementary regional 
health service areas that may cross existing boundaries. 
(b) HEALTH CARE FACILITIES.—
(1) IN GENERAL.—The National Health Board 
and its local authorities shall, not later than the ef-
fective date of health services and to the maximum 
extent feasible, establish and maintain such health 
care facilities as are necessary for the efficient and 
effective delivery to individuals of comprehensive pri-
mary health care services (defined in paragraph (2)), 
specialized health care services (defined in para-
graph (3)), special services (defined in paragraph 
(4)) and community-oriented health measures (de-
fined in paragraph (5)). Such health care facilities 
shall be established and maintained in a manner 
that, as soon as possible and to the greatest extent 
feasible, provides services in each community 
through a single comprehensive health center. 
(2) COMPREHENSIVE PRIMARY HEALTH CARE 
SERVICES DEFINED.—As used in paragraph (1), the 
term ‘‘comprehensive primary health care services’’ 
means those basic outpatient health care services 
typically needed for the promotion of health and the 
prevention and treatment of common illnesses and 
includes the following health care services— 
(A) general primary medical and dental 
care, including diagnosis and treatment, routine 
physical 
examinations, 
laboratory, 
and
radiologic services, and home visits by health 
workers, as appropriate; 
(B) preventive health services, including at 
least immunizations, nutrition counseling and 
consultation, and periodic screening and assess-
ment services; 
(C) children’s health services, including as-
sessment of growth and development, education 
and counseling on childrearing and child devel-
opment, and school and day care center health 
services; 
(D) obstetrical and gynecological services, 
including family planning and contraceptive 
services, pregnancy (prenatal and postnatal) 
and abortion counseling and services; 
(E) comprehensive geriatric services; 
(F) vision and hearing examinations and 
provision of eyeglasses and other visual aids 
and hearing aids; 
(G) 24-hour emergency medical services; 
(H) provision of pharmaceuticals and 
therapeutic devices, and medical appliances and 
equipment; 
(I) mental health services, including psy-
chological and psychiatric counseling;
(J) home health services; and 
(K) occupational safety and health serv-
ices, including screening, diagnosis, treatment, 
and education. 
(3) SPECIALIZED HEALTH CARE SERVICES DE-
FINED.—As used in paragraph (1), the term ‘‘spe-
cialized health care services’’ means those health 
care services of a specialized nature (whether deliv-
ered in an inpatient or outpatient setting) which, ap-
plying guidelines established by the National Health 
Board, may be provided most effectively and effi-
ciently in a community setting. 
(4) SPECIAL SERVICES DEFINED.—As used in 
paragraph (1), the term ‘‘special services’’ means 
supportive services and the facilities (including nurs-
ing homes and multiservice centers) in which such 
services are provided for individuals who are phys-
ically or mentally handicapped, mentally ill, infirm, 
or chronically ill, so as to promote the integration 
and functioning of such individuals within the com-
munity. 
(5) COMMUNITY-ORIENTED HEALTH MEASURES 
DEFINED.—As used in paragraph (1), the term 
‘‘community-oriented health measures’’ includes ef-
forts to focus organized community activities upon
the promotion of health and the prevention of illness 
and injury, support for self-help and mutual aid 
groups offering health promotion and rehabilitative 
support programs; surveillance of potential threats 
to community health, and prompt action to protect 
against such threats, and includes outreach efforts 
to ensure that all residents are aware of and able to 
utilize the health services of the Service, as needed. 
(b) ALLOCATION
OF
HOSPITALS.—The National 
Health Board, in consultation with its local authorities, 
shall periodically determine the necessity to establish and 
maintain inpatient and other specialized health care facili-
ties in particular locations. Where found appropriate, it 
shall establish and maintain— 
(1) general hospitals for the efficient and effec-
tive delivery of health care services to individuals re-
quiring inpatient diagnosis, treatment, care, and re-
habilitation for injury or illness; and 
(2) such other health care facilities as are nec-
essary, using guidelines established by the National 
Health Board to promote the efficient and effective 
delivery of health care services. 
