I
107TH CONGRESS
1ST SESSION
H. R. 3080
To establish a United States Health Service to provide high quality com-
prehensive health care for all Americans and to overcome the deficiencies
in the present system of health care delivery.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 10, 2001
Ms. LEE introduced the following bill; which was referred to the Committee
on Energy and Commerce, and in addition to the Committees on Edu-
cation and the Workforce, and Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
A BILL
To establish a United States Health Service to provide high
quality comprehensive health care for all Americans and
to overcome the deficiencies in the present system of
health care delivery.
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
‘‘Josephine Butler United States Health Service Act’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Purposes.
Sec. 4. Definitions.
TITLE I—ESTABLISHMENT AND OPERATION OF THE UNITED
STATES HEALTH SERVICE
Sec. 101. Establishment of the Service.
Sec. 102. Appointment of the National Health Board.
Sec. 103. Powers and duties of the National Health Board.
Sec. 104. Representation in local and regional authorities.
Sec. 105. Public accountability and financial disclosure.
Sec. 106. Inspector General.
Sec. 107. Establishment of health care delivery regions.
TITLE II—DELIVERY OF HEALTH CARE AND SUPPLEMENTAL
SERVICES
Subtitle A—Patients’ Rights in Health Care Delivery
Sec. 201. Basic health rights.
Sec. 202. Right to paid leave to receive health care services.
Subtitle B—Eligibility for, Nature of, and Scope of Services Provided by the
Service
Sec. 211. Eligibility for services.
Sec. 212. Entitlement to services.
Sec. 213. Provision of health care and supplemental services.
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.
Sec. 222. Operation and inspection of health care facilities.
Sec. 223. Provision of health services relating to reproduction and childbearing.
TITLE III—HEALTH LABOR FORCE
Subtitle A—Job Categories and Certification
Sec. 301. Effect of State law.
Sec. 302. Qualifications of health workers.
Sec. 303. Establishment of job categories and certification standards.
Subtitle B—Education of Health Workers
Sec. 311. Health team schools.
Sec. 312. Service requirement.
Sec. 313. Payment for certain educational loans.
Subtitle C—Employment and Labor-Management Relations Within the Service
Sec. 321. Employment, transfer, promotion, and receipt of fees.
Sec. 322. Applicability of laws relating to Federal employees.
Sec. 323. Applicability of Federal labor-management relations laws.
Sec. 324. Defense of certain malpractice and negligence suits.
TITLE IV—OTHER FUNCTIONS OF HEALTH BOARDS
Subtitle A—Advocacy, Grievance Procedures, and Trusteeships
Sec. 401. Advocacy and legal services program.
Sec. 402. Grievance procedures.
Subtitle B—Occupational Safety and Health Programs
Sec. 411. Functions of the National Health Board.
Sec. 412. Community occupational safety and health activities.
Sec. 413. Workplace health facilities.
Sec. 414. Employee rights relating to occupational safety and health.
Sec. 415. Definitions.
Subtitle C—Health and Health Care Delivery Research, Quality Assurance,
and Health Equity
Sec. 421. Principles and guidelines for research.
Sec. 422. Establishment of institutes.
Subtitle D—Health Planning, Distribution of Drugs and Other Medical
Supplies, and Miscellaneous Functions
Sec. 431. Health planning and budgeting.
Sec. 432. Distribution of drugs and other medical supplies.
Sec. 433. Miscellaneous functions of the National Health Board.
TITLE V—FINANCING OF THE SERVICE
Subtitle A—Health Service Taxes
Sec. 501. Individual and corporate income taxes.
Sec. 502. Other changes in the Internal Revenue Code of 1986.
Sec. 503. Existing employer-employee health benefit plans.
Sec. 504. Workers compensation programs.
Subtitle B—Health Service Trust Fund
Sec. 511. Establishment of health service trust fund.
Sec. 512. Transfer of funds to the health service trust fund.
Sec. 513. Administration of health service trust fund.
Subtitle C—Preparation of Plans and Budgets
Sec. 521. Determination of fund availability.
Sec. 522. Preparation of regional budgets.
Subtitle D—Allocation and Distribution of Funds
Sec. 531. National budget.
Sec. 532. Special operating expense fund.
