•HR 1200 SC4
DECEMBER 17, 1993
Additional sponsors: Mr. FIELDS of Louisiana, Mr. SYNAR, Mr. RICHARDSON,
Mr. GONZALEZ, and Mr. WAXMAN
Deleted sponsor: Mr. MFUME (added March 3, 1993; deleted November 22,
1993)
A BILL
To provide for health care for every American and to control
the cost of the health care system.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘American Health Security Act of 1993’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE 
I—ESTABLISHMENT 
OF 
A 
STATE-BASED 
AMERICAN
HEALTH SECURITY PROGRAM; UNIVERSAL ENTITLEMENT; EN-
ROLLMENT
Sec. 101. Establishment of a State-based American Health Security Program.
Sec. 102. Universal entitlement.
Sec. 103. Enrollment.
Sec. 104. Portability of benefits.
Sec. 105. Effective date of benefits.
Sec. 106. Relationship to existing Federal health programs.
TITLE II—COMPREHENSIVE BENEFITS, INCLUDING PREVENTIVE
BENEFITS AND BENEFITS FOR LONG TERM CARE
Sec. 201. Comprehensive benefits.
Sec. 202. Definitions relating to services.
Sec. 203. Special rules for home and community-based long-term care services.
Sec. 204. Exclusions and limitations.
Sec. 205. Certification; quality review; plans of care.
TITLE III—PROVIDER PARTICIPATION
•HR 1200 SC4
Sec. 301. Provider participation and standards.
Sec. 302. Qualifications for providers.
Sec. 303. Qualifications for comprehensive health service organizations.
Sec. 304. Limitation on certain physician referrals.
TITLE IV—ADMINISTRATION
Subtitle A—General Administrative Provisions
Sec. 401. American Health Security Standards Board.
Sec. 402. American Health Security Advisory Council.
Sec. 403. Professional, technical, and temporary advisory committees.
Sec. 404. American Health Security Quality Council.
Sec. 405. State health security programs.
Sec. 406. Complementary conduct of related health programs.
SUBTITLE B—CONTROL OVER FRAUD AND ABUSE
Sec. 411. Application of Federal sanctions to all fraud and abuse under Amer-
ican Health Security Program.
Sec. 412. National health care fraud data base.
Sec. 413. Requirements for operation of State health care fraud and abuse con-
trol units.
Sec. 414. Assignment of unique provider and patient identifiers.
TITLE V—QUALITY ASSESSMENT
Sec. 501. Functions of Quality Council; development of practice guidelines and
application to outliers.
Sec. 502. State quality review programs.
Sec. 503. Elimination of existing utilization review programs; transition.
Sec. 504. Development of national electronic data base.
TITLE VI—NATIONAL HEALTH SECURITY BUDGET; PAYMENTS;
COST CONTAINMENT MEASURES
Subtitle A—Budgeting and Payments to States
Sec. 601. National health security budget.
Sec. 602. Computation of individual and State capitation amounts.
Sec. 603. State health security budgets.
Sec. 604. Federal payments to States.
Sec. 605. Account for health professional education expenditures.
Subtitle B—Payments by States to Providers
Sec. 611. Payments to hospitals and other facility-based services for operating
expenses on the basis of approved global budgets.
Sec. 612. Payments to health care practitioners based on prospective fee
schedule.
Sec. 613. Payments to comprehensive health service organizations.
Sec. 614. Payments for community-based primary health services.
Sec. 615. Payments for prescription drugs.
Sec. 616. Approved devices and equipment.
Sec. 617. Payments for other items and services.
Sec. 618. Payment incentives for medically underserved areas.
Sec. 619. Authority for alternative payment methodologies.
•HR 1200 SC4
Subtitle C—Mandatory Assignment and Administrative Provisions
Sec. 621. Mandatory assignment.
Sec. 622. Procedures for reimbursement; appeals.
TITLE VII—PROMOTION OF PRIMARY HEALTH CARE; DEVELOP-
MENT OF HEALTH SERVICE CAPACITY; PROGRAMS TO ASSIST
THE MEDICALLY UNDERSERVED
Subtitle A—Promotion and Expansion of Primary Care Professional Training
Sec. 701. Role of Board; establishment of primary care professional output
goals.
Sec. 702. Establishment of advisory committee on health professional edu-
cation.
Sec. 703. Grants for health professions education, nurse education, and the Na-
tional Health Service Corps.
Subtitle B—Direct Health Care Delivery
Sec. 711. Setaside for public health block grants.
Sec. 712. Setaside for primary health care delivery.
Sec. 713. Primary care service expansion grants.
Subtitle C—Primary Care and Outcomes Research
Sec. 721. Set-aside for outcomes research.
Sec. 722. Office of Primary Care and Prevention Research.
TITLE VIII—FINANCING PROVISIONS; AMERICAN HEALTH
SECURITY TRUST FUND
Sec. 800. Amendment of 1986 code; section 15 not to apply.
Subtitle A—AMERICAN HEALTH SECURITY TRUST FUND
Sec. 801. American Health Security Trust Fund.
Subtitle B—Increases in Corporate and Individual Income Tax Rates; Health
Security Premium; and Surtax on Individuals With Incomes Over $1,000,000
Sec. 811. Increases in regular income tax rates.
Sec. 812. Increases in minimum tax rates.
Sec. 813. Health security premium.
Sec. 814. Surtax on individuals with incomes over $1,000,000.
Subtitle C—Employment Tax Changes
Sec. 821. Modifications of certain employment tax provisions.