In addition, the Board shall distribute and provide such 
health care services of a specialized nature (whether deliv-
ered in an inpatient or outpatient setting) as may be pro-
vided most effectively and efficiently. 
(c) SPECIALIZED SERVICES.—The Board shall, not 
later than the effective date of health services, establish 
and maintain— 
(1) specialized medical facilities for the efficient 
and effective delivery of highly specialized health 
care services, using guidelines it shall establish, to 
individuals requiring highly specialized treatment, 
care, and rehabilitation for injury or illness; 
(2) health care and supplemental services for 
individuals whose health care are related to occupa-
tional or other factors, including individuals residing 
within a region on a temporary or seasonal basis (in-
cluding migratory agricultural workers) and individ-
uals confined to prisons and other correctional insti-
tutions; and 
(3) such other health care facilities as are nec-
essary to promote the efficient and effective delivery 
of health care services. 
(d) HEALTH SERVICES.—States and the National 
Health Board, through its local and regional authorities, 
shall provide the following through health care facilities 
established pursuant to this section:
(1) Health promotion through education on per-
sonal health matters, nutrition, the avoidance of ill-
ness, and the effective use of health care services 
with particular emphasis on the appropriate and safe 
use (discouraging the overuse) of drugs and medical 
techniques. 
(2) Maintenance and appropriate transmission 
and transferal of personal health records for each 
user of the services consistent with section 201(9). 
(3) Referral services, including referrals, where 
appropriate, to other health care facilities. 
(4) Supplemental services (described in section 
213(b)), as appropriate. 
(5) Assistance to individuals who, because of 
language or cultural differences or educational or 
other handicaps, are unable fully to utilize the serv-
ices available from and delivered by the Board. 
(6) Information (A) on the rights ensured 
under this Act, (B) on the guidelines and standards 
established by the Board, and (C) on how the Board 
is implementing such rights and applying such 
guidelines and standards. 
(7) Information on the grievance mechanisms 
established pursuant to subtitle A of title IV and on
legal services available to pursue grievances against 
the Board. 
(8) Environmental health inspection and moni-
toring services, including investigations relating to 
the prevention of communicable diseases, in coopera-
tion with State and local authorities. 
(9) Research and data gathering on the leading 
causes of ill health and injury and on health care de-
livery, in accordance with section 421. 
(10) In the case of each inpatient health care 
facility, discharge planning and followup services (A) 
to identify patients who will need continuing care 
after discharge from the facility and (B) to plan, 
with the patient and the patient’s family, arrange-
ments and referrals to meet such postdischarge 
needs. 
(e) AUTHORITIES.— 
(1) EFFECTIVE
DELIVERY.—In its establish-
ment of health care facilities, the National Health 
Board shall seek to minimize fragmentation and du-
plication in delivery of health care and other services 
so as to promote the effective and efficient delivery 
of such services.
(2) COORDINATION.—The Board shall provide 
mechanisms to coordinate care across political and 
geographic boundaries as necessary. 
(3) ASSURING
AVAILABILITY
AND
ACCESSI-
BILITY OF SERVICES.—The Board shall take what-
ever additional steps are necessary to ensure that all 
of the health services required under this title are 
available and accessible in a timely manner to 
adults, infants, children, and individuals with dis-
abilities in its region. Toward that end, it shall— 
(A) ensure that users have access to a suf-
ficient number of each category of health work-
er, including primary care providers, specialists, 
and other health care professionals, in a man-
ner so that, to the maximum extent possible, 
such providers are geographically accessible to 
all residences and workplaces within the region 
and are culturally and linguistically appro-
priate; 
(B) ensure that services are available in a 
manner which ensures continuity of care, avail-
ability within reasonable hours of operation, 
and include emergency and urgent care services 
which shall be accessible at all times;
(C) ensure that any process established to 
coordinate care shall ensure ongoing direct ac-
cess to relevant specialists and shall not impose 
an undue burden on users with chronic health 
conditions; 
(D) ensure that appropriate steps are 
taken to eliminate any transportation or other 
barriers to the timely receipt of services; 
(E) ensure that a user who has a severe, 
complex, or chronic condition shall have access 
to the most appropriate health care coordinator 
(as defined in paragraph (4)(A)); and 
(F) ensure that priorities in the use of 
services and facilities shall be set by the appro-
priate health care professionals using criteria of 
medical necessity and that any limitations or 
delay in access to services shall be based only 
on limits of available service personnel and 
physical facilities. 