Sec. 533. Distribution of funds.
Sec. 534. Annual statement, records, and audits.
Subtitle E—General Provisions
Sec. 541. Issuance of obligations.
Sec. 542. Definitions.
TITLE VI—MISCELLANEOUS PROVISIONS
Sec. 601. Effective date of health services.
Sec. 602. Repeal of provisions.
Sec. 603. Transition provisions.
Sec. 604. Amendment to Budget and Accounting Act.
Sec. 605. Separability.
SEC. 2. FINDINGS.
The Congress makes the following findings:
(1) The health of the Nation’s people is a foun-
dation of their well-being.
(2) High quality health care is a right of all
people.
(3) Many of the Nation’s people are unable
fully to exercise this right because of the inability of
the present health care delivery system to make high
quality health care available to all individuals re-
gardless of race, sex, age, national origin, income,
marital status, sexual orientation, religion, political
belief, place of residence, employment status, or pre-
vious health status.
(4) The present health care system has failed to
provide financial coverage for health care services
for more than forty million Americans, and the per-
cent lacking such coverage grows each year.
(5) The present health care system has failed to
provide for sufficient effective preventive measures
that would address the deterioration in occupational,
environmental, and social conditions affecting the
health of the people of this Nation.
(6) Unnecessary and excessive profits and ad-
ministrative expenses have inflated the cost of health
care.
(7) The growth of for profit medical care and
for profit managed care is making it difficult for
health care personnel to provide, and users to re-
ceive, the full range of health services they believe to
be necessary, appropriate, and desirable.
(8) The health professions have failed to control
the cost of their services and the imbalance in the
number of health workers among geographic areas
or health care specialties.
(9) The present health care system has failed to
make full and efficient use of allied health workers.
(10) A United States Health Service is the best
means to implement the right to high quality health
care and to overcome the deficiencies in the present
health care delivery system.
SEC. 3. PURPOSES.
The purposes of this Act are as follows:
(1) To create a United States Health Service to
provide without charge to all residents, regardless of
race, sex, age, national origin, income, marital sta-
tus, sexual orientation, religion, political belief, place
of residence, employment status, or previous health
status, comprehensive health care services delivered
by salaried health workers and emphasizing the pro-
motion and maintenance of health as well as the
treatment of illness.
(2) To establish representative and democratic
governance of the Service.
(3) To provide health workers in the Service
with fair and reasonable compensation, secure em-
ployment, opportunities for full and equal participa-
tion in the governance of health facilities, and oppor-
tunities for advancement without regard to race, sex,
age, national origin, sexual orientation, religion, or
political belief.
(4) To increase the availability and continuity
of health care by linking local health care facilities
to hospitals and specialized care facilities.
(5) To overcome present disparities in health
and access to health care resources, especially for
currently underserved innercity and rural popu-
lations, minority groups, prisoners, and occupational
groups, by redistributing health care resources to
underserved populations, and by enhancing public
health and preventive health services.
(6) To finance the Service through progressive
taxation of individuals and employer contributions,
and to distribute these revenues on a capitation
basis, supplemented by allocations to meet special
health care needs.
SEC. 4. DEFINITIONS.
For the purposes of this Act, unless the context im-
plies otherwise:
(1) 
HEALTH
CARE
FACILITY.—The 
term
‘‘health care facility’’ means an administrative unit
composed of specified staff, equipment, and premises
and established by a health board as an appropriate
unit of organization for the delivery of specified
health care or supplemental services under this Act.
(2) HEALTH
WORKER.—The term ‘‘health
worker’’ includes—
(A) any employee of the Service; and
(B) any individual who for remuneration
delivers, administers any program in, provides
supporting services for, teaches the subject
matter of, or performs research in, health care
services.
(3) INDIRECT PROVIDER OF HEALTH CARE.—
The term ‘‘indirect provider of health care’’ means
an individual who—
(A) receives (either directly or through his
or her spouse) more than 1⁄10 of his or her
gross annual income from any one or combina-
tion of—
(i) fees or other compensation for pro-
vision of, research into, or instruction in,
the provision of health care,
(ii) entities engaged in the provision
of health care or in such research or in-
struction,
(iii) producing or supplying drugs,
medical equipment, or other articles for in-
dividuals or entities for use in the provi-
sion of or in research into or instruction in
the provision of health care, or
(iv) entities engaged in producing
drugs, medical equipment, or such other
articles;
(B) holds a fiduciary position with, or has
a fiduciary interest in, any entity described in
clause (ii) or (iv) of subparagraph (A); or
(C) is engaged in issuing any policy or con-
tract of individual or group health insurance or
hospital or medical service benefits.
