(B) 
CONSIDERATIONS.—In 
establishing 
such schedule, the Director shall take into con-
sideration regional differences in reimburse-
ment, but strive for a uniform national stand-
ard. 
(C) STATE PHYSICIAN PRACTICE REVIEW 
BOARDS.— The State director for each State, in 
consultation with representatives of the physi-
cian community of that State, shall establish 
and appoint a physician practice review board 
to assure quality, cost effectiveness, and fair re-
imbursements for physician delivered services. 
(D) FINAL GUIDELINES.—The regional di-
rectors shall be responsible for promulgating 
final guidelines to all providers. 
(E) BILLING.—Under this Act physicians 
shall submit bills to the regional director on a 
simple form, or via computer. Interest shall be 
paid to providers whose bills are not paid within 
30 days of submission. 
(F) 
NO
BALANCE
BILLING.—Licensed 
health care clinicians who accept any payment 
from the USNHI Program may not bill any pa-
tient for any covered service. 
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(G) UNIFORM
COMPUTER
ELECTRONIC 
BILLING SYSTEM.—The Director shall create a 
uniform computerized electronic billing system, 
including those areas of the United States 
where electronic billing is not yet established. 
(3) SALARIES WITHIN INSTITUTIONS RECEIVING 
GLOBAL BUDGETS.— 
(A) IN GENERAL.—In the case of an insti-
tution, such as a hospital, health center, group 
practice, community and migrant health center, 
or a home care agency that elects to be paid a 
monthly global budget for the delivery of health 
care as well as for education and prevention 
programs, physicians employed by such institu-
tions shall be reimbursed through a salary in-
cluded as part of such a budget. 
(B) SALARY RANGES.—Salary ranges for 
health care providers shall be determined in the 
same way as fee schedules under paragraph (2). 
(4) SALARIES WITHIN CAPITATED GROUPS.— 
(A) IN GENERAL.—Health maintenance or-
ganizations, group practices, and other institu-
tions may elect to be paid capitation premiums 
to cover all outpatient, physician, and medical 
home care provided to individuals enrolled to 
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receive benefits through the organization or en-
tity. 
(B) SCOPE.—Such capitation may include 
the costs of services of licensed physicians and 
other licensed, independent practitioners pro-
vided to inpatients. Other costs of inpatient and 
institutional care shall be excluded from capita-
tion payments, and shall be covered under insti-
tutions’ global budgets. 
(C) PROHIBITION OF SELECTIVE ENROLL-
MENT.—Selective enrollment policies are pro-
hibited, and patients shall be permitted to en-
roll or disenroll from such organizations or enti-
ties with appropriate notice. 
(D) HEALTH
MAINTENANCE
ORGANIZA-
TIONS.—Under this Act— 
(i) health maintenance organizations 
shall be required to reimburse physicians 
based on a salary; and 
(ii) financial incentives between such 
organizations and physicians based on uti-
lization are prohibited. 
SEC. 203. PAYMENT FOR LONG-TERM CARE. 
(a) ALLOTMENT FOR REGIONS.—The Program shall 
provide for each region a single budgetary allotment to 
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cover a full array of long-term care services under this 
Act. 
(b) REGIONAL BUDGETS.—Each region shall provide 
a global budget to local long-term care providers for the 
full range of needed services, including in-home, nursing 
home, and community based care. 
(c) BASIS FOR BUDGETS.—Budgets for long-term 
care services under this section shall be based on past ex-
penditures, financial and clinical performance, utilization, 
and projected changes in service, wages, and other related 
factors. 
(d) FAVORING NON-INSTITUTIONAL CARE.—All ef-
forts shall be made under this Act to provide long-term 
care in a home- or community-based setting, as opposed 
to institutional care. 
SEC. 204. MENTAL HEALTH SERVICES. 
(a) IN GENERAL.—The Program shall provide cov-
erage for all medically necessary mental health care on 
the same basis as the coverage for other conditions. Li-
censed mental health clinicians shall be paid in the same 
manner as specified for other health professionals, as pro-
vided for in section 202(b). 
(b) FAVORING
COMMUNITY-BASED
CARE.—The 
USNHI Program shall cover supportive residences, occu-
pational therapy, and ongoing mental health and coun-
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seling services outside the hospital for patients with seri-
ous mental illness. In all cases the highest quality and 
most effective care shall be delivered, and, for some indi-
viduals, this may mean institutional care. 
SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS, 
MEDICAL SUPPLIES, AND MEDICALLY NEC-
ESSARY ASSISTIVE EQUIPMENT. 
(a) NEGOTIATED PRICES.—The prices to be paid 
each year under this Act for covered pharmaceuticals, 
medical supplies, and medically necessary assistive equip-
ment shall be negotiated annually by the Program. 
(b) PRESCRIPTION DRUG FORMULARY.— 
(1) IN GENERAL.—The Program shall establish 
a prescription drug formulary system, which shall 
encourage best-practices in prescribing and discour-
age the use of ineffective, dangerous, or excessively 
costly medications when better alternatives are avail-
able. 
(2) PROMOTION OF USE OF GENERICS.—The 
formulary shall promote the use of generic medica-
tions but allow the use of brand-name and off-for-
mulary medications when indicated for a specific pa-
tient or condition. 
(3) FORMULARY
UPDATES
AND
PETITION 
RIGHTS.—The formulary shall be updated frequently 
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