(4) DEFINITIONS.—For purposes of this sub-
section: 
(A) HEALTH
CARE
COORDINATOR.—The 
‘‘health care coordinator’’ means a health work-
er who performs case management (as defined 
in subparagraph (B)) functions in consultation
with the health care team, the patient, family, 
and community. 
(B) CASE MANAGEMENT.—The term ‘‘case 
management’’ means a coordinated set of activi-
ties conducted for the management of an indi-
vidual user’s serious, complicated, protracted or 
chronic health conditions in order to ensure 
cost-effective and benefit maximizing treatment. 
(f) GUIDELINES.—The National Health Board shall 
establish guidelines for distribution and coordination of 
the delivery of health care and other services described in 
this section and shall, before the effective date of health 
services, plan and facilitate the transition to the new dis-
tribution of health care facilities and health workers to 
be effected on and after that date. 
(g) USE OF EVIDENCE-BASED CLINICAL DECISION 
CRITERIA.— 
(1) IN GENERAL.—The National Health Board 
shall authorize the National Institute of Evaluative 
Clinical Research described in section 422 to estab-
lish evidence-based clinical decision criteria, where 
feasible, that shall apply throughout the Nation. 
(2) CLINICAL DECISION CRITERIA DEFINED.— 
For purposes of this section, the term ‘‘clinical deci-
sion criteria’’ means the recorded (written or other-
wise) screening procedures, decision abstracts, clin-
ical protocols, and practice guidelines used as an im-
portant basis to determine the necessity and appro-
priateness of health care services, in combination 
with the facts of particular cases, the judgment of 
health care professionals, and the preferences of 
users. Such criteria shall be clearly documented and 
available to all health workers and shall include a 
mechanism for periodically updating such criteria. 
(h) NOTICE
OF DETERMINATIONS.—The National 
Health Board, and its local and regional authorities, shall 
provide users with timely notice of any determination to 
provide, deny, or delay provision of a service, and informa-
tion about the relevant clinical decision criteria upon 
which such determination is based, if any. Such notifica-
tion shall include information concerning the appropriate 
procedure to appeal such decision. 
(i) ACCOUNTABILITY.—In the case that the Health 
Service fails on the effective date of health services, to sub-
stantially and materially provide health care and supple-
mental services in accordance with this section, redress 
and alternative sources of care shall be authorized by an 
independent authority accountable to Congress and State 
legislatures. Such redress may include— 
(1) requiring the provision of services; and
(2) providing reimbursement for the provision 
of specified health care services in accordance with 
procedures and schedules in effect under title XVIII 
of the Social Security Act immediately before the ef-
fective date of health services. 
SEC. 222. OPERATION AND INSPECTION OF HEALTH CARE 
FACILITIES. 
(a) ESTABLISHMENT OF POLICIES.— 
(1) IN
GENERAL.—Each health care facility 
shall be subject to policies and organizational plans 
consistent with this section and with parts A and C 
of title III (relating to the health labor force) for the 
operation of such facility and shall establish proce-
dures to ensure that the facility is operated in ac-
cordance with such policies and plans. 
(2) HEALTH WORKER AND USER CONTROL.— 
The National Health Board and its regional and 
local authorities shall establish policies and mecha-
nisms for control of health care facilities by health 
care workers who are employed in, and users who re-
ceive services from, the respective facility, and shall 
promulgate rules preventing a financial conflict of 
interest by decisionmaking bodies. 
(b) EMPLOYMENT RESTRICTIONS.—