(4) NATIONAL
HEALTH
BOARD.—The term
‘‘National Health Board’’ means the National
Health Board of the Service.
(5) SERVICE.—The term ‘‘Service’’ means the
United States Health Service established in section
101.
(6) SERVICE-RELATED TERMS.—
(A) HEALTH CARE SERVICES.—The term
‘‘health care services’’ means the services de-
scribed in paragraphs (1) through (5) of section
213(a).
(B) SUPPLEMENTAL SERVICES.—The term
‘‘supplemental services’’ means the services de-
scribed in paragraphs (1), (2), and (3) of sec-
tion 213(b).
(7) USER.—The term ‘‘user’’ means an indi-
vidual who is eligible under section 211 to receive
health care services from the Service under this Act.
TITLE I—ESTABLISHMENT AND
OPERATION OF THE UNITED
STATES HEALTH SERVICE
SEC. 101. ESTABLISHMENT OF THE SERVICE.
(a) IN GENERAL.—There is established, as an inde-
pendent establishment of the executive branch of the
United States, the United States Health Service.
(b) AUTHORITY.—
(1) NATIONAL HEALTH BOARD.—The authority
of the Service shall be exercised by the National
Health Board and, in accordance with this Act and
guidelines established by such Board, by local and
regional authorities affiliated with the Board.
(2) EMINENT DOMAIN AUTHORITY.—The Serv-
ice shall have the authority, under the power of emi-
nent domain, to acquire by condemnation under ju-
dicial process real estate for the Service for public
purposes whenever it is necessary or advantageous
to do so.
(c) ADMINISTRATION.—The Board shall implement
administrative measures as necessary to assure the equi-
table distribution and allocation of health care resources
and services.
(d) ACCOUNTABILITY AND CONTROL.—The Board
shall establish mechanisms to assure accountable, rep-
resentative and democratic governance of the Service and
of health care facilities by health care users and workers,
with limits on conflicts of interest as described in this Act.
SEC. 102. APPOINTMENT OF THE NATIONAL HEALTH
BOARD.
The President shall, no later than 30 days after the
date of the enactment of this Act, appoint 21
individuals—
(1) who are 18 years of age or older;
(2) who are concerned about the health care
problems of the Nation;
(3) who approximate the Nation’s population by
race, sex, income, language, and region of residence,
and approximate the percentage of rural and fron-
tier populations; and
(4) no more than seven of whom are or have
been health workers, indirect providers of health
care, or members of the immediate family of such
workers or indirect providers within 24 months of
the date of such nomination, to serve as members of
the National Health Board of the Service.
SEC. 103. POWERS AND DUTIES OF THE NATIONAL HEALTH
BOARD.
The National Health Board shall—
(1) establish the boundaries of health care de-
livery regions, in accordance with section 107;
(2) establish procedures for creating local and
regional authorities within each health care delivery
region, to oversee and administer the delivery of
health services, pursuant to section 104, and other
provisions of this Act in their respective regions and
local areas;
(3) carry out such duties of the National
Health Board as it deems necessary and consistent
with the timetable given under this Act and the pur-
poses of the Service; and
(4) provide for the recording of minutes of each
of its meetings, and shall make such records avail-
able to the public for inspection and copying.
SEC. 104. REPRESENTATION IN LOCAL AND REGIONAL AU-
THORITIES.
The governing bodies of the local and regional au-
thorities created pursuant to section 103(b) shall consist
of representatives of users resident in their local area or
region and representatives of health workers employed by
the Service in their local area or region. Representatives
of such users shall comprise the majority of such rep-
resentatives and representatives of such health workers
shall comprise a minority.
SEC. 105. PUBLIC ACCOUNTABILITY AND FINANCIAL DIS-
CLOSURE.