Subtitle D—Other Revenue Increases Primarily Affecting Individuals
Sec. 831. Overall limitation on itemized deductions for high-income taxpayers
made permanent.
Sec. 832. Phaseout of personal exemption of high-income taxpayers made per-
manent.
Sec. 833. Modifications to deductions for certain moving expenses.
Sec. 834. Top estate and gift tax rates made permanent.
Sec. 835. Elimination of deduction for club membership fees.
•HR 1200 SC4
Sec. 836. Increase of Social Security benefits included in income.
Sec. 837. Long-term health care premium for the elderly.
Subtitle E—Other Revenue Increases Primarily Affecting Businesses
Sec. 841. Mark to market accounting method for securities dealers.
Sec. 842. Increase in recovery period for nonresidential real property.
Sec. 843. Taxation of income of controlled foreign corporations attributable to
imported property.
Sec. 844. Repeal of deduction for intangible drilling and development costs.
Sec. 845. Repeal of percentage depletion for oil and gas wells.
Sec. 846. Repeal of application of like-kind exchange rules to real property.
Sec. 847. Amortization of portion of advertising expenses.
Subtitle F—Estimated Tax Provisions
Sec. 851. Individual estimated tax provisions.
Sec. 852. Corporate estimated tax provisions.
Subtitle G—Alternative Taxable Years
Sec. 861. Election of taxable year other than required taxable year.
Sec. 862. Required payments for entities electing not to have required taxable
year.
Subtitle H—Deduction for Charitable Contribution of Appreciated Property
Limited To Adjusted Basis
Sec. 871. Deduction for charitable contribution of appreciated property limited
to adjusted basis.
Subtitle I—Minimum 5 Percent Rate of Tax on Interest Paid To Foreign
Persons
Sec. 881. Minimum 5 percent rate of tax on interest paid to foreign persons.
Sec. 981. Minimum 5 percent rate of tax on interest paid to foreign persons.
TITLE I—ESTABLISHMENT OF A
STATE-BASED 
AMERICAN
HEALTH 
SECURITY 
PRO-
GRAM; UNIVERSAL ENTITLE-
MENT; ENROLLMENT
SEC. 101. ESTABLISHMENT OF A STATE-BASED AMERICAN
HEALTH SECURITY PROGRAM.
(a) IN GENERAL.—There is hereby established in the
United States a State-Based American Health Security
Program to be administered by the individual States in
•HR 1200 SC4
accordance with Federal standards specified in, or estab-
lished under, this Act.
(b) STATE HEALTH SECURITY PROGRAMS.—In order
for a State to be eligible to receive payment under section
604, a State must establish a State health security pro-
gram in accordance with this Act.
(c) STATE DEFINED.—
(1) IN GENERAL.—In this Act, subject to para-
graph (2), the term ‘‘State’’ means each of the fifty
States and the District of Columbia.
(2) ELECTION.—If the Governor of Puerto
Rico, the Virgin Islands, Guam, American Samoa, or
the Northern Mariana Islands certifies to the Presi-
dent that the legislature of the Commonwealth or
territory has enacted legislation desiring that the
Commonwealth or territory be included as a State
under the provisions of this Act, such Common-
wealth or territory shall be included as a ‘‘State’’
under this Act beginning January 1 of the first year
beginning ninety days after the President receives
the notification.
SEC. 102. UNIVERSAL ENTITLEMENT.
(a) IN GENERAL.—Every individual who is a resident
of the United States and is a citizen or national of the
United States or lawful resident alien (as defined in sub-
•HR 1200 SC4
section (d) is entitled to benefits for health care services
under this Act under the appropriate State health security
program. In this section, the term ‘‘appropriate State
health security program’’ means, with respect to an indi-
vidual, the State health security program for the State in
which the individual maintains a primary residence.
(b) TREATMENT OF CERTAIN NONIMMIGRANTS.—
(1) IN GENERAL.—The American Health Secu-
rity Standards Board (in this Act referred to as the
‘‘Board’’) may make eligible for benefits for health
care services under the appropriate State health se-
curity program under this Act such classes of aliens
admitted to the United States as nonimmigrants as
the Board may provide.
(2) CONSIDERATION.—In providing for eligi-
bility under paragraph (1), the Board shall consider
reciprocity in health care services offered to United
States citizens who are nonimmigrants in other for-
eign states, and such other factors as the Board
determines to be appropriate.
(c) TREATMENT OF OTHER INDIVIDUALS.—
(1) BY BOARD.—The Board also may make eli-
gible for benefits for health care services under the
appropriate State health security program under this
Act other individuals not described in subsection (a)
•HR 1200 SC4
significant representation of consumers of health
services and providers of health services.
(c) ADVISORY
COMMITTEE
ON
COST
CONTAIN-
MENT.—
(1) IN GENERAL.—The Board shall appoint a
standing Advisory Committee on Cost Containment
to advise it with respect to the payments and cost
containment measures contained in title VI of this
Act.
(2) MEMBERSHIP.—The membership of the
committee shall include individuals (in such number
as the Board may determine) with national recogni-
tion for their expertise in health economics, health
care financing, provider reimbursement, and related
fields. In appointing individuals the Board shall as-
sure significant representation of consumers of
health services and providers of health services.
(d) ADVISORY COMMITTEE ON PRIMARY CARE AND
THE MEDICALLY UNDERSERVED.—
(1) IN GENERAL.—The Board shall appoint a
standing Advisory Committee on Primary Care and
the Medically Underserved to advise it with respect
to title VII of this Act, including with respect to the
delivery of services and the education and training
of health professionals, and to consider means of in-