(2) LICENSURE REQUIREMENTS.—Participating 
clinicians must be licensed in their State of practice 
and meet the quality standards for their area of 
care. No clinician whose license is under suspension 
or who is under disciplinary action in any State may 
be a participating provider. 
(c) PARTICIPATION OF HEALTH MAINTENANCE OR-
GANIZATIONS.— 
(1) IN
GENERAL.—Non-profit health mainte-
nance organizations that actually deliver care in 
their own facilities and employ clinicians on a sala-
ried basis may participate in the program and re-
ceive global budgets or capitation payments as speci-
fied in section 202. 
(2) EXCLUSION OF CERTAIN HEALTH MAINTE-
NANCE ORGANIZATIONS.—Other health maintenance 
organizations, including those which principally con-
tract to pay for services delivered by non-employees, 
shall be classified as insurance plans. Such organiza-
tions shall not be participating providers, and are 
subject to the regulations promulgated by reason of 
section 104(a) (relating to prohibition against dupli-
cating coverage). 
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(d) FREEDOM OF CHOICE.—Patients shall have free 
choice of participating physicians and other clinicians, 
hospitals, and inpatient care facilities. 
SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE. 
(a) IN GENERAL.—It is unlawful for a private health 
insurer to sell health insurance coverage that duplicates 
the benefits provided under this Act. 
(b) CONSTRUCTION.—Nothing in this Act shall be 
construed as prohibiting the sale of health insurance cov-
erage for any additional benefits not covered by this Act, 
such as for cosmetic surgery or other services and items 
that are not medically necessary. 
TITLE II—FINANCES 
Subtitle A—Budgeting and 
Payments 
SEC. 201. BUDGETING PROCESS. 
(a) ESTABLISHMENT OF OPERATING BUDGET AND 
CAPITAL EXPENDITURES BUDGET.— 
(1) IN GENERAL.—To carry out this Act there 
are established on an annual basis consistent with 
this title— 
(A) an operating budget; 
(B) a capital expenditures budget; 
(C) reimbursement levels for providers con-
sistent with subtitle B; and 
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(D) a health professional education budget, 
including amounts for the continued funding of 
resident physician training programs. 
(2) REGIONAL
ALLOCATION.—After Congress 
appropriates amounts for the annual budget for the 
USNHI Program, the Director shall provide the re-
gional offices with an annual funding allotment to 
cover the costs of each region’s expenditures. Such 
allotment shall cover global budgets, reimbursements 
to clinicians, and capital expenditures. Regional of-
fices may receive additional funds from the national 
program at the discretion of the Director. 
(b) OPERATING BUDGET.—The operating budget 
shall be used for— 
(1) payment for services rendered by physicians 
and other clinicians; 
(2) global budgets for institutional providers; 
(3) capitation payments for capitated groups; 
and 
(4) administration of the Program. 
(c) CAPITAL EXPENDITURES BUDGET.—The capital 
expenditures budget shall be used for funds needed for— 
(1) the construction or renovation of health fa-
cilities; and 
(2) for major equipment purchases. 
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(d) PROHIBITION AGAINST CO-MINGLING OPER-
ATIONS AND CAPITAL IMPROVEMENT FUNDS.—It is pro-
hibited to use funds under this Act that are earmarked— 
(1) for operations for capital expenditures; or 
(2) for capital expenditures for operations. 
SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLI-
NICIANS. 
(a) ESTABLISHING GLOBAL BUDGETS; MONTHLY 
LUMP SUM.— 
(1) IN
GENERAL.—The USNHI Program, 
through its regional offices, shall pay each hospital, 
nursing home, community or migrant health center, 
home care agencies, or other institutional provider 
or pre-paid group practice a monthly lump sum to 
cover all operating expenses under a global budget. 
(2) ESTABLISHMENT OF GLOBAL BUDGETS.— 
The global budget of a provider shall be set through 
negotiations between providers and regional direc-
tors, but are subject to the approval of the Director. 
The budget shall be negotiated annually, based on 
past expenditures, projected changes in levels of 
services, wages and input, costs, and proposed new 
and innovative programs. 
(b) THREE PAYMENT OPTIONS FOR PHYSICIANS AND 
CERTAIN OTHER HEALTH PROFESSIONALS.— 
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(1) IN GENERAL.—The Program shall pay phy-
sicians, dentists, doctors of osteopathy, psycholo-
gists, chiropractors, doctors of optometry, nurse 
practitioners, nurse midwives, physicians’ assistants, 
and other advanced practice clinicians as licensed 
and regulated by the States by the following pay-
ment methods: 
(A) Fee for service payment under para-
graph (2). 
(B) Salaried positions in institutions re-
ceiving global budgets under paragraph (3). 
(C) Salaried positions within group prac-
tices or non-profit health maintenance organiza-
tions receiving capitation payments under para-
graph (4). 
(2) FEE FOR SERVICE.— 
(A) IN GENERAL.—The Program shall ne-
gotiate a simplified fee schedule that is fair 
with representatives of physicians and other cli-
nicians, after close consultation with the Na-
tional Board of Universal Quality and Access 
and regional and State directors. Initially, the 
current prevailing fees or reimbursement would 
be the basis for the fee negotiation for all pro-
fessional services covered under this Act. 
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