(a) PROHIBITION OF CONFLICTS OF INTEREST.—
(1) IN GENERAL.—Individuals with direct or in-
direct conflicts of interest shall not serve on health
boards or authorities. Subject to paragraph (2), such
conflicts may consist of ownership of, employment
in, or other financial affiliation with any industry in
a position to profit or otherwise benefit from the ac-
tivities of the health board.
(2) EXCEPTION.—Paragraph (1) shall not
apply to employment as a health worker by the Serv-
ice as specified in this Act.
(b) DISCLOSURE.—Candidates for health boards or
authorities shall fully disclose any such potential conflicts
of interest, and if elected or appointed shall sever any af-
filiations that could result in a conflict.
SEC. 106. INSPECTOR GENERAL FOR HEALTH SERVICES.
Within the United States Health Service there shall
be an Office of the Inspector General for Health Services,
to be headed by an Inspector General for Health Services,
that shall have authority to ensure the effective operation
of the services pursuant to this Act and to investigate and
pursue any grievances against the National Health Board
or its local authorities. The Inspector General shall have
the same authority as an Inspector General has under the
Inspector General Act of 1978.
SEC. 107. ESTABLISHMENT OF HEALTH CARE DELIVERY RE-
GIONS.
(a) ESTABLISHMENT OF HEALTH CARE DELIVERY
REGIONS.—No later than 6 months after the appointment
of members of the National Health Board, such Board
shall establish, in accordance with this section, health care
delivery regions throughout the United States.
(b) REQUIREMENTS FOR DELIVERY REGIONS.—Each
health care delivery region shall meet the following re-
quirements:
(1) The region shall be a contiguous geographic
area appropriate for the effective governance, plan-
ning, and delivery of all health care and supple-
mental services under this Act for residents of the
region.
(2) The region shall have a population of not
less than 500,000 and of not more than 3,000,000
individuals, except that—
(A) the population of a region may be
more than 3,000,000 if the region includes a
standard metropolitan statistical area (as deter-
mined by the Office of Management and Budg-
et) with a population of more than 3,000,000;
and
(B) the population of a region may be less
than 500,000 if the National Health Board de-
termines that this is necessary to facilitate the
delivery of health care and supplemental serv-
ices or the effective governance of the health
program within such region.
A region under subparagraph (B) may be a sparsely
populated frontier area which consists of a very
large or multi-state geographic area.
(3) The boundaries of each region shall take
into account—
(A) any economic or geographic barrier to
the receipt of health care and supplemental
services in nonmetropolitan areas, and
(B) the differences in needs between non-
metropolitan and metropolitan areas in the
planning, development, and delivery of health
care and supplemental services.
(c) MODIFICATION OF BOUNDARIES.—The National
Health Board shall review the boundaries of regions no
later than 2 years after each decennial national census,
or upon receipt of and at such other times as it deems
necessary, and may modify the boundary of any region
in which there has been a substantial shift of population
justifying such modification or if such modification would
better carry out the purposes of this Act, and if such modi-
fication is approved in a referendum of residents in an
area whose regional identification would be changed by
making such modification.
(d) PROCESS.—At least 60 days prior to the estab-
lishment of the boundaries of any region, or modification
of the boundaries, the National Health Board shall col-
laborate with its regional authorities to provide for—
(1) notice in the area which would be affected
by the establishment of such boundaries of the
boundaries proposed to be established, and of the
date, time, and location of the public hearing on
such establishment as provided in paragraph (2);
and
(2) a public hearing at which individuals can
speak or present written statements relating to the
establishment of such boundaries.
TITLE II—DELIVERY OF HEALTH
CARE 
AND 
SUPPLEMENTAL
SERVICES
Subtitle A—Patients’ Rights in
Health Care Delivery
SEC. 201. BASIC HEALTH RIGHTS.
The Service, in its delivery of health care services to
users, shall ensure that every such individual is given the
following basic health rights:
(1) The right to receive high quality health care
and supplemental services from any facility within
the Service capable of providing such services with-
out charge and without discrimination on account of
race, sex, age, religion, language, income, marital
status, sexual orientation, dress, or previous health
status.
(2) The right to humane, respectful, dignified,
and comforting health care, and to the reduction of
pain and distressful symptoms.
