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respect to the circumstances under which, or the frequency
with which, the item may be prescribed.
(c) PRICES.—For each such listed item covered under
this Act, the Board shall from time to time determine a
product price or prices which shall constitute the maxi-
mum to be recognized under this Act as the cost of the
item to a provider thereof. The Board may conduct nego-
tiations, on behalf of State health security programs, with
equipment and device manufacturers and distributors in
determining the applicable product price or prices.
(d) EXCLUSIONS.—The Board may exclude from cov-
erage under this Act ineffective, unsafe, or overpriced
products where better alternatives are determined to be
available.
SEC. 617. PAYMENTS FOR OTHER ITEMS AND SERVICES.
In the case of payment for other covered health serv-
ices, the amount of payment under a State health security
program shall be established by the program—
(1) in accordance with payment methodologies
which are specified by the Board, after consultation
with the American Health Security Advisory Coun-
cil, or methodologies established by the State under
section 620, and
(2) consistent with the State health security
budget.
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SEC. 618. PAYMENT INCENTIVES FOR MEDICALLY UNDER-
SERVED AREAS.
(a) MODEL PAYMENT METHODOLOGIES.—In addi-
tion to the payment amounts otherwise provided in this
title, the Board shall establish model payment methodolo-
gies and other incentives that promote the provision of
covered health care services in medically underserved
areas, particularly in rural and inner-city underserved
areas.
(b) CONSTRUCTION.—Nothing in this title shall be
construed as limiting the authority of State health security
programs to increase payment amounts or otherwise pro-
vide additional incentives, consistent with the State health
security budget, to encourage the provision of medically
necessary and appropriate services in underserved areas.
SEC. 619. AUTHORITY FOR ALTERNATIVE PAYMENT METH-
ODOLOGIES.
A State health security program, as part of its plan
under section 405(a), may use a payment methodology
other than a methodology required under this subtitle so
long as—
(1) such payment methodology does not affect
the entitlement of individuals to coverage, the
weighting of fee schedules to encourage an increase
in the number of primary care providers, the ability
of individuals to choose among qualified providers,
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the benefits covered under the program, or the com-
pliance of the program with the State health security
budget under subtitle A, and
(2) the program submits periodic reports to the
Board showing the operation and effectiveness of the
alternative methodology, in order for the Board to
evaluate the appropriateness of applying the alter-
native methodology to other States.
Subtitle C—Mandatory Assignment
and Administrative Provisions
SEC. 631. MANDATORY ASSIGNMENT.
(a) NO BALANCE BILLING.—Payments for benefits
under this Act shall constitute payment in full for such
benefits and the entity furnishing an item or service for
which payment is made under this Act shall accept such
payment as payment in full for the item or service and
may not accept any payment or impose any charge for
any such item or service other than accepting payment
from the State health security program in accordance with
this Act.
(b) ENFORCEMENT.—If an entity knowingly and will-
fully bills for an item or service or accepts payment in
violation of subsection (a), the Board may apply sanctions
against the entity in the same manner as sanctions could
have been imposed under section 1842(j)(2) of the Social
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Security Act for a violation of section 1842(j)(1) of such
Act. Such sanctions are in addition to any sanctions that
a State may impose under its State health security
program.
SEC. 632. PROCEDURES FOR REIMBURSEMENT; APPEALS.
(a) PROCEDURES FOR REIMBURSEMENT.—In accord-
ance with standards issued by the Board, a State health
security program shall establish a timely and administra-
tively simple procedure to assure payment within 60 days
of the date of submission of clean claims by providers
under this Act.
(b) APPEALS PROCESS.—Each State health security
program shall establish an appeals process to handle all
grievances pertaining to payment to providers under this
title.
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TITLE VII—PROMOTION OF PRI-
MARY HEALTH CARE; DEVEL-
OPMENT OF HEALTH SERV-
ICE CAPACITY; PROGRAMS TO
ASSIST THE MEDICALLY UN-
DERSERVED
Subtitle A—Promotion and Expan-
sion of Primary Care Profes-
sional Training
SEC. 701. ROLE OF BOARD; ESTABLISHMENT OF PRIMARY
CARE PROFESSIONAL OUTPUT GOALS.