(3) The right to have all medically necessary or
appropriate health services delivered in a convenient
and timely manner. Any decision to deny or post-
pone such necessary or appropriate care shall be
made only on the basis of temporary and reasonable
limitations in the availability of service personnel
and physical facilities. Users shall have the oppor-
tunity for timely and effective appeal of any decision
to deny or postpone care.
(4) The right to choose the health workers who
shall be responsible for, and the health facilities in
which to receive, the individual’s health care serv-
ices.
(5) The right of access to all information, in-
cluding the individual’s health records and the med-
ical dictionary produced under section 433(b), which
promotes an understanding of health.
(6) The right to have all health care informa-
tion, reports, and educational materials translated
into the individual’s primary language.
(7) The right to receive, prior to the delivery of
any health care service, a careful, prompt, and
intelligible—
(A) explanation of the indications, diag-
noses, benefits, side effects, and risks involved
in the delivery of such service, and a description
of all medically necessary or appropriate alter-
natives to such service (including no treatment);
(B) answer to any question relating to
such health care service; and
(C) explanation of one’s health rights de-
scribed in this subtitle, and the right to have
such health care service delivered only with the
individual’s prior, voluntary, written consent.
(8) The right to refuse the initial or continuing
delivery of any health care service whenever such re-
fusal does not directly endanger the public health or,
in accordance with State law, the health of the indi-
vidual if the individual is dangerous to himself or
herself.
(9) The right to have all individually identifi-
able information and documents treated confiden-
tially and not disclosed (except for statistical pur-
poses and for the control of communicable diseases,
drug abuse, and child abuse) without the individual’s
prior, voluntary, and written consent.
(10) The right of access at all times to individ-
uals or groups for counseling, health information,
and assistance on health matters, including access to
user advocates who shall—
(A) assist users in choosing the most ap-
propriate sites from which to receive health
services and the most appropriate health work-
ers from whom to receive such services;
(B) provide counseling and assistance to
users in filing complaints; and
(C) investigate instances of poor quality
services or improper treatment of users and
bring such instances to the attention of the ap-
plicable authority.
(11) The right to be accompanied and visited at
any time by a friend, relative, or independent advo-
cate of the individual’s choosing, and the right to
have routine services, such as feeding, bathing,
dressing, and bedding changes, performed by a
friend or relative, if the individual so chooses.
(12) The right, in the event of terminal illness,
to die with a maximum degree of dignity, to be pro-
vided all necessary symptom relief, to be provided
(and for the individual’s family to be provided) coun-
seling and comfort, and to be allowed (if desired) to
die at home.
(13) The right of access to a complaint and
grievance system and to legal assistance to enforce
these rights.
SEC. 202. RIGHT TO PAID LEAVE TO RECEIVE HEALTH
CARE SERVICES.
(a) AMENDMENT
TO
FAIR
LABOR
STANDARDS
ACT.—The Fair Labor Standards Act of 1938 is amended
by inserting after section 7 (29 U.S.C. 207) the following
new section:
‘‘MINIMUM HEALTH LEAVE COMPENSATION
‘‘SEC. 7A. Each employee of any employer who in any
workweek is engaged in commerce or in the production
of goods for commerce, or is employed in an enterprise
engaged in commerce or in the production of goods for
commerce, shall be entitled to receive from the employer,
for each 35 hours he is employed by the employer (not
counting more than 35 hours in any workweek), com-
pensation for one hour of employment at the regular rate
at which the employee is employed (as that term is used
in section 7 of this Act) for an hour—
‘‘(1) during the period of 52 weeks beginning
with the workweek with which the entitlement is
earned, and
‘‘(2) during which the employee is unable to
work because of the need for the employee (or a de-
pendent of that employee) to receive necessary
health care services.’’.
(b) CONFORMING AMENDMENTS.—The Fair Labor
Standards Act of 1938 is further amended—
(1) in section 3(o), by striking ‘‘sections 6 and
7’’ and inserting ‘‘sections 6, 7, and 7A’’;
(2) in section 13—
(A) by striking ‘‘and 7’’ in subsection (a)
before paragraph (1) and inserting ‘‘, 7, and
7A’’;
(B) by striking ‘‘sections 6 and 7’’ in sub-
section (a)(3) and inserting ‘‘sections 6, 7, and
7A’’; and
(C) by inserting ‘‘7A,’’ in subsections (d)
and (f) after ‘‘7,’’ each place it appears;
(3) in section 14(d), by striking ‘‘6 and 7’’ and
inserting ‘‘6, 7, and 7A’’;
(4) in section 15(a), by striking ‘‘section 6 or
section 7’’ and inserting ‘‘section 6, 7, or 7A’’;
(5) in section 16—
(A) by striking ‘‘section 6 or section 7’’ in
subsection (b) and inserting ‘‘section 6, 7, or
7A’’;
(B) by striking ‘‘or their unpaid overtime
compensation’’ in subsection (b) and inserting
‘‘their unpaid overtime compensation, or their
unpaid health leave compensation’’;
(C) by inserting ‘‘or of unpaid health leave
compensation’’ in subsection (b) after ‘‘amount
of unpaid overtime compensation’’;
(D) by striking ‘‘section 6 or 7’’ in the
first sentence of subsection (c) and inserting
‘‘section 6, 7, or 7A’’;
(E) by striking ‘‘unpaid overtime com-
pensation’’ in the first sentence of subsection
(c) and inserting ‘‘, unpaid overtime compensa-
tion, or unpaid health leave compensation’’;
(F) by striking ‘‘or overtime compensa-
tion’’ in the second sentence of subsection (c)
and inserting ‘‘, overtime compensation, or
health leave compensation’’; and
(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.—
(1) IN
GENERAL.—No individual entitled to
make decisions regarding establishment, allocation,
or operation of a health facility may engage in the
private delivery of health care services.
(2) PRIVATE
DELIVERY
OF
HEALTH
CARE
SERVICES DEFINED.—For the purposes of this sub-
section, the term ‘‘private delivery of health care
services’’ means the delivery of health care services
for which an individual, group, or organization re-
ceives remuneration from any source other than the
Health Service Trust Fund established in section
511.
(c) OPERATIONS OF HEALTH CARE FACILITIES.—
(1) HOURS OF OPERATION.—Any health care
facility which provides health care services on an
outpatient basis shall be open during hours that will
permit all users to make use of such services.
(2) EFFECTIVE
DELIVERY.—In its establish-
ment of health care facilities under this section, the
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.
SEC. 223. PROVISION OF HEALTH SERVICES RELATING TO
REPRODUCTION AND CHILDBEARING.
(a) PROVISION OF SERVICES.—
(1) IN GENERAL.—The following services shall
be provided:
(A) FAMILY PLANNING.—
(i) Complete information on contra-
ception and provision of birth control ma-
terials or medication of the individual’s
choosing.
(ii) Complete and effective evaluation
and treatment of sexually transmitted dis-
eases and diseases of the reproductive or-
gans.
(iii) Complete information and coun-
seling with respect to pregnancy, child-
bearing, and possible outcomes involving
genetically induced anomalies.
(B) PREGNANCY.—
(i) Complete and effective pregnancy
testing.
(ii) Prenatal services, including phys-
ical examination, counseling, and instruc-
tion of expectant parents in nutrition,
childrearing, and children’s health care
services.
mencement of operations of the Service, shall be obliga-
tions of the Service.
(e) APPLICATION OF CONDITIONS.—
(1) TERMS OF EMPLOYMENT.—Compensation,
benefits, and other terms and conditions of employ-
ment in effect on the effective date of health services
for employees of the Federal Government performing
functions that are provided under this Act by the
Service, shall apply to all employees of the Service
performing similar functions until changed by the
Service in accordance with this Act. Subject to the
provisions of this Act, the provisions of subchapter
I of chapter 85 and chapter 87 of title 5, United
States Code (relating to unemployment compensa-
tion and life insurance), apply to employees of the
Service unless varied, added to, or substituted for in
accordance with paragraph (2).
(2) LIMITATION ON VARIATION.—No variation,
addition, or substitution with respect to fringe bene-
fits shall result in a program of fringe benefits which
on the whole is less favorable to employees of the
Service than fringe benefits in effect for employees
of the Federal Government on the effective date of
health services. No variation, addition, or substi-
tution with respect to fringe benefits of employees