(a) IN GENERAL.—The Board is responsible for—
(1) coordinating health professional education
policies and goals, in consultation with the Secretary
of Health and Human Services (in this title referred
to as the ‘‘Secretary’’), to achieve the national goals
specified in subsection (b);
(2) overseeing the health professional education
expenditures of the State health security programs
from the account established under section 602(c);
(3) developing and maintaining, in cooperation
with the Secretary, a system to monitor the number
and specialties of individuals through their health
professional education, any postgraduate training,
and professional practice; and
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(4) developing, coordinating, and promoting
other policies that expand the number of primary
care practitioners.
(b) NATIONAL GOALS.—The national goals specified
in this subsection are as follows:
(1) GRADUATE MEDICAL EDUCATION.—By not
later than 5 years after the date of the enactment
of this Act, at least 50 percent of the residents in
medical residency education programs (as defined in
subsection (e)(1)) are primary care residents (as
defined in subsection (e)(3)).
(2) MIDLEVEL
PRIMARY
CARE
PRACTITION-
ERS.—To assure an adequate supply of primary care
practitioners, there shall be a number, specified by
the Board, of midlevel primary care practitioners (as
defined in subsection (e)(2)) employed in the health
care system as of January 1, 2000.
(c) METHOD FOR ATTAINMENT OF NATIONAL GOAL
FOR
GRADUATE
MEDICAL
EDUCATION; 
PROGRAM
GOALS.—
(1) IN GENERAL.—The Board shall establish a
method of applying the national goal in subsection
(b)(1) to program goals for each medical residency
education program or to medical residency education
consortia.
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(2) 
CONSIDERATION.—The 
program 
goals
under paragraph (1) shall be based on the distribu-
tion of medical schools and other teaching facilities
within each State health security program, and the
number of positions for graduate medical education.
(3) MEDICAL RESIDENCY EDUCATION CONSOR-
TIUM.—In this subsection, the term ‘‘medical resi-
dency education consortium’’ means a consortium of
medical residency education programs in a contig-
uous geographic area (which may be an interstate
area) if the consortium—
(A) includes at least one medical school
with a teaching hospital and related teaching
settings, and
(B) has an affiliation with qualified com-
munity-based primary health service providers
described in section 202(a) and with at least
one comprehensive health service organization
established under section 303.
(4) ENFORCEMENT THROUGH STATE HEALTH
SECURITY
BUDGETS.—The Board shall develop a
formula for reducing payments to State health secu-
rity programs (that provide for payments to a medi-
cal residency education program) that failed to meet
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the goal for the program established under this sub-
section.
(d) METHOD FOR ATTAINMENT OF NATIONAL GOAL
FOR MIDLEVEL PRIMARY CARE PRACTITIONERS.—To as-
sist in attaining the national goal identified in subsection
(b)(2), the Board shall—
(1) advise the Public Health Service on alloca-
tions of funding under titles VII and VIII of the
Public Health Service Act, the National Health
Service Corps, and other programs in order to in-
crease the supply of midlevel primary care practi-
tioners, and
(2) commission a study of the potential benefits
and disadvantages of expanding the scope of practice
authorized under State laws for any class of midlevel
primary care practitioners.
(e) DEFINITIONS.—In this title:
(1) MEDICAL
RESIDENCY
EDUCATION
PRO-
GRAM.—The term ‘‘medical residency education pro-
gram’’ means a program that provides education
and training to graduates of medical schools in order
to meet requirements for licensing and certification
as a physician, and includes the medical school su-
pervising the program and includes the hospital or
other facility in which the program is operated.
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(2) 
MIDLEVEL
PRIMARY
CARE
PRACTI-
TIONER.—The term ‘‘midlevel primary care practi-
tioner’’ means a clinical nurse practitioner, certified
nurse midwife, physician assistance, or other non-
physician practitioner, specified by the Board, as
authorized to practice under State law.
(3) PRIMARY CARE RESIDENT.—The term ‘‘pri-
mary care resident’’ means (in accordance with cri-
teria established by the Board) a resident being
trained in a distinct program of family practice med-
icine, general practice, general internal medicine, or
general pediatrics.
SEC. 702. ESTABLISHMENT OF ADVISORY COMMITTEE ON
HEALTH PROFESSIONAL EDUCATION.
(a) IN GENERAL.—The Board shall provide for an
Advisory Committee on Health Professional Education (in
this section referred to as the ‘‘Committee’’) to advise the
Board on its activities under section 701.
(b) MEMBERSHIP.—The Committee shall be com-
posed of—
(1) the Chair of the Board, who shall serve as
Chair of the Committee, and
(2) 12 members, not otherwise in the employ of
the United States, appointed by the Board without
regard to the provisions of title 5, United States
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Code, governing appointments in the competitive
service.
The appointed members shall provide a balanced point of
view with respect to health professional education, primary
care disciplines, and health care policy and shall include
individuals who are representative of medical schools,
other health professional schools, residency programs, pri-
mary care practitioners, teaching hospitals, professional
associations, public health organizations, State health
security programs, and consumers.
(c) TERMS OF MEMBERS.—Each appointed member
shall hold office for a term of five years, except that—
(1) any member appointed to fill a vacancy oc-
curring during the term for which the member’s
predecessor was appointed shall be appointed for the
remainder of that term; and
(2) the terms of the members first taking office
shall expire, as designated by the Board at the time
of appointment, two at the end of the second year,
two at the end of the third year, two at the end of
the fourth year, and three at the end of the fifth
year after the date of enactment of this Act.
(d) VACANCIES.—
(1) IN GENERAL.—The Board shall fill any va-
cancy in the membership of the Committee in the
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same manner as the original appointment. The va-
cancy shall not affect the power of the remaining
members to execute the duties of the Committee.
(2) VACANCY
APPOINTMENTS.—Any member
appointed to fill a vacancy shall serve for the re-
mainder of the term for which the predecessor of the
member was appointed.
(3) REAPPOINTMENT.—The Board may re-
appoint an appointed member of the Committee for
a second term in the same manner as the original
appointment.
(e) DUTIES.—It shall be the duty of the Committee
to advise the Board concerning graduate medical edu-
cation policies under this title.
(f) STAFF.—The Committee, its members, and any
committees of the Committee shall be provided with such
secretarial, clerical, or other assistance as may be author-
ized by the Board for carrying out their respective
functions.
(g) MEETINGS.—The Committee shall meet as fre-
quently as the Board deems necessary, but not less than
4 times each year. Upon request by four or more members
it shall be the duty of the Chair to call a meeting of the
Committee.
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(h) COMPENSATION.—Members of the Committee
shall be reimbursed by the Board for travel and per diem
in lieu of subsistence expenses during the performance of
duties of the Board in accordance with subchapter I of
chapter 57 of title 5, United States Code.
(i) FACA NOT APPLICABLE.—The provisions of the
Federal Advisory Committee Act shall not apply to the
Committee.
SEC. 703. GRANTS FOR HEALTH PROFESSIONS EDUCATION,
NURSE 
EDUCATION, 
AND 
THE 
NATIONAL
HEALTH SERVICE CORPS.
(a) TRANSFERS
TO PUBLIC HEALTH SERVICE.—
From the amounts provided under subsection (c), the
Board shall make transfers from the American Health Se-
curity Trust Fund to the Public Health Service under sub-
part II of part D of title III, title VII, and title VIII of
the Public Health Service Act for the support of the Na-
tional Health Service Corps, health professions education,
and nursing education, including education of clinical
nurse practitioners, certified registered nurse anesthetists,
certified nurse midwives, and physician assistants. Of the
amounts so transferred in each year, not less than 50 per-
cent shall be expended for the support of the National
Health Service Corps.